Swimming is my best sport after six years of lessons and qualifications long ago. Life saving methods for drowning victims were taught every year, earning qualification each year at a higher level than the previous year.
In five decades of laboratories and industrial work frequent qualifications on a dummy victim in several methods including mouth to mouth CPR were required, and mouth to mouth since 1958 has been offered as the first choice to revive a downing swimmer. For infectious disease a mechanical ventilator is used when lungs fill with fluid and drowning occurs, but ventilator often fails to save the life. The lungs do not drain of fluid when the victim is lying on the back, also the tongue tends to slide down the throat and stop air flow.
In previous decades since 1911 for Boy Scouts, and since 1932 for general public an often taught method required the drowning victim to be placed lying on the chest, no pillow, hands palm down together under the head, and sometimes face turned to one side to help fluid to drain away from the mouth and lungs. Ventilation assistance was provided either mechanically or physically by a trained person. The trained person would kneel close to the victim's head facing the lying torso, then if the heart was not beating, apply moderate hand force on the back of chest or shoulder blades once or several times for heart beat, followed by moderate pulling of the victim's elbows to inflate lungs if the victim was not breathing. Repeating the sequence sometimes 16 times per minute causes the heart to pump blood and the lungs to inhale and exhale as the victim empties the lungs of fluid. Force is moderated for the size and age of the victim, to avoid injury.
It is called The Holger-Nielsen Method Of Artificial Respiration, or the back pressure arm lift method. A benefit is the tongue does not drop down the throat and block the air way, and the rescuer is not exposed to body fluids.
Article The Holger Nielsen method of artificial respiration
https://www.resuscitationjournal.com/article/S0300-9572(07)00168-2/abstract
https://trove.nla.gov.au/newspaper/article/49066799
https://www.merriam-webster.com/medical/back%20pressure-arm%20lift%20method
https://www.oceansidecpr.com/blog/cpr-tips-information/history-cardiopulmonary-resuscitation-cpr/
Article Back-Pressure Arm-Lift Artificial Respiration
For Hindi speaker, notice the rescuer wears mask and gloves, years ago.
https://www.youtube.com/watch?v=ykBk9xmTIHo
Even in the newer style of CPR a drowning victim is turned on one side to drain one lung, while supporting the head with one hand.
As an older person, a swimmer qualified in life saving, and one in the high risk category for Covid-19, I notice many news stories with photos of people dying of drowning in their own fluids while lying on the back with mechanical ventilator failing to save the life.
So many people are impacted with quarantines, loss of jobs and income, lost education opportunities, and shortage of supplies. If the dying could be prevented by unusual methods, then the disease might become more manageable, and a majority of people might return to a better life.
Is something important missing from treatments?
Why Are Victims Of Covid-19 Drowning Without Receiving H.N. Life Saving Treatments That Were Taught To Swimmers?
American Heart Association published in 2018 a history of CPR with a paragraph about Holgar Nielson. "Method is still in use."
https://www.heart.org/en/news/2018/05/01/cpr-through-history
CPR teaches mostly mouth to mouth resuscitation, but it is seldom practiced now with disease present. Holger Nielsen method is not found in training classes or certification programs. Some old people and history pages remember it was the preferred method for a while.
Medicine has reverted to the bellows method of Paracelsus from 1530, except the bellows has been mechanized, and the air filtered, possibly fortified with oxygen.
News programs stress the need to test everyone for Covid-19 virus. Then they predict 80% of people will eventually become infected with it, and 1.5% of them will die from it. A vaccine is years away and many people cannot wait for it.
To me a more effective treatment to prevent fatalities would be high priority, and possibly applied sooner than vaccine.
A disadvantage of Holger Nielsen method is the large amount of training needed for certification and to prevent injuries. Allowing a victim to lie on side or stomach to drain the lungs would be far simpler, especially if a ventilator was in use and the heart was still beating..
This is a wonderful observation and an interesting question. Seems it's because of the disadvantages of the technique.
Thankyou for answer.
Other methods in CPR were more successful for large numbers of people, also easier to learn, such that the previous methods were not often taught or used. Now a costly machine is used to decide the treatment parameters and take the grief for loss of a person.
A high death rate maybe reaching a million fatalities, combined with the destruction of a hundred times more families not allowed to work for a living, causes researchers to wonder if older methods might be helpful.
A higher survival rate would be very helpful in families and community.
