Coroner’s inquest into Manly Sea Eagles player Keith Titmus finds he died after ‘inappropriate training’

A coroner has concluded a promising NRL star fatally collapsed after an “inappropriately difficult” pre-season training session following a weeks-long investigation 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 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 preseason session of the year, which included both an outdoor session and an indoor session in a “hot and stuffy” gym.

The inquest was told that Titmuss had gained four stone during the off-season and that his fitness test results suggested he was “the least fit member of the team”.

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.

Lee found that the combined risk factors meant the training session was more difficult for Titmuss, who was then “at higher risk for 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.

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 said Mr Titmuss’ collapse came just two years after Manly star Lloyd Perrett survived a “near miss” when he collapsed from heat exertion during training.

Lee recommended the NRL use Mr Titmuss’ death as a case study for education and to raise awareness of heat illness.

It made recommendations on how to improve the NRL’s heat policy which is linked 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 modify training sessions based on environmental factors.

He also endorsed a mandatory two-week acclimatization period after players return to training following an offseason and suggested a requirement for a medical officer to approve strength and conditioning training programs.

Another key focus should be to implement screening to determine which players were at risk of heat illness and classify them to ensure tailored training sessions, the coroner said.

It also implemented a request from Mr Titmuss’ family that the NRL enforce mandatory reporting of all heat-related injuries to create a comprehensive understanding of the pervasiveness of the problem.

Titmuss’ 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 findings of this research are instructive not only for the NRL but for the sport in Australia and around the world.”

At the time of his death, Titmuss was on the cusp of his big break, having been elevated to the team’s top 30.

Outside the New South Wales State Coroner’s Court, Manly chief executive Tony Mestrov stated that 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 this to happen again under Manly’s watch.”

His mother wiped away tears in gratitude for the coroner’s recommendations when she spoke to media outside court on Friday.

She said it had been “very heartbreaking” to hear the details of her son’s last moments during the inquest.

“They’ve spent years trying to understand the cause of death and now we know,” Mrs Titmuss said.

“We are happy with the recommendations and hope that everyone involved will adopt them.”

He said his son’s family and “trusted tribe of good friends he has had since kindergarten” hoped the NRL would implement the suggestions and not “underestimate the impact of the heat”.

“Keith loved life and he loved rugby league,” his mother said.

“He really wanted to make his mark on the world of rugby league.”