7-year-old boy chokes to death on plum pit in Sapporo

it would be really good and no waste of time to train everybody on the heimlich maneuver. poor kid and parents and friends...

Did they really think he would survive long enough for emergency workers to get there? All school staff should be trained CPR and himelic maneuver.

You don't use the heinmlick on kids. You pick them up and turn them upside down and shake it free. You can crush a kid's ribs very easily.

Dangerously wrong advice. For adults as well as children 1 year old and up: 4-5 forceful blows between the shoulder blades, followed by abdominal thrusts (Heimlich) if still not dislodged. Continue alternating as required, as long as the person is still conscious. If unconscious, perform CPR.

For babies up to 1 year old: 4-5 blows to the back - hold the baby facing downward, and support the head. Follow with 4-5 chest compressions - two fingers, center of chest, compressing 1/3 of chest depth. Repeat as needed while conscious, switching to CPR if unconscious.

If others are present, immediately task someone with getting an ambulance on the way. If you're alone, treat the choking first while the victim is still conscious. Call an ambulance before starting CPR for an adult. Do 5 cycles of CPR before pausing to call an ambulance for an infant.

I'm a certified and active CPR instructor. The above is the current international guideline for choking, but a forum post is no substitute for a CPR course. Please take one and refresh each year!

BTW, broken ribs heal with few complications. Death is permanent in all cases to date. And shaking kids upside down has never been considered a best practice in modern medicine... No advice is better than bad advice.

a member of a special assistance class

Special assitance? what does that mean? Anyway how about removing the plum seed before giving it to the kids

A seven year-old in a special assistance class, "was warned against eating the plum whole".

That's the school absolved of any blame then.

Two words: Heimlich Maneuver

Everyone should know it. And if no one is around, you can do it by yourself.

http://www.wikihow.com/Perform-the-Heimlich-Maneuver-on-Yourself

Yeah. Good luck picking a 7yr old up by the ankles and shaking them, the pip may come out but you'll probably give them head trauma instead.

Kingboy, you do not know Japan! The ambulance workers here just pick you up and try to find a hospital for you, if they can find one willing to take you let alone having the brains to try and explain how to remove this plum seed?? from this kid's throat. RIP 7 year old kid

The "emergency workers" in this instance being ambulance men/women?

Not quite sure of the meaning of "special assistance class" in this case but if those who warned him were adults then they should have stopped him.

Belcanto is right here I have ties to physicians and I confirmed it. Some of the the things you read here from other commenters...what the heck.

Surely at the very LEAST; couldn't the emergency operator have told someone what to do!?

Frungy's right that when giving CPR to an unconscious choking victim, it's important to check for the foreign object before giving the rescue breaths. I do teach exactly this in CPR certification courses, and have to admit I shouldn't have omitted it here. My mistake.

That aside, there are a lot of incorrect and outdated suggestions in this thread. Resuscitation and first aid guidelines are revised every 5 years around the world, in response to the latest research on what's actually saving lives on the street and in hospitals. If you haven't taken a CPR course in the last couple of years, please do - many things have changed!

Frungy:

You then proceed to advise CPR on someone who's fallen unconscious... are you an utter idiot?

If you observe someone choke and subsequently fall unconscious, then yes, CPR is the next step - with extra care to removing the foreign object before giving rescue breaths.

Frungy:

CPR is required for heart failure NOT for an obstructed airway.

As in the unfortunate case we're discussing, an airway that remains blocked will lead to heart failure. No oxygen --> loss of consciousness --> no heartbeat soon after. So try to get the foreign object out using back blows and chest thrusts as long as the victim in conscious. If they lose consciousness, perform CPR.

Frungy:

Their heart may still be beating, circulating what little oxgen remains in the bloodstream and you want to INTERFERE WITH IT?!!?! First step before initiating CPR is ALWAYS to check whether the heart is still beating. You ONLY initiate CPR if the heart STOPS. You NEVER initiate CPR is there is any pulse.

