By way of an introduction: It has been accurately stated, “In every mistake there is the potential for growth.”
A tangible benefit (especially with hazardous activities) is to learn from other’s mistakes – arguably better at times than learning from your own. In that light, I propose a series of ex-post-facto incident learning. Titled: Mistake Institute (for lack of a better term). To promote learning from actual events, avoiding hypothetical rabbit trails that discussions often evolve into. With a tag question – “What can we learn from this?”
Open to anyone to submit: Published articles, SAR reports, first-hand experiences, et al., where the incident relates to canyoneering or its associated activities. Limiting each new thread to a single incident and then allow ample time for comments and responses, before starting a new MI thread. Again, the discussion should be limited to what actually occurred, as best as can be determined from the report given.
This has the potential to be valuable, even life-saving, instruction. I’ve never forgotten the story a paddler friend related to me years ago that highlights the value of such information. He attests to this day that his life was saved by an article in a kayaker’s magazine that he recalled – at the exact moment – when he needed it most. A simple thought, yet ostensibly impractical suggestion, from the article which came to him after several minutes of being helplessly tumbled in the throes of a hydraulic… “when all else fails, come out of your PFD”.
Scott Patterson
It has been accurately stated, “In every mistake there is the potential for growth.”
When it comes to canyoneering, it can also be accurately stated that “In every mistake there is the potential for death.”
ratagonia
Re-reading it, I think they made a mistake by not taking the injury seriously enough. We do not know the ultimate outcome, but a simple (very painful) dislocation was maybe converted to a permanent serious shoulder injury. If it was a client-guide relationship, as a guide I would be obligated to take much better care of the patient. As Kuenn said, the patient is not in a good position to make decisions, except when they are. We naturally prefer to self-rescue, and in this case, the desire to self-rescue and avoid embarrassment may have resulted in permanent injury. The desire to “buck up” and do the quickest possible self-rescue (rather than a slower, more cautious self-rescue) may have resulted in permanent injury.
So what is the proper care? Certainly reducing the dislocation is desirable, if talent is available to do so. However, there are counterindications to attempting this in some circumstances (though the injury mechanism as described indicates a simple disclocation that can be reduced). Certainly without, but even WITH reduction, that shoulder should be immobilized, which results in a much more “assisted” escape, much much slower. But it would not result in making the injury worse.
On the other hand, there are other considerations, when making the injury worse would be the right choice. Looming hypothermia and/or lack of the ability to come up with resources to improve the situation (ie, more people, more ropes, warm food, sleeping bags, medical care) might point toward going for a hasty-type self-rescue.
Tom
Heather Beasley
Oh man, I love this idea of reviewing an accident report for some online free open access canyoneering-education (FOAC, I guess. In the medical world, we have free open access med-ucation, or FOAM). First of all, I went canyoneering with Anna and her husband and totally am stealing their idea of keeping track of potential pitfalls, things that could’ve been done better, and risks in certain canyons–they are certainly very smart for doing this, and I believe it probably increases their recall of particular obstacles in certain canyons and enhances the experience as a whole! (Anna I want to go canyoneering with you again this Spring when I finally get some time off!)
One thing I immediately thought of with this particular accident report is how easy it is to actually learn a very low-risk technique for shoulder reduction that I have personally seen work well in the emergency department. As a NOLS-trained WFR, I learned a simple technique for reduction of shoulder dislocation in the backcountry using weighted objects and prone positioning on an elevated surface (letting the affected arm hang freely), but actually I believe the Cunningham technique to be far superior for anterior shoulder dislocations. Of course, it’s possible that this unfortunate man had a more complicated injury or a posterior dislocation where this technique might not work, but with this style of reduction, I probably wouldn’t hesitate to try it in the backcountry if the patient was willing. Have a look here, if you all are interested: http://lifeinthefastlane.com/cunninghams-shoulder-relocation/
Anna
This is a cool idea!
