Two former Manly players have described hearing their teammate Keith Titmuss screaming after a training session that led up to his sudden death.
Moses Suli and Sione Fainu gave evidence at an inquest on Tuesday, more than three years after emerging talent Titmuss fell ill during the Sea Eagles' preseason training.
The 20-year-old suffered a seizure after a cardio workout at the rugby league club's base at Narrabeen, on Sydney's northern beaches, on November 23, 2020 and died five hours later in hospital.
Suli and Fainu, both Tongan internationals who now play for St George Illawarra and Wests Tigers respectively, remembered the day of Titmuss's death being hot.
In a NSW Police interview played to the court, Fainu described the training session as a "nine out of 10" for intensity.
It was one of the first sessions back from the off-season break.
"It was hot, the sun was out on the field ... we were all saying 'we got this, we got this'," Fainu said, describing how the team would encourage each other through tough training sessions.
After training on the field for about an hour and a half, the team moved into the "dojo" where they continued another cardio workout.
Fainu said he heard Titmuss telling another teammate he had cramps when the training had finished, but he did not specify where in his body they were.
His next recollection was hearing Titmuss screaming.
Fainu and Suli told the court they could not see Titmuss as staff ushered them away, but both of them heard him.
Current Manly player Ben Trbojevic described Titmuss as a genuinely nice bloke who was humble and softly spoken.
He did not recall the day of his death as being particularly hot, and that it was overcast.
The players were encouraging each other to get through the training session, Trbojevic added.
"Footy is a tough game and it's all about making decisions under fatigue, we were pushing each other (in training) and saying 'keep going'," he said.
"Every session is hard in its own way."
Trbojevic was paired with Titmuss for part of the training in the dojo and said he encouraged his teammate to keep going.
"It was tough, we were all under fatigue," Trbojevic said.
"Looking at (Titmuss), he looked like he'd done a hard session but we all looked like that."
Asked if the Sea Eagles had a culture where it would be "frowned upon" if players had to sit out of training due to finding it too difficult, Trbojevic said he didn't think so.
"It's not from the coaching staff but more myself - I wouldn't want to miss a session and let my teammates down," he said.
While an autopsy was unable to find the cause of death, counsel assisting the coroner Adam Casselden SC told the court on Monday Titmuss most likely suffered exertional heat stroke.
Paramedics who arrived at the scene noted Titmuss's temperature was 41.9C, while his heart rate was over 140 beats per minute.
But coaching staff and medical practitioners did not identify that Titmuss was suffering heat stroke, treating the symptoms of his seizure instead.
NSW Ambulance expert Anna Holdgate assessed the care provided to Titmuss and concluded it was appropriate given the multiple challenges paramedics were trying to address at the time.
This included that Titmuss was having a seizure, his oxygen levels and blood pressure were low, along with a high temperature.
"It is difficult for anyone who doesn't work in this field to understand the challenges of managing something like this," Professor Holdgate said.
"I'm not saying the care was perfect because care is never perfect, but I think it was appropriate given the challenges they were facing."
