Good Swimmers Don’t Drown

May 12, 2011

Katharine M. Nohr, Esq.
Nohr Sports Risk Management, LLC

Multiple athlete drownings in triathlons have recently puzzled the multi-sport community. In July of 2008, a 60 year old male and a 52 year old male drowned in two different triathlons on the same weekend. A 32 year old male died during the swim of the New York City Triathlon the previous weekend.

Why do well-conditioned athletes die during the swim portion of the three discipline event, rather than during the more hazardous cycling portion or when they are more fatigued on the run? As aquatics safety expert Tom Griffiths has said, “good swimmers don’t really drown—they die of other specific causes, known as ‘drowning triggers,’ that predispose them to death in the water.” The trigger that commonly causes these mysterious drowning deaths is Jervell and Lange-Nielsen syndrome and Romano-Ward syndrome, which cause their sufferers to develop a sudden abnormal heart rhythm as a response to exercise or stress. These abnormalities can occur for no known reason in people who have “long QT” syndrome (“LQTS”), which refers to an interval seen on an EKG (electrocardiogram). Not everyone who has LQTS will develop a dangerous heart rhythm. However, when this does happen, it can be fatal.

Sports and recreation programs that include swimming pools, swim teams, water polo, diving, triathlon, open water swimming and recreational swimming may face drownings despite vigilant efforts of prevention. In reality these drownings may be better characterized as pool or ocean deaths, as they are related to the swimmer’s health condition rather than negligence by lifeguards, event directors, facilities or facility managers.

The Sudden Arrhythmia Death Foundation (SADS) mission is to “save the lives and support the families of children and young adults who are genetically predisposed to sudden death due to heart rhythm abnormalities.” SADS website, http://www.sads.org, explains that as part of their work they do the following:

• Advocate for individuals struggling to find answers due to the unexplained death of a loved one
• Provide referral to and assistance with research projects
• Work with other organizations – nationally and internationally – to advocate for measures beneficial to families and patients (AEDs in community, etc.)

Sports and recreation programs should consider partnering with SADS in their quest for safe swimming. One of the important elements in risk management for swimming is providing information to athletes and their parents, lifeguards, event organizers, coaches, athletic directors and facilities managers. SADS is an important resource for obtaining information and getting the word out about this unfortunate and serious medical condition. If athletes and parents are educated about LQTS, they are more likely to undergo testing to determine if they have the condition. If it is identified, medication might be prescribed that could prevent an untimely death during swimming.

Education about LQTS should also make lifeguards more aware of the risks to good swimmers, so that they focus their attention equally on all of their charges. This condition also provides further justification for investing in AED’s and associated training programs. With such awareness and tools for rescue and prevention, these mysterious drowning deaths can be reduced or eliminated.