Monday, June 30, 2008

Tragedy and Responsibility

First of all, I'd like to report that all of my Team in Training athletes had a terrific race, despite the heat at Pac Crest this weekend. I have a ton of pictures and I'm sure a lengthy write-up about our experiences there, which were overwhelmingly positive.

But before I tackle that, I feel compelled to write about the tragedy that unfolded before my eyes as I stood on the boat ramp ready to cheer my team on. At the transition area on the day before we cheered on the TNT half-Ironman participants, and one of my teammates (a nurse) and I had noted the lack of an ambulance and water safety crew (we also noted the heat and the utter lack of water for athletes at this very remote swim start). It was especially notable considering that the last triathlon we'd attended together (the Duck Bill Chill, a much much smaller race) had an ambulance, medic unit, and an paramedic/water safety crew standing by. The water safety medics (five or six of them) were literally standing on the beach at the swim start at that race.

So here at Pacific Crest I'm standing on the boat ramp at Wickiup Reservoir with camera in hand ready to catch all of my TNT athletes. A 45 year old male athlete comes in limp on a jet ski (according to the swimmer who aided him out of the water, he was waving arms frantically and then assisted onto the jet ski). At the top of the ramp, I hear a woman running up and down through the spectators asking if there is a doctor or a nurse among them. WTF??? Where are the trained medics? ambulance? emergency crew? First aid volunteers give CPR. I did not see an AED (Automated External Defibrillator) onsite (which signifigantly improves the possibility of survival of a cardiac arrest if used in the first 5 minutes or so). There is no ambulance. What feels like a very very long time later, they move aside spectators to bring in an ambulance. I don't know how much time had passed, but I know it was way too long to keep a guy alive on basic CPR with no oxygen, and no other aid equipment.

And the worst part of it is all of this is almost identical to the incident in 2005 in which a 41 year old athlete died with an ambulance not arriving for half an hour. The circumstances are eerily similar. Yesterday, I stood next to the victim's family member as she frantically tried to reach his wife, shook, and cried. It was just horrifying. From the race entrants listed on AA Sports pages, this man was part of a relay team that also included a 12 year old boy of the same last name. As an athlete almost the same age, with a son almost the same age, I can't imagine the tragedy that this family is dealing with today. My heart goes out to all of them.

I have no idea if an ambulance could've saved this man's life, and I don't think anyone will ever know for sure. But I do know that statistically the sooner you can get appropriate medical care, the better your chances are, and this man went a very long time without such medical care.

I do wonder and have questions about the responsibilities of race directors towards their participants. I've read the waivers we all sign, that it's a dangerous sport and we can't sue no matter what, but even with all of that I think there's some responsibility to provide basic emergency care, especially at an event that takes place 30 miles from the nearest medical facilities and ambulances.

Additionally, another participant I know in the overwhelmingly HOT half-Ironman was told that the medical tent ran out of IVs and they would have to go to the hospital to get one. They finisher's tent also was completely out of water and sports drink when I visited my athletes there, as was the race start.

I'm just processing all of this mentally, being a spectator to a fatality. I wonder how far we can reasonably expect race directors to go. I wonder why a race with only 100 participants charging $60 apiece like the Duck Bill Thrill can afford an ambulance onsite, while an "Event Weekend" with hundreds of participants at $75 apiece (Oly) and $225 apiece (HIM) cannot. I'm wondering how an athlete can die in a race and then another athlete can pass away a few years later in the same circumstances without anything happening in between to increase the safety of participants. I'm wondering how much as athletes we are supposed to just suck up the dangers, and how much the race should be responsible for in terms of adequate medical care.

Additionally, I saw this on Tales from the Tube : According to the Deschutes County Planning Department the organizers of the triathlon did not apply for a Outdoor Mass Gathering Permit which is required by Deschutes County Code 8.16.240. According to that code, "each Outdoor Mass Gathering or Extended Mass Gathering shall have as a minimum one ambulance."

9 comments:

Robin said...

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Steven said...

Hi Robin!
Thanks for visting my blog and commenting on my Pac Crest RR...it was indeed a very tough day.

I am so with you on the need for medical staff at Wickiup. It is so far from everything that the chances of surviving a heart attack or other major problem are nil.

