Choking - Caribbean Princess

[dforeigner]

The assumption that people possessing civilized eating habits do not tend to choke on Flinstones-sized pieces of meat?

 

Guilty.

 

Well, in this case, size does not matter. I have seen several food bolus related chocking cases and can attest that size does not matter.:eek: Regarless of gender or age.

[denneym1]

I don't blame Princess for their policy, but I think that they have to realize that they're going to be sued if somebody dies, too, so they may as well do the noble thing and try to save a life.

 

 

KaChing!! We have a winner!! Better to be sued for letting someone die, or for cracking a rib....hmm, thats a no brainer!! You can easily crack a rib doing CPR as well....does that mean the medical staff won't do CPR on you?? The Heimlich is a very simple procedure that can be taught in five minutes as part of any basic first aid class. (I am an EMT and certified instructor.) Some states now require all restraunt workers to be trained in it. A cruise ship may be a ship, but there is no reason it can't be operated with certain minimum levels of training and safety. Princess needs to come out of the dark ages on this particular subject.

BTW, if a person who is choking can cough or talk, they do have adequate air exchange and you should not intervene unless they are unable to eject the item themselves. Also, if a person choking looses conciousness, you should continue to do abdominal thrusts. Often after they loose conciousness thier muscles will relax enough to allow the object to be dislodged.

MD

[denneym1]

How does one choke on a piece of steak?

 

It happens every day, and to some of the most intelligent, well-mannered and careful people on the planet. There are lots of reasons it can happen. There are also people with medical conditions that make them very prone to choking who have the experience almost daily. I have never been there, but I have experienced being unable to get air as a firefighter once or twice. Its a pretty scary feeling, and I feel sorry for anyone who experiences it from choking or any other medical condition like asthma or COPD. Someday, maybe it will happen to you and we'll see then if you are quite so hard on others in the same circumstances.

MD

[drpack]

ALL crew are trained in basic first aid, period. It's international law. Every crew member must have a STCW95 certificate (Standards of Training Certification and Watch keeping for Seafarers) to work on-board. This certificate includes the following training:

 

Fire Fighting and Fire Prevention

Elementary First Aid

Personal Safety and Social Responsibility

Personal Survival Techniques

 

If they don't have one when they arrive, they must train on-board ship within the first few weeks. All crew members from the Philippines have this as standard because they receive this training before they join the ship in their own countries, as do most other nationalities who supply maritime workers to the industry.

 

Princess may have a policy of not allowing crew other than medical staff intervene, but if they do it's new because that certainly was not the case when I was there (left in 2006).

 

"STCW 95 stipulates the required competences associated with different tasks, the knowledge and understanding required to perform them, methods for demonstrating competence and criteria for evaluating it. The Convention embodies provision for "hands-on" training and the development of basic skills through use of simulators, laboratory training equipment and other practical training aids.

 

Although experience at sea remains an important part of a seafarers overall career development, it is no longer be enough to "serve your time."

In 2002, the International STCW 95 convention went into full effect. Since then, all seafarers must be trained in compliance with its provisions and carry certificates to that effect. Vessels are now subject to detention and seizure for non-compliance."

 

It's been a few years since I issued STCW Certificates. If I remember right, members of the Steward's Department and Food Handlers do not have to have STCW Basic Safety Training unless they are filling part of the vessel's required crew compliment. On a large passenger vessel such as a cruise ship, many of the non-rated crew members are part of the vessel's required crew compliment because they have assigned duties during shipboard emergencies or abandond ship. Odds are most of the non-rated crew have had Basic Safety Training. However I'm not sure if the Heimlich Maneuver is part of that training.

 

Guidelines for saving choking victims have been changed by the American Red Cross to back blows as the first maneuver and then only using abdominal thrusts if back blows doesn't work. I think all of us should have training in basic first aid. You never know when we might need it.

[spongerob]

"An immunity statute protecting persons who render “emergency care at the scene of an emergency” applies only to medical emergencies, the Court of Appeal for this district ruled yesterday."

I think choking and imminent asphyxiation constitute an emergency.

[Admiral Horatio Nelson]

The comments posted about what is required for crewmembers does not mention the Heimlich, it says, if quoted correctly, Basic First Aid.