From the journal of the American Heart Association (http://circ.ahajournals.org/content/116/25/e566.full):

It is not dangerous to perform chest compressions even if the heart is still beating. You cannot make a patient any worse than he or she already is. Yes, you may break ribs, but the alternative is almost certainly death.

2010 AHA Guidelines for CPR and ECC:

The BLS algorithm has been simplified, and "Look, Listen and Feel" has been removed from the algorithm. (Note that checking pulse has not been taught to laypeople for at least a decade. -Belcanto) Performance of these steps is inconsistent and time consuming. For this reason the 2010 AHA Guidelines for CPR and ECC stress immediate activation of the emergency response system and starting chest compressions for any unresponsive adult victim with no breathing or no normal breathing (ie, only gasps).

Don't sit alongside the choking casualty, impatiently tapping your fingers, waiting for the pulse to stop before starting CPR.

BTW, a 7 year old boy like in the article above would be treated with the same pattern as an adult, with minor modifications to CPR to account for body size.

I don't get a gold star for mentioning that I'm a CPR instructor - I just want people to evaluate sources on a topic as important as this. Too many outdated and dangerous statements in this thread. And hey, I'm still some anonymous guy, so please do your own research - and most important, take a CPR course soon!

Where can people do a 1st aid course in English???

This is very sad for him and his loved ones I am sure....but why in a country the size of Japan does a tragic household accident make national news?

@ disillusioned: What you outlined is for infants. Not for kids.

RIP Little guy.

Frungy seems well meaning, but his personal opinions are not consistent with current evidence based guidelines for resuscitation, and particularly for choking due to foreign objects. (Other scenarios like sleeper holds, anaphylaxis, etc. are off-topic and irrelevant to the article and to this discussion.)

The Mayo Clinic's page on choking (http://www.mayoclinic.com/health/first-aid-choking/FA00025) outlines three clear steps for laypeople assisting an unconscious choking victim:

Lower the person on his or her back onto the floor.

Clear the airway. If there's a visible blockage at the back of the throat or high in the throat, reach a finger into the mouth and sweep out the cause of the blockage. Be careful not to push the food or object deeper into the airway, which can happen easily in young children.

Begin cardiopulmonary resuscitation (CPR) if the object remains lodged and the person doesn't respond after you take the above measures. The chest compressions used in CPR may dislodge the object. Remember to recheck the mouth periodically.

If you can't quickly spot and remove the blockage in an unconscious victim, you should proceed directly to CPR. No shaking them upside down, no tracheotomies, no other funny business, please.

For lay rescuers, the standard is simple and crystal clear: if a choking victim is unconscious and not breathing, begin CPR. Checking the pulse or otherwise guessing whether the heart is still beating is in direct contradiction to current best practices.

Even if the heart is still beating, CPR is your best hope for dislodging a stubborn foreign object at that point, as per the Mayo Clinic guidelines. We've already established "It is not dangerous to perform chest compressions even if the heart is still beating. You cannot make a patient any worse than he or she already is. Yes, you may break ribs, but the alternative is almost certainly death." (http://circ.ahajournals.org/content/116/25/e566.full)

Frungy means well, but some of his "advice" is out of date and needlessly confusing. The simple solution is that everyone should take a CPR course and get methodical hands-on instruction based in current statistical evidence regarding what actually saves lives.

CPR is your best hope for dislodging a stubborn foreign object at that point, as per the Mayo Clinic guidelines.

Best hope? So, here's the question: What do you do when CPR doesn't dislodge the object? What are the options left in those critical minutes, and how long should it take to make the decision?

As a seasoned instructor (major city ER, backcountry rescuer) of mine liked to put it, "At that point, you're having a bad day." Meaning, sometimes you don't have any really good choices, and sometimes things just aren't going to turn out for the best.

I'm a layperson - not a doctor, nurse, or EMT. As such, there are legal and ethical limits to what I can do, even in a life or death situation. My best bet is to follow the protocols I've learned and been certified for to the best of my ability, until advanced care arrives and takes over.