Recently I started doing something similar for the canyons I visit. After each trip, mentally review the canyon(s), think about what happened and whether anything could have been done better, and ask whether there was some lesson to be learned. I just keep it in an Excel spreadsheet for now. Luckily so far there have been no serious mistakes that were not corrected in time, but in part that’s been due to reading & thinking about others’ mistakes on here. Usually there’s at least one small mistake or something that could be done better, especially in a first visit to a canyon.
Regarding the accident report: I learned from it that (1) you should take even minor-seeming injuries seriously, because strenuous actions can make a small injury much worse before you get out (2) it’s important to have more than one rescue-competent member in your party (3) if you think and act carefully and follow points 1 & 2, you may be able to self-rescue your party without needing outside help.
Taylor
1. Everyone made it home that day after a successful self rescue.
2. The team had the skills and tools necessary for a self rescue.
3. It’s possible the shoulder injury could have been made less severe by calling for a full rescue.
Kuenn
M.I., destined to be the shortest series since the debut of Brickleberry or The Adventures of Paddy the Pelican, maybe deserves one more observation.
Truer words never spoken.
Thoughts:
Regardless of whether you agree with the methods used, they made it out on their own wits and power. Good on them.
They discussed options pre- instead of post- and appropriately setup provisional measures, just-in-case.
One option that could have been helpful, and from my experience is underutilized under the right circumstances, is a counterbalance haul system. Very easy to setup, protect, and can offer that extra bit of assistance to a “marginally” injured victim.
Lastly, and I think they did this correct in their case; there are times when the decision of “how to proceed” is not up to the injured. Sometimes the team needs to usurp that authority. Injury severity is often masked by a temporary adrenaline stage and/or victim swagger – needs to be a consideration.
Anna
I really hope all the debate about the canyoneering-relatedness of your accident report doesn’t keep you from wanting to talk about “lessons learned” in accidents! Most people here would likely enjoy a more focused discussion of what we can take away from others’ mistakes, but it’s really easy for off-topic arguing from a few people to overwhelm a thread and make it seem pointless to contribute an on-topic thought. I certainly still think it’s a great idea.
That sounds interesting! Need to look this up…if someone is injured in a canyon, perhaps while on rappel, I could imagine that the top of the previous rappel might have a better location for helping the injured person rather than others going down to help. I will look more into this as a possibility for myself in the future.
This is a really good point. The question for me is how to assess that, and then to get everyone to agree on a plan. It’s so hard to get people to agree on even the simplest stupid things, deciding on a rescue plan when the injured person is protesting he/she is fine could be really hard. But I totally agree, people often don’t want to admit, or don’t know how badly, they are injured. Getting everyone else in the group on the same page would make enacting a rescue plan a lot easier.
AW~
What are the odds on that though? I would think the report is correct since you can read it on the internet.
wsbpress
Great points.
Somewhat in relation to about Taylor’s point three (3) and Anna’s point one (1) I am wondering if an assisted raise/haul maneuver would have been advantageous over the self-powered ascension. I’m not sure if it was possible – and I think they did a great job as it was – but I’m wondering if they would have done that differently knowing what they now know.
AW~
If you read the incident report, you would know that canyoneers go to a lowering system as a default option, including in waterfalls and hydraulics. Its the most effective way to get someone to higher elevation. If you would repeatedly climb the same ledge over and over again, as canyoneers do, you would know. If something goes wrong, you lower them, and problem solved.
For my fourth go-round on ledges, I like to break out the handled ascenders like most canyoneers. OK, thats a joke. We all carry and use use foot ascenders in case of a shoulder injury. I recommend using that same fortune telling 8 ball used for weather predictions to decide what to do as well, get some multi-purpose out of it. I could ask the window washers if you want…since apparently thats part of canyoneering too. Anything with ropes, or moving up down or sideways. Tightrope incidents? Add spacewalking.
“Canyoneers rap off all kinds of stuff climbers wouldn’t ….like twigs and dirt piles”
I forgot about them dirt piles we rap off. And I was chastising someone for saying bulldozers are relevant to canyoneering. Oh me oh my.
Kuenn
For the first submission, an accident report from the annual American Caving Accident 2013-2014.
What can we learn from this?