fatality

More on Triathlon Fatalities–A Scientific Report

September 18, 2017 By Larry Creswell, MD 4 Comments

Readers here at the blog will know that I’ve had a long-standing interest in triathlon fatalities. My interest was originally sparked by media reports and the paradox that seemingly healthy and fit triathletes might die on race day.

I was involved with an internal review of this problem at USA Triathlon (USAT), the governing body for the sport of triathlon in the United States. In 2011, that task force issued a formal report and set of recommendations for athletes, event organizers, and USAT itself. Those written recommendations are still valuable today as we work to reduce the number of triathlon race-related fatalities.

In this week’s edition of Annals of Internal Medicine, I joined with Drs. Kevin Harris and Barry Maron from the Minneapolis Heart Institute in reporting on “Death and Cardiac Arrest in U.S. Triathlon Participants, 1985-2016: A Case Series.” In this scientific report, we’ve gathered information about 122 athletes who died and another 13 athletes who suffered cardiac arrest but survived during triathlon races in the United States over the past 3 decades. This is, by far, the most comprehensive scientific report on this subject.

Special thanks go to the leadership at USAT which recognized the importance of this issue, has been proactive in working to reduce the number of race-related fatalities, and was extraordinarily helpful to our investigative team as we assembled the information for our new report.

The Important Observations

Victims were 47 +/- 12 years old
85% were men
Almost 40% were first-time triathlon participants
There were no elite or professional athletes among the victims
The overall rate for fatalities or cardiac arrest was 1.74 per 100,000 participants (2.40 for men, 0.79 for women). For comparison, the rates of cardiac arrest (including fatalities) are approximately 1.0 per 100,000 participants in marathons and 0.3 per 100,000 participants in half marathons.
The fatality risk in triathlon increases exponentially with age; the fatality rate was 18.6 per 100,000 participants among men 60+ years old
Fatality rates were similar for short, intermediate, and long-distance races
The majority of deaths (74%) occurred during the swim segment; smaller numbers of deaths occurred during the bike or run segments or after finishing the race
Among 22 fatalities occurring during the bike segment, 15 were due to traumatic injuries
At autopsy, clinically relevant (but presumably previously unrecognized) heart/vascular disease was found in many victims

A Recipe for Doing Better

We should focus on two strategies for reducing the number of fatalities: 1) we should work to prevent incidents of race-related cardiac arrest and 2) we should work to improve the survival rate for any such victims of cardiac arrest. Athletes, physicians, event organizers, safety personnel, and sport governing bodies can all play an important role.

Athletes should:

Make certain that their participation in a particular race is in keeping with their health, both chronic and acute, as well as their ability and preparation.
Consider their heart health before participating. This may be particularly true for first-time participants and for men who have reached middle age. For older men, testing for “hidden” coronary artery disease (CAD) or other forms of cardiovascular disease may be appropriate.
Assess their health on race day and consider not racing if they are “sick.” Symptoms, particularly systemic symptoms like fever, are related to DNF rates in other sports settings.
Be prepared for the rigors of a triathlon swim. It is important to be a capable swimmer and to have practiced open water swimming in advance of the race.
Think to STOP at the first sign of medical troubles (unexplained shortness of breath, chest pain/discomfort, or light-headedness), particularly during the swim segment.

Physicians should:

Be aware of the risks of participating in triathlon and be in a position to counsel their athlete patients about those risks in the context of the patient’s specific health situation.
Consider the potential value of cardiac screening, particularly for occult CAD in men who have reached middle age. Evidence-based screening protocols are not yet available, so an approach will need to be individualized. In most cases, an evaluation of the traditional risk factors for CAD would be appropriate and in some cases, additional testing such as calcium-scoring cardiac CT or stress testing may be appropriate. Athletes who are just beginning an exercise program should receive special attention in this regard.

Event organizers should:

Develop a robust safety plan, particularly for the swim segment, that enables prompt (near instantaneous) identification of a lifeless victim, and then rescue of that individual to a location where CPR, defibrillation, and advanced life support can be provided.
Have a communication system for all individuals involved in race-day safety.
Rehearse the safety response to a lifeless victim, especially for the swim segment.

