Coroner finds Manly rising star died after 'inappropriate' training, calls for heat policy changes
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A coroner concluded a promising NRL star fatally collapsed after an "inappropriately difficult" pre-season training session after a weeks-long inquest into the sudden death. Keith Titmuss lost consciousness immediately after a 139-minute training session at the team's headquarters on Sydney's northern beaches on November 23, 2020. On Friday, Deputy State Coroner Derek Lee concluded the 20-year-old had died of exertional heat stroke after an inappropriately difficult training session. He had been training for more than two hours in the first pre-season session of the year, which encompassed both an outdoor session and indoor session in a "hot and stuffy" gym. Bennett grilled on future at Souths | 11:41 The inquest was told that Mr Titmuss had gained four kilos during the off season and his fitness test scores suggested he was "the least fit member of the squad". Experts told the inquest that Mr Titmuss' higher body mass and lower aerobic fitness levels were risk factors that contributed to him overheating from exertion on the "mild" 24C day. Mr Lee found the combined risk factors meant the training session was more difficult for Mr Titmuss, who was then "at greater risk of heat illness". The evidence showed the young forward was likely experiencing involuntary dehydration by the time he entered the "very hot, very humid" indoor gym. One of the paramedics who treated the 20-year-old while he was seizing measured his temperature at nearly 42C, which was the highest they'd ever seen. Mr Lee found Manly staff and paramedics had both reacted appropriately when treating Mr Titmuss' alarming collapse and subsequent seizures. "There is no evidence to suggest anything more could have been done by those immediately present," he said. He determined the application of ice packs to the collapsed player "would not have resulted in any significant reduction in Keith's temperature" but could have presented a risk of injury. The inquest was told Mr Titmuss' collapse came just two years after Manly star Lloyd Perrett survived a "near miss" when he collapsed from heat exertion during training. Mr Lee recommended that the NRL use Mr Titmuss' death as a case study for education and to raise awareness around heat illnesses. He made recommendations about improving the NRL heat policy that is tied to an ongoing independent review by two heat illness experts commissioned by the NRL. He said the NRL should clarify heat guidelines applicable to indoor and outdoor training sessions as well as alter training sessions based on environmental factors. He also endorsed a mandated two-week acclimatisation period after players return to training from an off-season and suggested a requirement for a medical officer to sign off on strength and conditioning training programs. Another key focus should be implementing screening to determine which players were at risk of heat illness and classifying them to ensure tailored training sessions, the coroner said. He also implemented a request from Mr Titmuss' family that the NRL enforce mandatory reporting of all heat-related injuries in order to create a comprehensive understanding of the pervasiveness of the issue. Mr Titmuss' mother Lafo previously said she hoped the inquest could lead to changes for the sport her son loved so much. "We are encouraged (by) the NRL's internal review and its commitments to enhancing its knowledge and understanding across all clubs, staff and players," she said. "We hope the findings from this inquest will be instructive not just to the NRL but to sport across Australia and worldwide." At the time of his death, Mr Titmuss was on the cusp of his big break, after being elevated to the club's top-30 squad. Outside the NSW State Coroners Court, Manly chief executive Tony Mestrov declared the club would fully adopt the recommendations handed down by the coroner. "This can't happen again in the game, we all understand that," he said. "We don't want it to happen under Manly's watch ever again." His mother wiped away tears as she welcomed the coroner's recommendations when speaking to the media outside the court on Friday. She said it had been "very heartbreaking" to hear the details of her son's last moments during the inquest. "It's been years in the making of understanding the cause of death and we now do," Ms Titmuss said. "We're happy with the recommendations and we hope that all involved will take (them) on". She said the family and her son's "trusted tribe of good friends he's had since kindergarten" all hoped the NRL would implement the suggestions and not "underestimate the impact of heat". "Keith loved life and he loved rugby league," his mother said. "He was so looking forward to making his mark on the rugby league world."