Heimlich Maneuvering

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To fellow reformers across the nation, Miami Mayor Manny Diaz touted it as one of his "best practices": teaching young children lifesaving techniques such as CPR and the Heimlich maneuver. It seemed like a great idea. There are thousands of latchkey kids in poor neighborhoods, and quite a few care for younger brothers and sisters. Since 2005, an estimated 9,330 students in several local elementary schools have sat through two-hour courses paid for and designed by the Save A Life Foundation (SALF), a group that Diaz, in his position as a leader — now president — of the U.S. Conference of Mayors, has praised for bringing first aid to schools.

Among other things, the children learned they could use the Heimlich maneuver, the well-known abdominal thrust used to save a person from choking, on their baby brothers and sisters, according to a flyer sent home to parents. This was hardly surprising, since its creator, Dr. Henry Heimlich, sat on the foundation's board.

There are a couple of problems, though. Most important, the Red Cross and other emergency organizations say the Heimlich maneuver should never be performed on infants, and it can kill drowning victims. Then there are the allegations of deceit, mismanagement, and bad science that have been leveled against the foundation for the past two years.


Heimlich maneuver

The curriculum is no longer being taught in schools, and the officials most closely linked to the organization aren't talking about the issue. Diaz did not respond to an interview request. Repeated calls and e-mails requesting comment from SALF were not returned. And Dr. Ernesto A. Pretto, a leading Miami anesthesiologist at Jackson Memorial Hospital listed as a member of SALF's medical advisory board, also didn't respond to messages left at his office and on his voicemail.

"It's a fairly twisted web with this organization," says Dr. Robert Baratz, a Massachusetts physician being sued by SALF for comments he made about it on a television news show. "You have to pull off the strands one at a time to understand what's going on."

The beginnings of SALF are rather dramatic. In 1992, the daughter of a nurse named Carol Spizzirri was killed in a car crash in Illinois. As Spizzirri tells it, her daughter's arm was severed and she bled to death while cops simply looked on. "I asked [the police officer] what he did for my daughter, and he said his duty was to direct traffic," Spizzirri told a reporter. "I said, 'Your duty is to maintain life!'" Learning that officers and emergency personnel weren't required to be certified in first aid and CPR, she campaigned in Illinois and other states to change that.

A good cause, to be sure. However, her account is not entirely accurate. In 1995, the Chicago Tribune published a correction on a profile of Spizzirri that revealed her daughter hadn't died at the scene, but in a hospital more than an hour after the accident. Her arm hadn't been severed; she had suffered from a massive "depressed" skull fracture. The officers hadn't "balked" at helping the girl. Her injuries were so severe that no first aid likely could have saved her.

Yet the Tribune story, minus its correction, was picked up by newspapers around the nation. Spizzirri became famous, and SALF, with the help of celebrity endorsements from stars such as David Hasselhoff, grew larger.

In 2005, Mayor Diaz, flanked by schools superintendent Rudy Crew and fire chief William Bryson, announced SALF would offer a lifesaving curriculum in local schools. "SALF will be the cornerstone for all Miami-Dade schoolchildren and staff," Crew said in a press release still available on the group's website.

Crew and Diaz are not alone in inviting SALF to run programs in schools. The foundation has partnered with municipalities, states, and even the Department of Homeland Security and the U.S. Centers for Disease Control and Prevention in programs totaling millions of dollars of work for first-aid classes.

But even as the city started its partnership with SALF, the Red Cross and the American Heart Association began revising guidelines to de-emphasize the Heimlich maneuver. Studies had raised questions about its safety, and Heimlich himself has stirred more controversy by touting it in Florida and other states as a rescue method for victims of drowning, asthma, and cystic fibrosis.

In fact, using the Heimlich maneuver on a drowning person could injure or even kill him, some first-aid experts say. Often the primary problem is lack of oxygen reaching the brain, not water or other obstructions in the lungs and breathing passages.

In 2005, the Red Cross returned to an older approach that SALF has discouraged as a first response: the use of firm slaps to the back to dislodge objects in the trachea. If that fails after five attempts, then the abdominal thrust should be tried.

"There is some scientific evidence that potentially abdominal thrusts can be harmful — you can break a rib,'' says Jonathan Epstein, a Massachusetts-based paramedic who is on the Red Cross's advisory council on first aid. "That's why we don't practice it in classroom settings. We only simulate it."

All of this — the re-evaluation of the Heimlich maneuver, and Spizzirri's questionable background — stayed below the media's radar until November 2006, when a Chicago ABC-TV affiliate did a series of investigative reports about SALF. Among the findings: "The now-defunct Wisconsin college where Spizirri claims to have received a nursing degree never awarded her a degree of any kind."

In May 2007, SALF filed suit in Cook County (Illinois) Circuit Court against Baratz, Heimlich, and a Cincinnati blogger named Jason Haap for defamation. The suit alleged they were the TV station's primary sources and included charges of unspecified economic damages resulting from 11 severed relationships, including Homeland Security, the U.S. Conference of Mayors, and Miami: "Save A Life had been working with the City of Miami, had a branch in the Miami mayor's office, and had been providing LFSA training in Miami-Dade schools.... As a proximate result of defendant's actions, the City of Miami has terminated its relationship with Save A Life."

"Elementary schoolchildren really shouldn't be trying to do the Heimlich maneuver," said Baratz, who teaches medicine at Boston University. "They just don't have the bodies for it at that age."

Freddie Fernandez, a Miami-Dade fire chief who helped coordinate the program in schools, knew nothing about the controversy when New Times contacted him. He couldn't explain why a flyer sent home to parents said children had been taught to use the Heimlich maneuver on infants. "The Heimlich maneuver is never taught on infants one year and below,'' Fernandez said. "Now, children between one and eight, you can have a modified Heimlich maneuver."

The good news is the whole mess didn't cost local taxpayers anything. The city used $41,164 in grants from the foundation to pay for instructors, according to Vivianne Bohorques, who oversaw the SALF courses as the city's project manager.

True, thousands of local schoolchildren were taught the Heimlich maneuver and probably never got the necessary retraining in the back-slap method.

Just chew your food slowly if you're having a hot dog with one of them.

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