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Saturday, October 27, 2012

USA Triathlon Fatality Incidents Study Released

The USA Triathlon Fatality Incidents Study was released this week.

USA Triathlon is the National Governing Body for the sport in the United States. Due to the number of deaths in the sport in the recent past, it convened a panel to objectively review the event-related fatalities.

Over the past several months, USA Triathlon conducted a review of the collective experience with fatalities at USA Triathlon-sanctioned events from 2003 through 2011. Its goals were to bring clarity, identify potential patterns and underlying causes, and investigate opportunities to make any future improvements in event safety.

Its five-member Medical Review Panel included 3 physicians and 2 race directors with broad experience in triathlon, and interest or expertise in the issue of race safety. This group reviewed information for 45 cases and assembled its findings into a preliminary report.

The preliminary report was shared first with the attendees of the USA Triathlon Race Directors Symposium in January 2012 as well as a Review Group that included the editorial staff of the Daily News of Open Water Swimming and representatives from the broader triathlon community—athletes, coaches, event organizers, risk management experts, and medical professionals.

The information on each fatality included the individual's age, gender, and the name, date, format, and length of the USA Triathlon event, as well as a brief narrative of the circumstances of the fatality and press accounts of the fatalities.

But the information that was not available for review included a detailed medical history of the viction (i.e., medical conditions), a detailed accounts of medical treatment(s) provided at the event or during/after transport to the hospital, official autopsy findings, if any, experience level with triathlon or endurance sport in general, the safety plan in place for the event, medical resources on site for the event, and the water temperature and conditions during the swim leg. In some cases, limited second-hand information about victim’s medical history, medical treatment, and autopsy findings were available, but the panel recognized this information may not be accurate or complete.

USA Triathlon provided some good baseline information on the sport's popularity in this period of view (2003-2011): nearly 23,000 sanctioned events involved more than 3 million participants with 4,334 events involving 537,317 participants in 2011 alone.

Of the 45 fatalities, 9 were women and 35 were men ranging in age from 24-76 for an overall fatality rate for triathletes of approximately 1 per 76,000 participants.

- 5 deaths were traumatic, caused by injuries sustained in cycling crashes
- 38 deaths were non-traumatic
- 30 deaths occurred during the swim
- 3 deaths occurred during the bike
- 3 deaths occurred during the run
- 2 deaths occurred after an athlete had completed a race
- 1 death was of a non-athlete spectator who died from bike crash injuries
- 1 death was at a USA Triathlon training clinic

Of the 31 swimming-related deaths, 1 athlete died during a quarter-mile swim at a triathlon clinic due to cardiac arrest. The remaining deaths occurred in races that took place from March to November of various distances from 400 yards to 2.4 miles. 4 victims were relay swimmers; 26 victims were individual racers.

5 deaths were in the ocean; 13 in a lake; 6 in a bay or gulf; and 6 in a river.

3 had time-trial starts (with participants starting individually at 2-5 second intervals); 2 had mass starts; and 25 with wave starts with a range of 40-150 athletes per wave.

Complete information about wetsuit use by the victims was not available.

The vast majority of the victims was rescued from the water and received CPR and advanced life support measures at the scene. In two cases, there was a delay of up to several hours before the missing participants were found. In these cases the victims were pronounced dead at the scene.

Detailed autopsy information was not available for review, although available data indicates the swimming fatalities appear to be caused by episodes of sudden cardiac death (SCD).

Background on SCD

There are an estimated 4,300 sports-related SCDs in the U.S. annually, according to a recent scientific report published by the American Heart Association. These occur during all forms of athletic activity. According to a recent scientific report in the New England Journal of Medicine, most, but not all, episodes of SCD are thought to be due to an underlying, often unrecognized, abnormal heart conditions such as hypertrophic cardiomyopathy (HCM) or coronary artery disease. The treatment for sudden cardiac arrest is prompt bystander CPR, early defibrillation (within a few minutes), and follow-up hospital care. Even with prompt medical attention the survival rate for sports-related sudden cardiac arrest remains low, at 10-25%.

Studies indicate that triathlon’s rate of 1 fatality per 76,000 participants is similar in comparison to the sport of marathon running. A 2010 study on the London Marathon cited one fatality for every 67,414 runners over a 20-year period. A 2008 study examined the Twin Cities and Marine Corps Marathons and cited one fatality for every 75,000 runners since 1976.

Key Findings of the report included the following:

1. The fatality rate did not increase as a trend between 2003-2011. However, the total number of deaths increased as the total number of participants increased.

As the sport continues to grow (USA Triathlon annual membership more than tripled between 2003 and 2011), the incidence of fatalities in the sport will likely increase as well.

2. The fatality rate does not appear to be related to the length of the race, the type of swim venue, or the method of swim start (e.g., mass, wave or time trial).

