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 essence.

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.