July 18, 2017
Conrad Fivaz, a second-year medical student, was done for the day, relaxing, eating dinner, and watching a televised rugby game after a long day in the school’s dissection lab.
His meal of roasted potatoes, meat, and vegetables, was similar to any other meal served in the common room of his dormitory.
But those cubed potatoes? Those he will never forget.
Distracted by rugby, Fivaz was less attentive to the potato at the end of his fork. He couldn’t swallow it. The chunk lodged in his trachea, where soft foods such as potatoes, bananas, and hot dogs can adapt their shape and cause obstruction. Fivaz coughed. He threw his arms up over his head, an instinctive reaction alerting the student sitting next to him at the table. The student, his friend and college roommate Adriaan Van Biljon, didn’t hesitate.
“He knew exactly what was wrong,” said Fivaz, Medical Director, Priority Solutions™. “He went behind the chair and did the Heimlich. The piece of potato dislodged, and I was able to breathe immediately.”
Fivaz thanked Van Biljon profusely, and they finished their dinners while continuing to watch rugby.
Choking on food is frightening. Even more eye-opening, perhaps, is what could have happened.
The potato chunk lodged in his trachea cut off the supply of air to Fivaz’s lungs and caused the involuntary coughing and gasping for air. If fellow student Van Biljon hadn’t acted so fast, Fivaz could have experienced serious injury due to a lack of oxygen to his brain. Permanent brain damage can result in about two minutes and death in three minutes.
“Choking is a very time-limited event,” Fivaz said.
Choking is the fourth-leading cause of unintentional injury death in the U.S. Globally, choking due to a foreign object, including food, resulted in 162,000 deaths in 2013.1
Fivaz lived to tell the story because of a technique used successfully on George W. Bush, Queen Elizabeth, Elizabeth Taylor, and thousands upon thousands of people worldwide. It was invented by Dr. Henry Heimlich.
“I was a chest surgeon,” Heimlich said during a 1992 interview with Parade Magazine. “I knew there was enough air in the lungs that, if you pushed on the diaphragm, it would clear the airway. I knew it would work.”2
Heimlich was confident the procedure would work, although untested on humans; he could not test the procedure for obvious ethical reasons (pushing food down the throat of test subjects and then attempting to dislodge it), but he was so confident it would work he published his findings in 1974 (Pop Goes the Café Coronary, Emergency Medicine).
At that time, he was Director of Surgery and Physician-in-Chief of the Esophagus center at the Jewish Hospital. He concluded the article asking: Should you use, or learn of anyone using, the Heimlich method, by the way, please report the results either to emergency dispatch or to me.3
The Heimlich maneuver requires little more than the willingness of a bystander to firmly and abruptly pull the fist, covered by the other hand, into the top of the choking victim’s stomach.
While it’s impossible to say how many people the technique has saved, rough estimates number into the thousands. The Medical Priority Dispatch System™ (MPDS®) incorporates the Heimlich (by name) in PAIs (Protocol D: Choking (Conscious) – Adult/Child/Infant/Neonate) for adults and children. The technique is not advised for infants and neonates.
Heimlich was a great fan of EMDs and the MPDS. He was the featured speaker at the second annual International Conference of Emergency Medical Dispatchers (now known as NAVIGATOR) held in 1989, where he talked about the vital role of EMDs in EMS and his theories on creative thinking and application.
Prepare for rejection and ridicule, Heimlich told his audience. “If our peers initially understand and accept your idea, it’s not really very new or creative.”4
While Heimlich is best known for the maneuver, it is only one of many procedures and devices he developed during his decades-long career. He also designed a simple flutter valve from a flattened piece of tubing to inflate collapsed lungs that, during the Vietnam War, provided field response for soldiers with chest wounds. The Heimlich gave patients with esophageal cancer the ability to eat by constructing an esophagus from a section of the patient’s stomach.
The Heimlich maneuver, however, was his claim to infamy and, as he told a reporter, the number of people potentially saved wasn’t his badge of honor.
“You can’t picture thousands of lives,” he said. “What does move me is the individual people who come up to me and tell me their stories, or reading in the newspaper the story of the 5-year-old who saved a 6-year-old from choking. Those things move me.”5
While some have debunked the Heimlich maneuver and the man behind it (most notably his son Peter Heimlich), the technique still holds a place in the layperson emergency medical kit.
Choking on a potato certainly made an advocate of Fivaz.
“It worked for me,” he said. “It saved my life.”
Heimlich was 96 years old when he used the maneuver for the first time on a person who was choking, and quite successfully. In May 2016, he applied his theory to dislodge a piece of hamburger from the airway of an 87-year-old woman at a retirement home in Cincinnati, Ohio, USA, where the surgeon had lived for several years prior to his death in December 2016.
1 GBD 2013 Mortality and Causes of Death Collaborators. “Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.” Lancet. 2015; Feb. 25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340604/ (accessed March 22, 2017).
2 “There’s more to Heimlich than one maneuver.” Parade Magazine. 1992; June 28. https://www.newspapers.com/image/170939364/?terms=Henry%2BHeimlich (accessed March 22, 2017).
3 Heimlich H. “Pop Goes the Café Coronary.” Emergency Medicine. 1974; June. https://groups.google.com/forum/#!topic/misc.emerg-services/rJptw1G7yVc (accessed March 24, 2017).
4 “Dr. Heimlich tells philosophy, thanks EMDs.” Emergency Medical Dispatch! 1990; Volume 1 (No. 1): Pages 1–2.
5 See note 4.