3. The victims appear to have included athletes from a broad range of triathlon experience. Fatalities were not confined to inexperienced triathletes.

4. There is no clear evidence that swimming ability, typical drowning, anxiety/panic, wetsuit-related factors, lack of a warm-up, lack of medical exam or unusual medical problems (e.g., stroke, seizure, syncope, swimming-induced pulmonary edema (SIPE), pulmonary embolism, or bodily trauma) were responsible for deaths during the swim.

As it relates specifically to SIPE, recently a popular theory for cause of death in these cases, we recognize this clinical syndrome and the difficulties of establishing this diagnosis clinically or at autopsy. It is known from scientific reports that this syndrome affects swimmers and divers with progressive shortness of breath and low levels of oxygen in the blood—symptoms that resolve completely with cessation of swimming and removal from the water.

Although USA Triathlon cannot exclude the possibility of a role for SIPE in the victims’ deaths, it knows of no victim with an antecedent diagnosis of SIPE and it found no information in its review that would establish this diagnosis with certainty in the victims.

Part 2 will follow.

Copyright © 2012 by Open Water Source

2 comments:

  1. Steve, et al,
    After many years as a race director for Canada's largest open water swim event, and holding the fort as a co director of the IMC medical tent, I find
    this is a useful review that, regrettably, does not get us any closer to narrowing down the primary risk factors that might be identifiable and modifiable prior to racing. Regardless, there may still be value to wave starts, encouraging good training and medical screening, open water experience, and warmup prior to racing, as well as appropriate seeding in races.
    It is too bad that wetsuit info was not available, as it might continue to be a useful life preserver as a flotation device, perhaps reducing some risks when swimmers are wetsuited.
    It may have been interesting to hear about water/wave conditions, or water temperature, as well as whether starts had gun versus a quiet start (an adrenaline effect?). And what the athlete may have injected prior to starting the race--caffeine? excess food? Other supplements?
    Finally, it is of course frustrating to understand the limitations of autopsy, since cardiac arrhythmias escape detection, and the athlete can no longer tell the examiner what happened, including simply the accidental ingestion of water during the swim. For this reason, it may be useful to collect data on the swimmers that were successfully pulled out of the water prior to a potentially fatal event, to get their stories (I assume there have been some successful rescues over the years!). Greg Welch's story comes to mind as one example.
    For us in the medical support of these kinds of races, regular updates and improved data collection will remain vital in the quest to ultimately eliminate this unfortunate recurrance.

    ReplyDelete
  2. You bring up excellent points that may never be solved. Out of respect to the victim's family, and due to various legal considerations, information surrounding the conditions of a death are not provided by the race director or the local authorities. Therefore, there is no detailed or comprehensive data collection by any governing body or entity in order to enhance the knowledge surrounding these tragedies, at least in the open water swimming world.

    ReplyDelete

Thank you very much for your interest in the world of open water swimming.

The Staff of the World Open Water Swimming Association

2014 Global Open Water Swimming Conference

Learn more...
Courtesy of WOWSA, Huntington Beach, California.

2014 Global Open Water Swimming Conference Agenda


Friday, 19 September

5:30

PM


Welcome Reception at Mount Stuart House, Isle of Bute, Scotland

Documentary films shown throughout the reception:

Blue Journey-Amerika Samoa – Stronger Together: The Waterman’s Way
(film by Bruckner Chase)

Dancing With The Water, Crossing of Lake Pontchartrain
(film by Wayne Ewing about Matthew Moseley's Lake Pontchartrain crossing)

Bering Strait Swim Chukotka - Alaska
(film by Admiral Konstantin Sidenko about the relay between Russia and Alaska)

The Clean Swim – Hong Kong to Macau
(film about Simon Holiday's Pearl River Delta crossing)


Saturday, 20 September

9:00

AM


Registration and Coffee at Mount Stuart House, Isle of Bute, Scotland

10:00

AM


Keynote Speech:
Colleen Blair (Scotland) on The History of Scottish Swimming

10:20

AM


Christopher Guesdon (Australia) on Multidimensional Roles In The Sport

10:30

AM


Colin Hill (England) on Recent Explosion in UK Open Water

10:50

AM


Shelley Taylor-Smith (Australia) on The Feminine Code of Achievement - How a Lady from Down Under Revolutionized Professional Marathon Swimming

11:10

AM


Simon Murie (England) on Open Water Swimming Holidays: How A New Sector Was Created Within The Travel Industry

11:30

AM


Swimming The Oceans Seven
A round table discussion moderated by:
Kevin Murphy (England), with Stephen Redmond (Ireland), Anna-Carin Nordin (Sweden),
Darren Miller (USA), Adam Walker (England), Kimberley Chambers (New Zealand)

