Mountaineering accidents in the Sierra Nevada.

Two hundred and fifteen mountaineering accidents occurred in the Sierra Nevada over a 5-year period in climbers on Class V routes. Patients were evaluated for: climbing preparation and training, first aid experience, altitude acclimatization, age, anatomical site of injuries, and cause of the injury. Consideration as to evacuation procedure was also given. The effect of high altitude exposure impairs judgment and muscular coordination and implies poor acclimatization. Acute mountain sickness and hypothermia were documented in 104 patients, the majority of whom sustained injuries resulting from judgmental errors. Ninety-four injuries involved the ankle and lower tibia, an incidence similar to that seen in alpine skiing a decade ago. There were 17 deaths resulting most frequently from head injuries. Few climbers had formal training in basic mountain medicine which was reflected in the poor assessment and management of injuries, with an unnecessary reliance upon others for evacuation. Morbidity and mortality may be lessened by proper climbing preparation--instruction in mountaineering techniques as well as basic mountain medicine--and by prevention of acute mountain sickness and cold injury.