June 10, 2013 Regina M.

Benjamin MD MBA United States Surgeon General 1101 Wooton Parkway Rockville, MD 20852 Dear Surgeon General Benjamin: Thank you for your June 7, 2013 letter in response to recent inquiries from me and my congressman, Rob Woodall. You'll recall that I asked if your office's recommendations for responding to choking emergencies had changed since this September 30, 1985 Public Health Report posted on the website of the Heimlich Institute, a nonprofit corporation in Cincinnati that promotes the work of my father, Henry J. Heimlich MD: Surgeon General C. Everett Koop today endorsed the Heimlich manuever [sic], not as the preferred, but as the only method that should be used for the treatment of choking from foreign body airway obstruction. Dr. Koop also urged the American Red Cross and the American Heart Association to teach only the Heimlich Manuever [sic] in their first aid classes. Dr. Koop urged both organizations to withdraw from circulation manuals, posters and other materials that recommend treating choking victims with back slaps and blows to the chest. ..."Millions of Americans have been taught to treat persons who are choking with back blows, chest thrusts and abdominal thrusts," Dr. Koop said. "Now, they must be advised...and I ask for the participation of the Red Cross, the American Heart Association and public health authorities everywhere...that these methods are hazardous, even lethal." ..."The best rescue technique in any choking situation," Dr. Koop said, "is the Heimlich Manuever [sic]." Here's your response: Thank you for your inquiry regarding the Heimlich Maneuver. As Surgeon General, I provide Americans with the best scientific information available about how to improve their health and reduce the risk of illness and injury. First aid is a critical part of emergency preparedness and response, and I appreciate your attention to this issue. Dr. Koops endorsement in 1985 was based on the best available evidence at the time. Generally, scientific evidence reviews are conducted about every five years, or as individual conditions warrant, to examine the literature to determine if new studies have been published on the topic of interest. We are not aware of evidence reviews conducted since 1985, therefore the Office of the Surgeon General does not have a position. I was surprised to learn that your office is unaware of the evidence reviews and findings published by the American Heart Association (AHA) in 1992 (JAMA), 2000, 2005, and 2010 (Circulation). Each of the published findings provided treatment recommendations for responding to Foreign Body Airway Obstruction (FBAO).

Based on your letter, you may also be unaware of this information: The International Liaison Committee on Resuscitation (ILCOR) was formed in 1992 to provide a forum for liaison between principal resuscitation organisations worldwide...ILCOR comprises representatives of American Heart Association (AHA) European Resuscitation Council (ERC) Heart and Stroke Foundation of Canada (HSFC) Australian and New Zealand Committee on Resuscitation (ANZCOR) Resuscitation Councils of Southern Africa (RCSA) Inter American Heart Foundation (IAHF) Resuscitation Council of Asia (RCA - current members Japan, Korea, Singapore, Taiwan)

...In collaboration with the AHA, ILCOR produced the first International CPR Guidelines in 2000 and an International Consensus on CPR and ECC Science with Treatment Recommendations in 2005. (source) About five years later, ILCOR conducted its most recent evidence-based review of FBAO. Please click here for the review worksheet which posed this question: In adult and paediatric patients with foreign body airway obstruction (out-of-hospital and in-hospital), does the provision of abdominal thrusts, and/or back slaps, and/or chest thrusts, compared with no action, improve outcome (e.g. clearance of obstruction, ROSC, survival)? The results of the review were published in October 2010. Please click here to download copies of the findings published by ILCOR's member organizations (including the AHA), each of which includes treatment recommendations for FBAO. Would you please review these materials and then inform me whether or not your office's recommendations for treating FBAO have changed since Dr. Koop's 1985 Public Health Report? I'd also appreciate being provided with an indication of approximately when I may expect to receive your answer to my question. Thank you for your continued attention and I look forward to your reply. Sincerely,

Peter M. Heimlich 3630 River Hollow Run Duluth, GA 30096 ph: (208)474-7283 website: Medfraud blog: The Sidebar cc: The Hon. Rob Woodall, U.S. House of Representatives Dori Salcido, Acting Asst. Secretary for Public Affairs, U.S. Dept. of Health and Human Services Gayle Converse, Communications, Office of the U.S. Surgeon General