Race-day safety officials should:

Be trained in CPR and use of the AED.
Be familiar, through rehearsal, with the communication and safety plans.

Sports governing bodies should:

Provide education for athletes, event organizers, medical directors, and volunteer safety officials about life-threatening race-day emergencies.
Develop rules and sanctioning requirements that promote athlete safety.

Reference:

Harris KM, Creswell LL, Haas TS, Thomas T, Tung M, Isaacson E, Garberich RF, Maron BJ. Death and cardiac arrest in U.S. triathlon participants. Annals of Internal Medicine 2017 (in press).

Related Posts:

Japan and Triathlon Fatalities

February 25, 2016 By Larry Creswell, MD 2 Comments

I’ve recently returned from a trip to Tokyo, Japan, where I was the guest of the Japan Triathlon Union (JTU). The occasion was their organization’s 5th Annual Forum, which this year was devoted to the issue of triathlon race safety.

I appreciate the kind invitation from Mr. Otsuka and Mr. Nakayama, the help of JTU’s Kenta Kodama with the travel arrangements, and the tremendous help with translation from Ms. Tomoko Wada. My hosts were gracious in every way. I must also thank the kind folks at USA Triathlon (USAT)–Terri Waters and Kathy Matejka, for help with gathering some updated information to present in Japan, and USAT President Barry Siff for making the necessary connections with JTU.

As readers here will know, I’ve had an interest in triathlon-related fatalities and the broader issue of sudden cardiac death among endurance athletes. I had the opportunity to lead a recent USAT effort to learn more about triathlon-related fatalities and our work resulted in a 2012 report entitled “Fatality Incidents Study.” As I’ve said before, this report is good reading for athletes and event organizers who are looking for recommendations about how to race safely and conduct events with athlete safety as a first priority.

Sadly, there were 6 triathlon-related fatalities in Japan in 2015, the most ever in a single year there. Dr. Ryoji Kasanami, the Chairman of the JTU’s Medical Committee, had become familiar with our work here in the USA and was interested in learning how our findings might help JTU with better safety planning, on the parts of both athletes and event organizers.

I gave a talk at the Forum where I outlined the USAT experience with fatalities since 2003. In large part, the information is summarized in my previous blog post, Triathlon Fatalities: 2013 in review. I was able to include some updates through the 2015 season, but the central themes were the same now as then:

There is variation in the fatality rate from year to year, with an overall fatality rate of ~1 per 70,000 participants
Most fatalities occur during the swim portion of events
Most victims are male
Fatalities are most common among middle-aged athletes
There have been no fatalities among elite (professional) athletes
Among victims, there is a wide range in athlete experience and ability
There is a small number of trauma-related fatalities, arising from bicycle crashes
Among non-traumatic fatalities, the vast majority suffered cardiac arrest at the race venue
Available autopsy information for non-traumatic fatalities has shown heart abnormalities in the majority

Dr. Kevin Harris, from the Minneapolis Heart Institute, and I will be presenting an abstract at the upcoming American College of Cardiology meeting in April in Chicago on this topic. We’ll be sharing consolidated information about 106 fatalities, including the autopsy findings from 41 of the non-traumatic fatalities. I’ll report back here at the blog with an update in April.

Dr. Kasanami shared information about the Japanese experience with 37 fatalities over the past 3 decades. There were many similarities to the experience in the USA:

Some years were “safer” than others
Most fatalities occurred during the swim portion of events
Most victims were male
Fatalities were most common among middle-aged athletes
There have been no fatalities among elite athletes
There were no fatalities in young athletes

There were also some notable differences:

There were no fatalities during the bike portion
Autopsy was seldom performed in the victims

Interestingly, the bike course is always closed to vehicular traffic during triathlons in Japan, and this might obviously have an impact on the number of crashes and trauma-related fatalities. One interesting anecdote shared by a pathologist attendee related to the finding of inner ear bleeding (hemorrhage) in 2 victims. I’m not sure about the significance of this observation.

