Effects of experience and commercialisation on survival in Himalayan mountaineering: retrospective cohort study
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3782 (Published 13 June 2012) Cite this as: BMJ 2012;344:e3782All rapid responses
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I read with great interest the paper by Westhoff et al [1] on mortality rates in Himalayan mountaineering. The remarkable completeness of the Himalayan database that the study is based on is a great strength, and the authors report many notable findings. Most significant among these is the inexorable rise of the commercial expedition, increasing from less than 5% to nearly a third of all Himalayan climbs in only 20 years. The transformation of the world’s highest peaks from the cutting edge of mountaineering to high altitude recreation venue for the wealthy in less than a generation follows the pattern seen in the Alps in the middle of the nineteenth century. However, the objective dangers encountered in the Himalaya are much greater than in the Alps. This process has also been controversial, with concerns expressed about the effects of large scale tourism on the fragile mountain environment, and about the ethical dilemmas that accompany commercial expeditions- particularly on Everest, where reports of climbers walking past dying members of other expeditions, rather than curtailing their summit bit to offer help, have made disturbing reading [2].
Westhoff et al’s main findings are that there appears to be no survival benefit associated with increased Himalayan experience, and that commercial expeditions may be safer than traditional expeditions. They note that the first finding runs counter to what might be expected, and suggest that any learning effect may be offset by a tendency to attempt harder and thus more dangerous objectives in subsequent expeditions. This would seem likely. However, another possibility for the apparent lack of a learning effect may be to do with the previous experience of those taking part in the expeditions. Those in traditional expeditions and guides in commercial ones will almost certainly have served an “apprenticeship” in lower glaciated ranges such as the European Alps. The skills necessary to survive in this environment, such as assessing the safest route through hazardous terrain, minimising the danger from serac collapse and avalanche, and retreating safely in the face of deteriorating weather, will have been thoroughly tested before arrival in the Himalaya. While there are likely to be adjustments due to the larger scale of the mountains encountered, it is possible that these may be a small increment over the existing skill base, and the new learning may be a small effect set against the severe objective hazards that the highest mountains present. There may however be significant variations between mountaineers in skills in this area; for example the legendary British climber Don Whillans was renowned even within his circle of very competent climbing partners as the one most able to keep himself and his companions safe in dangerous circumstances [3].
The second main finding, that commercial expeditions may be safer, is very possibly true given the data presented, but needs to be interpreted with caution. The natures of traditional and commercial expeditions are likely to be so different from each other that it calls into question the value of the comparison. From the late 1970s onwards, the ethic in Himalayan climbing has moved away from “siege “ style expeditions, where a chain of high camps is maintained, allowing a flow of supplies and climbers from base camp to the summit. This is still the model that commercial expeditions tend to follow, but non-commercial expeditions moved to “Alpine style” ascents, where the climbers carry all their equipment on a continuous push. Non commercial expeditions also are more likely to eschew the use of supplementary oxygen, which is regarded by many alpinists, foremost among them Reinhold Messner, the first person to climb all 14 8000m peaks, as unethical in climbing terms [4]. The routes chosen are more likely to be novel, and selected for their difficulty or remoteness, as can be seen by the nature of the expeditions that attract funding from bodies such as the Alpine Club [5]. Lacking the “safety net” of a chain of camps, fixed ropes and oxygen, the margins for error on such expeditions are clearly much slimmer, and it is perhaps surprising that the death rates reported are not in fact higher.
The authors do report the death rate by decade, and show it falls from 3% to 0.9% over the time period considered. Given the concerns over the comparability of commercial and non-commercial expeditions, it would be interesting to see the change in rates over time for these very different enterprises set out separately. This may help start to answer some potentially more interesting questions than “are commercial expeditions safer than traditional ones?". These would include, are both commercial and non-commercial expeditions safer than they used to be? If so, what are the factors which have led to this? And are they different for the two types of expedition?
This would then allow focus on what can be done make particularly commercial expeditions safer still. These are bringing more and more people into an environment where they are entirely reliant on the skills and logistics of their guiding agency for their survival. This leads to many people, including local climbing and portering staff, losing their life on what is essentially an exotic package holiday. Given that the trend towards commercialisation of the high mountain environment is likely to continue, research into how to make this inherently dangerous activity as safe as is reasonably practicable should be a matter of priority.
