November 5, 2013 Patson Alleyne Permanent Secretary Ministry of Health (MOH !

ran" #alcott $%il&in' (%llo&en )oa&, St* Michael $arba&os, #est +n&ies ,ear Mr* Alleyne)e- .Heimlich mane%ver for asthma/ st%&y + receive& yo%r October 0, 2013 letter (attache& on October 21, 2013 via 2*S* Postal Mail* 3han" yo% for yo%r ans4ers to the 5%estions in my !ebr%ary 12, 2013 letter to yo%r a'ency* #o%l& yo% 6lease res6on& to these a&&itional 5%estions, 6referably via e7mail8 1 )e- this 5%estion in my letterWould your office please direct me to or provide me with a copy of all guidelines regarding the use of human subjects for medical research conducted in Barbados? 9o%r letter &i& not incl%&e this information* #o%l& yo% 6lease a&vise a66ro:imately 4hen + may e:6ect to receive it8 2 9o%r letter state&Please be informed that when the study was conducted, there was no formal Institutional Review Board/ ommittee in place in the !inistry of "ealth# "owever an application in the form of a letter was submitted to the !inistry and the research was approved by the then research committee of the !inistry# $his Research ommittee comprised of %r# Beverly !iller, now retired hief !edical &fficer, %r# "arold White 'deceased( and Professor )#R# Walrond# #o%l& yo% 6lease 6rovi&e me 4ith a co6y of that letter an& co6ies of all other &oc%ments re'ar&in' the st%&y8 Please re&act any confi&ential 6atient information* 3 9o%r letter state&It should be noted that permission was obtained from the parents whose children were enrolled in the study# *ttached is a copy of the guidelines for the study# )e'ar&in' yo%r claim that .6ermission 4as obtaine& from the 6arents 4hose chil&ren 4ere enrolle& in the st%&y,/ is yo%r claim base& solely on the abstract of the st%&y 4hich yo% attache& or &oes the MOH have a&&itional &oc%mentation an&;or information to s%66ort yo%r claim8 +f the latter, 4o%l& yo% 6lease 6rovi&e me 4ith com6lete& co6ies of all 6ermission letters from the 6arents8 Please re&act any confi&ential 6atient information* +f the MOH &oes not have co6ies of the 6ermission letters, 4o%l& yo% 4rite to st%&y a%thor ,r* Anne St* <ohn an& ,r* ,e:ter <ames, (=O of >%een =li?abeth Hos6ital (4here the st%&y 4as con&%cte& , as" them to 6rovi&e yo% 4ith co6ies, an& inform me of the res%lts8 3 Accor&in' to the article *sthma Probe by staff re6orter Maria $ra&sha4, $arba&os S%n&ay S%n, ,ecember 1@, 2012In an email to this newspaper, '%r# +t# ,ohn( stated that the study did receive approval from the local Institutional Review Board###and that the !inistry of "ealth was carrying out an investigation into the matter#### Per an A%'%st 13, 2013 item on my blo', since November 1A, 2012, +Bve sent m%lti6le in5%iries to ,r* ,e:ter <ames, (=O of >%een =li?abeth Hos6ital, as"in' for the name of the +nstit%tional )evie4 $oar& (+)$ an& 4ho hea&e& it* +Bve never receive& the information, therefore, 4o%l& yo% 6lease 4rite to ,r* St* <ohn an& ,r* <ames, as" them to 6rovi&e the name of the +)$ an& 4ho hea&e& it, an& inform me of the res%lts8

3han" yo% for yo%r contin%e& attention an& + loo" for4ar& to yo%r re6ly* Sincerely,

Peter M* Heimlich 3@30 )iver Hollo4 )%n ,%l%th, Ceor'ia 300A@ 2SA 6h- (201 0D07D213 e7mail- Peter*HeimlichE'mail*com 4ebsite- htt6-;;me&fra%&*info blo'- htt6-;;the7si&ebar*com cc3he Honorable !re%n&el <* St%art MP, Prime Minister of $arba&os (heryl (o: Mac6herson Ph,, Presi&ent, $ioethics Society of the =n'lish7S6ea"in' (aribbean =li?abeth #oec"ner, (iti?ens !or )es6onsible (are an& )esearch, +nc* ((+)(A)= Professor =*N* $arton, =&itor7in7(hief, #est +n&ian Me&ical <o%rnal ,r* ,onal& Simeon, ,r* (* <ames Hos6e&ales, (aribbean P%blic Health A'ency Maria $ra&sha4, $arba&os S%n&ay S%n

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G O V E R N M E N T O F HA KB AD OS

MINISTRY OF HEALTH
FRANK WALCOTT BUILDING, CULLODEN ROAD, ST. MICHAEL BARBADOS, W.I.

