'Hottest ever' training: Manly teammate tells inquest into Titmuss death

Manly player Keith Titmuss likely died after not receiving adequate treatment for exertional heat stroke at a training session with the NRL club, an inquiry has heard.

The 20-year-old's sudden death was probed during an inquest that began on Monday, more than three years after the emerging talent fell ill at pre-season training.

Noting body cramps while stretching after a cardio workout, Titmuss suffered a seizure at the club's base at Narrabeen, on Sydney's northern beaches, on November 23, 2020.

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He died five hours later at Royal North Shore Hospital after being taken there in an ambulance.

While an autopsy was unable to ascertain the cause of death, counsel assisting the coroner Adam Casselden SC told the court that Titmuss most likely suffered exertional heat stroke, a life-threatening condition.

Paramedics who arrived at the scene noted Titmuss' temperature was 41.9 degrees, while his heart rate was over 140 beats per minute (bpm).

Casseldon added that paramedics took the temperature three times because they could not believe his body had exceeded the average by almost five degrees.

"I did not believe it. I'd never seen a temp like this before," one paramedic said in their submission.

"You could literally feel the heat radiating off him."

Teammate and childhood friend Joshua Schuster said their indoor training facility did not have air conditioning.

The facility had large cooling fans but they were not turned on while the doors remained closed.

"It was worse (inside). It was probably the hottest I've ever been in it," he told the inquest attended by Titmuss' family.

Coaching staff and medical practitioners did not identify that Titmuss was suffering from heat stroke.

The inquest was told no ice packs were used, with one physician giving the young athlete a paper bag to treat hyperventilation.

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Former Manly prop Lloyd Perrett collapsed in similar circumstances in 2017 but survived when then-chief medical officer Luke Inman treated the player for heat stroke.

Like Titmuss, Perrett exhibited a body temperature of over 40 degrees, while he had a heart rate above 160bpm.

After the defibrillator showed no problems with the player's heart, Dr Inman told the inquest he placed ice packs on areas with large arteries to cool Perrett.

"Without the education, it's extremely difficult (to diagnose) even for a doctor," he said.

"But if the defibrillator shows there's no need for resuscitation, there's a high chance it's heat stroke.

"If it's not detected or treated, they're dead after 20 or 30 minutes.

"They'll cook internally. It's nearly impossible to get them back after that point."

Titmuss died three days into his time as a member of the club's top-30 NRL squad.

He had been a rising star at the club, having delivered the Sea Eagles their maiden Holden Cup title in 2017 with the match-winning try on the siren to beat Parramatta.

"Keith was highly respected by his teammates and coaching staff. He was also loved for his gentle and kind nature and he was a true team player," Peggy Dwyer SC told the court on behalf of Manly.

"He was a huge talent, with a natural gift for the game he loved so much."

Former teammates Moses Suli, Sione Fainu and Ben Trbojevic will give evidence to the inquest on Tuesday.