I cannot believe that the Atherton's haven't learned their lesson by now with two deaths in three years there. I would expect to an ambulance at the boat ramp from here on out. We can only hope.

Take care and stop by the blog from time to time. I'll do the same.

Trihardist said...

I can't believe that this is a TNT race. I would expect a TNT race to be very, very well-set-up, like Wildflower or Philadelphia.

This is beyond sad; this is completely disappointing. I want to believe that our community is better than this.

TriestoTriMom said...

I am disheartened to see so many misleading and misinformed bloggers out here. I too was at the event with my husband and kids, and we all participated in events. I happened to be in that tri, and my perception was seeing Mr. Findlay raise his arm, and meet the boat. I thought he was resting or coming in, and kept swimming. While spotting the next buoy, I saw him across the jet ski. I didn't see anything coming out of the swim as I was focused on getting to my bike.

Here is where what appears to misinformation comes in: according to a source at AA Sports, there WAS an AED at the scene, as well as medical personnel. An abulance, no, but trained professionals and an AED purchased by Carol (one of the race directors) and brought to every event, yes.

Think of how torn up everyone is about this - you, me, and we don't really even count. The family? My god what they must be going through. The race volunteers that tried to save him? This will haunt them forever.

Point is - blogs are great ways to share information. BUT, if they are merely speculation, opinion or assumptions, they should be called out as such. The first blog that appeared - and by a journalist no less, is now off the net. Remember that many people take opinions as facts, and from there the story goes rampant.

Oh - and BTW - no water at the swim? You lost your credibility at that very point. There was a huge table of water and Heed right as you walked into the staging area. Get the facts, form your opinion, and post it as such. Let's call it social responsibility.

Robin said...

TriestoTriMom, I'm just a blogger stating my own perceptions of an event. Whether or not AA sports states that they had medical personnel onsite, what I saw and heard was people frantically racing through the crowd calling out for a nurse or a doctor. What I saw was volunteers assisting someone. What I saw was an absence of an ambulance and medics.

As for the water table, if you'd like I can post a photo I took of it. It's a big table, with an empty water jug on it (I know, because one of my athletes tried to get some water from it), and a few scattered cups laying around the table (again, my athlete picked up several before finding one that still had a bit of Heed) in it, and this athlete was one of the first to come out of the water. Whether or not there was a big table, it didn't have enough water and Heed on it for the number of athletes there. A few cups is not adequate.

Again, my goal here is not to be a muckraker, but to get us athletes thinking and talking about what is and is not acceptable in races we choose to participate in. Again, I have no idea whether or not better medical attention would've saved the life of this particular athlete, but you can bet I won't be signing up for any races that don't have an ambulance and medical support at the water, and I would not recommend such races to anyone I coach either.

jenyen said...

Hi Robin,

I was at Pac Crest too! I'm part of TNT Silicon Valley in California. Good job at the race!

http://www.active.com/donate/tntsvmb/jenyen2008

Nancy Toby said...

Very sad sad story.

There have been a number of deaths in the water in the last few years in triathlon. I'd be interested in seeing the numbers compiled. Everyone seems to take an "it can't happen to me" approach, but I don't think that cavalier attitude is justified.

Tom said...

You’re right; this is your “blog”, and a great way to share information of common interest. I was one of onsite medics for AA Sports at Wickiup Reservoir for both days of the Pacific Crest Triathlon. We apparently saw the event from different views. I was not in any specific uniform, but my shirt looks like a standard AA Sports blue pullover, except that it says “Medical,” instead of “Manager.” I may have been difficult to see me because of the number of participants and spectators that came forward to offer assistance. This was amazing. As Mr. Findlay was brought ashore and placed on the boat ramp, hands were right there checking for a pulse, positioning his head, checking for breathing, and readying to start chest compressions.

I have been teaching first aid and CPR for 30 years and have always wonder how much impact I was having when teaching a basic class to the public. The percentage of people that have received CPR training is phenomenal. There were nearly a dozen people that rushed to help, and while there was some discussion as to what to do, the basic response remained the same. The training kicked. Here was a group of people that for the most part had never met, that came together to try to save a life.