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J L i SECTOR
MAKING B A R B A D O S WOK K B i n 1 ER

Our Ref: Your Ref:

22 J Vol.3

Tel. No.: (246) 467-9300 (PABX) Fax: (246) 426-5570 October 4, 2013

Mr. Peter M. Heimlich 3630 River Hollow Run Duluth, Georgia 30096 USA Dear Mr. Heimlich, Re: "Heimlich Maneuver for Asthma" Medical Study I wish to refer to your correspondence dated February 12, 2013 concerning "the Heimlich Maneuver for Asthma" medical study and the following issues which you raised: i. Was the study approved by the Ministry of Health's ethics committee? If so, on what date? Who was in charge of the committee? Would your office please obtain the name of the Institutional Review Board and the name of the individual in charge of the board and provide the information for me? Would your office please direct me to or provide me with a copy of all guidelines regarding the use of human subjects for medical research conducted in Barbados? Woidd your office provide me with a determination whether or not the "Heimlich maneuver for asthma" study was conducted in compliance with those guidelines?

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Please be informed that when the study was conducted, there was no formal Institutional Review Board/Committee in place in the Ministry of Health. However an application in the form of a letter was submitted to the Ministry and the research was approved by the then research committee of the Ministry. This Research Committee comprised of Dr. Beverly Miller, now retired Chief Medical Officer, Dr. Harold White (deceased) and Professor E.R. Walrond. It should be noted that permission was obtained from the parents whose children were enrolled in the study. Attached is a copy of the guidelines for the study. It is hoped that the information satisfies your queries. Yours sincerely,

Patson Alleyne Permanent Secretary (Ag) PA:oj Attach...

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Studies II

(Q-49) Utilization of the Heimlich Manoeuvre as an adjunct in the management of asthma in paediatric patients: a prospective study S Feannyt MA St John, P Howard Department of Paediatrics, Queen Elizabeth Hospital, Barbados Objective: The objective of the present study was to determine the usefulness of a modified Heimlich Manoeuvre for treatment of asthma in Barbados. Materials and Methods: Subjects were randomly selected from the Accident and Emergency database and studied prospectively between August 2002 and July ?003. Written consent was obtained from parents for participation of patients. Screening included history, present condition, and fulfilling inclusion/exclusion criteria, with physical examination and lung function tests according to the study protocol. Results: The study population consisted of 67 patients aged 6-16 years with a control group of 34 patients and a study group of 33 patients. Spirometry values for the study group showed progressive improvement in FEV (17.85%) and PEFR (30.8%), which was statistically significant. Changes in the control group readings of 6.75% and 13% respectively were not statistically significant. All symptom scores improved: 75% for exercise tolerance and 28% for quality of life scores in the study group was (statistically significant) contrasting with total asthma scores of 37% and 0% changes in the quality of life scores in the control group. Improved spirometry and symptom scores were consistent for the study group but fluctuated in the control group. No adverse effects were reported. Conclusion: This study has provided data to support the potential benefits of the modified Heimlich Manoeuvre as adjunctive therapy for asthma, with a consistent improvement in objective parameters of spiromctry, subjective symptom scores and quality of life assessment.

(O - 50)

faculty of Medical Science* TU r,

;*<**_ . a s Saras;;

Results: The male/female ratio was 1 8 1 ,

8"0 /+ i
AI\

" " " W<M> i.o.i, mean age was

DuT^edf r r 8 e n c y visks in the p "2-2

m the past 12 months was associated with smoke (p < 0.025), pets (p < 0.025), odours (p < 0.005) and inhaLd
P ag niSt m e t S C ^ f S r > -d doseUe (MDI) (p < o 05). Children aged 1-5 years and 6-12 years were more likely to get attacks in the dry and rainy season

L L ( 8 6 - 3 % ) l y e t 1 7 9 ( 60 %) P^ents visited the.BR * least once in the past 12 months r ^ , U r p n S - D U S t freqUent,y wheezing and repeat ER v.s.ts in children are associated with pete odours, smoke and JCS with fi MDI E d u c a L 7 / parents/guardians of asthmatic c h i l d r e n ' t o ^ T avo,d tnggers for wheezing and learn efficient iMD, U S e * ecommended. The early onset of asthma in children and age-related climatic changes needs to be explored

West Indian Med J 2005; 54 (Suppl. 2): 45