I’m intrigued by the many similarities of the Japanese experience with race-related fatalities. I also know from preliminary discussions with officials at Triathlon Australia that the experience in Australia is similar as well. I suspect that the causes of cardiac arrest in participating athletes are common broadly, and are more dependent on simply the human condition rather than race-related factors that might be specific to one region or another (eg, race safety or technical rules, approach to medical care on site, warm-up, etc.).

I’ll mention here that the Medical Committee of the International Triathlon Union (ITU) is very interested in this issue, particularly as it relates to elite athletes. I understand that efforts are being made to implement the requirement for mandatory periodic health evaluations, including EKG screening, for youth, U23, and elite athletes who participate in ITU races, perhaps beginning in the 2017 season. This follows on the heels of the international rowing federation adopting a similar policy, gradually, during the 2014 and 2015 seasons.

I worry a little about the ITU focus on elite athletes, since the problem of race-related fatalities seems to be largely one of age-group athletes, but I hope that age-group athletes will be paying attention to any recommendations that are implemented.

Lastly, I’ll close with some photographs from the trip. Since this was my first-ever visit to Tokyo and Japan, my hosts graciously afforded me about 8 hours of free time one day for the purpose of sightseeing and I took advantage. I hope to return to Japan soon to see even more.

Triathlon, Open Water Swimming, and the Heart: What Can We Learn From Dolphins and Seals?

March 16, 2015 By Larry Creswell, MD Leave a Comment

A recent study about marine mammals caught my eye. I don’t know much about non-human biology and physiology, but this study on dolphins and seals may shed some light on the problem of fatalities during open water swimming or triathlon events.

The Study

A group of investigators headed by Terrie Williams from the University of California at Santa Cruz shared their report, “Exercise at depth alters bradycardia and incidence of cardiac anomalies in deep-diving marine mammals” in the January 16th edition of Nature Communications (1).

This group of investigators has been interested in the physiology of the so-called “dive response” in marine mammals. This is a response that is governed by the involuntary, or autonomic, nervous system, which has two antagonistic components: the parasympathetic nervous system and the sympathetic nervous system. As a group, the marine mammals depend on feeding by chasing pray to depths that can range up to 3,000 m. Even at lesser depths, these mammals must maintain a breath-hold under large hydrostatic pressures while they undergo extreme exertion to catch their pray. During a dive, breath-holding stimulates the parasympathetic nervous system to slow the heart rate (producing bradycardia). At the same time, the exertion required to chase pray stimulates the sympathetic nervous system, producing an increase in the heart rate. The current study offers the first detailed study of the interplay between the components of the autonomic nervous system during routine diving and feeding activity in these animals.

The investigators created an electrocardiograph-accelerometer depth monitor that was deployed on 10 Atlantic bottle-nosed dolphins and 3 Weddell seals. This device allowed high-fidelity recording of the heart rate, ECG, water depth, and swimming stroke frequency (a measure of exertion) during dives. For the dolphins, measurements were made for 74 dives to depths of up to 210 m. For the seals, measurements were made for 91 dives to depths of up to 390 m.

The Results

As expected, there was a strong relationship between diving depth and heart rate for both species, with heart rates falling during descent and reaching a minimum at the lowest depth of the dive. Superimposed on this effect was an additional effect of exertion. For the dolphins, the maximum heart rate was 1.7 to 3.7 times greater during periods of extreme exercise compared to gliding alone. For the seals, the maximum heart rate was 1.5 to 1.8 times greater during periods of extreme exercise compared to gliding alone.

The surprising finding was that cardiac arrhythmias occurred in more than 73% of the dives. The investigators defined arrhythmias to include ectopic beats or significantly increased variability in the interbeat interval (IBI). There were apparently no sustained or fatal arrhythmias., but there were discrete examples of “wandering pacemaker” and ventricular premature beats. In the Weddell seals, there were often patterns of alternating periods of tachycardia (fast heart rate) and bradycardia (low heart rate) during periods of constant, intense exertion.

The presence of cardiac arrhythmias was strongly correlated with increased depth of dive (parasympathetic activation) and increased exertion (sympathetic activation). As an example, cardiac arrhythmias occurred in 81% of the dolphin dives to >210 m but in only 26% of dives to <100 m.

