Rock Climbers’ Self-Perceptions of First Aid, Safety, and Rescue Skills

Rock Climbers’ Self-Perceptions of First Aid, Safety, and Rescue Skills

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  Wilderness and Environmental Medicine,  13,  238 244 (2002) ORIGINAL RESEARCH Rock Climbers’ Self-Perceptions of First Aid, Safety, andRescue Skills Aram Attarian, PhD From the Department of Parks, Recreation, & Tourism Management, North Carolina State University, Raleigh, NC. Objective.  —Rock climbing is a challenging and demanding sport that requires specialized equip-ment and training. One significant area of training involves being familiar with first aid and rescueskills. This study reports climbers’ self-perceptions of their first aid, safety, and rescue skill compe-tencies. Actual technical skills were not measured. Methods.  —Data were collected through a World Wide Web (WWW)-based questionnaire admin-istered over a 15-month period. The questionnaire requested information on respondents’ climbinghistory, first aid training, personal safety practices, and partner and self-rescue skills. Results.  —Two hundred forty-one climbers completed the Web-based survey. Findings showed thatthe majority of climbers reported receiving some form of first aid training, were attentive to personalsafety practices, and perceived themselves to be confident in partner and self-rescue techniques. Conclusions.  —On the basis of the results obtained in this study, it appears that training and spe-cialized skills are considered by rock climbers to be important components of managing risk. Key words:  rock climbing, first aid training, safety, rescue Introduction Over the past decade, significant growth and interesthave been shown in the adventure sport of rock climb-ing. The American Alpine Club (a nonprofit organizationfounded in 1902 to promote climbing knowledge and mountain conservation and to serve the American climb-ing community) estimates that there are currently300000 to 500000 active climbers in the United States. 1 Much of this growth can be attributed to media expo-sure; the development of newer, safer, lighter, and moreavailable equipment; and the growth of climbing pro-grams, indoor climbing walls, training and instructionalguides, and books. Other social and economic factorshave also played a significant role in the growth of thesport. 2 However, despite all of the advances in technol-ogy and safety during recent years, rock climbing re-mains an inherently dangerous activity, suggesting thattraditional safety practices may not be sufficient to pre-vent accidents. 3 Many fear that as rock climbing growsin popularity, accident and injury rates will increase. 4 For 54 years (1947–2000), the American Alpine Club Corresponding author: Aram Attarian, PhD, Department of Parks,Recreation, & Tourism Management, North Carolina State University,Box 8004, Raleigh, NC 27695-8004 (e-mail: aram   has maintained records of climbing accidents and fatal-ities. According to  Accidents in North American Moun-taineering, 5 a publication of the American Alpine Club,the average number of climbing accidents (ice, rock, and snow) reported annually in the United States was 104.5(range, 15–203). During this same 54-year period, themean number of climbers involved in climbing accidentswas 190 per year, resulting in an average of 89 injured climbers and 24 fatalities per year. Almost half of theaccidents reported involved a fall or slip on rock. 4 Dur-ing the past 12 years, a total of 1786 accidents werereported in  Accidents in North American Mountaineer-ing, 5 of which almost half (42%) were due to rock climbing. The number of rock climbing accidents re- ported for the past 12 years is listed in Table 1.Hazards and potential accidents in rock climbing can be minimized or reduced through the proper use of equipment, the development of good judgment, the gain-ing of experience, and the acquisition and practice of appropriate technical skills. 6 Because of the severity and type of injuries, the topography, the isolated location of most climbing accidents, severe weather, and limited transport to medical facilities, 4,7,8 first aid and patientcare requirements will differ greatly from those provided in traditional prehospital care settings. In the settings  239  Rock Climbers’ Self-Perceptions Table 1.  Cimbing accidents—United States 1989–2000* Year Totalaccidents †  Rock climbing Percentage 198919901991199219931994199519961411361691751321581681395056645371738660354138305446514319971998199920001581381221504859616430435043Totals 1786 745 42 *Data from  Accidents in North American Mountaineering 2001. 