If I have an unconscious choking victim and I can't dislodge the object by sweeping the airway or CPR, well, it's a bad day. Regardless, I'm not going to grab my Bic pen and do an improvised tracheotomy, say. That's outside my training, and outside the definition of "reasonable assistance" that would protect me from liability for the outcome of my actions. For me, it would be the wrong choice. It would likewise be grossly negligent for me to suggest it when teaching a standard CPR course for laypeople.

If you're trained in battlefield medicine or are a medical professional, you might decide differently. If that's you, you know who you are. But that's not the vast, vast majority of people, and it's not a realistic, legal, or ethical option for them.

The standard first aid and resuscitation protocols are the protocols precisely because they're going to be the most effective in the most situations for the most people. They're not perfect, and they're no guarantee of a favorable outcome. We can only act to the best of our ability and training, and hope it's a good day.

belcanto-

naruhodo

I would be interested in doing it in Japan, but don't know about restrictions for foreigners. (language no prob). I was turned down to be a fire volunteer- don't remember official word, but the guys who take turns walking around the neighborhood at night, and run to help w/fires if help needed. But turned down because, not Japanese! I would imagine classes would not be so.

I believe treatment depends whether the boy was conscious or not.

Elbuda: You got that right and all the while never exceeding the speed limit. I child has died needlessly and still some posters choose to attack one another. We weren't there so we don't know (but can sure guess) how unprepared the staff was. From the writing it would SEEM that they did nothing more than call an ambulance and stood by. I'm no medical expert but I know that just about anything would have been better than standing there. See too much of that here. Dennis Bauer: That is exactly what I thought. Would have most likely prevented this whole thing.

I find it hilarious that Belcanto's advice has 9 positive votes, while my advice about checking the airways has -3 votes...

Why is it hilarious? Because St. John's, the Red Cross, the Mayo clinic, etc. all agree with me in their choking guidelines. In cases of choking check the airway.

I guess this just goes to show that the average person knows so little about medicine that they can't distinguish good advice from bad.

Damn I'm confused! The video states to perform CPR if they are unconcious and here it says don't perform CPR if there is a beating heart. Every time I read about this, I get different information and different procedures to follow. Hope no one is near me if they start choking because moi is confused!

CPR is your best hope for dislodging a stubborn foreign object at that point, as per the Mayo Clinic guidelines.

Best hope? So, here's the question: What do you do when CPR doesn't dislodge the object? What are the options left in those critical minutes, and how long should it take to make the decision?

If you're trained in battlefield medicine or are a medical professional, you might decide differently. If that's you, you know who you are.

People would be amazed at how little training it takes to perform one competently.

and outside the definition of "reasonable assistance" that would protect me from liability for the outcome of my actions.

The boundaries of what is "reasonable" are subject to consideration and change. I believe all can agree with two basic facts: 1) If the item does not get dislodged, or the injury is of a nature that the larynx is blocked, the victim will surely die within a matter of minutes; and 2) Getting air to the victim's lungs by a proven means is more important than just giving up.

There's a third fact that should be considered also: Impromptu tracheotomies have saved thousands of lives.

I am not discounting in any way the proper protocol of first aid measures, and the fact that the tracheotomy would be the very last resort. For me, it is more negligent to exclude knowledge of an option that will almost guarantee that a life is saved if no other procedure has cleared the airway, as long as that knowledge can be backed up at some later point with dedicated training and proper instruments -- which, yes, aren't much more sophisticated than a pen tube.

Lastly, wouldn't it be better to have the properly trained first responder going into a situation with a high degree of confidence that they will be able to get the victim breathing again? This isn't rocket science, nor should it be.

@Frungy

What you say is very sensible. I especially liked this:

Real life trauma situations are dynamic. The rules are useful as guidelines for how textbook situations often go, but they're no substitute for using your brain and balancing various factors such as ETA on the ambulance, likely cause of the problem, etc.

