The Big Squeeze
Death by choking known by EMTs and medical examiners as "Cafe
Coronary" because it mimics so many characteristics of a heart attack,
also has some important similarities to drowning. The victim gasps
for air, becomes cyanotic (turns blue) with insufficient blood oxygen,
and often grasps at his or her chest to relieve the pain of pressure
on the lungs. Death is usually preceded by unconsciousness.
Now the similarities go further to include the Heimlich maneuver,
for the past three decades a standard emergency response to choking
and more recently adapted as an effective first-aid treatment to
reverse the tragedy of drowning. In 27 incidents reported by the
National Pool and Water Association for one recent year, an astonishing
24 drownings were averted by the use of the Heimlich maneuver alone;
only three had to be given CPR, and every one of the victims survived.
However, there can be a couple of big differences between what
happens in the environment of a swimming pool and in a lake or open
ocean. For one thing, most pool water is treated with chemicals
which can be extremely caustic, so the faster such water can be
removed from the lungs, the lower the risk of subsequent pneumonia
or long-term damage. In either setting, time is obviously of the
Probably the biggest difference between the two settings is that
the Heimlich maneuver, CPR or any other life-saving response is
far easier to administer when the victim has been removed from deep
water to the shallow end of the pool or to dry land. But even in
the middle of a lake or on the open ocean, it's still a viable option
that can make the difference between life and death.
In either setting, the rescuer takes a position behind the victim,
passes his arms under the victim's arms, joining his hands about
halfway between the victim's navel and breastbone, just below the
rib cage. He makes a fist of one hand with the thumb toward the
victim's abdomen, then using both hands drives his fist sharply
inward and upward toward the solar plexus. This action is repeated
as often as necessary - typically four or five times - until no
more water comes out of the subject's mouth.
This is obviously a lot easier on land than in the water. When
the rescuer is swimming, a flotation device should be wedged between
his chest and the victim's back to keep the body in an upright position
with the face safely clear of the water. The rescuer also should
take care that his own head is out of the way if the victim should
suddenly rear back during this exercise, a not uncommon part of
the gag reflex associated with the coughing up of water.
The Heimlich maneuver doesn't always result in immediately restored
breathing even on land. In the water, the problem can be that the
airway is closed due to the patient being bent forward; the solution
is to reposition the flotation device further down the back so the
person's head is forced backwards and the airway opens.
Once on deck, the victim should be laid on his back with his
head turned to one side. The rescuer should wrap his leg's around
the victim's opposite thigh, and repeat the maneuver until water
no longer comes from the mouth or until breathing is restored. If
the patient still fails to respond, check the pulse and use rescue
breathing or CPR.
In describing this technique in Sea magazine, Captain Victoria
Sandz offers a frontal compression approach - similar to the above
but focused on the center of the breastbone rather than below the
ribs - when the victim is pregnant or too large for the rescuer
to embrace effectively from behind.