The mother of an up-and-coming NRL player who died following a pre-season training session says she hopes an investigation into his death can help save others.
Keith Titmuss lived his life with “absolute completeness", his mother Lafo told an inquest on Wednesday.
The 20-year-old suffered a seizure after a cardio workout at the Manly Sea Eagles base at Narrabeen, on Sydney's northern beaches, on November 23, 2020.
He died in hospital five hours later.
Titmuss most likely suffered exertion heat stroke, although an autopsy was unable to confirm the exact cause, the inquest was previously told.
Family and supporters watched on in the Sydney courtroom wearing black shirts bearing the number 623, Titmuss’s posthumously awarded Sea Eagles first-grade player number.
His mother said it was fitting her son’s player number sat between those of his mates, Josh Schuster and Jason Saab.
“Keithy loved Manly, he loved his brothers in arms on and off the field, and he loved and respected the training staff,” Ms Titmuss said.
“We sincerely hope the recommendations from this inquest will be instructive, not just to the NRL, but all codes across Australia and worldwide,” she said.
Ms Titmuss added the family was grateful for the inquest providing clarity and understanding about the events that led to her son’s death.
"We try to honour him each day by living our best lives … just thanking him for leaving us an imprint of fond memories," she said outside court.
Deputy State Coroner Derek Lee thanked the family for participating in the inquest.
“It’s extremely challenging and to be so generous, to share collectively your memories of Keith with a courtroom of people who are mostly strangers, I am very much grateful for that,” he said.
Mr Lee adjourned the inquest for oral submissions on March 22.
Earlier on Wednesday, specialist acute-care physician Simon Quilty said sporting codes should enforce a standard two-week acclimatisation period when players return from the off-season.
It was well-known there was a high risk of exertion heat stroke and heat illness in the first five days after players restarted training.
“That extends out to 14 days, so it makes sense that a 14-day period of acclimatisation should be a standard across all sporting codes, not just professional sporting codes,” he said.
University of Technology Sydney professor Aaron Coutts said all sports could benefit from a period of acclimatisation.
“You’d aim to build up to a full session over two weeks,” the sport and exercise science expert said.
Manly players had returned from the off-season to complete a 139-minute training session before Titmuss's death.
“It would be a very long-duration session and a large load for Keith to complete as the first training session of the year,” Prof Coutts said.
Titmuss had gained more than 4kg during the off-season and the expert said most of it would have been fat rather than muscle.
A lower aerobic fitness compared to other members of the squad may have also decreased the 20-year-old's ability to thermoregulate, Prof Coutts said.
An arterial blockage could also have compromised the young player's heart health, making it more difficult for him to recover from heat-related illness, Dr Quilty told the inquiry.
The expert spent several years working in the Northern Territory and published a study in 2021 suggesting only three per cent of heat-related deaths were identified as such.
“I don’t feel clinicians and first responders are adequately trained in recognising the implications of heat on illness,” Dr Quilty said.
But recent statements from the NRL’s chief medical officer Sharron Flahive showed some progress on the issue, he added.
“There’s a greater appreciation of the extent heat contributes,” Dr Quilty said.