[1]. Westhoff JL, Koepsell TD, Littell CT. Effects of experience and commercialisation on survival in Himalayan mountaineering: retrospective cohort study. BMJ 2012;344:e3782
[2]. http://www.bbc.co.uk/news/uk-england-beds-bucks-herts-18199899 Everest climber Leanna Shuttleworth reaches summit
[3]. The Villain (2005) Jim Perrin, pub Mountaineers Books
[4]. All Fourteen 8000ers (1999) Reinhold Messner, pub Mountaineers Books
[5]. The Alpine Club website http://www.alpine-club.org.uk/expeditions/Expeditions2.htm
Competing interests: The author has been on guided climbing trips in the Alps and Peruvian Andes
The paper is interesting. May I however, ask the readers to take a step back: Mountaineering can be a sport. But, when it is turned in to "extreme sport", it deserves no applause. Yes, Mallory did go towards the summit of the Everest "because it is there". However the countless "sportsmen" and "charity fund-raisers" fly thousands of miles and scramble up, they should pause and think. How much environmental degradation are they causing?
Competing interests: No competing interests
To the Editor,
The retrospective cohort analysis on deaths of mountaineers from Nepal Himalayas (>8000 m altitude) by Westhoff et al (1) has brought an interesting conclusion. Although it may seem an unusual and unexpected outcome to find commercial expeditions safer, especially when they often are blamed for taking more risks and bringing relatively untrained as well as unfit climbers (clients) to the most challenging peaks, it is not entirely a surprising result. First, the commercial expeditions are guided by extremely experienced climbers hiring a good pool of Sherpas who have already summitted a number of times. Secondly, the resources they managed to collect from the fees raised happen to be cost-effective as compared to other smaller and individual expeditions. Third, they are extremely organized, aided by the communicating systems (base camp, higher and forefront) and weather forecast.
For the last half a decade, there has been a great deal of interest from the medical community in high altitude exposure both in terms of research (2) and medical facility (3). The emergency facility right at the base of Mt Everest must be accounted for the decreased mountain morbidity and mortality. The effective and prompt evacuation of critical cases is critical in saving lives. This is again more likely to happen in commercial expeditions.
The categorization of ‘mechanism of death’ does not seem to be plausible. The category ‘Exposure’ is vague. Fall, Crevasse, Avalanche and Falling Debris can occur to any climber despite being experienced, technically strong or acclimatized. I believe that these kinds of deaths can occur even more in other technical peaks that are not included here e.g. Pumori.
Finally, preparation/training and experience will certainly help but the number of expeditions is important as well. If they keep going back-to-back to lead their commercial expeditions; the risks will increase. The commercial expeditions in themselves will differ as more and more people with certain interest e.g. youngest climber, oldest climber, seven summits, political interest, personal achievement or charity climbing get involved. Therefore, the commercial per se may need to be split up and analyzed carefully to differentiate risks and benefits of them.
Climbing is a sport and everyone should be allowed should they be interested and they should climb safely including the Himalayas (4).
Reference List
(1) Westhoff JL, Koepsell TD, Littell CT. Effects of experience and commercialisation on survival in Himalayan mountaineering: retrospective cohort study. BMJ 2012; 344.
(2) Grocott MP, Martin DS, Wilson MH, Mitchell K, Dhillon S, Mythen MG et al. Caudwell xtreme Everest expedition. High Alt Med Biol 2010; 11(2):133-137.
(3) Freer L. Evererest ER. 2012.
Ref Type: Online Source
(4) Burtscher M. Climbing the Himalayas more safely. BMJ 2012; 344.
Competing interests: No competing interests
Re: Effects of experience and commercialisation on survival in Himalayan mountaineering: retrospective cohort study
Dear Sir
Westhoff JL, et al [1] are to be congratulated on their interesting, comprehensive and detailed analysis of this very large dataset. The data analysed reflects a lifetime‘s work by Elizabeth Hawley. They confirm what every mountaineer knows: that not all 8000m peaks carry equal risk.
