My adventures

Some Thoughts on The Escape from Alcatraz Triathlon

March 5, 2013 By Larry Creswell, MD Leave a Comment

It was a sad day Sunday at the Escape from Alcatraz Triathlon. As you may know, 46-year-old triathlete, Ross Ehlinger, died during the event. I thought I’d share some thoughts about the race. I was there.

I can clearly remember reading about the Escape from Alcatraz Triathlon for the first time back in 2005, the year I took up triathlon. I thought it was absolutely incredible that large numbers of athletes could actually make the swim from Alcatraz Island to San Francisco to start the race. Knowing that no prisoner was ever confirmed to have escaped, I had thought that the swim was impossible.

But of course, that’s the lure.

I did the race for the first time in 2007 and I’ve been back for the race in 2011, 2012, and again this year. It’s an extraordinary race for many reasons, including the epic 1.5-mile swim across San Francisco Bay and the breathtaking scenery for the bike and run portions of the event. It’s no wonder that the race attracts a field from across this country and around the world. Each year it’s the lucky winners of an entry lottery who get the chance to Escape.

The race is usually held in early June, but this year the race was moved to early March. I understand that, because of this summer’s America’s Cup yacht races in San Francisco Bay, it was impossible to hold the race at its usual time. I personally have enjoyed the cool temperatures for this race in June, but even I was concerned about the possibility of poor weather with the March 3rd date.

The weekend in San Francisco actually brought unseasonably warm temperatures. I was surprised. Several of the employees at my hotel remarked how lucky we were with the good weather. Nonetheless, the water temperature was very cold. I went for a practice swim (in my wetsuit) at the Aquatic Park on Friday before the race and lasted only 18 minutes before getting out, freezing cold. We’d learn from the race officials that the water temperature was in the low 50’s. As it turns out, the temperature in the Bay is almost always in the low 50’s, regardless of the time of year.

The night before the race, I laid in bed thinking about the swim and safety. I was even a little bit worried about my own safety. It’s a challenging swim.

Race morning brought cloudy skies, low cloud or fog cover, ~50-degree temperature, and a brisk wind into the Bay from the direction of the Golden Gate Bridge.

The trip out to Alcatraz Island on the San Francisco Belle for me and the nearly 2000 athletes lasted about an hour. The ride was smooth and there was the usual banter between racers about the swim, sighting, and the race in general. We learned from the boat announcer that there was a 4 km per hour outward current. To put that into perspective, I’d bet that 80%+ of the field is unable to swim 4 km per hour….so for almost everyone, it would be impossible to swim back to the boat if you changed your mind! We also got advice from the boat announcer that, because of no swim warm-up, we ought to put things “into 5th gear” when we entered the water and get away from the boat quickly. I thought that was odd advice. We learned that there would be 100+ boats/kayaks in the Bay to provide assistance if needed.

The start of the race was delayed because of the (unexpected) passage of a cruise ship between us and shore. The up-to-40 year olds start first, then the older folks, including me. I was among the first of the older competitors to jump off the boat into the water. And off I went.

There was moderate surface chop because of the wind. And with the wind coming from the right, there was inherent difficulty for swimmers, like me, who breathe to the right side. There were also several foot swells. As you swam “across the river” toward shore, there would be times when you were in a gulley, with water all around you….and other times when your were “surfing” at the top of a swell. The conditions were the most challenging of my 4 Alcatraz races. I was worried enough….and focused enough….on the mechanical aspects of swimming, that I didn’t really notice the water was cold. I remember thinking early on that it would be a difficult day for most of the swimmers. Little did I know.

I finished the swim in just over 35 minutes, 6th for my M50-54 age group and 127th overall. I’d learn later that 22 of ~140 athletes in my age group took longer than an hour. There were a lot of swimmers who took longer than an hour. I went on to enjoy the rest of the race, appreciating the cheers from my family who were there, and really appreciating the chance to be a part of the event. I can remember noticing that the competitors in the race seemed much more spread out than usual. When I was returning from the bike portion, there were still athletes just starting the bike, more than 2 hours after the start of the race. And similarly, when I was finishing my (rather slow) run, some 3 hours and 40 minutes after the start, I noticed that there were still athletes just starting out on the run.

Back at the hotel shortly after the race, I learned the sad news that one of the competitors had died during the swim. Ross Ehlinger, 46 years old, married, father of three. The online edition of the Austin Statesman had a touching article yesterday about Ross and his family.

