Alone And Choking


AeroMD Air Ambulance 

Brett Patterson and Brian Dale

Brett and Brian:

This question was asked in my EMD certification class: How do you give a 1st-party caller instructions to do the Heimlich maneuver on themselves? I have not been able to find it anywhere in the panel directions (cardset version 13.0).

Craig Chandler

Paramedic, EMD Instructor

Dauphin County Department of Public Safety

Hanover, Pennsylvania (USA)

Craig:

We have had this question come up a few times over the years. I remember conversations about the ability of this person to do such a maneuver on themselves given the inability to speak and for the EMD to get through the initial interrogation to the point where they would know the person is choking and read such instructions to them. I have heard calls where the first party has a partial obstruction, and the EMD only has to read instructions on what NOT to do until help arrives. I believe a person with a 100% occlusion would not stay y conscious long enough to call 911, have the EMD understand what was happening on that scene, be able to provide an instruction set without even knowing the age (size) of the caller, and have these instructions be successful. I also have never heard such a case in real life (audio file).

Brett’s response follows. As Chair of the Medical Council of Standards, and the Academy’s go-to expert in dispatcher CPR, he will have more information on this than I.

Regards,

Brian Dale

Associate Director of Medical Control and Quality Processes

International Academies of Emergency Dispatch®

Craig:

Brian has summed this up well. While the hypothetical inquiry is relatively common, perhaps twice per year, I have yet to hear an actual occurrence where the EMD would have been privy to what was happening at the scene. As Brian states, a full obstruction, where Heimlich maneuver instructions are appropriate, makes speech or even sound impossible, and this leaves the EMD with no clue when to give such instruction.

The other option would be to provide such instructions to a 1st party caller with a partial obstruction after telling them what not to do, which may be counterproductive if the caller doesn’t understand the sequence of events. Also, there is some evidence that esophageal impaction (bolus), where communication may be possible, can be exacerbated by the Heimlich maneuver.

Perhaps a better way to deal with this is public education. If one knows what to do ahead of time, when not in distress, it will hopefully be recalled and applied successfully.

Finally, your email prompted a quick literature search. While I could find a few loose recommendations for the self-induced technique, I couldn’t find a body of research that supports it.


Brett A. Patterson 
Academics & Standards Associate 
Chair, Medical Council of Standards 
International Academies of Emergency Dispatch 

Brett Patterson is Academics & Standards Associate and Chair of the Medical Council of Standards for the IAED. His role involves protocol standards and evolution, research, training, curriculum, and quality improvement. Prior to working with the IAED, he spent 10 years working in the Pinellas County EMS System, Florida. He answers members’ protocol questions in the Journal FAQ column. 

Brian Dale is the Associate Director of Medical Control & Quality Processes for the IAED. Dale served with the Salt Lake City Fire Department (SLCFD), Utah (USA) in Salt Lake City, Utah, for more than 25 years, and was appointed SLCFD Chief in May 2015.

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