Race Safety and USA Triathlon


I had the chance to attend the annual USA Triathlon Race Director’s Symposium this weekend in Colorado Springs.

Along with Stuart Weiss, MD (medical director of the ING NY Marathon. NY City Triathlon, and upcoming Ironman New York triathlon), Richard Miller, MD (a trauma surgeon at Vanderbilt University), Bob Burnett (a New England race director), and Robert Vigorito (a mid-Atlantic race director), I’m serving on a Medical Review Panel convened by USAT to review the experience with race-related fatalities over the past decade and to offer recommendations about improving race safety going forward.

We’ve had a chance to review preliminary information about race-related fatalities from 2003-2011 and I was asked to present some information to about 80 race directors from across the country who were attending the Symposium.

Some Preliminary Information about Triathlon Fatalities

A snapshot of event-related fatalities at USAT-sanctioned events:
-44 athlete fatalities, including 5 traumatic deaths and 39 non-traumatic deaths
-All 5 traumatic deaths occured with bicycle crashes
-Most (and, conceivably all) of the non-traumatic deaths were due to sudden cardiac death (SCD)
-The majority of the non-traumatic deaths occurred in the swim leg of a race, but there were also deaths in the bicycle and running legs….and 2 deaths that occurred after athletes had completed a race and left the race venue
-Deaths occurred in athletes in nearly every age group
-Deaths occurred in races of every distance from short sprint to Ironman distance

Some Information about Sudden Cardiac Death (SCD)

I shared some general information about SCD, describing reports from 2011 on NCAA athletes and on the French general population:

-In NCAA athletes, the incidence of SCD is 1 per 43,770 athletes per year
-Basketball and swimming appear to have the highest risk

-In the French general population, the risk of SCD is 4.6 cases per 1,000,000 population per year
-Deaths were noted in nearly every conceivable sporting activity
-Deaths were noted in individuals from 11 years old to 70+ years old
-Extrapolated to the U.S. population, there should be 4000+ fatalities in the U.S. due to SCD each year

Feedback from the Attendees

I had a chance to hear from the race director attendees about many relevant experiences. Indeed, several of the race directors who were present had firsthand knowledge about some of the fatalities.

Race directors from Utah were able to share with the audience their approach to dealing with the aftermath of such a fatality–from sharing information at the race venue, to working with family members of the victim, to working with the medical and EMS crews who attended to the victim.

There were many suggestions about how we might work to reduce the number of fatalities:

-Easier access to AED’s, including deploying an AED on a boat so that CPR and defibrillation might occur earlier in the event of a swim leg event
-Reducing anxiety among swimmers before the race. Attendees noted that the NYC Triathlon already employs psychologists to conduct pre-race briefings where coping strategies are discussed
-Wearing inflatable devices during a swim which could be deployed if/when a swimmer experienced difficulties
-Designing swim courses to limit the distance from shore
-Having pre-established action plans for the specific possibility of SCD during the swim

One particularly heart-warming story came from a young race director who shared his personal story of having SCD at the swimming pool in 2010, receiving 14 minutes of CPR, and being resuscitated successfully. He now has an internal defibrillator and is working through the issues of how active he can continue to be. He’s continuing his passion for triathlon by serving now as a race director.

A Visit to USAT’s Offices

On the last evening of the Symposium, we visited the offices of USAT for supper and some fellowship. I was totally fascinated by the many photographs and memorabilia on the walls of the office. The highlights were photographs of the Olympic triathlon teams from the 2000, 2004, and 2008 Olympic Games. Really inspiring.


Our Review Panel’s work will continue in the coming weeks as we work to understand more about the athletes who died and about the circumstances surrounding their deaths. I’m optimistic that when we’re finished with our review, we’ll be able to offer some useful advice to USAT and some information to the endurance sport community at large. I’ll keep you posted.

I’d be happy to receive comments and suggestions from the readers here about how we might improve race safety.

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  1. says

    Dr. Creswell,

    Thank you for your informative article about SCD. I was awestruck by the statistical significance of SCD occurrence in athletes compared to the general population. Using your numbers, SCD is 23 times more likely to occur in NCAA athletes than in the French population. Especially alarming is the concentration of SCD in Swimmers! I am a triathlete and developer of the USAT Approved Swim IT, swim safety device. ITs primary purpose is to provide Peace of Mind in the Open Water. Regarding the fatalities which are concentrated in the swim portion of triathlon, has anyone ever studied the correlation of anxiety and drowning? I believe the anxiety induced drownings could be eliminated with a swim safety device that empowers the swimmer to feel a sense of control over there preservation.
    I applaud USAT in taking the lead in studying the cause of fatalities in triathlon and look forward to reading about your implementation of recommendations for increased safety in triathlon.
    Thank you, Rick Senn
    President, Lo Drag Inc.
    The Swim IT

  2. says

    Hi Larry,

    Great post and I am so glad to hear about the progress being made on managing this problem.

    I agree that having the participants wear a self-inflating safety device would be a great benefit. I have been using the Swim IT in my Fearless Swimming Open Water Course For Triathletes and have made it mandatory equipment for my Ocean Skills For Triathletes Class. The Swim IT is comfortable, sturdy, does not interfere with the swimmer or with those around him and it deploys flawlessly. It makes the swimmer instantly visible as it remains tethered to his leg and it gives him something to float on.

    Ultimately, USAT must find a way to manage the liability issues and the risk, while encouraging greater numbers to participate in the sport-not an easy task.

    I look forward to reading more posts as things develop.

    Best Wishes,
    Ingrid Miller
    Fearless Swimming For Triathletes (Meyer & Meyer 2011)

  3. says

    It’s great there is a device like the Swim It that is race legal and provides peace of mind. the goal is to never have to use it, but it’s nice to know it’s there.

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