The authors concluded that our previous understanding of the dive reflex in marine mammals was not totally correct. Given that these animals depend on diving for their food sources, the development of cardiac arrhythmias during feeding appears to be mal-adaptive. In fact, feeding might actually be dangerous.

My Thoughts

At first glance, the physiology of the diving response of dolphins and seals during feeding seems far afield from open water swimming and triathlon. And moreover, we already know about the development of cardiac arrhythmias during submersion in breath-holding humans as well as other marine species. The important observation here, though, is what I might call “irritability” or “instability” in the heart rhythm during periods of intense parasympathetic and intense sympathetic activation….and that’s the possible link to human fatalities during open water swimming or triathlon.

We know from autopsy reports of triathletes who’ve died during the swim portion of an event that there are sometimes only subtle abnormalities of the heart, and often nothing that seems explanatory. That leaves us in a difficult position to explain such deaths. In a previous blog post, I wrote about one very plausible hypothesis. Two UK physiologist,s X and X, proposed the concept of “autonomic conflict,” where a surge in both the parasympathetic and sympathetic stimulation of the heart might lead to a fatal arrhythmia. I’ve been intrigued with this hypothesis because it seems to fit many of the observations made about the swim victims. It is easy to see where exertion, cold water, anxiety, etc. might lead to strong sympathetic activation. And it’s equally easy to see where facial wetting, water entering the mouth/hypopharynx/nasopharynx, and breath-holding, even without diving, might lead to strong parasympathetic activation. In that instant, in an athlete with some sort of susceptible heart, a fatal arrhythmia might occur.

The new observations about the dolphins and seals seem to play into this hypothesis.

2. Triathlon Fatalities: 2013 in Review

Reference:

1. Williams TM, Fuirman LA, Kendall T, et al. Exercise at depth alters bradycardia and incidence of cardiac anomalies in deep-diving marine mammals. Nature Communications 2015;6:6055.

Triathlon Fatalities: 2013 in Review

December 30, 2013 By Larry Creswell, MD 6 Comments

With the 2013 triathlon coming to a close here in the United States, I thought I’d provide an update about triathlon fatalities. I’ve been working on a talk for next month’s USA Triathlon (USAT) Race Directors Symposium about this issue and it gave me the opportunity to gather some new data about the 2012 and 2013 seasons. I’ll also reflect on the media coverage of this issue in 2013, point you to some resources that may be helpful for athletes and event directors, and share my thoughts about the challenges and opportunities that remain.

The USAT 2012 Report

It’s been just over a year since USAT released its final report on event-related fatalities from 2003-2011. In addition to providing information about 45 fatalities during that 9-year period, the report concluded with a set of recommendations, in a framework of shared responsibility, for athletes, race directors, and USAT itself. The report is worthwhile reading for everybody in our triathlon community. I still believe that all of the reasonable opportunities for reducing the number of fatalities are included in those recommendations.

Media Attention in 2013

The issue of triathlon fatalities continues to receive attention in the media. Each of the fatalities in 2013 drew the attention of the local media and some garnered attention in the national media as well. The death of Ross Ehlinger at this year’s Escape from Alcatraz Triathlon in March received the most attention, with widespread reporting in the national media. I was at the race that day and shared some of my thoughts in a previous blog post. There was a fair bit of criticism in the media about issues such as particularly difficult water conditions for the swim that day, unusually cold water temperatures, an earlier-than-usual event date, and a large number of swimmers who required rescue or repositioning during the swim portion of the event. We learned months later from autopsy information that Ehlinger had significant, unrecognized coronary artery disease. Early speculation in that regard turned out to be correct.

The issue also received national attention in May in a short report in USAToday entitled Swimming Deaths Trouble Triathlon Officials. That report included a table (essentially from the USAT report) that recognized again the large proportion of fatalities that had occurred during the swim portions of events over the years. The article highlighted the stories of several athletes who died during the 2012 season and offered commentary by USAT CEO, Rob Urbach, and Dr. Rudy Dressendorfer about potential mechanisms and causes.

