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    Nearly all of the deaths you studied occurred during the swimming events. Did this surprise you, given that swimming is the first leg of the triathlon and, presumably, the athletes are not suffering from the heat or from exhaustion at this point in the competition? Yes, exactly. We were first surprised by this but I note this trend continues beyond the end of our study also in several non-sanctioned races we did not formally look at.

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    While at first I was surprised, it does make sense for a number of reasons: first, the adrenaline surge and pure number of athletes entering the water at the same time; second the fact that I suspect many athletes come from a background in running or other sports and may be less adept at swimming; third, swimming in a triathlon is totally different sport than doing some laps in the pool due to variability of extremes of waves [as well as] people swimming around you and on top of you; fourth, the inability to rest properly if needed or call for help as you could do in the marathon and bike [segments]; and, fifth, the difficulties in being noticed if the swimmer is in trouble due to the number of athletes in a body of water, which is not transparent.

    I think these are some of the factors that are related. It would appear that most of the deaths that you studied were the result of cardiovascular abnormalities. How is it possible to train for a triathlon without such problems arising well in advance of the competition?

    We don't know the death rate while training for a triathlon.

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    I know deaths have occurred but I agree it's probably less than the triathlon itself. I suspect the adrenaline rush with competition and the above factors contribute. Why are the swimming events so dangerous from the perspective of cardiac arrest? I think because of the delay in identification and rescue and the time to get to dry land to use resuscitation equipment.

    Time matters with resuscitation. What can be done to improve the safety of triathlon competitors? First, knowledge of risk of the race for the competitors will be helpful and hopefully allow people to take training seriously, especially for the swim. Second, if there are any concerns regarding suitability of the competitor, such as symptoms with training of chest pain, shortness of breath, syncope passing out , family history of cardiac disease or—in athletes of older age—other cardiac risk factors.

    Each of the people in these groups should be fully evaluated before participation. Whether races can mandate pre-op exams or more testing similar to what is done for high school and college sports and whether that would make a difference is unknown.

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    Third, I know many race directors are interested in making races safer through the number of people on the water, staggered starts, et cetera. These efforts should help. Another question is whether some minimal proficiency for open-water swimming should in some way be evaluated prior to enrollment in the race.

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    Larry Greenemeier is the associate editor of technology for Scientific American , covering a variety of tech-related topics, including biotech, computers, military tech, nanotech and robots. You have free article s left. Already a subscriber?

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