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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 tragic 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.

There is a currently very popular saying in medical care circles that "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.

T 

I am speaking entirely anecdotally, but I would say that most triathletes are good enough at alternative strokes (such as backstroke, breast stroke, side stroke) that they probably don't need extra practice and can naturally turn to one of those strokes if necessary. Some of them (breast stroke notably) are hard to do in a wetsuit with long legs. And in most cases I think triathletes would want to get back to freestyle as soon as they feel comfortable.  That said, the better and more versatile a swimmer, the better for handling unexpected things in the water.

I have no plans to continue the dialogue per se, although I will be very interested to see where it goes in the triathlon community.  As I mentioned in the newspaper story, USA Triathlon earlier this fall appointed a five-person committee of experts to look in the deaths, their possible causes, and ways that everyone (athletes, race directors, coaches) can possible reduce them. I have learned that Triathlon America, the trade organization for this sport, is also looking into the problem in a very serious way with an eye to coming up with things that people and races can do that might reduce the risk.

You make many good points. Certainly people who enter open-water swims (such as the 4.4-mile Chesapeake Bay swim in this area) are more likely to have practiced open water swimming and are probably more comfortable with it than many inexperienced triathletes, some of whom (as you say) view the swim as a necessary evil that will take them to the next part of the race.  Certainly nobody can argue that practice and experience are likely to help, but the interesting thing about panic attacks is that even experienced triathletes report having them, and often after having done many races.  It is interesting to note that the New York City Triathlon (which had two deaths this year and one in 2008) now requires that an entrant attest or promise that they have or will do an open-water swim of a specified length before race day.

Most races already limit the field and sell out early (or, in the case of NYC, rely on a lottery).  Even with limited fields there are always going to be a lot of people in the water at the same time, and people are always going to be excited, and it's always going to be early in the morning, so most of the conditions that may contribute to panic are going to be hard to avoid.

Hard to say. Obviously practicing in the open water wit a wetsuit is essential before one does his or her first race, but it sounds as if your fiance has quite a bit of experience already.  It may sound hopelessly naive, but I think it's good for spectators to tell the person they've come to watch that they shouldn't do anything that seems dangerous just because there's an audience. In other words, it's okay to bail out.  It's a hard lesson for competitors, even run of the mill occasional triathletes to learn, but it's an important one.  There's always another day (except, of course, for these tragic victims in which there wasn't).

I think everyone needs to learn (and perhaps practice) ways to calm themselves down, which is a kind of auto-biofeedback.  Your way sounds like a good one (and a common one).

This is a problem but my impression is it is associated with deep diving, not so much with surface swimming. I also don't think (again, this is just my anecdotal observation) that triathletes in the swim leg are doing a lot of strokes without breathing, as would be the case in a sprint in a pool.

There is another, very unusual phenomenon that I should have mentioned in the article called "swimming-induced pulmonary edema" that has been seen mostly, but not exclusively, in military rescue and combat swimmers. Over-hydration, tight wetsuits (especially in the thigh) and some other things appear to be risk factors for this rare and only now being examined phenomenon. It is possible some of the swimming deaths might have had a component of SIPE in them.

I think many people think pool training is an acceptable proxy for the swim leg of a triathlon, especially a sprint triathlon.  I do not think it is. It is interesting to note that at least four of the deaths this last season occurred in sprint races, the shortest. I think some people are less likely to practice something they're a little scared of. It also isn't that easy to do. You need someone in a kayak or boat to go with you in open water. So it takes some organization.

It's impossible to tell whether disorientation or impeded sight lines played a role in these deaths. I'm sure poorly marked courses don't help. I know from my own experience that in ocean swims (parallel to the shore) in which the swells periodically make the beach invisible it can get kind of scary.

I do not know if there has been any research on whether there can be actual impedance of the breathing by a wetsuit.  My personal guess would be that wetsuits don't actually mechanically make it more difficutl to breathe. It is the sensation of having something bear-hugging your chest that can be frightening.

Interesting strategy. Hadn't really thought that synchronized swimming might be good training for triathlon.

I haven't looked into this but I got a number of interesting e-mails from scuba divers relating experiences like yours. There is obviously some similarity, although panic 30 feet down would seem to be a much more dangerous event.

I didn't look into the difference between trime trial vs. mass starts. That is another thing that needs to be studied and measured.