ESPN took an interest in this issue and worked with USAT to gather information during the early part of the 2013 season. In October, long-time ESPN reporter Bonnie Ford wrote an article enetitled Trouble Beneath the Surface, that examined in some detail the facts surrounding swim-related fatalities in triathlon. The article raised questions not only about athlete preparation for events but also about safety-related preparations by event organizers. As part of its Outside the Lines program, ESPN also released a short video report by T.J. Quinn that paralleled Bonnie Ford’s reporting. I was able to join Ford, Quinn, and cardiologist John Mandrola, MD, as a panelist for that broadcast which is available now as an archived podcast. I wrote about the experience in more detail here at the blog. The discussion was pretty short, but we had a chance to talk about both athlete and event organizer responsibilities for improved safety. I’ll thank ESPN for taking on the issue and drawing our attention to opportunities for improvement in race-related safety.

The public scrutiny this year wasn’t directed only at triathlon, though. The Tough Mudder series of races came under criticism for the general health risks of participation. An article in the NY Daily News was typical of the reporting about seemingly high rates of athlete injuries and emergency room visits. The death of an athlete at an April race at the Walk the Plank obstacle, presumably because of drowning, also received considerable attention in the media. This article in Outside Magazine is typical of the reports that raised concerns about safety planning and inadequate lifeguard resources for the large number of participants.

The 2012 and 2013 Fatalities

The USAT 2012 report detailed the event-related fatalities for 2003-2011. We’ve had 2 seasons since then. The fatalities in 2012 and 2013 occurred against a backdrop of continued strong participation numbers for the sport in the United States.

In 2012, there were 4,310 sanctioned events where there were 565,325 finishers. Fourteen athletes died, a fatality rate of approximately 1 per 40,000 participants. It appears that 2012 had the highest fatality rate in the past decade. Thirteen athletes died during the swim portion and the remaining athlete died during the bike portion of an event. These athletes included 13 men and 1 woman who ranged in age from 34 to 69 years.

In 2013, through November, there were 4,084 sanctioned events where there were a total of 512,972 finishers. Eight race participants died, a fatality rate of approximately 1 per 64,000 participants. Five athletes died during the swim, 2 died during the bike, and 1 died during the run portion of an event. These athletes included 6 men and 2 women who ranged in age from 31 to 70 years.

An additional athlete died in 2013 during an event-sponsored practice swim the day before a sanctioned race which was then cancelled because of the fatality. There has been ample discussion these past couple years about the value of a swim warm-up immediately before a race. No doubt, this can be helpful in many ways. But we must remember that sudden cardiac death can occur at any time–not only during a race. In fact, the vast majority of sports-related sudden cardiac deaths each year occur outside of competition.

From press accounts, we know of 1 survivor of cardiac arrest during the bike portion of the August 4, 2013 edition of the Cleveland Triathlon. Todd Rains, a 44-year-old man, collapsed during the bike portion of the event, received prompt CPR by fellow participants, and was successfully resusciated. The number of such incidents at triathlons remains largely unknown. Given that the survival rate for out-of-hospital cardiac arrest is thought to be <15%, I suspect the number is small.

Updated Overall Statistics

With the addition of the 2012-2013 data to the previously reported 2003-2011 data, we now know there have been 68 event-related fatalities over an 11-year period. That span includes nearly 32,000 events with more than 4 million participants. Narrowing the focus a bit, we might include only the 65 athletes who died at a race, and exclude the 1 spectator death, 1 fatality at a clinic rather than a race, and the 1 death during the practice swim. In terms of race-related incidents, the approximate fatality rate since 2006 is approximately 1 per 65,000 participants.

If we include all 68 athlete fatalities, 49 (72%) occurred during the swim, 11 (16%) during the bike, 4 during the run, 2 after the race, 1 in a spectator, and 1 in a pre-race practice swim.

Coverage in the Triathlon Media

The issue of race safety garnered the attention of the triathlon media in 2013. I’d like to thank the various editors.

In the April, 2013 issue of Triathlete Magazine, Warren Cornwall, a triathlete, wrote an article entitled What Lies Beneath. That article is now available online with a new title, “Are You Fit to Race Triathlons?” Cornwall’s interest in triathlon race safety was spurred by his participation in the 2012 USAT National Championship races in Burlington, Vermont, where Richard Angelo died during the Olympic distance race. Cornwall writes about the potential causes of athlete fatalities and shares his personal story of undergoing a cardiac evaluation. He offers a good sidebar on the pros and cons of various diagnostic tests to determine “Are You Fit to Race?”

