Loved ones of Manly Sea Eagles rising star Keith Titmuss have finally received answers about his death more than three years after he collapsed during pre-season training.
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 that 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 included both an outdoor session and an indoor session in a ‘hot and stuffy’ gym.
Keith Titmuss (pictured) died after collapsing during pre-season training with Manly in November 2020.
The Sea Eagles forward was just 20 years old when he died after what one corner has called an “inappropriate” level of exercise.
The investigation found that Mr Titmuss had gained four stone during the off-season and his fitness test results suggested he was “the least fit member of the team”.
Counsel assisting the coroner, Adam Casselden SC, said the “unnecessarily and inappropriately harsh” session highlighted the need for individualized training programs tailored to each player’s build and fitness level.
Experts told the inquest that Mr Titmuss’ greater body mass and lower levels of aerobic fitness were risk factors that contributed to him overheating from exertion on the “mild” 24C day.
Coroner Lee found that the combined risk factors meant the training session was more difficult for Titmuss, who was then “at increased risk of heat illness”.
Evidence showed the young striker was likely experiencing involuntary dehydration when he entered the “very hot and very humid” indoor gym.
One of the paramedics who treated the 20-year-old while he suffered seizures measured his temperature at almost 42C, which was the highest they had ever seen.
Titmuss (pictured playing for Hunters Hill rugby club as a teenager) recorded a temperature of 42 degrees before he died, and paramedics said it was the highest they had ever seen.
The promising striker had been training for more than two hours, with part of the program carried out in a “hot, sweltering gym”, before suffering heatstroke.
Coroner Lee found that both Manly staff and paramedics had reacted appropriately in treating Mr Titmuss’ alarming collapse and subsequent seizures.
“There is no evidence to suggest that those immediately present could have done anything else,” he said.
It determined that applying 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 into Mr Titmuss’ collapse came just two years after Manly star Lloyd Perrett survived a “near miss” when he collapsed from heat exertion during training.
In his closing submissions, Mr Casselden suggested Coroner Lee should recommend that Manly and the NRL use Mr Titmuss’ tragic death as a case study for heat illness education and awareness.
It made a series of recommendations on how to improve the NRL’s heat policy which are linked to an ongoing independent review by two heat illness experts who were commissioned by the NRL.
Titmuss’ devastated father Paul and mother Lafo (pictured) hope his death will result in major changes by the NRL.
Casselden suggested clarifying heat guidelines applicable to indoor and outdoor training sessions, as well as modifying training sessions based on environmental factors.
He also backed a mandatory two-week acclimatization period after players return to training following an offseason and a requirement that a medical officer approve training programs.
Another key focus should be to implement screening to determine which players are at risk for heat illness and classify them to ensure personalized training sessions, Casselden said.
Mr Titmuss’ family called on the NRL to enforce mandatory reporting of all heat-related injuries to create a comprehensive understanding of the pervasiveness of the problem.
Titmuss’ family and supporters wore T-shirts in his honor as the coroner heard the case (pictured).
His mother, Lafo, previously said she hoped the investigation could lead to changes in the sport her son loved so much.
“We are encouraged by the NRL’s internal review and its commitments to improving its knowledge and understanding among all clubs, staff and players,” he said.
“We hope the results of this research are instructive not only for the NRL, but for the sport across Australia and around the world.”
At the time of his death, Titmuss was on the cusp of his big break after being elevated to the team’s top 30.
Throughout the investigation he was described as “kind”, “gentle” and “a genuine guy”, “hard-working” and liked by his teammates and friends.