Climbing is a rapidly growing sport with many specializations. Climbing activities range from the cutting-edge athleticism of sport climbing (which in 2020 will become an Olympic event) to the ancient pursuit of climbing mountains, one of the most traditional of human activities.
This text discusses the medical concepts relevant to all the various climbing activities available to enthusiasts today. These range from urban climbing centers to remote alpine peaks, and from long-distance trekking alpinists for whom a single vertical endeavor may last months to sport climbers for whom it may last minutes. Common among all these concepts is a need for quality education and information about prevention and treatment of common climbing illnesses and injuries.
Our perspective is that this quality is best delivered through the tools of evidence-based medicine. We believe the best medical science available, and the most up-to-date and authoritative consensus guidelines, should drive the training and practices of climbers engaging in medical care, whether it be first aid or formal healthcare delivery in the field. When appropriate, we share the recommendation grade of formal consensus recommendations from professional societies to convey the strength of a recommendation (Figure I-1).
In addition, we include references to source material and studies more often than many other texts of this sort. In this way, we encourage you to access the primary material when it interests you, or when the position we are taking challenges other teachings you have read or received. We, the authors of this text, are all healthcare providers ourselves as well as avid climbers, and this is exactly the approach we take when analyzing conflicting medical information. Furthermore, we each have a different niche in the healthcare profession, as well as different backgrounds in terms of climbing that we bring to bear in writing this text. Together, we strive to make this text your single most important and useful guide for navigating medical issues during your climbing adventures.
FIGURE I-1. GRADING RECOMMENDATIONS (AMERICAN COLLEGE OF CHEST PHYSICIANS)
Grade of recommendation/description |
Benefit vs risk and burdens |
Methodological quality of supporting evidence |
Implications |
1A. Strong recommendation, high-quality evidence |
Benefits clearly outweigh risk and burdens, or vice versa |
RCTs* without important limitations or overwhelming evidence from observational studies |
Strong recommendation, can apply to most patients in most circumstances without reservation |
1B. Strong recommendation, moderate quality evidence |
Benefits clearly outweigh risk and burdens, or vice versa |
RCTs with important limitations (inconsistent results, methodological flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies |
Strong recommendation, can apply to most patients in most circumstances without reservation |
1C. Strong recommendation, low-quality or very low-quality evidence |
Benefits clearly outweigh risk and burdens, or vice versa |
Observational studies or case series |
Strong recommendation but may change when higher quality evidence becomes available |
2A. Weak recommendation, high-quality evidence |
Benefits closely balanced with risks and burden |
RCTs without important limitations or overwhelming evidence from observational studies |
Weak recommendation, best action may differ depending on circumstances or patients’ or societal values |
2B. Weak recommendation, moderate-quality evidence |
Benefits closely balanced with risks and burden |
RCTs with important limitations (inconsistent results, methodological flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies |
Weak recommendation, best action may differ depending on circumstances or patients’ or societal values |
2C. Weak recommendation, low-quality or very low-quality evidence |
Uncertainty in the estimates of benefits, risks, and burden; benefits, risk, and burden may be closely balanced |
Observational studies or case series |
Very weak recommendations; other alternatives may be equally reasonable |
Source: Guyatt G, Gutterman D, Baumann MH, et al. “Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians task force.” Chest. 2006 Jan; 129 (1): 174–81. * RCT: randomized control trials |
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The text is divided into four sections:
Life—addressing life threats, initial management of all conditions, and prevention/lifestyle topics;
Medical—addressing the management of specific medical and trauma conditions, divided by body systems and injury types;
Environmental—addressing the prevention and treatment of conditions arising from particular environmental conditions; and
Rescue—addressing skills and steps necessary to move from initial management of illness/injury to communication with external resources, extrication, and evacuation.
One challenge in a text like this is the depth in which to discuss medical conditions. We hope this will be a useful text for both healthcare providers and those without any formal healthcare training. Often, terms and language from the healthcare vocabulary are the most useful way to communicate concepts. In these cases, we define such terms the first time they are used, and include a glossary which can be easily referenced whenever such terms appear later in the text. In addition, a basic understanding of anatomical terminology is necessary to facilitate discussions of climber evaluation and treatment. Figure I-2 describes basic anatomical terminology and can serve as a resource for you when reading later chapters.
FIGURE I-2. RELATIVE ANATOMICAL TERMINOLOGY (SEE GLOSSARY ON PAGE 319 FOR ADDITIONAL TERMINOLOGY)
Anterior: |
front of the body or a body part |
Posterior: |
back of the body or a body part |
Distal: |
further from the trunk on an extremity |
Proximal: |
closer to the trunk on an extremity |
Superior: |
higher |
Inferior: |
lower |
Abduction: |
movement away from the torso |
Adduction: |
movement towards the torso |
External rotation: |
rotation away from the midline |
Internal rotation: |
rotation toward the midline |
Palmar: |
on the palm side of the hand |
Ventral: |
on the front side of a body part; in the hand, synonym with palmar |
Dorsal: |
on the back side of a body part; in the hand, opposite to the palm |
Flexion: |
movement of a joint towards or into a bent position |
Extension: |
movement of a joint towards or into a straight position |
Medial: |
on the inside and towards the midline of a body portion with two sides |
Lateral: |
on the outside and away from the midline of a body portion with two sides |
Pronation: |
in the hand, turning the hand so the palm is facing downwards |
Supination: |
in the hand, turning the hand so the palm is facing upwards |
Prone: |
lying face down |
Supine: |
lying face up |
On the other hand, we’ve worked hard to eliminate medical jargon or medical terms when they aren’t necessary to convey a concept. We feel that orthopedic injuries in particular are an area of great interest for climbers, so in our discussion of them in Chapter 4, we go in great depth into the medical terms and sometimes hospital-based management of these conditions. In these cases, such depth is necessary, as climbers may often be navigating long courses of hospital, clinic, and rehabilitation management of complex orthopedic conditions, and having this depth of information in one text may prove very helpful.
No text can replicate hands-on training. Multiple times in this book, we encourage you, the reader, to obtain specific certificates or enroll in hands-on training courses to become more adept with the skills needed to manage conditions in a vertical environment. We, the authors, collectively make up Vertical Medicine Resources™, a medical guiding and consulting company. VMR is dedicated to providing training and support for clients in a vertical environment in a unique medical guide format. In addition to this book, we offer certification courses, specialty training, on-site medical support, and consulting services. Numerous other high quality wilderness medicine schools, degree programs, and training opportunities exist. Some are discussed in this book. We strongly recommend you use this book as a launching pad for ideas about further training or a reference source to confirm and enhance the training you have already received. Either way, it is most effective when accompanied by hands-on training.
Most importantly, climb hard, climb safe, and we hope this text offers you aid for those times when injury, illness, or preparatory challenges threaten your enjoyment of this activity we all love so much.