Interview with swim death author
Written by: Dan Empfield
Date: Thu Nov 17 2011
Its author is David Brown, a physician, a regular writer for the post, and a triathlete. A follow-up to the article is a print Q&A, also in the Post, that generated a lot of interest and questions.
While this may seem an aberrant year, in fact deaths in the water in triathlon do occur more frequently than they did in prior decades, and not just because triathlon is a bigger sport. They also, it seems to me, occur at a much higher rate per the number of competitors. I wrote about this in 2008, when, as early as July, there were 8 deaths year-to-date. The New York Times wrote about it back then.
As Dr. Brown notes in his Post article, a trade group in which I'm involved, Triathlon America, is looking at this issue right now, and I anticipate we'll have a set of best practices to present at our annual conference February 17-19 upcoming, in North San Diego County.
I interviewed Dr. Brown about his article, and here are his responses.
David Brown: There has been very little research on the cause of death of swimmers in triathlons other than the autopsies that are performed on nearly all the victims. The details of those autopsies are generally not available to the public although the one-sentence "manner and cause of death" generally is. In my opinion there needs to be some very basic epidemiology done about this problem. What is the sex, age, experience, training, co-existing medical conditions, medications used, etc. in these cases? As to my hypothesis that panic attacks underlie most of them, the first question that needs to be answered is how common panic attacks are among triathletes. This can only be determined by conducting statistically valid surveys. I personally think that for at least a while races should have mandatory pre-race meetings in which one of the conditions of getting the colored band on your wrist is filling out anonymously a two- or three-sentence survey about whether the competitor has ever had what he or she considers a panic attack during a race, whether the person has ever had to change swim strategy (such as floating on the back and letting the pack go by) in response to panicky feelings, and whether the competitor has ever aborted a race because of such feelings. In addition, I think everyone who drops out of a race in any of the legs should be formally debriefed to find out why they decided to stop and what was happening in the minutes preceding the decision (and anything else the competitor might think relevant). An agreement to undergo this brief interview or to answer a questionnaire should be an explicit and clearly displayed condition that the athlete agrees to when he or she signs the waiver at the time of registration. I think there should be a low threshhold for sending to the emergency room people who drop out of the swim and are clearly breathless and in a not-normal condition. Only with an X-ray and some other tests is it possible to determine whether any of these people have "swimming-induced pulmonary edema", a highly unusual and poorly understood condition mostly seen in military rescue and combat swimmers.
There is a saying in medicine: "If you don't measure it, you can't change it." It seems to me that any attempt to try to reduce these deaths begins with measurement. That said, it may be difficult to "prove" that panic attacks are the most common cause of these events. But a lot more information can be gathered to throw light on the causes.
David Brown: I did not ask the relatives of the people who died whether they knew whether the person warmed up in the water before the race. There should be a formal protocol of questions asked of relatives and witnesses after a death or close call, and this question could be part of it.
David Brown: I think the fact that the swim is the first event and is the one with the most jarring sensation—wet and cold—has something to do with the higher risk of this part of the multisport event. But I don't think the "burst of energy" theory is likely to be correct, for two reasons. I would suspect that most of the people who died did not go out especially hard. I doubt if they were testing their physical limits. I know from my experience and talking with many triathletes that panic attacks often occur soon after starting when nobody but a few aggressive leaders is going very hard or is even able to keep up a consistent, unbroken rhythm. The second reason is that even if people were pushing themselves "too hard" that is a situation that doesn't result in death. Lots of people have started out in running or bike races at an unsustainable pace and without adequate warmup. They slow down, either voluntarily or involuntarily. But they don't die or have fatal cardiac events.
David Brown: Good question and one that should be part of a more systematic inquiry into these deaths. I did not ask about water temperature. I only spoke with one race director of a fatal triathlon, the one at Dewey Beach, Del.; the widow of the victim did not want to talk I had only a passing reference to him.
David Brown: I believe all races should have mandatory pre-race meetings in which panic attacks are talked about in a non-judgmental way, with perhaps a few short clips of experienced swimmers testifying as to their existence. I think advice should be given about strategies for calming oneself during a race when this happens. Again, advice from an accomplished swimmer, as long as it's clear, might be the best way to transmit that information. Placing rescue boats, kayakers, etc., in strategic places early in the swim, and telling competitors where they will be, would be useful. (Putting a couple of these in the direct line of the pack might be useful, so people who are not at the edge will have easy access to them). I think every race should have a policy that anyone who drops out in the swim will automatically get into the race the next year without paying an entrance fee. There may be some other strategies, too, but these are ones that have come to mind. However, none of them have ben proved useful. If one wanted to be truly scientific, some races should introduce these "interventions" and other races should do what they are doing now "standard care" just like a scientific study, and then compare the two.
Doug Casa is in charge of the Korey Stringer Institute at the University of Connecticut and knows quite a bit about sudden death in sport. We had a few words with Doug after the 2012 Team Timex Camp. 3.05.12
Senior Hong Kong police officer Andy Naylor died Saturday after developing unspecified medical problems during the swim portion of the Ironman U.S. Championship in New York City. 8.13.12
Is there any reasonable set of dos and don’ts that would serve to decrease deaths? In my view, yes. What can you, as an athlete, do to survive and prosper during the swim? What can you as an RD do? 8.13.12
The sport of triathlon has lost eight of its competitors during races in the United States so far in 2008. The good news: so far our roads have been safe. The bad news: so far the water has been less so. What mitigates risk factors during the swim leg of a triathlon? 7.29.08
New triathletes—or triathletes new to the ocean—are quite often scared to death of negotiating waves during an open-ocean swim. Wouldn’t you like to be able to go through the waves without giving them a second thought? 8.02.00