While CPR was started I prepared the AED. Once the pads were in place, everyone stopped and waited for the computer in the AED to analyze the rhythm. “No shock; resume CPR,” came the response. CPR resumed. We had an oxygen tank on the ramp in a non-descript case. In the shuffle, the case disappeared. It was not stolen; it had been pushed out of the way and over the edge of the ramp. I found it after the rescue concluded.

Our bystanders were doing excellent CPR. We had distal pulses and I could hear air entering the lungs as I listened with a stethoscope. Re-checks were made and the AED analyzed the rhythm; still, “No shock.”

With proper CPR in progress, and relief volunteers backing up those doing compressions and using the bag/mask resuscitator, I started to get information from the victim’s family about any medical conditions that might affect the rescue effort. I also reassured them that the ambulance had been called before he was brought ashore.

Were you one of the volunteers? I hope so, because there were so many, and they all disappeared back to their routines once the rescue concluded.

There was one group of young ladies, I believe with one of the Team in Training groups, who approached me and asked if they could stand in a certain area near the rescue. I thought it was awfully close to the scene. However, their secondary intent was to provide us with a shield that blocked the view from the other swimmers and kept them on the mats heading up to the arch. Great idea; I didn’t think of it. Thanks.

The wait for the ambulance was long, but longer for those working on Mr. Findlay. Two people could not have kept it up; the volunteers were essential. Why no ambulance on scene? That was a staffing problem with the La Pine Fire Department. AA Sports offered to cover the expense, but they just did not have the staffing for a second ambulance over the Pacific Crest Weekend, and their primary responsibility was to the town of La Pine. An EMT team with a resuscitator, oxygen, and an AED is a good start. A trauma center in the parking lot would be a dream. There are no private ambulance services operating in Central Oregon; jurisdictional boundaries prevented other options.

Since Sunday I have heard a variety of uninformed comments. There was one “blog” that opinioned that the AED reported “No shock” because the victim was wet. This is absurd. This is not an issue for an AED. Diaphoresis (sweating) is common in heart attack victims. Such a concept implies that the AED could never work.

Another was that a chiropractor cannot legally provide emergency medical assistance. Why yes, I am a chiropractor. I am also an EMT, and have been since 1974. I am a first aid and CPR instructor. As an EMT, I developed the EMS program for Pacific Northwest Search and Rescue, one of Clackamas County’s primary search teams. I have completed training in sports medicine and have worked with athletic teams for nearly 20 years. I have also served as a Certifying Officer for Oregon DHS EMS program, helping to credential new EMT’s in Oregon. I believe I have a reasonable grasp on EMS.

I was also accused of doing nothing more than telling someone to call 911. You know, I did tell someone to call 911 as soon as I saw Mr. Findlay’s general appearance 50 yards offshore. I guess the rest of the “stuff” I described above was nothing.

The common complaint has been that there were no medical personnel at the lake, and if it was not for the bystanders this incident would have been a total disaster. That statement has a “ring of truth” in that if it were not for those bystanders, we (the medical team) would not have been able to do what was done for Mr. Findlay. Those unselfish individuals gave their best, and helped us give ours. This was a community effort. I may have been part of the “official” medical team, but those volunteers were a very essential part of our team as well. We had a single goal, to try to save a life. That failure is depressing, but the “team effort” was a success. That should be the focus of discussion, the willingness of people to come to the aid of another person.

Tom Freedland

Robin said...

Tom, I think it's awesome that you and all the volunteers involved provided such excellent care at such a critical time. And I know what a mental toll participating in such a rescue takes on the people involved, especially in such sad circumstances where the life cannot, ultimately, be saved.

I don't think it's mutually exclusive to both be appreciative of all of the staff and volunteers who worked so hard to save Mr. Findlay, and also to be concerned about the fact that transport to a medical facility took so long. I also personally curious why Air Life wasn't called, a helicopter ambulance that operates within 100 miles of Bend.

My viewpoint on this is colored by over 20 years in the sport of triathlon and attending so many different races in different venues. And while I have many many good things to say about AA sports and so many of their races (many of which I have recommended to those I coach), I have to say that I believe if this ambulance situation really can't be remedied (due to jurisdiction, etc.) after two similar deaths at this lake, then this is not a race I would ever choose to do, or recommend to any other athlete.

And again, many thanks are in order to you and everyone who tried in whatever way to help the victim in this circumstance.