In the 2013 edition of New Zealand’s Iconic Adventures magazine, Mark Banham wrote an article entitled, “Heart of the Matter.” He addresses the issue of sports-related sudden cardiac death, starting with the ancient story of Phillipdes and then turning to modern endurance athletes. He offers a set of heart health tips that will be useful for athletes.

The November/December issue of Inside Triathlon featured an article by Torbjorn Sindballe, entitled “From the Heart.” Sindballe, as you may know, retired from the sport of triathlon in 2009 because of problems related to a heart condition known as bicuspid aortic valve (BAV). He was born with an aortic valve with 2, rather than the normal 3, leaflets. With time, individuals with BAV are predisposed to having problems with leakage–or regurgitation–of the valve as well as enlargement of the nearby aorta. Sindballe developed both of these problems. He describes the diagnosis of his condition in 2005 and talks about how this impacted his elite triathlon career. He includes 4 tips for a long and healthy life: 1) react immediately to serious symptoms; 2) get a check-up; 3) chase your dreams, but respect your body; and 4) change triathlon’s overachieving culture. All good advice.

In the December online edition of Triathlete Europe, Drs. Merghani, de Meyer, and Sharma wrote an article, entitled “Cardiac Screening: Heart Health and Triathlon.” Written by a group of authors who are among Europe’s foremost experts in sports cardiology, this article addresses some of the underlying cardiac causes of sports-related sudden cardiac death and talks about the value in cardiac screening for endurance athletes.

Resources for Athletes

A couple new resources for athletes in 2013 deserve mention.

As part of its SwimSmart initiative, World Triathlon Corporation (WTC) produced a short video on swim safety narrated by Paula Newby Fraser. Fraser details a 10-point safety checklist as triathletes prepare for their next triathlon swim. This checklist is applicable to all triathletes–not just those participating in Ironman events. Ten minutes listening to this video might save your life.

USAT has a very active webinar program. Their listing of upcoming as well as archived webinars is available here at the USAT website. Earlier this year I hosted a webinar on Heart Health and Endurance Sport, a 45-minute look at some of the heart issues that are faced by endurance athletes. A portion was devoted to the topic of cardiac screening of athletes. Best of all, it’s free!

I’ll mention that I’m toying with publishing a very short eBook that deals with triathletes, open water swimming, and safety. The book would answer the question: What can I do as an athlete to make my next triathlon swim as safe as possible? I’d like to reach as many triathletes as possible and I’d like to leave readers with a simple, ~10-point plan. Please let me know if you have advice, suggestions, etc.

Resources for Race Directors

Several developments on the race director front in 2013 deserve mention.

USAT issued a new set of Recommendations for Multi-sport Age Group Swim Segments regarding water temperature. I’ve written about this issue in a previous blog post. This is a step forward, bringing USAT into the collection of governing bodies that have thoughtfully considered the issue of water temperature and athlete safety. All of us in the triathlon community will need to become familiar with the new recommendations. Both athletes and event directors should be familiar with the safety issues and possibilities of hypothermia or heat-related illness at the extremes of water temperatures. I understand that USAT will be rolling out infomational pieces as we move into the 2014 race season.

I mentioned at the top of this post that I’m speaking at the upcoming USAT Race Directors Symposium. This year’s event will be held as a virtual, rather than an in-person, symposium. Check out the details at the USAT website.

WTC and Rev3 Triathlon each rolled out water safety initiatives this year. I wrote about the details in a previous blog post at the start of the season. I mentioned the WTC water safety video earlier. Let me also mention a collection of 4 articles on athlete swim safety written by professional triathlete, Malaika Homo, for Rev3. They’re good reading. I know that the WTC and Rev3 initiatives got a lot of attention this year both inside and outside of the triathlon community. I hope that these organizations will report back about their successes and their thoughts about a course forward.

