Fran Crippen, a medal-winning open-water swimmer on the U.S. national team, died on Saturday during the FINA Open Water 10-kilometer World Cup in Fujairah, south of Dubai. When Crippen did not finish the race, a search was launched and the 26-year-old was found just 400 meters from the finish.Initial reports said that Crippen had died from a heart attack or from heat exhaustion, however an official cause of death has not been released. Race officials said a medical report and autopsy had been completed but declined to release details.
Concerns have been raised about the swimming conditions of the race. Although the local FINA () officials claim that the water temperature was in the low 80′s, others claim that the temperature outside was 100° and the water temperature was 87°.
The winner of the race, German Thomas Lurz, has said: “The water was amazingly hot…There were many swimmers who had serious problems in the water.” In fact, three other swimmers – two U.S. women and one Brazilian – were taken to a hospital. All were to be released by Monday.
Crippen’s sister, swimmer Maddy Crippen, speaking on said her brother had safety concerns about FINA events: “The one thing that I do know is that in the months leading up to this event my brother had written letters to different organizing committees about safety, the number of people that were there, the doctors that should be there, the support staff and the lack thereof.” She plans to honor her brother’s legacy by continuing his push for greater safety measures in long distance races.
The sports medicine of open water swimming is something I certainly haven't thought much about, but brings up some unique issues. According to
"Open Water swimming presents a unique set of challenges to swimmers. There are no lane lines, walls, or starting blocks to dictate what it takes to win. The elements often play a deciding role in determining the winner of an Open Water event. The unpredictable conditions also make it possible for women and men to compete along side one another. "An excellent presentation by Dr. Jim Miller on the outlines some of the medical conditions to which open water swimmers may be subject.
Hypothermia: Ranging from mild (body temperature 99-91F°) to severe (body temperature less than 86 F°). Symptoms will range from shivering with mild cognitive impairment to coma, falling blood pressure, and life-threatening cardiac irregularities. Treatment for mild hypothermia includes simple re-warming by blankets (especially solar blankets) and removal from the exposure. With increasing hypothermia, evacuation should be undertaken, although aggressive rewarming may not be warranted in moderate hypothermia, as it can cause shunting of cold blood into the core, further dropping the core temperature.
Hyperthermia: A number of heat illnesses exist including:
Heat stroke – Heat stroke is the most serious heat-related illness. It occurs when the body becomes unable to control its temperature: the body’s temperature rises rapidly, the sweating mechanism fails, and the body is unable to cool down. Body temperature may rise to 106° F or higher within 10 to 15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not provided. Warning signs of heat stroke vary but may include the following:
- An extremely high body temperature (above 103° F),
- Red, hot, and dry skin (without sweating)
- Rapid, strong pulse
- Throbbing headache
- Dizziness
- Nausea
- Confusion
- Unconsciousness
Heat syncope -- body temperature above 40° C (104° F) with fainting. Often considered an earlier stage of heat stroke
Heat edema -- swelling of the extremities associated with exposure to high temperatures
Heat cramps – Muscle pains or spasms that happen during heavy exercise in hot weather.
Heat tetany – Usually results from short periods of stress in intense heat. Symptoms may include hyperventilation, respiratory problems, numbness or tingling, or muscle spasms.
Treatment of the above conditions will obviously depend on the severity of symptoms. Heat stroke is a medical emergency, requiring transport to a medical facility where gradual central cooling can be done with close monitoring of the potential effects of multi-system damage. Less severe heat illnesses are treated with removal from the heat and rehydration with attention to electrolyte loss.
Hyponatremic Collapse: Hyponatremic collapse is a common and potentially serious complication of long distance open water swimmers. Fluid overload is the likely etiology. According to a 2008 article in Emergency Medicine Australasia, : "Fluid intakes are typically high in athletes who develop hyponatremia, although hyponatremia can occur with relatively modest fluid intakes. The development of fluid overload and hyponatremia in the presence of a modest fluid intake raises the possibility that athletes with this condition may have an impaired renal capacity to excrete a fluid load." Symptoms include a loss of central nervous system function, ranging from decreased coordination and verbal capacity to coma. This is also a medical emergency and needs to be transported to a care center for treatment.
Stings and Bites: Open water swimmers can be subjected to a number of injuries from "wildlife" such as jelly fish, Portuguese Man-O-War, sea lice, sea snakes, venomous shells, octopus (spotted), and coral, not to mention sharks, rays, and turtles. Stings from jelly fish, Man-O-Wars and sea lice are described as searing localized pain, with localized red spots. Systemic symptoms can also occur, including nausea, vomiting and hives. Treatment includes spraying the affected area with white vinegar as soon as possible. Adolph’s meat tenderizer (Bromelain which is one of two protease enzymes extracted from the plant family Bromeliaceae) can also be considered. Do not rub the site, since this will release more of the contents of the imbedded darts. In severe allergic reactions, an epi-pen can be used. Sea lice can be treated by lightly applying rubbing alcohol.Chafing: Chafing is caused by prolonged exposure to water, salt and waves. It is a true laceration, and as such is prone to infection and the same complications as any other laceration. The most common locations include suit lines, shoulders, armpits, inner thighs, and the back of the neck. Prevention is important with the use of lubricants such as lanolin, Vaseline, Body Glide or Bag Balm. Treatment includes topical antibiotics with staph activity, although neosporin should be avoided because of its susceptibility to causing cutaneous sensitization.