Choking posters in Texas restaurants may soon be a thing of the past

David Litke, program administrator for the Waco-McLennan County Public Health Disrict. holds signs that are required to be displayed in restaraunts.

Most diners will probably never miss them. But the red-and-white choking signs posted in Texas restaurants may soon be a thing of the past.

A bill filed in the State House by State Rep. Ralph Sheffield, R-Temple, seeks to eliminate a state rule that requires restaurants to post a sign with instructions on how to do the Heimlich maneuver.

The move, which consists of a sharp upward thrust to the abdomen, is designed to dislodge an airway obstruction by forcing air out of the lungs.

Sheffield said he introduced the bill because a growing number of health officials said back blows should be tried on a choking victim before abdominal thrusts are administered.

“Some people have actually been injured by people trying to perform the procedure just by seeing the poster,” Sheffield said of the Heimlich maneuver.

The bill sailed through the House last month and was passed by the Senate Thursday. Sheffield said he is confident Gov. Rick Perry will sign it since the bill has drawn no debate.

Texas mandated the posting of Heimlich maneuver signs in 1989. Restaurants that fail to post them lose points on inspection scores.

For the past few decades, most experts endorsed the Heimlich maneuver as the best response to choking.

But five years ago, the American Red Cross changed its training to recommend back blows as the first response. A growing number of groups have signed on to that approach, including the Mayo Clinic.

The recommendation is that a choking victim receive a series of forceful blows to the back, between the shoulder blades. If those back slaps don’t work, abdominal thrusts can then be tried. For stubborn obstructions, the groups recommend alternating between a cycle of five back blows and five abdominal thrusts.

But the American Heart Association has not adopted the new approach. The organization said both back slaps and abdominal thrusts are effective. But for simplicity’s sake, it continues to teach the Heimlich maneuver as a first response.

A spokeswoman for the regional heart association office said it doesn’t have a position on Sheffield’s bill.

Mark Silva, director of health and safety and regional development for the Waco American Red Cross office, said it teaches the updated method. But he doesn’t see any harm in the posters. The truth is, people aren’t likely to consult any poster in an emergency, he said.

“The folks that do respond are going to be the folks who already know how to respond,” Silva said.

Mike Beheler, acting president of the Waco Restaurant Association, said he supports Sheffield’s bill because it would give eateries a choice in what poster, if any, to display. He described the Heimlich poster as “ugly” and said choking incidents are rare.

Elite Circle Grille said they will likely leave the sign up, said Daniel Hindsley, a manager. Although he has never seen anyone choke at the restaurant, it is always a possibility, he said.

“As a fail-safe, I don’t see a problem with having them up,” Hindsley said of the signs.

Glen Garey, general counsel for the Texas Restaurant Association, said if the bill becomes law, some eateries will no doubt replace the Heimlich signs with American Red Cross posters that display the updated method. Those posters are used in some other states, he said, adding that Texas is the only state that requires Heimlich posters.

Clear the airway

Dr. David Hurst, medical director of Hillcrest Baptist Medical Center’s emergency department, said the first thing witnesses need to do if someone is choking is ask that person to sit down, relax and take deep breaths. The person may be able to cough up the obstruction or otherwise clear their airway, he said.

If that doesn’t work, the witnesses should open the person’s mouth and look for an obstruction, Hurst said. If an object is visible, an attempt should be made to pull it out.

If that fails, Hurst then recommends the back blows and Heimlich maneuver cycle. The reason he supports the use of back blows first, he said, is because they are effective but less likely to injure people.

With the Heimlich maneuver, people tend to put their hands across the middle of the choking person’s chest, rather than just above their navel as recommended, he said.

“They just crush the chest and hurt the patient,” Hurst said.

Dr. Boris Murillo, a pulmonologist for Providence Healthcare Network, also supports the back-blows-first approach. Both methods carry some injury risk, but back blows are easier for people without medical knowledge to do correctly, he said.

Murillo also noted that the Heimlich maneuver shouldn’t be used on young children and pregnant women. It can also be difficult to perform on obese people, he said.

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