Saving a Life With the Heimlich Maneuver

Swallowing may seem easy and automatic, but in reality, it’s “a complicated process of moving food from the mouth all the way into the esophagus,” says Shumon Dhar, M.D., assistant professor and laryngologist at the University of Texas Southwestern Medical Center. Putting aside those with medical conditions such as stroke, or past surgery that might affect the head and neck, our ability to coordinate that process can begin to deteriorate as we reach our seventh decade, he says.

A glance in a mirror reveals the steady advance of gray hair, wrinkles and sun spots — the visible signs of aging. But what’s going on below the surface? The late Nora Ephron titled one of her books I Feel Bad About My Neck. In the days after Helen’s café heroics, I felt curious about mine.

Swallowing gets harder with age

As we age, many aspects of swallowing can deteriorate. Our saliva becomes dryer, our teeth decay, and the muscles of chewing and swallowing get weaker, Dhar notes. Once we transport chewed food from the mouth to the back of the throat — swallowing’s starting line — it passes through a series of muscles and valves whose functions may have weakened, leading to food getting stuck in the throat and causing choking, explains Dhar. The whole process slows as we age, so in addition to the degradation of all the body parts involved in swallowing, we increasingly need longer to accomplish the task.

History of the Heimlich

If you’re older than 50, you were around in 1974, when an obscure journal, Emergency Medicine, published an article by an equally obscure thoracic surgeon. In “Pop Goes the Café Coronary,” Henry Heimlich, M.D., described his work developing a way to help people choking on food. At the time, the American Red Cross, the American Heart Association and other groups recommended back slaps to counteract choking. As head of surgery at Cincinnati’s Jewish Hospital and one of the first surgeons to perform an operation that fixed damaged esophagi, Heimlich believed that back slaps only served to drive a lodged object deeper into the throat. He envisioned a better method, formed a research team and tested his theory on dogs. He inserted a tube with a balloon at the end into an anesthetized dog’s airway, then inflated the balloon.

When the dog began to choke, pressure was applied just below the lungs, causing the lungs to “act like a bellows” — as Heimlich had theorized — and expel the obstruction.

The Chicago Daily News reported on Heimlich’s article, and the doctor’s advice quickly spread. Five years after he published his research, Heimlich himself Heimlich’d Johnny Carson on The Tonight Show. Another six years passed before the surgeon general and various medical associations embraced the lifesaving Heimlich maneuver — also known as “abdominal thrusts” — as illustrated with diagrams posted in countless restaurants around the country to this day. This past September, New Hampshire Gov. Chris Sununu used the technique to help save the life of a contestant at a local lobster-roll-eating contest.

Learning the Heimlich

A few days after I got home from my visit to Chicago, I attended a “choke safety” class that offered basic training to local police, teachers and restaurant employees. Though I’d stayed calm back in the restaurant with an airway blocked by calamari, something about revisiting the event brought up intense emotions — fear, mostly, and the feeling of helplessness. The instructor, Michelle, screened a short training video. Then it was time to put theory into practice.

Michelle stepped behind a staffer named Monica, who wore a heavily padded vest. Michelle wrapped her arms around Monica, just as Helen had embraced me, and gave a sharp upward thrust with her forearms. A bright yellow thumb-sized projectile flew from Monica’s vest, indicating success. Special effects! Fun!

They demonstrated the technique again, Michelle noting the 45-degree angle of the Heimlich motion. When it was my turn, I needed a few tries to dislodge the foam food, but oh, what a satisfying moment it was. I practiced a few more times, accepted a certificate and left the training session feeling relieved. A burden I didn’t know I was carrying was gone now. And even better — I’d know what to do if I was on the other side of the table next time.

Be a lifesaver

The universal sign for “I’m choking” is both hands placed loosely around the neck, says Elizabeth Lipton Daly, executive director of the National Foundation of Swallowing Disorders. She cautions that when performing the Heimlich maneuver on a person of advanced age, be gentle but firm. “Depending on the amount of pressure you apply, too much force might cause injury like cracking the choking person’s ribs.” Here’s a visual guide on how to perform abdominal thrusts.

For use if the choking person:

1. Can’t speak or cough
2. Is conscious
3. Is over 1 year old

How to do the Heimlich maneuver in five steps

1. Stand behind the choking person. Press your fist, with your thumb facing in, into the the person’s abdomen, just above their belly button.
2. Wrap your other hand around your fist and hold tight.
3. Quickly thrust upward and inward into the person’s belly.
4. Repeat several times until the object that’s causing the choking comes loose.
5. If the object cannot be dislodged, or if the person loses consciousness, call 911.