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Question Triggers Probe into Drowning

"You don't have much in terms of cause of death."

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In the late afternoon of June 23, Ada County Paramedics pulled Felix Martinez from the New York Canal.

He wasn't breathing. He had no pulse.

By the time Boise firefighter Brent Matthews dove into the canal, Martinez had been flowing with the current for an undetermined amount of time. Responders said precious time had passed before paramedics were able to pull Martinez onto the canal bank.

Matthews said strongly implied in the KTVB interview that he had used the Heimlich maneuver--an emergency technique in which abdominal thrusts are repeated until a blockage is pushed out of a choking victim's airway--until sand and other debris poured out of Martinez's mouth. Matthews then performed CPR for 25 minutes until he believed the victim had a pulse. Martinez was quickly loaded into an ambulance and taken to Saint Alphonsus Regional Medical Center.

Martinez's condition worsened; within five days, he was dead. The Ada County coroner said the cause of death was drowning.

"I had just recently read a few articles on the effectiveness of performing the Heimlich maneuver on drowning victims before starting CPR," Matthews told KTVB.

But the American Heart Association insists that the Heimlich maneuver isn't effective for drowning victims. In fact, the AHA, which has outlined the drowning rescue protocols used by first responders across the country, explicitly advises against the Heimlich maneuver because it can cause vomiting and aspiration, all of which can hinder resuscitation efforts.

Weeks later, Matthews told investigators he didn't use the Heimlich maneuver, and misspoke to KTVB about his use of the technique.

"It turns out that, sort of contrary to what KTVB reported, and it just may have been a simple misunderstanding, but it appears that the firefighter who pulled Mr. Martinez from the canal did, in fact, not use the Heimlich," said Boise Fire Department Communications Director Lynn Hightower.

Martinez, a homeless man, may not have attracted much attention prior to the incident, but because of the circumstances of his rescue, he has been the subject of a formal inquiry--in large part because of Peter Heimlich, son of Dr. Henry Heimlich, for whom the maneuver is named.

Heimlich has crusaded against misapplications of his father's medical technique for decades, and the maneuver has been explicitly disadvised by the American Heart Association, the Red Cross and the Institute of Medicine at the National Academy of Sciences since the mid-1990s.

"My father, against all reason and against every drowning expert, believes that water goes into the airway and lungs of a drowning victim, thereby causing the victim to die," Peter Heimlich told Boise Weekly. "I'm simply sharing the consensus of the profession because my father was a famous guy. He had access to the media and made bizarre claims about how drowning works."

Heimlich said when he first saw KTVB's report on the rescue, including the interview with Boise firefighter Matthews, he was incredulous.

"My first question was, 'What articles is [Matthews] talking about?"

Heimlich fired off a request for an inquest into the rescue and death of Martinez to the office of Mayor Dave Bieter and Hightower. Hightower told him to submit a records request to the Boise Fire Department; Bieter's office passed along the request to legal counsel and the Boise Police Department. Heimlich said he felt like the case had been sidelined, but BW confirmed that a copy of the request was received by Ada County Coroner Erwin Sonnenberg.

"A fireman is a city employee. He used an unapproved drowning-rescue treatment on a patient. At this point, there are no parties interested in finding out why Mr. Matthews performed this treatment on Mr. Martinez, and I think there needs to be some governmental oversight," Sonnenberg told Boise Weekly.

According to Sonnenberg, a so-called "hold" has been placed on Martinez's body pending further investigation, and he wouldn't speak in detail about Martinez's case but did offer general comments about drowning victims and the Heimlich maneuver. Sonnenberg said if the procedure had been the cause of death, it would be evident in the autopsy.

"You'd find internal damage from broken ribs or something torn," he said. "You'd find damage if that caused it."

In fact, the term "drowning" could be misleading. Medically speaking, it is the result of respiratory distress caused by a person being submerged underwater, but that process can take days or even weeks, and can culminate even after a survivor has left the hospital.

Drowning was listed as the cause of death five days after Martinez was pulled from the New York Canal and taken to the hospital. According to Sonnenberg, "drowning" describes the manner of death, rather than the cause.

"You've got the situation itself: found in the water, brought out. You don't have much in terms of cause of death," he said.

He also noted that Martinez had an unusually high blood-alcohol content at the time of his rescue--.38 percent--but that was not the cause of death, as Martinez would have metabolized the alcohol in his blood long before his death June 28. Rather, Sonnenberg said alcohol could only have "contributed" to Martinez's death if it were the reason he was in the canal in the first place.

Heimlich's attempts to spur an investigation by the Boise Fire Department have been successful, and an incident review is taking place so BFD can better discern the facts of the case.

"After [the review], we'll better understand what was done, and we'll learn from it. We learn from all the calls we go on," said BFD Division Chief of Special Operations Paul Roberts.

The after-action review was informal, but Roberts said the department would cast a more critical eye on the case because someone from out of town raised questions about it.

"This [investigation] might be more in-depth because someone from the Heimlich family called in," he said.