I would definitely want to be on your team for developing the protocol and training for emergency situations. Real-life trauma situations are definitely moment-by-moment -- but, if we've done our jobs well, they will cause minimum trauma to the first responder. There is no substitute for knowledge and training.

In short, knowledge of the Heimlich (sp?) and also don't forget the trachea cut, and the wherewithal to act quickly could've saved the kid's life. I was choking once, my Dad ran to get a knife and match for sterilization while my big bro whacked my back and solar plexus. Luckily it came out then, no cut.

I could imagine in Japan tho, if it was the wrong group, this could happen; "me do the heimlich? no no no, I'm not good enough, you do it"

"me?? but I'm still just a beginner, you do it!" not to mention bickering and accusations about whose "sekinin" it is.

Lowly, I'm glad you made it!

You raise a good point about bystander reluctance, which is a real factor not only in Japan. Good training is one factor in reducing hesitation. Especially when most people (on this thread and on the street) aren't trained in even the basics of first aid, extended discussion of field tracheotomies seems a bit silly. If you're an ex-corpsman or a medical professional, great, but that's not most of us.

This study (http://www.ncbi.nlm.nih.gov/pubmed/17169872?dopt=Abstract) found an 86.5% success rate for the Heimlich maneuver alone. Another paper by the UK Resuscitation Council notes that in half of cases a combination of techniques will be required to dislodge the object, which implies that rotation of back blows and Heimlich is going to push that success rate even higher. (So your dad's blameless response aside, it's no surprise that the knife wasn't needed.)

So after we achieve a society in which most people are trained in basic first aid and ready to save a life in the vast majority of situations, then great, let's start advocating for improvised surgery by laypeople.

Yeah, I'd like to know 1st aid too, chuck.

BelCant0-

thx, glad to still be here. my Dad was a trained lifeguard w/long yrs of experience, I don't know that he actually did any tracheotomies, but he learned about all that stuff. but what he told me and I have heard since from other sources is it is fairly straightforward as long as you know where the trachea is, and you get the cut cleaned well soon enough to avoid infection. Just open a hole in the right spot and it won't bleed significantly.

Lowly, here's a great page detailing emergency tracheotomy. (http://www.anatomyatlases.org/firstaid/Choking.shtml)

Note that the scenario has a thoroughly trained Marine corpsman performing the procedure. It's not trivial, and is simply never going to be appropriate for laypeople, like the school staff who were in charge of the Sapporo victim.

Get this: FNN's Japanese coverage of this accident says that school staff called 119 and tried using a vacuum cleaner to remove the plum pit. My whole point is that this kid almost certainly would have lived if the staff had learned and performed the standard basic first aid response for choking. Let's work on getting folks trained in the basics rather than go on and on about dubious cowboy "solutions".

Frungy JUN. 30, 2013 - 02:33AM JST:

BelCanto raised an interesting issue in terms of legal implications. Japan has a "Good Samaritan Law" that actually requires you to render assistance, and protects you from legal liability if things go badly. In fact Japan's law is phrased in such a way that you have a duty to rescue/assist and can be criminally charged if you do NOT take all reasonable steps and it results in death or injury.

OK, you're just making things up. Gobsmackingly absolutely false, despite the impressively rich detail and authoritative tone. Or can you provide a citation?

From the Tokyo Emergency First Aid Association (the folks who teach the Japanese fire department courses):

We do not have a law like this [the GS Law] in Japan. However those who have taken action for lifesaving with good intentions are supposed that [sic] they are not held liable. In fact, no citizen has ever been convicted as the result of his or her actions.

Wikipedia has a quite interesting discussion of the legal landscape, if you read Japanese. (http://ja.wikipedia.org/wiki/%E5%96%84%E3%81%8D%E3%82%B5%E3%83%9E%E3%83%AA%E3%82%A2%E4%BA%BA%E3%81%AE%E6%B3%95) It's not actually as simple as the Tokyo Emergency First Aid Assoc. puts it.

