USA Triathlon is creating a task force to determine if anything more can be done to prevent deaths such as those that occurred at recent races in New York City, Washington, D.C., and Louisville, Ky.
An independent panel of three physicians and two certified race directors will review the cases and see if there are common factors among them, USA Triathlon Rob Urbach told The Associated Press. The panel's findings will then be presented to a larger review committee of medical professionals and industry personnel to determine what, if any, actions should be taken.
The move comes after five triathletes died following U.S. races over the last two months.
Two competitors, a 64-year-old man and a 40-year-old woman, died in August during the swim portion of the Nautica New York City Triathlon. Later that month, a 46-year-old man died during the swim leg of the Ironman Louisville triathlon and a 58-year-old professor at Bates College in Maine died after having a problem in the water during a triathlon in that state.
Earlier this month, a 59-year-old man died during the bike portion of the Nation's Triathlon in Washington.
"We felt in all cases we've adhered to best practices," Urbach said. "At this point, I'm being advised there's nothing (additional) that can be done. But as a responsible governing body, we're taking a look through this."
There is no deadline, Urbach said. But one task force member, Dr. Lawrence Creswell, said the group hopes to begin its research in October and wrap up by the end of the year.
A progress update will be given at USA Triathlon's race director symposium in January in Colorado Springs, Colo.
"I thought the events were unsettling," said Creswell, a heart surgeon, assistant professor at the University of Mississippi Medical Center and an avid triathlete. "I think that the participants in triathlons would take some comfort in knowing that USA Triathlon was interested in the problems, interested in understanding the problem better and trying to see if there's anything that can be done to limit participants' risk. I think it could be something positive with a broader impact."
Deaths during triathlons remain rare, and as more people participate there is bound to be a corresponding increase in the number of fatalities. According to research published last year in The Journal of American Medicine, there were 14 deaths among the almost 960,000 participants in U.S. triathlons between 2006 and mid-September 2008, a rate of 1.5 deaths per 100,000 participants.
Of the 14 deaths, however, all but one occurred in the swim portion.
"The results were a surprise to me," said Dr. Kevin Harris, a cardiologist at the Minneapolis Heart Institute and lead author of the JAMA article. "We saw a cluster of events in the triathlon, but we didn't realize before getting into the details that the vast majority were going to be during the swim portion."
Some have blamed triathlon's boom in popularity for the disparity in when deaths occur. First made famous by the Ironman, weekend warriors have flocked to the shorter sprint (typically a half-mile swim, 25-kilometre bike ride and 21-kilometre run) and Olympic (1.5-kilometre swim, 40-kilometre bike ride and 10-kilometre run) distances. Triathlon, Urbach said, is now the fastest-growing adult participation sport in the world.
According to a study by the Sporting Goods Manufacturers Association, 1.978 million people in the United States did a triathlon last year, up almost 64 per cent from the previous year and a 148 per cent increase since 2007.
But it is hard, particularly for first-time triathletes, to replicate the race-day experience of the swim during training. Most swim training is done in a pool, not open water, and some people panic when they find themselves in a cold lake, river or ocean with poor visibility and waves, surrounded by other competitors thrashing around.
Yet the larger, more serious problem, Creswell and Harris said, is logistics.
It is obvious almost immediately when someone collapses or experiences problems while running or biking, and medical attention — even if that's just a spectator administering CPR — is usually available within seconds.
In the water, despite having lifeguards and water safety personnel nearby in boats or kayaks, it is tough to see someone struggling among all the splashing bodies, which look virtually identical in their wetsuits and race-issued swim caps. When a person in distress is spotted, it takes additional precious seconds to get that person to shore, where there are defibrillators and ambulances.
"It's hard to tend to them," Creswell said. "There are a few survivors when people have sudden cardiac death at a marathon or a running event. ... But it's very hard in the water portion of a triathlon. I think that's the challenge."
Harris and his group suggested setting proficiency standards for participants, particularly for swimming, though Harris acknowledged that would be tough to implement. A full physical before a race would uncover underlying heart conditions or other medical issues, but even that provides no guarantee.
The first year Bill Burnett was a race director, a 38-year-old man had a fatal heart attack during the swim portion of one of his triathlons. The man had been told by a doctor two weeks earlier that he was good to go.
"He did what he was supposed to do," said Burnett, whose Streamline Events company produces several multisport events in New England. "Now I often wonder, should there be some type of question you ask before you do a triathlon? The debate is still out there. I'm not so sure about that. You have to trust that when someone is going to do that, that they're in good shape."
There are already strict standards for safety, aid stations and medical personnel at any USA Triathlon-certified race, and they are reviewed on a regular basis. But after the recent deaths, Urbach said he felt the federation had to go even further to ensure everything was being done to protect competitors.
"If we find, in fact, something different or additional we could be doing," Urbach said, "we will."