Surgeon General Koop's Declaration regarding the Heimlich Maneuver (1985)

September 30, 1985

Public Health Reports 1985;100:557

Surgeon General C. Everett Koop today endorsed the Heimlich manuever, not as the preferred, but as the only method that should be used for the treatment of choking from foreign body airway obstruction.

Dr. Koop also urged the American Red Cross and the American Heart Association to teach only the Heimlich Manuever in their first aid classes. Dr. Koop urged both organizations to withdraw from circulation manuals, posters and other materials that recommend treating choking victims with back slaps and blows to the chest.

"More than 3,000 people die from choking in the United States each year," Dr. Koop said. "Most adults choke while they are eating. Meat is the usual culprit, but other foods and objects can also cause choking, especially in young children."

For years, medical opinion differed on the best way, or ways, of dislodging an object from the throat of a choking victim. Sharp blows to the back, finger sweeps of the throat and manual thrusts to the chest were methods often recommended.

The American Red Cross and the American Heart Association concluded during a July 11-13 conference held to establish first aid standards for both organizations that methods other than the Heimlich Manuever can be dangerous and that only the Heimlich Manuever should be used to treat a choking victim.

"Millions of Americans have been taught to treat persons who are choking with back blows, chest thrusts and abdominal thrusts," Dr. Koop said. "Now, they must be advised . . . and I ask for the participation of the Red Cross, the American Heart Association and public health authorities everywhere . . . that these methods are hazardous, even lethal."

A back slap, the surgeon general said, can drive a foreign object even deeper into the throat. Chest and abdominal thrusts, because they refer to blows to unspecified locations on the body, have resulted in cracked ribs and damaged spleens and livers, among other injuries.

"The best rescue technique in any choking situation," Dr. Koop said, "is the Heimlich Manuever."

The recommended technique, devised in the early 1970s by Henry J. Heimlich, M.D., now president of the Heimlich Institute at Xavier University, depends for its success on the fact that a choking victim's lungs have a large volume of air in them even if the person was exhaling when the choking began. If a rescuer presses sharply and repeatedly on the victim's abdomen, with one balled fist wrapped in the opposite hand, at a point just above the navel, but below the rib cage and the diaphragm, that reservoir of air is expelled up the airway with a great deal of force, thus dislodging the obstruction from the victim's throat.

"The Heimlich Manuever is safe, effective and easily mastered by the average person," Dr. Koop said. "It can be performed on standing or seated victims and on persons who have fallen to the floor. It can be performed on children and even on one's self."

Dr. Koop suggested that persons who wish to learn when and how to perform the Heimlich Manuever contact their local Red Cross or Heart Association chapter for expert instruction.

At the same time, he cautioned that the best way to deal with obstruction of the airway is to prevent it. He cited the following advice from the American Red Cross: cut food into small pieces and chew slowly and thoroughly, especially if you wear dentures; don't laugh and talk while chewing and swallowing; avoid excessive intake of alcohol before and during meals; keep children from walking, running or playing while they have food in their mouths; and keep small objects, such as marbles, beads and thumbtacks, out of the reach of infants and small children.