[I'm not a legal expert and am simply summarizing the Wikipedia discussion below.]

In a nutshell there is a civil law (article 698) that applies specifically to the business sphere, and absolves one of responsibility for acting urgently on another's behalf, provided the actor has no obligation to act (e.g. is not an employee who does already have that obligation), as long as one acts with good intentions and as long as one makes no serious errors.

The argument exists that in common law, the above civil code is a defacto Good Samaritan Law, but this legal opinion is still debated. Additionally, there is a possibility that a rescuer could have the burden of proving that no serious errors were made. (Doctors may be held to have an obligation to act, further complicating application of the above law.)

Criminal code article 37 spells out when punishment may be suspended for breaking the law in the course of responding to an emergency. The key point is that your actions must not result in damage greater than the damage you were seeking to avoid. And again, this only applies to people who do not have a professional obligation to act, such as doctors.

Despite the fact that to date rescuers have not been held responsible for acting (and I'm personally confident they will not be held responsible in the future), there is not solid legal precedent for absolution of responsibility, only the absence of a record of being held responsible. Thus, there is a push for passage of a proper Good Samaritan Law, to replace the current patchwork of laws and opinion.

thx belcanto,

I have decided I may not have remembered correctly the correct cut point. I had thot it was the soft spot between the collar bones and the sternum, but that article seems higher up. Will have to research, train, before testing out. (which I hopefully never have to do).

Lowly, your first step is getting certified in basic CPR and first aid. :)

Then retrain at least every year, no matter how long your card says it's good for. In numerous studies, even pros show deterioration of basic technique after just a few months.

Do that, and then you can start thinking about what's next. :)

Frungy and BelCanto, please do not address each other any further on this thread, since all you are doing is bickering.

Japanese news is reporting that the school staff used a freakin' vacuum cleaner to try to suck the plum pit from this poor boy's throat. There is no 100% guarantee, but research (not opinion) makes clear this boy would have had an extremely high likelihood of being saved if the school staff had provided the standard choking response you learn in any basic first aid course.

Want to do something about this tragic death? Take a basic first aid / CPR course and retrain every year. If you have a kid in school here, demand that your board of education provide the same training for all staff. These are things that will actually make a difference. Anything else is the domain of medical professionals at best, or fantasists at worst, and doesn't concern this article or us laypeople.

@BelCanto:

Thank you very much for posting this link. I'll post it again:

Here's a great page detailing emergency tracheotomy. (http://www.anatomyatlases.org/firstaid/Choking.shtml)

One thing I really thought was great was asking another person to watch the clock and signal when each minute had passed.

I agree with much you have to say too. In my view, the need to preserve human life takes the highest priority. Every responsible adult should make it their priority to enroll in first aid / CPR training. A small space in the trunks of our cars and in public building locations (well-marked) should be reserved for the essential things needed for rendering aid to others.

Yabits, just a guess but you seem like you may have some medical / medic background, if you're comfortable with the idea of performing a tracheotomy. If so, fair play.

I just want to emphasize, and I hope you'll agree - this is NOT a procedure that one should consider doing without serious training. Sure, once you know how, it's not rocket science. But the page I linked, and the procedure, are not aimed at most people reading this thread.

If you're not a trained medic or the equivalent, you should not be contemplating this procedure. If you are not currently certified in basic first aid and CPR, you're many miles from needing to even think about this.

(Agree with everything in the latter part of your comment, too, BTW. Cheers!)

Lowly, that's a bummer to hear they turned you down. I imagine it's a pretty Japanese organization, with all that implies. Maybe they did you a favor by turning you down. :) I considered joining the local volunteers as well, but then decided I could be more useful to society elsewhere.

Tons of foreigners have been through the fire department basic first aid courses, though, no problem. Call or drop by your local FD to find out when and where. Local FD websites almost universally suck. :)

Or, you can check out http://www.tokyo-bousai.or.jp/lecture/kyukyu/teate/teate01.html. Click the apply button to get a calendar. But this site doesn't list all local FD courses.

