Paramedics called to give evidence over Manly player Keith Titmuss’ death

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Veteran paramedics who rushed to help treat Manly Sea Eagles player Keith Titmuss before his tragic death have described “chaotic” and “extremely challenging” scenes.

The young forward died in hospital after suffering seizures following a cardio workout at the club’s base at Narrabeen, on Sydney’s northern beaches, on November 23, 2020.

A coronial inquiry into the incident was told the 20-year-old’s death was determined to have been the result of exertional heat exhaustion, which likely caused the seizures.

Appearing before the court on Tuesday, NSW Ambulance paramedic Grant described an “extremely challenging” environment and was grilled over the fast-paced treatment.

“It was a very chaotic scene. There was a lot going on,” he said.

“While the patient was seizing he had uncontrollable movement of his arms.

“My main priority was to get that seizure activity under control, that was my sole focus.”

The court was told another paramedic at the scene recorded Mr Titmuss’ temperature as 41.9C, the highest he said he had ever seen in his time with the ambulance service.

Questioned whether paramedics could have applied ice to cool Mr Titmuss down before he was relocated to an ambulance, paramedic Grant said it was not practical.

“Putting ice packs on a patient is not going to do anything … when he has got full body movements, they are not going to stay there and cool effectively,” he said.

“My focus when I was with Keith was to get that seizure activity under control, then I could focus on other things. Until that was under control, it was my sole purpose.”

The paramedic said that according to their training and in response to Mr Titmuss’ seizures, his priority, even inside the ambulance, was to ensure his airways were clear.

The court was told emergency personnel also prioritised administering intravenous fluids to the young forward, and that the seizures also likely exacerbated the heat stroke.

Both paramedics told the court that inside of the club’s “tin shed dojo” was hot and “oppressive”, causing them to sweat while administering assistance.

Seasoned intensive care paramedic Simon O’Brien, who arrived after the first team, was questioned whether others present at the time could have helped paramedics.

The court was told a number of other players were present at the gym, having helped Mr Titmuss when he began seizing, as well as a doctor and two physiotherapists.

Asked if it would have been appropriate to have asked for their help in applying ice, Mr O’Brien told the court: “You have to think about the safety of the patient.

“Whilst I appreciate what is being asked, someone might get injured. The patient might get injured. These are factors that are going to exacerbate the situation.”

NSW Ambulance Associate Director of Clinical Practise, Marty Nichols, said while ice could have been applied in the ambulance, he backed the actions of paramedics.

“Based on what was presented in the initial treatment, the priorities they established of airway management, managing the seizure with a thought of moving the patient out to an ambulance, I still think that’s sound,” Mr Nichols told the court on Tuesday.

“From what I see of this case, the paramedics were prioritising the high value priorities. I don’t know how reasonable it would be for them to engage in the availability of ice.

“We rarely see a patient with this level of heat stroke. To ask someone with even less understanding to assist when they have back up on the way, I’d put it out of my mind.”

Professor Ian Seppelt was also called to give evidence on Tuesday.

He told the court both the actions of Manly Warrignah staff and the paramedics were “reasonable”.

He described the efforts of emergency service personnel in the ambulance as a “valiant last ditch attempt to save a dying 20-year-old”, and that they had “tried their hardest”.

Questioned over what lessons could be learned from Mr Titmuss’ death, Professor Seppelt suggested it was likely exertional heat exhaustion would be come more common.

He urged for better recognition of the symptoms of exertional heat exhaustion, including in sports environments and within recognition of an increasingly hot climate.

“It strikes me that Manly Warringah have had two cases in a few years and no other club has reported any similar incidents. Its clear we are going to see more cases,” he said.

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