 

In Calif the Good Samaritan Law only applies to people who render medical aid at the scene of an injury As of March 22, 2007 a CAL Appeals Court found that the Good Samaritan Law only applies to medical emergencies.

"An immunity statute protecting persons who render “emergency care at the scene of an emergency” applies only to medical emergencies, the Court of Appeal for this district ruled yesterday." An article can be found here:

 

EVERYBODY on-board a Princess ship receives first aid training. And like I said in an earlier post, most of the countries that supply ship board personnel train their people in STCW95 at home before they even join a ship.

 

Basic first aid does include the Heimlich. Now before anyone gets excited and pulls out their Grey's Anatomy on terms of First Aid, it does include it in the first aid you receive when training for the STCW95. And as someone who has completed the on-board training with Princess, I can tell you that it does get taught on-board.

 

As far as the US law, I'm sad for you that your country needs 'the Good Samaritan Law'. It makes a black and white issue like saving somebodies life into a grey area (that's gray for you in the US), and this is where this whole situation stems from.

 

Only when I have worked ships in the US have I heard crew say that in the event of a medical emergency they might NOT help somebody because they could get sued (obviously not including the medical staff). And I would imagine that very subject was running through the minds of the people working in the restaurant during the incident.

[Jacqueline]

This is not a task that requires more than a few minutes of "training". Its almost common sense.

If the Cruiselines basic concern was not to be sued, then they would not bother to sail, as there are suits lodged on what must be a regular basis.

 

Had the passenger choked to death, there would have been one BIG lawsuit and incredibly bad PR ! I can see it now; "Passenger dies on Cruiseship. Staff stands by and watches as elderly gentlewoman falls to floor. While they call for help, they arrived too late. CPR was initiated when the medical staff arrived 10 minutes later. Passenger could not be revived.Her grandchilder watched in horrow. Others in dining room were traumatized. Many eyewitnesses offered their dramatic version of what happened.They could not enjoy their cruise after this traumatic event. They are also suing the cruiseline..."

[MamaTried]

I find it hard to believe that the couple of people who posted here criticizing and chastising the OP for her unfortunate incident, accusing her of eating like a neanderthal, have never choked on anything before...not one piece of meat, tortilla chip, peanut, etc...or their own foot for that matter.

 

If dysphagia (difficulty swallowing) or choking were only caused by people not cutting their meat into small pieces then why are esophagrams/barium swallows performed on patients all day, every day at nearly every medical institution in the world? There are many reasons people choke - GERD, esophageal varices, Barrett's, Schatzki's ring...just to name a few. But the fact of the matter, like what happened with the OP, is sometimes it just happens! She was being kind enough to inform other passengers of her experience and I for one am glad she did.

[lawyerrose]

I was always taught that you don't interfere with choking as long as the person is coughing and breathing, let the individual clear it. To jump in and pound someone on the back, as so many people think they should do is the worst thing to do. That can startle the person to inhaling whatever is lodged in the throat. Heimlich is to be reserved for full blockage of the throat.

 

You are absolutely right, Boss.

[nrdsb4]

I find it hard to believe that the couple of people who posted here criticizing and chastising the OP for her unfortunate incident, accusing her of eating like a neanderthal, have never choked on anything before...not one piece of meat, tortilla chip, peanut, etc...or their own foot for that matter.

 

If dysphagia (difficulty swallowing) or choking were only caused by people not cutting their meat into small pieces then why are esophagrams/barium swallows performed on patients all day, every day at nearly every medical institution in the world? There are many reasons people choke - GERD, esophageal varices, Barrett's, Schatzki's ring...just to name a few. But the fact of the matter, like what happened with the OP, is sometimes it just happens! She was being kind enough to inform other passengers of her experience and I for one am glad she did.

 

My mother has had some devastating strokes over the years. She chokes a lot, regardless of how her food is prepared or cut. So far we've never had to initiate any emergency protocols to help her out, but the possibility will always loom.

[nrdsb4]

I Love You (colloquially) nrdsb4, whoever you are. You write well, you speak well and you make sense. I'm also quite sure you have an excellent medical background.

