New disengagement guidelines come into effect; understand what has changed

International recommendations on how to act in cases of choking – a practice commonly associated with traditional practices Heimlich maneuver – just underwent their biggest update in decades. Published by leading global institutions, the choking guidelines modify essential points of emergency care and have attracted the attention of specialists, particularly because of the topicality of the subject. In 2023 alone, more than 2,000 Brazilians died due to airway obstruction, according to Health Ministry data.

For the otolaryngologist Dr. Gilberto Pizarroof the Paulista Hospital, the changes represent an important advance in the way of approaching situations that evolve in seconds. “For many years, the Heimlich maneuver was considered the ‘primary step’. Today, the recommendation is more comprehensive and prioritizes a sequence that increases the safety of the victim and bystanders.”explain.

What has changed, anyway?

Among the main adjustments of the new protocol are:

A more judicious use of the Heimlich

The Heimlich maneuver is no longer the universal first resource and is now only indicated when blows to the back are not effective, or when there are clear signs of persistent total obstruction. The new protocol encourages a rapid assessment of the situation before moving directly to abdominal compressions.

Backstrokes with technique specific to each age group

The protocol reinforces the importance of interscapular blows, but with different techniques for adults and children.

• Adults: The rescuer stands behind the victim, leans the torso slightly forward and applies five vigorous blows to the area between the shoulder blades;
• Young children: the child is placed face down on the rescuer’s forearm, with the head slightly lower than the torso; then five firm but controlled blows are delivered to the same region.

New specific guidelines for young children

The guidelines emphasize that babies and young children present different anatomical risks and require their own techniques, thus avoiding abdominal compressions in children younger than one year.

Emphasis is placed on rapid recognition of total or partial obstruction

The update highlights signs such as inability to speak, ineffective coughing, cyanosis and lack of air entry – fundamental in defining the maneuver to adopt.

Clearer instructions for single victims

The current protocol details safe ways to attempt to clear the airway without assistance, including using the back of a chair or the edge of a rigid surface to apply controlled pressure to the upper abdomen – a technique already incorporated into the emergency manual.

According to Dr. Pizarro, these changes make care safer and reduce the risks associated with inappropriate application of the maneuver. “The update brings a more didactic and, at the same time, more effective protocol. It is an essential step so that laypeople and professionals can act with precision”, States.

Voluntary action

In November, Paulista Hospital applied the new protocol for the first time in training offered to approximately 60 employees of the Hilton São Paulo Morumbi, covering the kitchen, restaurant, reception, security, human resources and administration teams.

The training, led by doctors Dr Gilberto Pizarro and Dr Luciana Fernandesincluded hands-on simulations on adult and child mannequins, demonstration of updated choking techniques and prevention guidelines – particularly for children and the elderly, who account for the majority of cases in the country.

According to Pizarro, this approach of teams dealing with the public on a daily basis really increases the impact of the update. “A new protocol is useless if it doesn’t reach those on the front lines. Seeing hospitality professionals learn to act when faced with a problem is actually saving lives before the emergency arises”strong points.

*Source: Alessio Venturelli, from Máquina CW