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December 18, 1987

The Heimlich Maneuver and Drowning-Reply

JAMA. 1987;258(23):3389. doi:10.1001/jama.1987.03400230048027

In Reply.—  I am disappointed in Dr Patrick's Letter and his innuendos of omitted references and case details. Dr Patrick's own article appears in a nonindexed journal and is referred to in JAMA's 1986 "Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care" as an anecdotal report.1 Likewise, the "article" that Dr Patrick attributes to me in the Annals of Emergency Medicine is not an article, but a letter to the editor.2 It is of interest that Dr Heimlich's reply to this letter acknowledged the risk of vomiting and aspiration from use of subdiaphragmatic pressure but stated that the "evacuation of stomach contents is warranted because distention of the stomach elevates the diaphragm, thus restricting respiration."3None of Dr Patrick's references support efforts at removing water from the airway before mouth-to-mouth resuscitation. Dr Patrick's own anecdotal story was of a 2-year-old child who had been