Triathlon-Related Deaths - The Facts and What You Should Know
by Larry Creswell, M.D.
Last August I volunteered to help with a USA Triathlon (USAT) review of race-related fatalities in recent years. Since this issue has been in the news these past couple weeks with athlete deaths at the inaugural Ironman New York triathlon and again at the USAT National Championships in Burlington, Vermont, I thought I’d share my experience with the review, some data you might find interesting, and some thoughts about a path toward better race safety.
My partners on the USAT Medical Review Panel included Richard Miller, MD, a trauma surgeon at Vanderbilt University; Stuart Weiss, MD, an emergency medicine physician who serves as the medical director for the ING New York Marathon as well as the New York and Ironman New York triathlons; Rob Vigorito, a long-time race director for events including Eagleman 70.3; and Bill Barnett, a race director for several New England events. Everybody in the group is an athlete and each of the race directors had first-hand experience with a fatality at one of their races.
Our charge was to review information about all of the event-related fatalities at USAT-sanctioned events from 2003-2011, analyze the data for patterns, and organize the data so they could be shared easily. A second phase of the project is still underway. The data from our review have been shared with a broad constituent group in American triathlon -- athletes, event directors, USAT officials, physicians, event directors. USAT is now in the process of collecting feedback. There will be a report forthcoming that presents the data along with recommendations about how to improve race safety.
Never before have I spent an entire year focused on learning about one very specific problem like this. I’ve learned a lot. The stack of articles I’ve read -- both in the popular and scientific press -- is pretty tall. In scientific circles, there hasn’t been much written about triathlon fatalities, but there is a considerable and growing body of material about this issue in other sports. By best estimates, more than 4,000 athletes die each year in this country from sports-related sudden cardiac arrest (SCA). Virtually no sport or form of exercise is spared in that regard. The International Marathon Medical Directors Association and USA Swimming have recently issued recommendations about the prevention of SCA in running and swimming events, respectively.
I’ve also learned a lot through discussion -- with triathletes and family members; race directors whose events were involved; USAT administrators and race officials; experts in pre-hospital care of cardiac arrest victims; experts at the condition known as immersion pulmonary edema (IPE); participants in bystander CPR and resuscitation for athlete victims; an attorney specializing in risk management for national sports governing bodies; an athlete who himself had been successfully resuscitated after cardiac arrest while swimming; and many, many others. From virtually everyone concerned, I’ve heard how unsettling these fatalities have been for our triathlon community.
We can dispel some common misperceptions:
I don’t want to preempt USAT’s final report on this issue, and I honestly don’t know at this point what form it will take and when it will be made public, but I’d like to share my personal view about a path forward. I see this as an issue of shared responsibility.
The Athlete’s Responsibilities
The Event Director’s Responsibilities
Larry Creswell, M.D., is a cardiac surgeon and Associate Professor of Surgery at the University of Mississippi Medical Center in Jackson, Mississippi. In addition to his regular column on Endurance Corner, he maintains The Athlete's Heart blog to offer information about athletes and heart disease in an informal way and to encourage exchange and discussion that will help athletes build a heart-healthier lifestyle. You can contact him at firstname.lastname@example.org.