If you can understand Japanese, you're all set. You can request an English translation of the text in advance, but English courses are still rare, unfortunately.

I don't think there are a lot of people even reading this thread anymore, and even fewer on the fence about what lessons to draw from the article and related discussion. :) But...

Here's why the standard first aid procedures are the procedures: because they work better (i.e. save more lives) than any other course of action, for the greatest possible number of people, in the greatest possible number of cases.

This isn't even subject to debate. The best experts in the world review the evidence from real research into what works and what doesn't work - for both laypeople and medical personnel. They revise the internationally accepted resuscitation guidelines every 5 years based on the latest research. When you go learn basic first aid and CPR, you're learning procedures that directly reflect these evidence based guidelines. So you're learning what works best for regular people the greatest percentage of the time. End of story.

So if "procedure" says move straight to CPR (with airway check) for an unconscious choking victim, then heck yeah that's what I'm going to do. You should too. Not because you're unthoughtful or too hung up on procedure. Because it's proven to have the best chance of saving a life when performed by a lay rescuer. That's what procedures are about. That's the beauty of them.

First aid for regular people is being continually refined with two goals in mind 1) to be effective in the greatest possible number of cases, and 2) to be simple and understandable, thus more likely to be performed. It's not complicated. Explanations and rationales that seem complicated, and the people who provide them, should be viewed with skepticism.

This is tragic.

Proper, comprehensive, and ongoing training of the staff is second to nothing in these situations. People have to know what they are doing.

Being that the airway is not guaranteed to clear in some circumstances, don't overlook the possibility that an emergency tracheotomy may need to be performed to save a life. With massive brain injury or death minutes away, all reasonable options to sustain life have to be considered.

yabits Jun. 30, 2013 - 12:44AM JST

CPR is your best hope for dislodging a stubborn foreign object at that point, as per the Mayo Clinic guidelines. Best hope? So, here's the question: What do you do when CPR doesn't dislodge the object? What are the options left in those critical minutes, and how long should it take to make the decision?

Hi Yabits. The problem with CPR is that once started it cannot be stopped. You've taken over beating for the heart, and now you can't stop or no blood will circulate. Once you move directly to CPR that means you have no other options unless you have a spare person who can try to clear the airway while you conduct CPR (and that's tricky since CPR isn't gentle and the way you need to position yourself leaves very little room for a 3rd person to start inspecting the airway).

The window of opportunity is between unconsciousness and cardiac arrest (the heart stopping). After the heart stops you need CPR to make the best of a bad situation and give the paramedics the maximum amount of time to arrive. Ambulance response time is excellent in Japan, but still the average response time is between 6.2 and 9.3 minutes (Yasunaga, et al. International Journal of Health Geographics, 2011, 10:26).

Assuming the best case (that you didn't follow standard procedure and initiate CPR and THEN call 119), then the ambulance arrives 6.2 minutes later... by which point the person is brain damaged. The outside average is 9.3 minutes, by which time the person is most likely brain dead. Why? Because no new oxygen can enter the system for so long as the airway is obstructed.

Note that these are average times. Looking at the data in 19.6% of cases the ambulance arrived in under 5 minutes from the call. In 86.4% of cases in under 11 minutes. Only in 13.6% of cases did they arrive 11+ minutes from the call being made. Note that after the 5 minute mark 1-month neurologically favourable survival drops sharply, or to put it simply, the brain damage becomes more and more severe and while the person may survive to the hospital they often die later.

There is simply no downside to trying to dislodge the object while the heart is still beating on its own. The patient's system is oxygenating itself, it doesn't need help. Proceeding directly to CPR before it is required is recommended ONLY because it minimises the number of steps that people have to remember, NOT because it maximises patient survival, and NOT because it is the best course of action. It is based on statistics that show that cardiac arrest is the most common complaint, not choking, and if it were cardiac arrest I would definitely say that following the procedure is the best way to go. However in the case above it simply isn't.

