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NASCO Position Paper Re: Abdominal Thrusts For Drowning Rescue, John Hunsucker (Undated)
NASCO Position Paper Re: Abdominal Thrusts For Drowning Rescue, John Hunsucker (Undated)
, PE
President, NASCO
The National Aquatics Safety Company
1002 Ave. L
Dickinson, TX 77539
Phone: (281) 337-5628
Fax: (281) 337-0043
Email: johnnasco@aol.com
NASCO Position Paper
The Use of the Sub‐Diaphragmatic Thrust in Drowning
Most of the controversy over the use of the sub‐diaphragmatic thrust in drowning cases is that AR and
CPR are delayed. This is stated in the November 9, 2006 ACFAS (Advisory Council on First Aid and Safety
of the American Red Cross) Scientific Review Sub diaphragmatic Thrusts and Drowning Victims. There is
also concern that the sub‐diaphragmatic thrusts will further injure the drowning victim or cause them to
vomit.
We have read the concerns about doing sub‐diaphragmatic thrusts and have addressed each one. We
have developed our training protocols to make sure the possibility of delay is minimized. We train our
lifeguards to do only five sub‐diaphragmatic thrusts that take 4‐6 seconds and are done in the pool
during retrieval so that CPR is not delayed. We also train our lifeguards to apply the sub‐diaphragmatic
thrusts using the official American Heart Association procedure so that the possibility of physical injury is
minimized. As far as the fear of vomiting is concerned, many people receiving artificial respiration or
CPR will vomit during those procedures, so this is a non‐issue. Our lifeguards are trained to position the
drowning victim so that the vomit will not harm them.
The American Heart Association and the American Red Cross use a universal set of protocols for
teaching CPR. We do not take a stand on whether anyone else should change their CPR protocols just for
drowning. At NASCO we are looking at a single condition – drowning and the application of sub‐
diaphragmatic thrusts. We do a single quick set of 5 sub‐diaphragmatic thrusts taking 4‐6 seconds while
still in the water. This is part of our retrieval of the drowning victim and does not delay CPR.
We take no stand on Dr. Heimlich’s assertions about water in the lungs or his argument that sub‐
diaphragmatic thrusts should be done until no water or fluid comes out of the victim’s mouth. We do
not follow this technique.
There is another reason why we have kept the sub‐diaphragmatic thrusts in our retrieval procedures. In
a respiratory emergency, treatment is often delayed and this can be very serious. In most drowning,
from our own research in the industry, the lifeguard who does the rescue (often a high school student)
will not do AR or CPR. This will usually be done by supervisors, bystanders or EMS. Even medical
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professionals are hesitant to do mouth‐to‐mouth resuscitation (see “Health Care Professionals’
Willingness to Do Mouth‐to‐Mouth Resuscitation” in the Western Journal of Medicine Dec. 1997 v167
n6 p392 (6)) so treatment is often delayed while equipment is retrieved or EMS is called. We have never
heard of a case where a guard was unwilling to do a sub‐diaphragmatic thrust, which needs no
equipment. It is a procedure that can and will be applied with no delay.
Our protocols are based on our experience doing rescues. We have found that the sub‐diaphragmatic
thrust can revive drowning victims. In our case studies, respiration was restored on more than fifteen
drowning victims by using sub‐diaphragmatic thrusts with no additional physical injury from the sub‐
diaphragmatic thrusts being incurred. We have documented all the cases where it has occurred and are
willing to share this with qualified medical research facilities. These reports are considered part of the
person’s medical history and fall under The Health Insurance Portability and Accountability Act of 1996
(HIPAA) Privacy Rule . Anything that could identify the victim: name, location, age, time of occurrence,
etc. cannot be distributed.
The lack of clinical evidence to support our position is the same problem that the American Heart
Association wrote about in the December 13, 2005 edition of Circulation p. IV‐2 (when the 2005 CPR
guidelines were issued). "...few clinical resuscitation trials have sufficient power to demonstrate an
effect ... experts were often confronted with the need to make recommendations on ... retrospective
observational studies ... or extrapolations." Our documented cases of drowning would be considered a
"retrospective observational study".
Here at NASCO, we are very aware that medical protocols can change quickly due to new research and
development. We review these changes, modify our procedures as appropriate, and then submit the
changes to our Technical Advisory Board, made up of aquatic professionals from a variety of
backgrounds, for approval. This procedure allows us to evaluate the research and implement the new
standards that come from the medical community with regard to drowning and resuscitation. All our
procedures are reviewed annually and the changes are introduced in our annual international safety
school.
Historically, many of the procedures in lifeguarding have evolved through experience and our use of the
sub‐diaphragmatic thrust is based on experience. We are using sub‐diaphragmatic thrusts because we
have found that they work in drowning cases if applied during the retrieval phase. We at NASCO
strongly support the drive for clinical studies that can prove which procedures are most effective for
lifeguarding, but up to now those particular studies have not been done.
One of the oldest medical ethics is that of “Do no harm.” At NASCO we feel that our use of the sub‐
diaphragmatic thrusts as used in our training and protocols has done no harm and has helped us save
lives.
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To summarize:
1. NASCO follows the official 2005 American Heart Association Guidelines for Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care. We do not take a stand on whether anyone else
should change their protocols just for drowning.
2. NASCO uses five sub‐diaphragmatic thrusts during the retrieval phase of a rescue in such a way that it
does not delay either the AR phase or the chest compression phase of CPR. We also train our lifeguards
to apply the sub‐diaphragmatic thrusts correctly so as to minimize the possibility of injury.
3. NASCO has had repeated successes in using the sub‐diaphragmatic thrust during the retrieval phase
of a rescue and can provide documented cases to qualified medical research facilities in accordance with
HIPAA.
4. NASCO takes no stand on the research or techniques Dr. Heimlich cites when he writes about water in
the lungs or using sub‐diaphragmatic thrusts to remove the water. NASCO follows the AHA protocols for
CPR.
5. NASCO would strongly support any clinical study of drowning that would increase survival rates.
Thanks for your inquiries. Lifeguarding is an area that needs the clinical studies that will answer once
and for all the question of what procedures work best. Right now, we have found that the use of the
sub‐diaphragmatic thrust during the retrieval phase of a rescue has worked, has saved lives, and when
used correctly in our protocols, has neither delayed CPR nor caused additional injuries.
NASCO's motto has always been "To Reduce the Loss of Life Due To Drowning" and we will do
everything in our power to promote that goal.
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