Restaurant patrons can breathe more easily; Health: Some Baltimore-area eateries are teaching their employees how to save lives with Heimlich maneuver training.


The dinner was supposed to be a celebration of sorts, a reward for hard-working Red Cross emergency service workers and volunteers. Instead it became an emergency of its own.

Gonzalo Hernandez and Ken Smallwood, both employees of the Red Cross of Central Maryland, had just finished helping 20 families involved in a five-alarm apartment fire in Baltimore City. Now they were taking some of their volunteers out to dinner.

The party of seven sat around the table of a Reisterstown restaurant on that August evening in 1997, talking and laughing. When the food arrived, laughter and conversation continued.

Hernandez took his first bite of steak and began chewing. He tried to swallow, and even took a drink, but the food wouldn't go down. He was choking.

Few people at the restaurant or the table noticed. But when Smallwood saw Hernandez with his hands crossed at his throat, he rushed over and began performing the Heimlich maneuver, a series of abdominal thrusts designed to dislodge food or objects lodged in the throat. Within seconds, Hernandez was breathing again. "I do believe that Ken ... saved my life," says Hernandez, 39, who lives in Cockeysville.

What would have happened if Smallwood hadn't been present? Would anyone else in the restaurant have seen that a man was choking? Would they have known how to help him?

Finding someone in a restaurant to help in a medical emergency is often a matter of chance. But at a small number of Baltimore-area restaurants, it is becoming a matter of course.

This winter, ER-7, Sinai Hospital's emergency center, began offering an emergency-readiness training session designed for restaurant employees. Called ER-7 First Response, the one-hour program, taught on-site, deals with preventing and treating choking, heart attacks, stroke, symptoms of high and low blood sugar, bleeding and burns.

A half-dozen restaurants have already participated in the program, which costs $80 to $225, depending on the size of the group. More are scheduled to take part in the coming weeks.

Maryland law doesn't require restaurant first-aid training. But for restaurateurs such as Brian Boston, chef/partner of the Milton Inn in Sparks, the training is essential. "This is the responsible thing for us to do," says Boston, a 17-year veteran of the restaurant business, whose restaurant serves 500 people on a busy Saturday night. "We have a lot of elderly guests, and although we've been lucky not to have any major problems, there's always that potential."

Although calling 911 would be his first action in a medical emergency, Boston worries that an ambulance might not be able to respond in time. "We're pretty far out," he says. "An ambulance would probably take seven to eight minutes to get here. For a lot of life-threatening situations, that's not fast enough." "We feel more at ease knowing that we're able to handle [an emergency medical] situation," says James Brown, executive manager of Clyde's/Tomato Palace in Columbia, whose managers have participated in a first-aid/CPR program administered by the Red Cross of Central Maryland. "This makes us feel prepared."

Choking is a restaurant's top concern, according to Sister Marie Seton Walsh, a registered nurse at LifeBridge Health who is teaching the ER-7 First Response program. "Alcohol numbs," she says. "And people in restaurants are often laughing and talking with food in their mouths."

Choking is the sixth leading cause of death due to unintentional injury in the United States, more prevalent than deaths due to unintentional injuries caused by firearms. In 1998, 3,200 people -- 61 Marylanders -- died from choking, according to the National Safety Council. Some 1,700 of those choking deaths occurred outside the home.

In addition to teaching the Heimlich maneuver, restaurant first-aid courses also teach participants about the warning signs of heart attack and stroke -- information that seems basic.

But according to a recent Discovery Health Channel/American Heart Association survey, nearly half of Americans do not know the proper procedures to take when someone has a heart attack or stroke and are not trained in CPR. "It's rare that a year goes by that I don't hear about a person choking at a restaurant table or having a heart attack or a dizzy spell," says Warren Green, president of LifeBridge Health. "It's always best to try to avoid medical problems rather than treat them after the fact. We want to prevent people from having to be in the emergency room in the first place."

Hernandez jokes with Smallwood about the choking incident now, but they are serious when they talk about the need for more people to learn basic first aid. "I think it should be mandatory for people who work in restaurants," Hernandez says. "Even if it's only one or two people per shift who have been trained, it could save someone's life."


* For more information about ER-7 First Response, an emergency-readiness-training session for people in the restaurant industry, call 410-521-5905, or visit

* The American Red Cross of Central Maryland offers classes in such subjects as workplace first aid, CPR and automated external defibrillator (AED). Call 410-764-4609, or go to

* The American Heart Association offers CPR and automated-external-defibrillator (AED) classes. Call 877-242-4277. For CPR information, visit

The Heimlich maneuver

Choking is the sixth leading cause of unintentional-injury death in the United States. Performing the Heimlich maneuver can prevent choking deaths.

If you think a person is choking:

1. Ask, "Are you choking?" If the victim can speak, cough or breathe, do not interefere.

2. If the victim cannot speak, cough or breathe, perform the Heimlich maneuver until the foreign object is expeled.

To perform the Heimlich maneuver:

1. Make a fist. Place the thumb side against the abdomen, above the belly button but below the rib cage.

2. With your free hand, grasp the fist and press into the abdomen with quick, upward thrusts.

3. Repeat the maneuver until the object has been expelled from the airway or the victim becomes unconscious. The victim should be examined by a physician as soon as possible.

SOURCES: National Safety Council, American Heart Association

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