Two triathletes died last week during the swim portion of a Triathlon on the hudson river in New york city. The athletes went into cardiac arrest during the swim portion of the event and died. Cardiac arrest, (also known as cardiopulmonary arrest or circulatory arrest) is the cessation of normal circulation of the blood due to failure of the heart to contract effectively.
A cardiac arrest is different from (but may be caused by) a heart attack, where blood flow to the muscle of the heart is impaired.
Arrested blood circulation prevents delivery of oxygen to the body. Lack of oxygen to the brain causes loss of consciousness, which then results in abnormal or absent breathing. Brain injury is likely if cardiac arrest goes untreated for more than five minutes. For the best chance of survival and neurological recovery, immediate and decisive treatment is imperative.
Cardiac arrest is a medical emergency that, in certain situations, is potentially reversible if treated early. When unexpected cardiac arrest leads to death this is called sudden cardiac death (SCD). The treatment for cardiac arrest is cardiopulmonary resuscitation (CPR) to provide circulatory support, followed by defibrillation if a shockable rhythm is present. If a shockable rhythm is not present after CPR and other interventions, clinical death is inevitable.
The risk of sudden death in a triathlon is 1.5 deaths per 100,000 participants compared with 0.8 deaths per 100,000 participants in a marathon.
As reported by the New York Times, a 2010 study published in The Journal of the American Medical Association showed that 13 of the 14 deaths in triathlons from 2006 to 2008 took place during the swim legs. Autopsies on nine of the victims found that seven had heart abnormalities, which researchers think were exacerbated by the stress of swimming in open water.
“What do you do if your goggles come off? If you bump into a boat? If someone swims over you? If any of these things happen in the open water and you’re not prepared for it, you can panic and can get into real trouble.”
“So many things can go wrong in an open-water swim,” Dr. Stuart Weiss, the New York City Triathlon medical director, said last week. “There’s some combination of water, adrenaline, pushing yourself hard, and all these things somehow work together to put people into an abnormal heart rhythm.”
Organizers of the race said last week that they were considering requiring open-water swim certifications for 2012 entrants, as well as certification of a recent medical checkup showing a clean bill of health. But a spokesman indicated that USA Triathlon was less far along on such considerations.
“The topics of athlete certification, as well as its feasibility, and the current requirements for swim starts continue to be discussed and evaluated, and we will consider all options moving forward,” the spokesman, Chuck Menke, said.
Cook said that swim certification was necessary.
“You need some form of certification that says this person can swim in open water for, say, one hour,” he said. “If they don’t pass it, they shouldn’t be let in the race.”
The rising numbers of untrained first-time triathletes comes as part of the sport’s phenomenal growth in recent years. USA Triathlon membership has grown from 16,000 members in 1993 to 140,000 in 2010.
The surge reflects a change in perception. Not long ago, the notion of doing a long-distance swim, followed immediately by long-distance cycling and running, seemed impossible for all but the most elite endurance athletes.
But now triathlons are often seen as the province of weekend warriors, albeit especially fit ones. That in turn has attracted first-time triathletes who often lack specific training. The number of one-day memberships in USA Triathlon, which one needs to compete in its sanctioned events, rose to 326,732 in 2010 from 100,000 in 2000.
Triathlon organizers are also aware of the dangers, typically assigning more lifeguards than the USA Triathlon minimum of one per 50 participants (one per 30 for ocean swims). They also are moving away from the especially chaotic mass starts. At the New York race, swimmers started in groups of 20 every few seconds, although that change was made because of choppy water.
“USA Triathlon-sanctioned events must meet the requirement of a minimum of three minutes between start waves and no more than 150 athletes per wave,” said Kathy Matejka, the event services director of USA Triathlon. “Time-trial starts, which include fewer than 20 athletes starting at shorter intervals, also are permitted.”
USA Triathlon is aware of the risks and dangers of participating in a Triathlon. To that end, all participants are required to sign a waiver/release of liability in order to participate in the event. The law on waivers/releases varies from state to state.
Race organizers need to have a safety plan in place. The plan should insure:
1. Sufficient number of lifeguards and Emergency doctors on hand during a race;
2. Defibrillators on site;
3. Paramedics on site.
In addition to enhancing the safety requirements during a race an additional consideration is to require a yearly physical with cardiac testing.