A casual glance of the numerous forums on the internet is revealing. The leading climbing forum in the UK carries regular threads about the injured and dead from climbing and mountaineering incidents. The responses to the original post - itself usually a query about an incident report or a link to a media story - usually take the form of sympathies and condolences (in the event of a fatality) or recovery wishes (to an injury). Rarely, if ever, is there a moment at any time afterwards where a learning moment can occur. After a fatality, the coroner's inquest takes place a considerable amount of time later and the process is concluded with barely a mention in the climbing media.
Sometimes, the national body (the BMC), local climbers or manufacturers (DMM spring to mind here) recreate the situation which caused a serious injury so that the lessons can be learned...unfortunately, this is the exception rather than the rule because it tends to be equipment failures not human error that is the focus of this approach. The other source of information, the mountain rescue teams don't have the budget to advertise themselves, nevermind highlight the lessons from the numerous callouts they attend. Besides, they take the view that their role is not to judge but to record what happened at an incident. The internet offers a tantalizing glimpse of another way - using film clips of safer practice to inform the wider community on Youtube and Vimeo.
It's not that climbers and mountaineers are finding new or innovative ways to become casualties, because they're not. Usually, it's the same decision-making failures that are responsible. I am tired of hearing all about the casualty's right to do as they pleased, the concept of individuality, the right to kill oneself in 'risky endeavours'. Bruce Tremper in Staying Alive in Avalanche Terrain makes the point succinctly,
'I have, unfortunately, participated in several dozen missions of either rescue, body recovery or accident investigation and have attended the funerals of half-a-dozen friends and coworkers who have died in the mountains. With every one of them there were the tears of spouses, children, parents, siblings and friends whose lives will never be the same. There were also the invisible strings attached to the rescuers who risked their lives...and the lawmakers who passed restrictive rules for others in the wake of an accident or lawsuit...So where is the individual? I don't think I have ever seen one.'
There is a view, quite widely held it would seem, that professionals delivering outdoor activities are rarely involved in incidents. In fact, there appears to be evidence that this isn't the case. In the Alps, guided parties are involved in similar numbers of incidents as non-guided parties. However, there is an important distinction, the outcomes for guided parties is much better in terms of serious injury and fatalities. A discrete conversation with a leading British IFMGA guide heavily involved in developing the culture of the British professionals in the UK and overseas, revealed that the challenge is changing professionals' attitudes towards their own practice. The key message is that the guide, instructor, leader and supervisor isn't infallible.
The work that Ian McCammon published in his research on heuristic traps is now becoming more widely understood, such that the question is not 'What was he/she thinking when they did x?' but 'Why weren't they thinking?' McCammon's work suggests that far from being fully aware at all times, humans are capable of functioning in an unthinking mode using heuristics or mental shortcuts. It's these heuristic shortcuts that are part of the problem. Bruce Tremper speculated that experienced guides and leaders fall victim to unusual conditions...and complacency...by using heuristic shortcuts. In short, they fall into the heuristic trap.
What's the answer? A considerable amount of research has been done into the heuristic trap and there are a number of things that can be done. The answer is to institute a thorough system of procedures, checklists, rules, coaching and to develop good instuctional habits...and to stay mindful of the heuristic traps. Perhaps the best way of seeing things is to develop a dynamic approach to risk assessment, better called strong 'situational awareness'. We're still fallible but systems reduce incidents caused by ego or ignorance or not thinking.
Belay if you will…Or how to spot lemons and BE A SWAN RATHER THAN a
Human Error Accidents in Adventure Activities: cause and prevention - Marcus Bailie
How to Make Decisions for the Right Reasons in Avalanche Terrain - Tim Blakemore IFMGA
Evidence of Heuristic Traps in Recreational Avalanche Accidents - Ian McCammon
Staying Alive in Avalanche Terrain - Bruce Tremper