 

Pia

 

Thanks.:) I have worked in some hairy situations, but there is always more to learn (I don't know diddly about pediatrics or labor and delivery for example), and all of us in the medical profession make mistakes or are misinformed about certain issues. Anyone who says that they haven't made a medical mistake on the job is fibbing. I've even caught some pretty bad errors by doctors for whom I have a lot of respect. Mistakes on doctors' orders are usually the result of rushing and/or being distracted. For the sake of patient safety, it's important that we all watch each others' backs. Lots of safeguards are in place to prevent one person's mistake from having tragic consequences and yet still things happen. One thing I do know, I couldn't just stand idly by and watch someone choke to death, fear of lawsuits or no.

[Host Caroline]

Let's cut the discussion re manners, size of bites etc... well, maybe get some manners in some cases would be a good idea from the tone of some dear departed posts..:: sheesh ::.. it's an unfortunate incident that has nothing to do with that... and if the discussion "pops up" again on this thread ... well.. you know:rolleyes:

[TheHlibichuks]

Just as a side comment from a social psychologist: if you are ever in an emergency situation in a crowded room, you should automatically assume that no one will help you. It's called the Kitty Genovese effect, or dissolution of responsibility. It basically means that the more people there are around you, the less likely you are to get help, because everyone assumes that someone else will help.

 

To combat this effect, when you see no one rushing to your aide and you need it, you should do everything you can to indicate that ONE PERSON should help you. Point to them, walk towards them making the choking sign, somehow indicate that you expect person Y to assist you. Yes, you can pick this person pretty arbitrarily, as once you have placed the weight of responsibility on them, they'd have to be pretty cold to NOT help you. However, until then, you can presume that responsibility for your life is equally distributed amongst everyone you can see.

 

So it's possible that all the staff assumed another staff member would do it, and because they weren't *quite* sure what to do, figured they'd let it go, thinking someone else could do a better job.

 

Is it sad? Yes. Is it a quality of every human being on the planet that doesn't know better? Yes.

[Pia1913]

Just as a side comment from a social psychologist: if you are ever in an emergency situation in a crowded room, you should automatically assume that no one will help you. It's called the Kitty Genovese effect, or dissolution of responsibility.

 

 

So, do you know who Kitty Genovese was? New Yorkers would/should, but do others?

[mandabear]

Vaguely remember who Kitty Genovese was... She was horribly, terribly, loudly attacked and murdered in NYC. Many people heard/saw what was going on, but no one did anything about it...right?

[MamaTried]

That name sounds familiar...was she the Central Park Jogger?

[MamaTried]

Never mind, I just remembered the jogger survived her attack.

[Sandytoes]

Holland America Line officers and staff who work closely with guests receive annual CPR and AED training. The dining and bar staff also receives training in the Heimlich Maneuver to manage any choking incidents.

All Cruise Lines should follow suit.

 

Most states have a Good Samaritan law to protect people who help in an emergency. You cannot be sued for giving first aid unless it can be shown that you are guilty of gross negligence.

 

 

It's such a shame something as wonderful as saving someone’s life by using CPR or the Heimlich Maneuver can result in lawsuits, liability and people being sued. I'd rather have a broken rib then be dead. And thank my lucky stars I'm alive.

[Roxilla]

....A piece of filet mignon became lodged in my throat....I was clutching my throat, could not talk and was feeling faint when a policeman and fellow passenger came to my aid....It is now Princess' policy for crew members not to come to the aid of someone choking....QUOTE]

 

 

OK, I’ll bite the bullet and ask why you expect the staff of Princess to watch you personally 24/7, train the staff for any and all emergency situations and you yourself not be held responsible for your own actions.

 

YOU cut your meat, YOU choose the size of the bite and YOU made the mistake. Instead of making a post about being conscious of what you shove in your mouth because Princess’ waiters are not trained in the sub routines of CPR, you point fingers at everyone else.

 

Thank you for letting us know that ship staff who make about $10 a week have not been trained in how to be a “first responder”, but somehow I knew this already.

 

Despite what you may think, Princess is a business. Their job is to make money for the shareholders. Because they have been sued in the past by other pax, this policy was put in place.

 

Ps

If one of your servers, who was not trained, had come to your aid, odds show that the pax who had the training would have sat there for another minute or two. The staff themselves did what they should have done, stay out of the way.

