Dr. Edward A.Patrick & Dr. Henry J. Heimlich Regarding the Heimlich maneuver



Edward A. Patrick M.D, PhD, FACEP

The Patrick Institute

431 Ohio Pike, 125 South

Cincinnati, Ohio

(513) 528-2941

May 28, 2003

A reporter from the Cincinnati Enquirer walked up the driveway of my home on May 19, 2003..... The reporter.. (indicated) he was looking for Dr. Edward Patrick as he (the reporter) is doing a story on Dr. Patrick and Dr. Henry Heimlich. He asked why I did not get proper credit for the development of what now is called the Heimlich maneuver.

I have the greatest respect for Dr. Heimlich, his work, and his contributions. He himself once told me that I have not received proper credit for the development of what has become known as the Heimlich maneuver. In any case, I am grateful to have had the opportunity to help develop a treatment for choking that has saved many lives.

Many articles have been written about Dr. Heimlich and myself, and each of us have published numerous papers, books and given presentations at conferences. Although those articles are available for review, it is appropriate under the circumstances that I provide the following information.

I have always viewed that Dr. Heimlich and I worked together to develop what has become known as the Heimlich maneuver just as the Wright brothers worked together to develop the first flying machine.

During my undergraduate and graduate education at the Massachusetts Institute of Technology I was interested in electromechanical energy conversion, which involves the conversion of energy from one form (such as potential energy) to another form (such as kinetic energy). When I went to medical school in 1970, I already was a tenured associate professor of Electrical Engineering, later promoted to full professor. My training as both a doctor of engineering and medical doctor set the stage for me to propose that potential energy stored in the lungs could be used to remove an obstructing foreign body by converting that potential energy to the kinetic energy in a flying foreign object that had been lodged in the airway.

Early in our collaboration, during an operation on a patientís abdomen, Dr. Heimlich demonstrated for me that compressing the abdominal contents upward below the diaphragm pushed upward against the diaphragm, which then compressed the lungs. We discussed how this process could expel a foreign body, and I knew that this process was an application of the electromechanical energy conversion model that I had developed.

At this time and for about 12 years, researchers for the American Heart Association made several serious errors in their research concerned with treating choking. For example, they incorrectly concluded that the back slap was superior to the Heimlich maneuver because the back slap produced more pressure at the victimís mouth than did the Heimlich maneuver. In a presentation at the national Academy of Sciences, I used my energy model for choking treatment to show that the concept pressure removes a foreign body is flawed. Instead, it takes pressure acting over time (that is, energy) to remove a foreign body. Although the peak pressure of a back slap may be higher than that for the Heimlich maneuver, the back slap pressure wave is like an impulse compared with the longer lasting pressure wave produced by the Heimlich maneuver. In developing the best treatment for choking, which could consist of a sequence of procedures, I had to prove that use of the back slap in the treatment sequence would reduce the probability of a good outcome.

I was then prepared to accomplish this task because in the late 1960ís and early 1970ís I had become much involved in the statistical analysis of data, having published the first textbook on statistical pattern recognition, Fundamentals of Pattern Recognition, Prentice Hall, 1972, and supervised research of those receiving PhDís in this area. My work, which has become part of what now is known as outcome analysis, was published in my book, Decision Analysis in Medicine, CRC Press. I maintained that treatments for choking could be evaluated with statistical outcome analysis and not double blind studies, the latter being impossible. At that time many researchers in the medical community did not understand outcome analysis.

Through our appearances on national talk shows, the call went out for the public to report choking cases. For each of the reported cases, an assistant and I sent out a questioner and found 1,432 verifiable cases qualified to be records, each based on my feature list (a list of findings corresponding to signs, symptoms and treatment sequence), for outcome analysis. The treatment feature recorded the sequence - only the Heimlich maneuver, only the back slap, the Heimlich maneuver followed by the back slap, the back slap followed by the Heimlich maneuver, and these combined with such procedures as CPR or the finger sweep. Using a minicomputer, I computed the Expected Outcome for different sequences and showed that the estimated probability of a bad outcome was almost 4 times higher if the backslap was used anywhere in the treatment sequence. Again, based on these studies, I opposed the use of the back slap in the treatment of choking.

Researchers for the American Heart Association (AHA) claimed that their own data (which they sent me) showed the back slap superior, only for them later to admit that their data was flawed. Dr. Day of Yale University criticized the AHA researchers for using flawed data in the first place, and he praised my work.

In 1985.., Surgeon General Koop called me to indicate that.. he was giving a press release to the American people declaring that the back slap was lethal and the Heimlich maneuver would be the only treatment for choking. Dr Heimlich and I had developed the Heimlich maneuver as the best treatment for choking Ė it "flew"!