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Dr. Henry Heimlich, Medical Innovator

Monday, January 5 2009

Dr. Henry Heimlich invented the famous first-aid maneuver that has saved the lives of countless choking victims and the Heimlich flutter chest valve, which has saved the lives of thousands of soldiers on the battlefield.

Wartime experience stays with young doctor

It wasn't long after Heimlich was born in 1920 that his parents knew their child had an unusually creative mind. They would often find him staring into space for hours, apparently in deep thought. Then he would present them with a new use for an old object, such as a broken umbrella.

A bright student, Heimlich was admitted to Cornell Medical School a year early and received his medical degree in 1943, in the midst of World War II. He was soon sent with a Navy weather unit behind enemy lines in Inner Mongolia, when one of the Chinese soldiers he was working with got shot in the chest, and Heimlich was unable to save him.

"I never forgot this person because it was the first patient who died in my hands in my short career. That stayed with me," he recalls.

Heimlich becomes chest surgery pioneer

After the war, Heimlich became one of the first surgeons in America to be certified in thoracic, or chest surgery. As he recounts in his essay in a newly published collection called One Can Make a Difference, Heimlich was especially interested in the physiology of lung collapse. That's a condition called a "pneumothorax," meaning "air in the chest." It occurs when the chest wall is punctured - during surgery, for example, or as a result of a stabbing or gunshot wound - and air, blood or other material is permitted to enter the chest through the rupture, compressing and collapsing the lung.

"In those days," Heimlich explains, "You had to put a tube in the chest, and it was attached to a regulated suction, which took the air and blood out of the chest. Therefore, the lung expanded, and the person was saved."

Surgeon creates medical device out of modified noisemaker

Heimlich knew well that there was no suction on the battlefield, which caused the death of thousands of soldiers. Heimlich imagined a small, portable valve which, when placed in the wound, would drain air and other fluid from the chest cavity, but allow no air or liquid to enter from the outside.

He went to a store and bought a toy noisemaker based on a similar valve and excitedly returned to his hospital to modify it and add a drainage tube. He sterilized it, put it on a holder and waited.

"Finally, a man came in with a collapsed lung from a pneumothorax," says Heimlich. "I put a tube in his chest with the valve and… the lung came up, and stayed up. That was just what I thought would happen!"

Here's why: When a person breathes in, the lung expands, which forces air and blood out of the tube and through the valve. Nothing can get back in through the wound. Each time a patient takes a breath, the lung expands, because there is no blood or air in the chest to block it.

Valve saves thousands of American, Vietnamese soldiers

In 1963, Heimlich presented the valve to a medical products manufacturer, which called it the "Heimlich Chest Drain Valve." The next year, Heimlich was demonstrating his device at a medical conference, where it caught the interest of several Navy doctors. They ordered a set of the flutter valves for experimental use on the battlefields in Vietnam, where American military involvement was growing. It worked so well, Heimlich says, that the U.S. military began to issue Heimlich Chest Drain Valve kits to every American soldier.

"If your buddy was shot in the chest, you put the tube into the bullet hole and held it on with a piece of tape," says Heimlich, "and you didn't need a doctor or a nurse. The lung came up and stayed up. They just left the tube in for a week or two until it healed."

The device saved the lives of thousands of American soldiers in Vietnam. Before long, the valve was also in common use by the North Vietnamese army, America's enemy in the conflict. That pleases Heimlich, who wants his medical inventions to benefit all people, without distinction.

Long after the war was over, he recalls, the Vietnamese government invited him and a delegation of other surgeons to visit as its honored guest.

"They said I would 'live on in the hearts of the Vietnamese people forever'," he says, adding, "I cried at that moment."

Anti-choking technique developed to prevent sixth-leading cause of accidental death

In the United States today, Heimlich is best known for the anti-choking technique often called the "Heimlich Maneuver." He devised it in 1972 after learning that choking was the sixth leading cause of accidental death in America. In his view, the high death rate was largely due to the sharp backslaps that were then the first choice of treatment for choking. He believed backslaps only lodged the object deeper into the throat.

Being a chest surgeon, he knew there would always be enough air in the lung that if one would compress the lung one could cause a flow of air.

"So I conceived of pushing the diaphragm upward into the chest, making the chest cavity smaller, which would compress the lungs and cause this flow of air that would carry an object away."

To create that pressure, a rescuer stands behind the choking victim and use his arms and hands to exert pressure on the victim's diaphragm. This creates the pressure necessary to expel the choking object from the airway and out the mouth.

The near-universal knowledge of this maneuver is deeply gratifying to Heimlich, but he refuses to stop his search for new ways to combine innovation and emergency medicine.

"Invariably, I move on to the next project and the next thought."

Some of Heimlich's new ideas are controversial. But no one can doubt that untold thousands of human beings owe their lives to Heimlich's skill and inventiveness.

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