12:30

PM


Coffee and Break

1:00

PM


World Open Water Swimming Awards Luncheon:
with co-hosts Shelley Taylor-Smith (Australia) and Steven Munatones (USA)

Pádraig Mallon (Ireland), 2013 World Open Water Swimming Man of the Year

Olga Kozydub (Russia), 2013 World Open Water Swimming Woman of the Year

Bering Strait Swim, 2013 World Open Water Swimming Performance of the Year

Honoring: Vladimir Chegorin, Maria Chizhova, Elena Guseva, Ram Barkai, Jack Bright, Oksana Veklich, Aleksandr Jakovlevs, Matías Ola, Henri Kaarma, Toomas Haggi, Nuala Moore, Anne Marie Ward, Toks Viviers, Melissa O’Reilly, Ryan Stramrood, Cristian Vergara, Craig Lenning, Rafal Ziobro, Andrew Chin, Jackie Cobell, James Pittar, Paolo Chiarino, Mariia Yrjö-Koskinen, Ivan Papulshenko, Zdenek Tlamicha, Zhou Hanming, Oleg Adamov, Andrei Agarkov, Alekseev Semen, Tatiana Alexandrova, Roman Belan, Elena Semenova, Alexander Brylin, Afanasii Diackovskii, Vladimir Nefatov, Evgenii Dokuchaev, Oleg Docuckaev, Roman Efimov, Dmitrii Filitovich, Olga Filitovich, Victor Godlevskiy, Olga Golubeva, Alexei Golubkin, Alexander Golubkin, Alexandr Iurkov, Oleg Ivanov, Pavel Kabakov, Eduard Khodakovskiy, Aleksandr Komarov, Aleksandr Kuliapin, Andrey Kuzmin, Irina Lamkina, Vladimir Litvinov, Andrey Mikhalev, Victor Moskvin, Nikolay Petshak, Sergey Popov, Vladimir Poshivailov, Grigorii Prokopchuk, Dmitrii Zalka, Natalia Seraya, Viacheslav Shaposhnikov, Olga Sokolova, Andrei Sychev, Alexei Tabakov, and Nataliia Usachaeva [represented by Admiral Konstantin Sidenko and Nuala Moore]


2:30

PM


Alexey Salmin Pavlovich (Russia) and Dmitry Dragozhilov (Russia)
on the 2016 Winter Swimming World Championships [film]

2:50

PM


Sally Minty-Gravett (Jersey) on Motivating Swimmers

3:10

PM


Dmitry Blokhin (Russia) and Aleksei Veller (Russia)
on the First World Ice Swimming Championships [film]

3:30

PM


Matthew Moseley (USA)’s Dancing With The Water, Crossing of Lake Pontchartrain [film]

3:50

PM


Simon Holliday (England) and Doug Woodring (Hong Kong)’s The Clean Swim – Hong Kong to Macau 2014 [film]

5:00

PM


International Swimming Hall of Fame (ISHOF)
and International Marathon Swimming Hall of Fame (IMSHOF)

IMSHOF Induction Ceremonies and Dinner
with co-hosts Shelley Taylor-Smith (Australia) and Steven Munatones (USA).

Recognition of International Swimming Hall of Fame honorees:

  • Elizabeth Fry (USA), IMSHOF Honour Swimmer

  • Vojislav Mijić (Serbia), IMSHOF Honour Swimmer

  • James Anderson (USA), IMSHOF Honour Administrator

  • Dr. Jane Katz (USA), IMSHOF Honour Administrator

  • Indonesian Swimming Federation Open Water Committee (Indonesia), IMSHOF Honour Organisation

  • Melissa Cunningham (Australia), Irving Davids – Captain Roger Wheeler Award by the International Swimming Hall of Fame and IMSHOF Honour Swimmer

  • Sandra Bucha (USA), ISHOF Honor Open Water Swimmer and IMSHOF Honour Swimmer

  • Jon Erikson (USA), ISHOF Honor Open Water Swimmer and IMSHOF Honour Swimmer [represented by Sandra Bucha]

6:30

PM


International Swimming Hall of Fame (ISHOF) Introduction Video.
Welcome speech by host Shelley Taylor-Smith (Australia)

6:45

PM


Dinner

7:30

PM


International Swimming Hall of Fame (ISHOF)
Induction Ceremonies and Dinner with host Shelley Taylor-Smith (Australia)

Recognition of International Swimming Hall of Fame honorees:

  • Mercedes Gleitze (England)
    ISHOF Honor Pioneer Swimmer and IMSHOF Honour Swimmer
    [represented by daughter Doloranda Pember]

  • Dale Petranech (USA)
    ISHOF Honor Contributer and IMSHOF Honour Administrator