Initial news reports have provided some information about the incident, but I must say that reports have sometimes been conflicting. The race reported that Ross was rescued from the water less than a minute after he had jumped into the water, that he received CPR during transportation to shore, and that he could not be resuscitated. The Race Director, Bill Burke, commented early that the rescuers suspected a heart problem as the cause.

There is a very poignant account on Facebook by a fellow competitor, Richard Iazzetta, on how he came across the lifeless victim during the swim, and along with 2 other swimmers, provided assistance during the rescue. Richard, Calley, and Matt are heroes here. We owe them our thanks.

I understand that an autopsy is being performed and that the results will be reported publicly in due time. And perhaps those autopsy findings will shed some light on what happened. I also suspect that bystander accounts will become available and, if the incident truly happened in the first minute (and so, fairly close to the boat), there might be videotape footage from the boat that captured the event. Until all of the available information is gathered, we can at best speculate about what happened.

I got a couple media inquiries yesterday that were focused on the recent USA Triathlon study of event fatalities. The final report from that study is useful reading for all triathletes. In a nutshell, the majority of triathlon fatalities occur during the swim and most are thought to be due to sudden cardiac arrest…a fatal arrhythmia. But there are a handful of potential causes for a death during the swim portion, including trauma, stroke, seizure, pulmonary embolism, and “ordinary” drowning. I wrote a short article at Endurance Corner that summarizes my take on things.

There seemed to be a chorus yesterday about the poor race conditions and questions about whether those conditions may have contributed in some way to the victim’s death. At this point, we just don’t know.

From the standpoint of fatalities, the Escape from Alcatraz has a remarkable safety record. This is the first fatality in the 33-year history of the event. That safety record speaks to the quality of the event management by IMG and the race direction by TriCalifornia and, more recently, Premier Event Management. Over the years, tens of thousands of competitors have jumped off the boat into icy cold water and made their way safely to shore….in spite of cold water temperatures and challenging conditions.

The race reported that about 150 swimmers had to be rescued during Sunday’s race, either to be carried to shore or repositioned to a safer spot on the course to complete their swim. This is apparently a much higher number than usual and it does raise questions about the preparedness of the athletes as well as safety planning by the race organizers.

We ought to learn something from Sunday’s tragedy. We owe it to our triathlon community. And we now owe it to Ross Ehlinger and his family.

Dan Empfield wrote an article yesterday at Slowtwitch entitled “Dare You to Move.” He gets at the idea of doing something. I agree.

I’ll borrow here from the USAT report….

If you’re an athlete, I’d encourage you to:
1. Visit your doctor for a physical examination with an emphasis on your heart health. Do this before you train or compete.
2. Consult with your doctor about warning signs like chest pain/discomfort, shortness of breath, light-headedness, blacking out, or palpitations.
3. Your health, fitness level, and preparation should guide your choice of race or event. Be certain that your race plan is consistent with your health, fitness level, and preparation.
4. Practice and prepare for an open water swim. San Francisco Bay is not for first-timers.

If you’re a race director or event organizer, I’d encourage you to:
1. Place a primary emphasis on athlete safety. Ensure that the safety plan, unique to your event, takes into consideration all features that can impact athlete safety.
2. The safety plan for the swim should be extraordinarily robust, allowing nearly instant recognition of the lifeless swimmer and providing for early CPR and defibrillation.
3. Hold a mandatory safety briefing where athletes can be provided information about the expected conditions and the safety resources that will be available.

I’d urge you to do something. Personally. And make plans today to do it.

Wrap-Up from USAT RD Symposium 2013

January 21, 2013 By Larry Creswell, MD Leave a Comment

I spent the past couple days at the 2013 USAT Race Director Symposium in Colorado Springs. I had the chance to attend last year’s meeting and I’m thankful to the USAT folks for the opportunity to return to this year’s Symposium. Let me share some of the safety-related highlights:

A Common Problem

The Symposium was held at the Cheyenne Mountain Resort in Colorado Springs and the Resort offered van service from the airport. The USAT Symposium was not the only meeting at the hotel, and I shared the van with a woman who was attending a different meeting. We exchanged travel stories and talked about each other’s meetings. When she learned that I’d be speaking about athlete fatalities, she shared that she had a daughter who was a runner and recalled a story about a local athlete who had died during a running race.