There are several recent and upcoming USAT webinars on the topic of race safety, and that are targeted to event directors: Setting Up Your Medical Team for a Long Course Event–J. Rizzo; Emergency Management Plan Case Study: Preparing for the Unexpected–E. Sarno; Preparing for the Storm: A Look into Crisis Management–B. Davison; and 9-1-1: Preparing for Emergencies at Your Event–J. Flint.

USAT is planning for a first annual conference for medical professionals in May, 2014 at the Olympic Training Center in Colorado Springs. Details should be available soon. The 2-day conference will be targeted at medical professionals with involvement in multi-sport event planning and management. Athlete safety will figure prominently in the program. I’d encourage event organizers to pass this information along to their events’ medical directors and staff.

Lastly, I’ll point out an interesting panel session at the upcoming Triathlon Business International conference next month in Los Angeles. Targeted at race directors, the January 27th panel session on the “Hot Topic” of water safety will include: Bill Burke, race director; Bonnie Ford, ESPN reporter; Dan Ingalls, National Marine Safety Center; Captain Danny Douglas, Venice Beach Lifeguard Operations; and Charlie Patten, Rev3 Triathlon. This should be a lively session!

Challenges and Opportunities

Our challenge remains to reduce the number of athlete fatalities at triathlons. Athletes, event organizers, and USAT all have a role to play. I’ve been encouraged this year by the level of engagement about this issue. As a community, our awareness may never have been greater. But there’s obviously more work to do. Even a single fatality is one too many. So here ‘s what I’d like to see in 2014:

Education and awareness. I hope that the issue of race safety will continue to receive attention by the triathlon media in 2014. I’m convinced that athletes want information that may help them train for and compete in triathlons safely. Let the various editors know that race safety continues to be an important issue. USAT and the other relevant governing bodies can also help with print, video, webinar, or in-person educational activities. Topics related to heart health, cardiac screening, and athlete preparation for open water swimming would appear to be the important topics for athletes. If you have expertise in these areas, volunteer to help USAT in their efforts, volunteer to help your local race director, or offer to speak to your local tri club. I know they’d be happy to hear from you. I also hope that the media outlets will work hard to find and share the good stories–the stories of athletes who had major medical problems at events, but overcame them and are back to training and competing. We don’t hear enough of those stories.

Further investigation. USAT is partnering with Kevin Harris, MD, from the Minneapolis Heart Institute to investigate in further detail the medical histories, initial treatment, and autopsy information for athletes who’ve died at triathlons in the past decade. This is a big undertaking. I’m hopeful that this investigation will shed additional light onto the causes of the athlete deaths and suggest additional steps we might take in the future to make racing more safe. As part of that work, we will be trying to identify survivors of cardiac arrest at races. If you know of such an athlete, please let me know. Often, there is a lot to learn from the so-called near misses. I’m hopeful that much of this work will be completed in 2014 and that I might be able to report back at this time next year with some highlights. There are probably countless areas of worthwhile investigation when it comes to athlete safety and multi-sport events. If you’re an investigator with an idea for a potential study, I’d urge you to be in touch with USAT. Maybe it’s a project on athlete pre-race anxiety. Or, perhaps it’s a project related to swimming-induced pulmonary edema (SIPE). If there’s an interest in improving athlete safety, I bet they’d be receptive.

Safety planning. Event organizers must continue to work on planning the safest possible events. Given the information at hand about athlete fatalities, safety planning for the swim portion of events should obviously receive special attention. It’s critical that safety plans and lifeguarding resources allow for the almost immediate identification of a lifeless swimmer and then rescue so that CPR and early defibrillation can be provided. It seems simple, but it’s logistically complex. My hope for 2014 is that the event director community will work together to develop educational materials and best practices that can be shared widely. USAT could facilitate this exchange.

I remain optimistic that, together, we can make a difference in 2014.

ESPN Outside the Lines: Triathlon Safety

October 27, 2013 By Larry Creswell, MD Leave a Comment

Last weekend’s ESPN Outside the Lines show devoted to triathlon race safety is now available on podcast.

The show included a video report from ESPN reporter, T.J. Quinn and then a panel discussion that I joined along with Dr. John Mandrola and ESPN reporter Bonnie Ford.

If you missed the television broadcast, the podcast would be good listening for any triathlete.