  • Claudio Plit (Argentina)
    ISHOF Honor Open Water Swimmer and IMSHOF Honour Swimmer
    [represented by Shelley Taylor-Smith]

  • Judith van Berkel-de Nijs (Netherlands)
    ISHOF Honor Open Water Swimmer and IMSHOF Honour Swimmer
    [represented by Niek Kloots]

  • George Young (Canada)
    ISHOF Honor Pioneer Swimmer and IMSHOF Honour Swimmer
    [represented by the Catalina Channel Swimming Federation]

  • David Yudovin (USA)
    ISHOF Honor Open Water Swimmer and IMSHOF Honour Swimmer


Sunday, 21 September

9:00

AM


Registration and coffee at Mount Stuart House, Isle of Bute, Scotland

10:00

AM


Nuala Moore (Ireland) on The Mindset of 1000m at 0ºC

10:20

AM


Admiral Konstantin Sidenko (Russia)’s Bering Strait Swim Chukotka - Alaska in 2013 [film]

10:40

AM


Ned Denison (Ireland) on Swimming The World

11:00

AM


Bruckner Chase (USA)’s Blue Journey-Amerika Samoa
Stronger Together: The Waterman’s Way
[film]

11:20

AM


Rok Kerin (Slovenia) on Lifestyle Benefits From Open Water Swimming

12:00

PM


Survey distribution and group photo-taking

2:00

PM


Swim at Stravvana Bay, Isle of Bute






CLICK HERE TO REGISTER FOR THE CONFERENCE

The Global Open Water Swimming Conference is a conference on the sport of open water swimming, marathon swimming and swimming during triathlons and multi-sport endurance events.

The conference which has been attended by enthusiasts and luminaries from 6 continents, is devoted to providing information about the latest trends, race tactics, training techniques, equipment, psychological preparation, race organization and safety practices used in the sports of open water swimming, marathon swimming and triathlons.

The conference's mission is to provide opportunities to listen and meet many of the world's most foremost experts in open water swimming, and to meet and discuss the sport among swimmers, coaches, administrators, event organizers, sponsors, vendors, officials, escort pilots, and volunteers from kayakers to safety personnel.

Dozens of presentations at the 2014 Conference at the Mount Stuart House cover numerous aspects of the vast and growing world of open water swimming where attendees can learn and share the latest trends, race tactics, training modalities, swimming techniques, equipment, race organization, logistics, operations, and safety practices for open water swimming as a solo swimmer, competitive athlete, fitness swimmer, masters swimmer, triathlete, multi-sport athlete, administrator, race promoter, sponsor or referee.

The conference was first held in Long Beach, California as part of the 2010 USA Swimming National Open Water Swimming Championships. It has since been held on the Queen Mary in California, at Columbia University and the United Nations in New York City, and in Cork, Ireland. This year in September, it comes to another iconic location, the Mount Stuart House on the Isle of Bute in Scotland.

"The Global Open Water Swimming Conference was started due to the desire and need for athletes, coaches, referees, administrators, race directors, promoters and sponsors from around the world to share, collect and learn information about the growing sports of open water swimming, marathon swimming and triathlons," said founder Steven Munatones. "Other swimming conferences usually offering nothing on open water swimming or perhaps a speech or two, but we thought open water swimming deserves its own global conference. It is great that the community shares its information via the online social network, but there is nothing like meeting other open water swimming enthusiasts face-to-face and talking about the sport from morning to night."

Speakers at the conference include English Channel swimmers, ice swimmers, record holders, renowned coaches, world champions, professional marathon swimmers, renowned race directors, officials and administrators from the Africa, Americas, Asia, Europe and Oceania.

"Because the audience is passionate and educated about the sport and its finest practitioners, the Global Open Water Swimming Conference is also the location of the induction ceremonies for the International Marathon Swimming Hall of Fame and the annual WOWSA Awards that recognize the World Open Water Swimming Man of the Year, the World Open Water Swimming Woman of the Year, the World Open Water Swimming Performance of the Year, and the World Open Water Swimming Offering of the Year. Special Lifetime Achievement Awards are also occasionally presented to individuals who have made significant contributions to the sport over their career."


Copyright © 2014 by World Open Water Swimming Association

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Open Water Swimming Magazine


Open Water Swimming Magazine

The Open Water Swimming Magazine is the monthly magazine entirely focused on open water swimming heroes and heroines of every age, ability, and background. Published by the World Open Water Swimming Association, the Open Water Swimming Magazine is a free benefit to WOWSA members.

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2014 Open Water Swimming Almanac



An Almanac for Open Water Swimming

An almanac is essentially a body of knowledge which is so complete that it enables people in different fields to make predictions about the future of their respective industries.

This, for example, was the purpose of the traditional farmers almanacs. It enabled farmers to determine as accurately as possible which crops to plant for the greatest harvests in a given year.

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