5 †Includes accidents reported on ice, rock, and snow. where rock climbing is practiced, participants must beself-sufficient, able to improvise, and able to provide pa-tient care in potentially hazardous terrain and situations.The caregiver must also be well-versed in rescue and evacuation techniques. This study reports rock climbers’self-perception of their first aid, safety, and rescue skillsand their ability to handle climbing-related emergencies. Methods Data for this descriptive study were gathered from aWorld Wide Web (WWW)-based survey using anApache Server Project ( server runningon a Linux system (Red Hat Linux; survey was administered using an online databaseformat (MySQL; integrated with ascripting preprocessor (PHP; using theCarolina Climbers’ Coalition Web site ( as the location of the survey. The purpose of the study was announced and participationwas encouraged through the Carolina Climbers’ Coali-tion Web site and an announcement in  The American Alpine News,  a quarterly publication of the AmericanAlpine Club. Data were collected for 15 months, fromApril 2000 to September 2001. The survey consisted of 31 questions designed to collect information on respon-dents’ climbing history, first aid training, personal safety practices, partner and self-rescue skills, and related de-mographic information. The variety of survey questionsrequired respondents to check a response from either a3-choice list (yes, no, or undecided) or a scalar list (nev-er, occasionally, often, or always). 9 Demographic and  personal information for climbers was gathered by pre-senting respondents with a set of categories from whichto choose. An attempt was made to determine the rep-resentativeness of the sample by comparing the demo-graphic characteristics of the climbers completing theWWW survey with previously conducted rock climbingstudies using traditional sampling methodology. Results CLIMBING HISTORYDuring the survey period, 241 climbers completed theWeb-based survey. Of this group, 89% were male, and 11% female. The mean age of respondents was 28 years(range, 16–59 years). Climbers were highly educated overall with correspondingly high incomes. One third (37%) reported earning undergraduate degrees, and 34%completed some level of graduate education. Thirty-six percent of the respondents earned incomes between$20000 and $59999.00. Over half (57%) were em- ployed in professional or technical fields.Overall, respondents were relatively experienced and active climbers. The majority (58%) had been climbingmore than 5 years, while only 2% had been climbing  ½ year or less. One in every 4 respondents reported climb-ing outdoors more than 60 days a year. Thirty-seven per-cent had climbed in more than 20 different climbing ar-eas worldwide. Climbers were asked to identify all rock climbing and environmental organizations in which theyheld memberships. Seventy-seven percent of respon-dents reported being a member of a rock climbing or environmental organization. Of those who indicated membership, one third (33%) were members of the Ac-cess Fund (a national, nonprofit organization dedicated to preserving America’s climbing resources), and 15% belonged to the American Alpine Club.Climbers were asked to self-rate their climbing ability.Categories included traditional, sport, or hybrid (com- bination sport and traditional). Traditional climbers arethose climbers who protect rock climbs with equipment(‘‘protection’’) that they place as they ascend to safe-guard themselves from a fall. Traditional climbing (or adventure climbing) is how the sport has been practiced for decades, although many climbers now practice sportclimbing. Sport climbing involves climbs that have an-chors preplaced. Sport climbs tend to be shorter in lengthand are technically more demanding than traditionalrock climbs.Traditional climbers represented over half (54%) of those responding, while 37% were hybrid climbers, pur-suing both sport and traditional routes. The remaining8% identified themselves as sport climbers. The Yosem-  240  Attarian Table 2.  Yosemite Decimal System*The Yosemite Decimal System (YDS) is a rating system that describes terrain according to the techniques and equipmentrequired to travel that terrain. The YDS consists of 5 classes, with the fifth class subdivided by a decimal notation.Class 1—Walking and hiking; scrambling. Generally, hands are not needed.Class 2—Hiking, mostly on established trails, involving some scrambling with occasional use of hands.Class 3—Climbing or scrambling with moderate exposure. Angle steep enough that hands are needed for balance.Class 4—Intermediate climbing with exposure extreme enough that most climbers will want a belay. A fall could beserious or fatal. Intermediate climbing requires the use of hands and arms for pulling oneself up.Class 5—Technical rock climbing is encompassed in class 5 climbing. A rope, specialized equipment, and training are used  by the leader to protect against a fall.Class 5—Consists of the following subclasses:5.0–5.4: A person of reasonable fitness can climb at this level with little or no rock climbing skills.5.4–5.7: Requires rock climbing skills and/or strength.5.7–5.9: Good rock climbing skills and strength needed to climb at this level.5.10–5.14: Training, well-developed techniques, and time commitment are required to climb at this level. *See Graydon D, ed.  