Some people will endlessly quote the first aid procedure, but if they don't know enough to actually explain WHY the procedure is the best way to go then I would suggest that you follow the advice of someone who actually does know enough anatomy to explain WHY they're recommending an alternative course of action. And also bear in mind that in many places first aid qualifications are extremely low level and easy to get, in most countries a level 3 certification is just a couple of days of training, with no real life experience of trauma situations.

Real life trauma situations are dynamic. The rules are useful as guidelines for how textbook situations often go, but they're no substitute for using your brain and balancing various factors such as ETA on the ambulance, likely cause of the problem, etc.

BelCanto raised an interesting issue in terms of legal implications. Japan has a "Good Samaritan Law" that actually requires you to render assistance, and protects you from legal liability if things go badly. In fact Japan's law is phrased in such a way that you have a duty to rescue/assist and can be criminally charged if you do NOT take all reasonable steps and it results in death or injury.

It would be grossly irresponsible to say, "I was just following the standard first aid treatment" when you were perfectly aware that the result of following that procedure would be brain damage and/or death in the overwhelming majority of cases. It would be far easier to say, "Yes, I didn't follow standard procedure by starting CPR 2 minutes later than normal, but the kid was going to die if I followed procedure, so I took a risk on trying to clear the blockage. It didn't work out, but it was the best option I had at the time". Or better yet, "I didn't follow procedure, but your son is alive, so no harm, no foul."

+> BelCantoJun. 30, 2013 - 05:31PM JST

Get this: FNN's Japanese coverage of this accident says that school staff called 119 and tried using a vacuum cleaner to remove the plum pit. My whole point is that this kid almost certainly would have lived if the staff had learned and performed the standard basic first aid response for choking. Let's work on getting folks trained in the basics rather than go on and on about dubious cowboy "solutions".

What was the Ambulance crew's response time? Without that information you cannot state conclusively that the standard approach would have worked. If the response time was more than 10 minutes from the start of choking (not when the call was made), then he was already brain dead, i.e. dead. The standard CPR course you advised would have been circulating dead and deoxygenated blood.

The school teachers methods may have been dangerous (I don't recommend the vacuum cleaner approach as a first, second or even third choice, it is far too easy to collapse both lungs and cause permanent damage and there are safer ways to accomplish your objective), but if the ambulance ETA was more than 10 minutes it could not cause more harm than death.

OK, you're just making things up. Gobsmackingly absolutely false, despite the impressively rich detail and authoritative tone. Or can you provide a citation?

After the Sarin Gas attack in Tokyo in 1994 one of the key factors in the high death rate was that EMS workers were not allowed to intubate to save lives without a doctor's order and supervision. (Okumura, T., Suzuki, K., Fukuda, A., Kohama, A., Takasu, N., Ishimatsu, S., & Hinohara, S. (1998). The Tokyo Subway Sarin Attack: Disaster Management, Part 1: Community Emergency Response*. Academic Emergency Medicine, 5(6), 613-617.)

As a result of this the law in Japan was reformed based on other international "Good Samaritan" laws. "In countries like Italy, France, and Japan, for example, the law specifically requires that citizens help others in distress" (Yan, Y. (2009). The Good Samaritan's new trouble: A study of the changing moral landscape in contemporary China1. Social Anthropology, 17(1), 9-24).

Also, "The Act, also called "Good Samaritan Law,"" exempts a person who attempts to save the life of a person" (Leem, S. (2010). What Must be Done to Spread the Use of AED?-The Japanese Example.)

There are three citations, providing both the background and practical implications of the new legislation. It is largely unknown, but it IS NOT, as you so elegantly put it, "false". Next time you try to call someone a liar perhaps you should check your facts?