 

OK, I'll bite back. I agree. It is certainly proper for people who have apparently been given basic first aid training (according to the Admiral -thanks) to just stand around and watch someone choke to death. After all - she cut her own meat and put it into her mouth didn't she? It's all her own fault isn't it?:rolleyes:

IF it really is the procedure to wait and not come to the aid of the passenger then Princess should be ashamed. It takes all of 20 minutes to teach virtually anyone the heimlich maneuver - I know, as a certified instructor I do it all the time. Additionally, the cruise line would be at MUCH higher risk of losing a court judgement for failure to render aid than for attempting to help. Especially since they do apparently have basic first aid training which should have included aid for the choking victim.

[Andy99]

Im shocked...I would have thought at least the head waiters should be trained in a simple life saving technique. If someone was choking and you saved there life I dont think they should have the right to sue you if you broke a rib in the process...

[surfklutz]

I remember when the Heimlich maneuver was first introduced ( or maybe it way just introduced to me - I'm not THAT old). My roommate was explaining it to a group of people and said that you take your fists and push firmly against the scrotum. She, of course, meant sternum. You could see the look of horror in all the men's faces - but one of them piped up and said "yep, that would probably do it."

[Tarheelbelle]

Broke ribs is a term use loosely. On the elderly, when performing check compressions with proper hand placement, one will separate the sternum (attached via cartilage) from the rib cage. The one performing the chest compressions will fill an awful crunch on the first compression.

 

If the patient ends with literally a broken rib from chest compressions during CPR, it is usually do to improper hand placement.

 

As a physician, I have seen both.

[ShedQueen77]

Sorry again. Never had this happen before!

[ShedQueen77]

Wow - this is a surprise - I would think it would be standard practice to teach anyone in the food industry about the Heimlich maneuver. I was choking at Wendy's several years ago - and one of the 18 year olds came to my aid and did the maneuver. We got talking - and apparently at that time, everyone who worked for Wendy's had to know - and use if necessary - the heimlich maneuver.

 

You would think a service industry like a cruise line would want to do no less. I wonder if it is just Princess or all lines that take such a hands off approach.

 

I was a manager of a Wendy's for 11 years. As part of my job requirement, I had to be certified through the AHA to train employees how to do the Heimlich. Thank God the training never had to be used by anyone in my employ, but I'm so glad to hear that the requirements aren't placed in vain and helped you! :)

 

So, do you know who Kitty Genovese was? New Yorkers would/should, but do others?

 

I'm an Iowan and I know! :) That poor woman was beaten and murdered while basically the whole neighborhood watched and did nothing to help her. We studied this case in detail in my Social Psychology class. It came up during our study of the bystander effect and diffusion of responsibility. I tell you, that class was a really big eye opener about how messed up society can be!

 

To the OP - How scary for you! I've choked pretty hard before, but never to that point. I'm glad someone came to your rescue.

 

I've had to Heimlich two of my kids before. One at age 9 months got an animal cracker lodged in her throat and my 11 year old was the recipient of it a few weeks ago when he choked on piece of hard taco shell. It was scary enough on my end, and I could breathe! :)

[nrdsb4]

Broke ribs is a term use loosely. On the elderly, when performing check compressions with proper hand placement, one will separate the sternum (attached via cartilage) from the rib cage. The one performing the chest compressions will fill an awful crunch on the first compression.

 

If the patient ends with literally a broken rib from chest compressions during CPR, it is usually do to improper hand placement.

 

 

Yep, that was me. As much training as I've had, basic first aid, basic CPR, ACLS, no one ever told me to expect that. I haven't done chest compressions hundreds of times like a paramedic would, but I've done them a few times, and this was the only time this happened to me. It felt like his whole chest caved in, with a remarkable "CRUNCH", and at that moment, I felt a split second light headedness. I thought I had not only crushed his chest, but squashed his heart too. I literally felt sick to my stomach for just a moment. He lived to tell the tale, so I guess it all worked out. To read this thread, I guess I should be thankful I wasn't sued...

 

The memory of this gives me the creeps. But I'm probably the only ICU nurse ever who gets the heebe jeebies from giving a deep IM injection. YEEEEEECHHH!! Love those IV medications!:D

 

:)