In news reports yesterday, I read about the sad news of a triathlete who died during the swim portion of the Ironman Louisville triathlon over the weekend. This death comes just a month or so after the highly publicized deaths of 2 triathletes during the New York City Triathlon. It’s been a while since I’ve written about the issue of sudden cardiac death during triathlons, so I thought I’d share some thoughts.
There has still been little reporting about the tragic event at the Louisville race, but I’ve learned that a 46 year old man was pulled from the water a little more than 300 yards from the start of the triathlon and brought back to the start area to receive further care. Authorities said that he had suffered cardiac death (SCD), was taken to the Louisville’s University Hospital, and was pronounced dead there. I’ve read that an autopsy was performed, but the findings have not been released.
At last month’s New York City Triathon, 2 athletes suffered SCD. One athlete, a 64 year old man died on the day of the event and a 40 year old woman was apparently resuscitated but died a short time later. These deaths attracted a lot of attention in the popular press and I had the opportunity to share some of my thoughts in an article entitled “Why is the Swim the Most Deadly Leg of the Triathlon?” that appeared in the Wall Street Journal. The swim portion of that triathlon was particularly rough and many athletes had to be rescued. Some observers raised questions about conducting the race in those conditions and about the quantity and availability of on-water support to rescue swimmers who weren’t capable enough to complete the swim. I must say, though, that the event organizers are very experienced with directing large triathlons and there appeared to be a robust water safety plan….at least from afar. I was also contacted by The Weather Channel which wanted information and an opinion about how the weather–including water temperature and current–might have played a role in the athletes’ deaths. Again, I suspect this wasn’t a big a factor.
The unfortunate truth is that a small number of athletes will suffer SCD during training or competition….and this is true regardless of the sport. I’ve written previously in a column at Endurance Corner about a recent study by Dr. Kevin Harris of fatalities during triathlon events. In a study of all of the USA Triathlon (USAT) sanctioned events during a 3-year period in the United States, he identified 14 triathletes who died. I recently read in a notice from USAT that nearly 2.3 million individuals completed a triathlon in 2010 in the United States, so you can see how rare an event a race-related fatality really is. Interestingly and importantly, in almost all triathlon fatalities, the victim died during the swim portion of the event and the cause was almost always cardiac-related.
I’ve read through the many discussion threads on this issue at Slowtwitch and other forums and there are obviously many opinions….and many unanswered questions. I think that most of us in the triathlon community could agree that it would be great to prevent some or all of these fatalities, if it were possible. But how?
As I see it, there are only a couple possible ways:
1. Identify victimis of SCD more quickly and provide better and faster medical care so that there might be more survivors.
2. Ensure that, before participating, athletes learn about any heart conditions they might have….and receive necessary treatment and counseling about participating.
USAT Task Force
The week before last I received an email from Rob Urbach, the CEO of USA Triathlon. In that email to USAT Race Directors, he paid special attention to the recent deaths during the New York City Triathlon and indicated that USAT would be convening a taskforce to look at the issue of fatalities during triathlon events. This is a tremendously worthwhile pursuit. I hope that USAT can assemble a group of experts representing the triathlon, medical, and other relevant communities and make a careful assessment of the information that is available about these events. I think this group should:
1. Review the fatalities to look not only for causes of death but also pre-existing medical conditions that might predispose the athlete to sudden cardiac death.
2. Make a careful review of the experience in other endurance (or other) sports (both in and out-of-competition), to place the triathlon statistics into proper perspective.
3. Evaluate the race-day safety resources that are in place to deal with athletes who might suffer sudden cardiac arrest. It is extraordinarily difficult to tend to the victim of SCD in/on the water and we know that CPR and early defibrillation (with just a few minutes) is needed for victims to survive. I’m not aware of any athlete survivors of in-water SCD at a triathlon.
4. Consider what warnings should be issued to participants in terms of the risk of competing and what role that organizers should play (if any) in ensuring the physical ability and medical health of the participants.
As we await the work of the task force, I’d make the following suggestions:
1. For race directors and event organizers. Carefully and critically evaluate your safety plan as it relates to victims of SCD, particularly during the swim. Consider the communication system(s) that are available to water safety personnel and the plans for early CPR and defibrillation should they be needed.
2. For athletes. Realize that there is some small risk of SCD during a race. You should consult with your physician about your particular risk and what, if anything, can be done to reduce that risk. Most athletes would be well served by visiting with a physician for a careful medical history and physical examination that is focused on heart-related problems. Make certain that your overall and heart health are in order before training and competing.
3. For doctors. Become knowledgable about the heart problems that face athletes and be ready to offer sound advice to your athlete patients.
4. For the press. Always give some context for reports on sports-related deaths. Remind your audiences that these events are rare and that exercise provides many proven benefits in spite of any small risk of race-related SCD.
The Novice says
I recently blogged about this topic (http://ironrogue.blogspot.com/2011/08/learn-to-swim-you.html), and to sum it up: I’m worried that knee-jerk reaction to this phenomenon will put an unfair onus on race organizers.
Does the idea of increasing swim distances to increase the priority of swimming (thereby increasing swim proficiency in participants) make sense to you?
Does SCD happen only to people with an undiognosed (or diognosed) heart problem and family history, or can it happen to anyone? For example, if a person with no heart condition or family history of heart condition, are they at risk of SCD (at all) if they play endurance sports or participate in a triathalon?
Lawrence L. Creswell, M.D. says
In some sense, anything is possible.
Most SCD events occur in the setting of some sort of (perhaps unidentified) heart disease.
Lawrence L. Creswell, M.D. says
To The Novice–
I do think it’s important for swimmers to be prepared for the swim portion of a triathlon. I think it’s easy to underestimate the difficulty.
I have thought that most SCD events during the swim portion of a race are heart problems–not swimming problems.
I think it would be logistically difficult for event organizers to monitor athletes’ preparedness and I’m not certain this would decrease the number of SCD events.
pensive pumpkin says
I’m a Long QT patient currently training for a half marathon, and reading through your back posts. Just wanted to let you know how much I appreciate your take on these issues.
Lawrence L. Creswell, M.D. says
I like “pensive pumpkin”