Heimlich Maneuver or Back Blows: History of Recommended Responses to Choking

If you take a CPR course from the American Red Cross or the American Heart Association you will find the content to be nearly identical. However, the two organizations have noticeably different recommendations on how to respond to a child or adult who is conscious and choking. What follows is a brief history of the recommended responses to conscious choking – a history that has been filled with controversy since 1974.

When first aid courses began being taught to the public, the conventional response to a choking victim was to give them a “back blow” or “back slap”. As early as 1933 the American Red Cross was recommending this method. You can see an example of traditional back slaps in the film, “Field of Dreams” when Burt Lancaster’s character, a doctor from the 1920s, saves a choking child.

In 1974 everything changed. Dr. Henry Heimlich, who developed the Heimlich maneuver, often called abdominal thrusts in safety classes, published an article about the maneuver. By 1976 both the American Heart Association and the American Red Cross had incorporated abdominal thrusts. Responders were told to give back blows, but if back blows failed to dislodge the object, give abdominal thrusts.

Heimlich wrote in the New York Times that back blows would cause an object to get lodged into the windpipe. This has never been proven scientifically. He also called back blows, “death blows.”

In 1986, both organizations stopped recommending back blows. Abdominal thrusts became the only recommended response for conscious choking for children and adults.

Controversy and criticism of Dr. Heimlich began to emerge, much of it via his son Peter. Peter Heimlich has a website devoted to exposing his father as “a spectacular con man and serial liar.” Dr. Heimlich is accused of secretly funding a study in 1982 that persuaded the American Heart Association to drop back blows from its recommended responses to choking.

Nevertheless, abdominal thrusts remained the only recommended response to conscious choking for children and adults for twenty years.

In 2006, the American Red Cross reintroduced back blows as the initial response to choking. The approach is called, “five and five.” If five back blows are unsuccessful in clearing the airway, then five abdominal thrusts are used. The rescuer alte
ates between sets of back blows and abdominal thrusts until the object is cleared. However, the American Heart Association has not reintroduced back blows. They continue to recommend abdominal thrusts as the only response to conscious choking for children and adults.