Criminal code article 37 spells out when punishment may be suspended for breaking the law in the course of responding to an emergency. The key point is that your actions must not result in damage greater than the damage you were seeking to avoid. And again, this only applies to people who do not have a professional obligation to act, such as doctors.

And how, precisely, would the course of action I advocated be causing greater damage? The heart is beating, blood is circulating, so CPR is redundant at that point. It adds nothing and potentially does damage. On the other hand, checking the airway and trying to clear it does absolutely NO damage, and could save the life.

Explanations and rationales that seem complicated, and the people who provide them, should be viewed with skepticism.

Likewise people who say, "It is procedure", but are unable to explain the rationale behind the procedure should be viewed with skepticism. If they can't explain why they're doing something, then they probably don't know what they're doing.

BelCantoJun. 28, 2013 - 06:05PM JST Dangerously wrong advice. For adults as well as children 1 year old and up: 4-5 forceful blows between the shoulder blades, followed by abdominal thrusts (Heimlich) if still not dislodged. Continue alternating as required, as long as the person is still conscious. If unconscious, perform CPR.

You left out the most critical steps that make your advice as dangerous or worse than the preceding advice.

Visually check the mouth and throat, and attempt to dislodge any obstructions. The object may be lodged at the top of the throat, or the tongue may be obstructing the air passage. Failing to mention this very simple, very common sense check makes me sincerely doubt your claim to being a "certified and active CPR instructor".

You then proceed to advise CPR on someone who's fallen unconscious... are you an utter idiot? CPR is required for heart failure NOT for an obstructed airway. Their heart may still be beating, circulating what little oxgen remains in the bloodstream and you want to INTERFERE WITH IT?!!?! First step before initiating CPR is ALWAYS to check whether the heart is still beating. You ONLY initiate CPR if the heart STOPS. You NEVER initiate CPR is there is any pulse.

... please give me the name of the institute where you are a "certified and active CPR instructor" ... so that I can recommend that no-one ever go near it. Your advice is a hundred times more dangerous than holding a kid upside down and slapping them on the back a few times (seriously, this can do very little damage compared to initiating CPR on a beating heart).

Tom DeMickeJun. 29, 2013 - 05:01PM JST Damn I'm confused! The video states to perform CPR if they are unconcious and here it says don't perform CPR if there is a beating heart. Every time I read about this, I get different information and different procedures to follow. Hope no one is near me if they start choking because moi is confused!

The reason for my advice is pretty simple Tom, so I'll explain.

When someone is choking the problem is lack of oxygen. Without oxygen you have 5 minutes before brain damage, and 10 minutes brain death on average. CPR doesn't alleviate this problem in any way, it just moves the blood with some oxygen left in it around so that it can reach the brain and other tissues. If the heart is still beating it is already doing this, so CPR does nothing new.

Now consider that time limit again. If the heart is already doing what CPR would be doing what would be a better use of that time? How about clearing the airway? That would solve the real problem here, which is the lack of oxygen. If you do that then the person will be able to breathe and will regain consciousness naturally and with minimal damage.

If someone is choked unconscious using a sleeper hold or something, and still has a regular heartbeat do you start CPR? No, because their heart isn't the problem. The problem is lack of oxygen. Make sure their throat is okay, their airway is clear and they'll recover just fine.

Let's take the alternative, because first aid is all about the best possible option under the circumstances. Let's say you start CPR without trying to clear the airway. Well, the person has the original amount of oxygen in their system, so all you're doing is circulating it for them and they'll be brain damaged in 5 minutes and brain dead in 10 minutes. The net result is PRECISELY the same as if you did nothing for them... except that the corpse will have some broken ribs from the CPR. You might luck out and the relaxing of the neck muscles during unconsciousness might release the object, but that could happen if you did nothing too.

A simple rule, address the problem, don't just blindly follow a procedure that makes no sense.

You don't use the heinmlick on kids. You pick them up and turn them upside down and shake it free. You can crush a kid's ribs very easily. But, I agree that first aid procedures should be taught to all teachers.

What's to investigate?