Over the time course of the study, a number of potential confounding factors have occurred. Commercial expeditions guiding large numbers of relatively inexperienced climbers up established routes only started in the 1990s. In addition, there have been marked improvements in both equipment and our understanding (and treatment) of high altitude pathophysiology.
Comparison of attrition rates of a first time climber on a commercial trip and an experienced climber putting up a new route using the much more challenging alpine or capsule style of ascent is like comparing chalk and cheese. A more meaningful comparison would be attrition rates of experienced and inexperienced mountaineers on the same routes used by commercial expeditions.
The mortality classification the authors describe is understandable but may be overly simplistic. They divide non-traumatic deaths into either exhaustion or acute mountain sickness (AMS). AMS tends to occur on acute ascent to intermediate and high altitude. [2] Whilst it may develop into High Altitude Pulmonary Oedema (HACE) or High Altitude Cerebral Oedema (HACE), AMS itself almost never causes death.
Firth et al [3] studied the 212 deaths on Everest between 1921-2006. Deaths were be classified as involving trauma (objective hazards or falls, n=113), as non-traumatic (high altitude illness, hypothermia, or sudden death, n=52), or as a disappearance (body never found, n=27). Using this classification the majority of deaths due to objective hazards occurred relatively low on the mountain (6-7000m) and tended to affect the sherpas disproportionately (as a result of their frequent load carries through the icefalls). Whereas most western climbers died above 8000 m, typically dying during descent and often with developing cognitive impairment and ataxia, symptoms of high HACE or high altitude cerebral dysfunction.
Climbing above 7000m places a huge physiological stress on the cardio-respiratory systems. [4] However the brain is the most oxygen sensitive organ and its normal function is profoundly challenged above 7,500m. [5, 6] The mountain environment is potentially hazardous at any altitude but at extreme altitude the risks are compounded by the additional challenges of confusion, lethargy and ataxia and struggling with judgement calls. [7] Sadly, as Westhoff et al [1] demonstrate, these can affect any mountaineer whether or not they are experienced.
Professor Chris Imray
Consultant Vascular Surgeon
Warwick Medical School, UHCW NHS Trust, Coventry
Mr Mark Wilson
Consultant Neurosurgeon
Imperial College, London
[1]. Westhoff JL, Koepsell TD, Littell CT. Effects of experience and commercialisation on survival in Himalayan mountaineering: retrospective cohort study. BMJ 2012;344:e3782
[2]. Imray C, Booth A, Wright A, Bradwell A. Acute altitude illnesses. BMJ. 2011 Aug 15;343:d4943. doi: 10.1136/bmj.d4943
[3] Mortality on Mount Everest, 1921-2006: descriptive study. Firth PG, Zheng H, Windsor JS, Sutherland AI, Imray CH, Moore GW, Semple JL, Roach RC, Salisbury RA. BMJ. 2008 Dec 11;337:a2654. doi: 10.1136/bmj.a2654.
[4] Arterial blood gases and oxygen content in climbers on Mount Everest. Grocott MP, Martin DS, Levett DZ, McMorrow R, Windsor J, Montgomery HE; Caudwell Xtreme Everest Research Group. (Collaborator and Subject 3) New England Journal of Medicine. 2009 Jan 8;360(2):140-9.
[5] The cerebral effects of ascent to high altitudes. Wilson MH, Newman S, Imray CH. Lancet Neurol. 2009 Feb;8(2):175-91.
[6] Wilson MH, Edsell M, Davagnanam I, Hirani SP, Martin D, Levett DZH, Thornton J, Golay X, Strycharczuk L, Newman, S; Montgomery H and Grocott M P W and Imray CHE for the Caudwell Xtreme Everest Research Group. Cerebral oxygen delivery is maintained by middle cerebral artery dilatation in hypoxia. Journal of Cerebral Blood Flow & Metabolism (2011) 31, 2019–2029; doi:10.1038/jcbfm.2011.81
[7]. http://news.bbc.co.uk/today/hi/today/newsid_9722000/9722707.stm
Competing interests: No competing interests