Qualifications become old and certifications expire for older methods. There is no one qualified to teach them. Training videos date from 1940.
The most recent reference is one paragraph two years ago. Before that the reference is a short article of three pages, and more than 12 years old. Then the references start with 1958 and go back in time to 1932 and 1911, with previous centuries giving a history of lives saved in different ways.
When the old method is needed and no one is qualified to teach it, then universities might hold a seminar inviting various scientists, medical people and technologists to contribute papers. The published notes add up to a validated process, protocol, and syllabus for training instructors.
Mathematics can be applied to the need for air and blood flow, drainage and replenishing fluids. Rescuer and victim might be any sizes, not usually a best matched pair. so the training is lengthily and complicated, but also helpful in the first step of qualification.
The present trend is not meeting the need. So researchers look further.
When looking at front of chest cavity, lungs are in the back behind other organs.
Lying on the back puts lungs at the lowest place where fluid might collect.
When lying on the chest, lungs are at a high spot allowing them to drain.
Hard to find information is located on Norwegian Wikipedia with photo of Danish Red Cross training postcard 1955 to 1957 from the National Library Of Norway, which grants license to use and asks for credits. The site notes that today Heart Lung rescue is recommended instead.
Holgar Nielsen was a swimming instructor and program manager as Lieutenant Colonel in the Military of Denmark. He died in 1955, and his method continued to be taught until 1958. It is one of several CPR methods I trained with and was qualified to use at various times.
Red Cross taught thousands of people, mostly children this method in a summer swimming program with six levels of qualifications. The swimming program continues with other methods.
The photo shows how the complete method can be used if the heart has stopped and the person is not breathing.
it is fairly simple to notice that any part of the method can be used or omitted when not needed.
Of great interest the rescuer is not exposed to body fluids, and one person can perform the rescue without additional equipment in remote locations.
News stories say that as many as 30% of deaths in Covid-19 come from blood clots, but drowning is a more common problem.
A person lying chest down should be attended to make sure other suffocation does not occur from restrictions around the mouth, especially important for infants who would normally be sleeping on the back.
It may be of interest to know that a working group from major aquatic rescue organisations (including ILS, IMRF, IDRA) are working on joint guidelines with feed-back and interaction of some 80 experts around the world. The guidelines should be ready by the end of the month.
In the discussion above there are some fundamental misunderstanding. 1) Peter Safar in the 60's showed that these pull-put techniques were dramatically inferior to mouth-to-mouth ventilation after which these techniques were rapidly removed from the courses; apart from an individual supporter, taken serious by no one, this technique is now extinguished; 2) Water will not drain from the lungs. An interesting reference may be Bierens JJ, Lunetta P, Tipton M, Warner DS. Physiology of drowning: a review. Physiology. 2016;31:14766. doi: 10.1152/physiol.00002.2015.
Thank you for reply and with your impressive qualifications, specializing in the topics we discuss. Also thank you for diplomatic presentation of differing opinions. You are better qualified to write than most of the people finding this page. Maybe Belgium is not in need of different directions. Much of the world is lacking resources and not able to act on advice.
Push pull method was used for more than 40 years, 25 years as the recommended method, and around 1940 taught in military schools. Other methods preceded it, and water did drain from lungs in several documented methods for about 300 years, when lungs were full. Often lungs are not full and drainage does not occur. Mouth to mouth is now called heart lung, with variations and is noted in the previous discussion as the preferred method. The H.N. is still in use according to AHA reference two years old.
Heart lung techniques would be fully acceptable if people could stop dying in such large numbers, and drowning was not given as cause in 70% of cases.
Not many people will do mouth to mouth except for close family or friend. I trained and qualified many times on a dummy.using mouth to mouth, sanitized and with plastic barriers, or hand held devices, sometimes pressurized air cylinders, oxygen, or pumps always with my hands on the volunteers. Preferred equipment is now a machine costing up to $50,000 and in short supply for developed countries, but not available at all for others. It needs electricity and several people to run.
Researchers in 1958 proved mouth to mouth is maybe 15% better than push pull when lungs are not full of water and a person is willing to do it. Mouth to mouth was adopted and taught beginning in 1959. The H.N method continued for remote places and people with diseases. It was suppressed as much as possible, even from the histories and libraries, only a foot note remaining. The one photo in Danish language, and two old videos, one with no sound, and one in Hindi language, are all that is left from four decades and hundreds of thousands of training classes for millions of people.
