BelCanto comments

Posted in: Nobel winner Oe: Japan should follow Germany, quit nuclear power See in context

Or... maybe we can be more like France, generating 75% of electricity from nuclear. Meanwhile, Japan is the 5th largest producer of CO2, and is backing off of climate change goals. Want to know something that is actually likely to "wipe out Japan's future," Mr. Oe?

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Posted in: 7-year-old boy chokes to death on plum pit in Sapporo See in context

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.

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Posted in: 7-year-old boy chokes to death on plum pit in Sapporo See in context

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 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.

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Posted in: 7-year-old boy chokes to death on plum pit in Sapporo See in context

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!)

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Posted in: 7-year-old boy chokes to death on plum pit in Sapporo See in context

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.

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Posted in: 7-year-old boy chokes to death on plum pit in Sapporo See in context

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. :)

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Posted in: 7-year-old boy chokes to death on plum pit in Sapporo See in context

Lowly, here's a great page detailing emergency tracheotomy. (

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. ( 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.

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Posted in: 7-year-old boy chokes to death on plum pit in Sapporo See in context

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 ( 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.

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Posted in: 7-year-old boy chokes to death on plum pit in Sapporo See in context

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.

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Posted in: 7-year-old boy chokes to death on plum pit in Sapporo See in context

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 ( 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." (

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.

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Posted in: 7-year-old boy chokes to death on plum pit in Sapporo See in context

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!


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.


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.


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 (

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!

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Posted in: 7-year-old boy chokes to death on plum pit in Sapporo See in context

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.

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Posted in: Fujisawa beach cleaning fundraiser planned for March 14 See in context

JeffLee, who pissed in your cornflakes? I've done beach clean ups here, and almost everything is debris washed onto the beach from who knows where, not local litter. It can be an eye-opener regarding the permanence of plastic waste, and a good springboard for understanding the impact of consumption.

Good on the organizers for actually getting out and doing something within their circle of influence! Better than sitting around meaning about imperfect solutions.

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Posted in: Tough man Terence Lee loses street fight in Kanagawa See in context

Holy cow, I used to go to the same gym as this guy! Didn't know he was "famous". Pretty short, but thick for a J guy. ALWAYS wore the shades. Moved really stiffly, maybe from an injury? Certainly didn't appear to have any capacity for speed or flexibility.

I hope I don't find my best days behind me at 45...

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