Moutaineering Freedom of the Hills.  Seattle, WA: The Mountaineers; 1992. Table 3.  Climbers’ reported level of first aid training*  Level of training  n  Percentage ParamedicOther CPR onlyWilderness EMTEMTWilderness first aid  No formal trainingAdvanced first aid Wilderness first responder Basic first aid 789111618213045722. *CPR indicates cardiopulmonary resuscitation; EMT, EmergencyMedical Technican. ite Decimal System (YDS) represents the method climb-ers use to measure the difficulties of terrain and de-scribes their climbing abilities (Table 2). Almost half (48%) of the survey participants considered themselvesadvanced climbers (YDS, 5.10–5.11), while noviceclimbers (YDS, 5.0–5.6) consisted of a small percentage(4.5%) of climbers responding. Intermediate climbers(YDS, 5.7–5.8) and expert climbers (YDS, 5.12–5.14)made up 40% and 7% of the respondents, respectively.FIRST AID TRAININGClimbers were asked to respond to a series of questionsabout their first aid training and experience. The initialquestion posed to climbers required a response to thequestion ‘‘I know someone who has been involved in aserious climbing accident.’’ Well over half (65%) re- ported knowing someone who had been involved in aserious rock climbing accident. Almost the entire sample(99%) felt that first aid and rescue techniques were im- portant skills for climbers to possess. When asked toidentify their level of first aid training, 91% indicated formal first aid instruction; however, it is not knownwhether or not their first aid training was up to date. Of this group, almost one third (30%) received basic firstaid training, 19% were certified Wilderness First Re-sponders, and 12% had advanced first aid training.Climbers’ first aid training is listed in Table 3.PERSONAL SAFETY PRACTICESPersonal safety practices are the tools and techniques aclimber uses to help minimize a potentially dangeroussituation. For this study, personal safety practices in-cluded the availability of first aid kits and cell phonesand the use of climbing helmets and prusiks (frictionknots that are used for ascending, locking, or holding arope). Nearly 7 in 10 (67%) climbers reported carryinga first aid kit when they climb (contents unknown).When asked if a cell phone was carried on climbing tripsfor emergency use, 48% responded ‘‘never.’’ Twenty-one percent of climbers who reported carrying a cell phone indicated that they had used it to report an acci-dent. A minority of climbers (14%) reported not wearinga climbing helmet. Table 4 lists climbers’ responses tocell phone and helmet use. A majority (81%) reported carrying prusiks or similar devices with them when theyclimb.Climbers were also asked to answer a series of ques-tions on their familiarity with 4 personal safety skills: 1)ability to ascend a fixed rope (climb a rope using avail-able equipment); 2) ability to carry out a belay escape,an important first step in a self- or partner rescue (for a  241  Rock Climbers’ Self-Perceptions Table 4.  Climbers’ personal safety practices Safety practice Never (%) Occasionally (%) Often (%) Always (%) Carry a cell phoneWear a helmet116 (48)33 (14)55 (23)53 (22)35 (14)73 (30)35 (14)82 (34) Figure 1.  Z-drag. description of the belay escape, see Fasulo 10 ); 3) abilityto execute a ‘‘Z-drag,’’ a mechanical advantage systemdesigned to help the rescuer raise a victim (Figure 1);and 4) ability to construct an equalized anchor, which isthe foundation for any belay or rescue system (Figure2). Climbers believed themselves to possess adequate personal practices. Almost every climber (91%) reported  being able to ascend a fixed rope and execute a belayescape (81%), and just over half (54%) felt competentto construct and execute a Z-drag system. Ninety-three percent of climbers surveyed reported confidence in their ability to build an equalized anchor.PARTNER AND SELF-RESCUEPartner and self-rescue skills may require that an injured climber or lead climber be rescued from a multipitchclimb or evacuated from the base of a cliff. In general,climbers perceived themselves capable of partner and self-rescue execution. The majority (80%) felt theycould rescue an injured climber from a multipitch climb,while 66% felt comfortable rescuing an injured lead climber. Over half (54%) reported they could improvisea rescue in any situation, and 88% said they could safelyevacuate an injured climber from the base of a cliff.More than half (56%) of the climbers answered ‘‘no’’when asked if they had ever participated in a course or clinic in partner and self-rescue techniques. However,93% indicated that they would participate in a partner and self-rescue course if it was offered. Discussion It should be noted that the findings presented in thisinvestigation are only representative of the time period and climbers who elected to participate in the study. Be-cause of the limitations inherent in Web-based surveys,it was not possible to collect data from a sample thatwas representative of all climbers. 9 This should be takeninto consideration before drawing any conclusions or making any generalizations beyond the sample used inthis study.Conducting surveys by means of the WWW is be-coming a popular method for collecting information.While the WWW offers major advantages over moreconventional survey techniques, there are some concernswith this approach (eg, sampling bias due to qualified individuals not accessing the Internet 11 and use of a non-random and nonrepresentative sample). 12 Internet surveys along with more traditional methodsof data collection can only collect information from re-spondents who choose to participate. However, uniqueto Web-based surveys is the potential for low responserates, as well as the difficulty of gathering any infor-  242  Attarian Figure 2.  Equalized anchor. mation about nonrespondents. 13 The nonrandom natureof a Web-based survey is a concern if nonrespondentsare different from respondents. The Internet, because of its design, does not allow much information to be gath-ered about nonrespondents unless they provide it. Websoftware can only provide limited data. One way to over-come this limitation is to register visitors, whereby theymust provide a minimum amount of information aboutthemselves before they are fully able to enter the Website. 14 An alternative method used in this study to determinesample representativeness was to compare the demo-graphic characteristics of the climbers completing theWWW survey with those of previously conducted rock climbing studies using traditional sampling methodolo-gy. 15–18 Through this process, it was found that climberson average are well-educated men, 27 to 30 years of age,with moderate incomes and less than 10 years of climb-ing experience. Similar findings were reported in thecurrent study.Rock climbers are attracted to the sport because of thechallenge, risk, and uncertainty it offers. It is preciselythese characteristics that require climbers to develop a personal risk-management plan. This process involvessetting safe and reasonable goals that will challengeclimbers and allow a margin for safety. Considerationshould also be given to the difficulty of the route, theamount of time available, the demands of the approach,and the details of the descent. Each of these factorsshould be compatible with the climber’s experience, fit-ness, skill level, and equipment availability. Climbersshould also have a working knowledge of first aid, per-sonal safety practices, and partner and self-rescue tech-niques.Our findings suggest that climbers perceive them-selves to be taking the appropriate preventive measuresand preparation into consideration as an important partof their climbing experience. This is supported by thenumber of climbers who reported that they carry firstaid kits, have familiarized themselves with partner and self-rescue skills, have received first aid training, carrycell phones, and have elected to wear helmets. This latter finding is encouraging, since wearing a helmet has beenshown to reduce injury and, in some cases, save the lifeof the climber. 5,7 Given the limitations of Web-based surveys, futurestudies exploring climbers’ first aid, safety, and rescueskills can be performed using more traditional researchmethodology. Both qualitative and quantitative measurescan be used to measure climbers’ knowledge and eachof the skills presented herein. For example, a randomsample of climbers can be contacted at predetermined climbing sites throughout the United States and asked to participate in the study. Face-to-face interviews can beconducted, along with the administration of a short‘‘skills-assessment’’ test, whereby the climber explainsor demonstrates a particular skill.When they do occur, rock-climbing accidents are usu-ally a combination of objective hazards (‘‘acts of God’’or naturally occurring events) and subjective hazards(risks that originate from the climber). Paulcke and Dumler  19 described these ‘‘climber-srcinated’’ factors
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