The issue of race-related fatalities is obviously not confined to the sport of triathlon.

CPR Class

The Symposium began on Thursday afternoon and included a 2-hour class in CPR. This was an outstanding addition to the program. I took note last year that the organizers of the Boston Marathon, in conjunction with the American Heart Association and American Red Cross, offered a short CPR class for runners, family members, and other supporters at their 2012 event. We all benefit from a high prevalence of bystanders who know CPR. In a comprehensive study of sudden cardiac arrest at half marathon and marathon running events, Dr. Jonathan Kim and his colleagues last year reported that the survival rate was nearly 30%, due entirely to the availability of prompt bystander CPR and prompt defibrillation. This is in sharp contrast to the rather dismal survival rates of ~10% that are typically reported for out-of-hospital cardiac arrest.

Growth in Triathlon

On Friday morning Rob Urbach, USAT CEO, reported on the growth in the sport of triathlon–growth that is represented in the number of participants, annual members, and events. As it turns out, the assembled group of Race Directors represented more than 60% of last year’s races nationally–accounting for more than 350,000 finishers. The growth in our sport is both an opportunity and a challenge. With this growth, we’ll need an ever-increasing commitment to the issue of race safety.

John Korff

Friday morning’s keynote speaker was John Korff, owner and organizer of the New York City Triathlon. He’s a terrific story-teller. And with more than a decade of experience with that event as well as with last year’s Ironman New York race, he had a lot of stories to tell. And while most of those stories were amusing (in a New York sort of way), he also shared a little bit about the personal side of having athlete fatalities in those events.

Race-related fatalities have certainly captured the public’s attention–particularly in large media markets like New York. It’s that attention, particularly after athlete deaths in 2011 that prompted USAT’s recent review of race-related fatalities.

My Talk

I was invited to share with the Race Directors the USAT final report on athelte fatalities during 2003-2011. I’ve written previously about this issue here at the blog and also in a column at Endurance Corner.

I’d call your attention to the final report which is available in its entirety at the USAT website. This is, by far, the most comprehensive look at the issue of event-related fatalities in triathlon. And while there may well be questions that still deserve our investigation, there is a bunch of useful information to help guide us as we try to improve in the area of race safety. It’s useful reading for athletes, race directors, and virtually anbody involved in the sport.

The last 2 pages of the final report outline a vision of Shared Responsibility for Race Safety, where athletes, event organizers, and USAT all have a role. For each of these groups, there is a concise set of recommendations that may help to reduce the fatality rate going forward. I truly believe that all of the viable strategies that are likely to have a favorable impact are included in that short list.

Safety Planning

We heard from Andy Emberton, Operations Manager, Communications Director, and Risk Manager for World Triathlon Corporation (WTC), the folks that own the Ironman series of races. Andy offered very practical advice for incident management (including fatalities among others) and explained in detail how careful event and safety planning were essential. An ounce of prevention! It’s clear that WTC has placed an emphasis on race safety and has gained tremendous experience over the years with large, long-distance triathlon events in a large number of venues throughout the world.

Bill Burke

The Saturday program included a great talk by Bill Burke, the owner of Premier Event Management in New Orleans. Bill has had the opportunity to serve as race director for a bunch of large, high profile races including the New Orleans 70.3, Nation’s Triathlon, Hy-Vee Triathlon, Escape from Alcatraz Triathlon, New York City Triathlon, Ironman New York, and the Olympic Trials for 2004 and 2008, among others.

He also has a unique history of having dealt with 10 athlete fatalities at his races over the years. When I’ve talked with groups about the issue of race-related fatalities, I’ve often worried that the discussion of statistics often removes the human side of this issue. Bill did a terrific job of describing the very human aspects of these tragic events. He told the individual stories of 8 of those athletes, sharing a little bit about their athletic and personal history together with the details of how their race-day deaths unfolded. You couldn’t help but have a tear in your eyes. For the assembled Race Directors, he shared his insights about careful event and safety planning as well as interacting with surviving family members after the incidents.

A Few Thoughts

All organized sports, and particularly the endurance sports, will continue to need to address the issue of event-related fatalities. Organizations such as the International Marathon Medical Directors Association and USA Swimminghave issued reports on this topic. As the scientific community continues to learn about the causes–and opportunities to prevent–sports-related sudden cardiac arrest, we should work to incorporate these findings in our efforts to improve race safety.