It is rather suspicious when the histories are destroyed. I'm not an individual supporter. There are no classes at all, except maybe in rural India where some of the comments show knowledge and offer corrections to the training film.
ILS, IMRF, IDRA group you mentioned gave several excuses in April and May then scheduled a new seminar for August. IMRF issued guide lines in April. It says stay at home and do SAR training on computer, maintain your equipment and hope for the best.
https://www.international-maritime-rescue.org/news/imrf-covid-19-operational-guidelines-guidance-for-sar-organisations
https://www.international-maritime-rescue.org/Handlers/Download.ashx?IDMF=77b41c9f-1553-4e69-b6bb-f2dcb1b1c729
All of these carry a disclaimer to avoid offending special interest groups who wish to control the eventual guidelines.
One of the preliminaries says use mouth to mouth if appropriate. Generally I'm not impressed with chapters of noncommittal discussions, pretending to be guidelines.
I trained and qualified on all of these methods beginning nearly seventy years ago, and have no particular preference when people and machines are available. Otherwise people have died and are continuing to die with weak explanations. Maybe some assumptions can be challenged.
About draining water from lungs, I have personally drained water from lungs, when lungs have much water, which is not always the case.
Your reference which carries your name tells why people drown, not how to save them.
Article Physiology Of Drowning: A Review
Please notice that I have asked a question for advice, not knowing the answer.
Thank you again for your well informed reply, and diplomatic presentation, which brings pleasant memories of my years in the low countries.
Jerry Decker Here is an excerpt from a news article published back in on May 4th:
Thousands of patients suffering from severe cases of Covid-19 are experiencing a simple treatment in hospitals throughout the world: They are being placed face-down on their hospital bed in a practice known as proning. This change in position is often enough to improve lung functionality and reduce the impact of respiratory distress caused by Covid-19.
Here is the link to the short article:
Why Lying Face-Down Helps Relieve Coronavirus Symptoms
How ‘proning’ Covid-19 patients helps them breathe
📷Jesse Smith · 5 min read
https://elemental.medium.com/why-covid-19-patients-are-laying-facedown-in-hospitals-b31e1b18a13c
David, thank you for the link. A search for proning finds a number of articles from medical publications. It seems that some medical staffs are trained in proning and others are not.
This article fills a vacancy in the information that caused me to write the question.
A major point is that proning can be practiced in places where advanced machinery is not available, when applied by a trained staff.
Apparently the practice is used in some less developed countries, but not widely reported.
I wonder if public information on proning might have helped more people at home to avoid hospitalization.
https://www.mnhospitals.org/Portals/0/Documents/patientsafety/Pressure%20Ulcers/Manual%20Proning%20in%20Critical%20Care.pdf
https://youtu.be/GA7eXWRkTbg
Coming back on my earlier message, please find attached the drowning resuscitation guidelines in times of COVID19.
Best regards
Joost Bierens
Joost Bierens
Did not find an attachment.
In public there are some hands only CPR articles of advice, recently published.
Like the advice for proning, advice for hands only CPR appears to have been given in April and May, after this question was asked.
Compression only CPR was recommended in the IDRA-ILS-IMRF reference if machines are not available. Also advice was given for compressed bottles and air hoses, all of which I trained with and qualified at various times. These are procedures most people could do in an emergency, but most effective with training.
Joost Bierens thank you for the reference and advice. Please notice the comments on proning that is taught and used in some large hospitals.
David S Bracken thank you for the references on proning, which are reported to help 70% to 80% of Covid-19 patients. Also it is noted the several authoritative references on proning are recent from April and May. Guidelines article for medical staff is recently published.
The question is answered with several comments showing that medical staffs are looking into ways to use knowledge and procedures recently developed and from the past. It leaves a better feeling than is resulting from public media reports.
I believe we have completed the topic.
A variety of heart lung procedures are being used with lives saved by new and old methods. I would feel confident in using any of these methods for strangers in emergency, with usual precautions and personal protective equipment.
News reports indicate that the death rate of Covid-19 patients has gone down substantially since this question was asked.
Some hospitals have announced that they do not have enough staff to practice proning on Covid-19 patients.
Recently a local doctor told me that all Covid-19 patients who are on ventilators get a proning treatment every day in the affiliated hospital, beginning last May.
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