The meaning of accidents

From today’s NPS Morning Report (emailed to me by M this afternoon):

Zion National Park (UT)
Canyoneer Killed In Fall In Heaps Canyon

Keith Beidermann, 48, of Garden Grove, California, fell to his death while canyoneering in Heaps Canyon the evening of Monday, June 4th. Beidermann’s two companions were at the Upper Emerald Pools waiting for him to descend after completing the 285-foot last rappel out of the canyon when he fell to his death for unknown reasons. Once his companions determined that Beidermann had not survived the fall, they hiked down the Emerald Pools trail to Zion Lodge and reported the incident to park dispatch at 11:34 p.m. Rangers responded and confirmed the death. Beidermann and his two companions had a valid permit for Heaps Canyon. Canyon district ranger Kevin Killian was the IC; ranger Craig Thexton is the primary investigator for the NPS, working in conjunction with the Washington County Sheriffs Office. Heaps Canyon is temporarily closed to canyoneering while the incident is under investigation.

Hazard and death are party to the game anytime we go play outside, and as Hemingway said this is a large part of why we find it worthwhile. Physical and psychological consequence are one of the major indexes of meaning, much as some would like to deny that. In climbing and canyoneering, exposure makes this more obvious, but the possibility of paralysis or death from endoing into a rock is just as likely.

So, when a colleague, known or un, is lost the question of why is asked immediately. To remind us that we can rationalize the world in which we live, and sooth ourselves in the knowledge that there is more than chance the law of averages waiting. The easiest trick to this is the question of competency, self-assurance that your knowledge is greater than the victims and thus your fate is safe.

This is often an illusion.

I’ve done lots of silly and careless things in the backcountry, as I can only presume have we all. Keith Beidermann was hanging from bolts and crouched on a ledge the size of your computer screen, 160 feet down a 190 foot wall that bottoms out at a massive undercut. As you sit at the anchor station waiting to rappel, you’re looking at a talus slope and pool 290 feet below, a drop made larger by the fact that 90 percent of it goes through empty air. At the end of a long day and faced with such a large obstacle in the dark, it’s easy to get rattled. I watched one of my best friends shake and equivocate at the same spot, and even though I was two feet away waiting my turn, it was hard to be sympathetic because of the weight of my own fear.

Keith Beidermann fucked up and killed himself, but he (and indirectly his companions) made a mistake that is not unreasonable.

The following is a Utah Canyons egroup post by one of Keith’s partners, edited somewhat:

…I know there are many people with a hole in their heart so I thought
its time to release the Q&A:

Q: What happened?
A: Keith free fell over 260ft (most likely 270+) to his death

Q: Explain
A: User error – rigging – biner block failure – rope run through
large
carabiner used for lowering blocked by much smaller Petzl Attache.

Q: Go on…..
A: Well Keith was the last person down the final rappel in Heaps. I
was the first..lowered..then finally the rap to the bottom to retrieve
the brand new Imlay 8mm 300ft rope..there was a significant delay on
my descent from the end of the rap rope being stuck and then released
but being thrown on top of me resulting in 30-45 mins of tied off
massive knot undoings…I attached the rope for raising
via a water knot with a radio communication(incl to be replaced)…it
was dark and the remaining two had working safe headlamps.

The rope was rigged,I then took off all my stuff off my harness save
for my large rescue steel carabiner. I then was attached to the rope,
although not “onrope”..basically I didnt think a firemans belay was
safe enough for the next descender.

The next descender descended on the system Keith went on and it was
very eventful, but not as far as the rigging.

Final sequence:

Adonis to Keith: “…lost control..not injured…Keith – recheck the
system….this is it..but we have as much time as you need, if you
want
to take 2 hours to rest or whatever so be it”

Keith:”Im fine…”
Adonis: “Ive changed from a loose attachment belay to a munter hitch
bottom belay with about 5ft of slack.”
Keith :”Why?”
Adonis: “Had too much diffuculty with the belay…(person) almost
died…

Keith:”On rappel”
Adonis:”Roger that”
……
Keith:”Too much..Adonis release more slack”
Adonis:”Well, alright then”
Keith:”I know what I’m doing(as opposed to the previous
descender)..let
it out…..

I then was on a very loose bottom belay and radioed that. Moments later Keith fell to his death.

The only scenario that makes any sense based upon the evidence, is
that Keith started the rap(ATC with leg munter hitch(rope runs through ATC
then munter on carbiner attached to leg portion of harness)), then
tied off(rope wrapped around both legs) with the slack to address the pull
cord side thus unweighting the rope and allowing the Attache to move
to slip out…Keith was untying the waterknot, and as soon as the two ropes were unjoined the system was somehow weighted, the Attache pulled through. Just before that, there was a
loss of control on the rope, I was going like mad to tighten the
system, but before that could even happen, the rappel rope started to
fall(I knew immediately it was a biner block failure), I looked at
the pull cord which was someways away from me and it wasnt moving up,
Keith died downhill of me and the rest of the rope fell on top of me.

The last rap in Heaps is logistically tricky. You need 600 feet of rope to get down the 300 foot drop, and then pull your (expensive) rope down after. So you have the descent line on one side, tied to typically two shorter ropes tied together to make a 300 foot pull line. The combined lines are looped through a metal link at the top, and the descent line snakes through when pulled and the whole mess falls to the ground. One must prevent the rope connection from pulling through the link, and this it seems is where the party went wrong.

See below.


Rap line clove hitched to the spine of one carabiner, “blocking” the line from pulling through the anchor link (another, larger biner) when weighted.


Note the problematic nature of the rig when the blocking biner shifts. Biner shifting under load is to be expected.


Bye bye.

In this case it seems that the knot connecting the pull cord to the descent line was problematic and Keith decided to retie it. While this was occuring, the biner shifted, the system failed, and Keith fell. Had a smaller rapid link been used, the biner would not have been able to pull as it evidently did (rangers found Keith’s body on the ground with the rope in his rappel device, and a biner clove hitched into the rope 6 feet above him).

What is confusing is some of the other descriptors used in the narrative. Was the narrator on the pull side of the rope, and thus providing with his body weight redundancy for the biner block, or was he on the descent line and providing with his weight assistance in slowing the rappellers descent? That the second descender “lost control” and basically I [the narrator] didn’t think a firemans belay was safe enough for the next descender” would seem to support the later. This being the case, the narrator’s “going like mad to tighten the system” would also make sense. This leaves the unanswered question, why did they have a sketchy rigging system for blocking the ropes?

The lateness of the hour, the difficulty of the day(s) behind them, the frustration and confusion caused by the obvious rigging difficulties they had, all likely contributed. It also to me points to a lack of planning and competence amongst the group, insofar as they had a lack of clarity in their rigging and ropework, and more importantly that they arrived as late as they did. It’s far more difficult to finish in the dark (whatever the means) when you don’t expect to do so. I infer that this group did not.

The following is a post authored by my friend Steve Ramras, know as Ram to most. Ram is the gentleman in the foreground of the Choprock canyon photo in the blog sidebar, in his 50’s, remarkably driven, and gets more days in the mountains and canyons in a year then most do in a decade (being self-employed helps). He’s also one of the best wordsmiths I know, insisting on keeping his talent underground. As usual, his words don’t bear much improving:

Talking helps. I have sought out several friends just to talk with.
We will talk and speculate about the accident, but do so just
briefly. All manner of other things to discuss. And it is healing.
When Amy S. fell and decked from 60 feet on Mt. Hallett in 1991,(and
miraculously survived), when Johnny B. and the Melon returned with
her, we talked for days as the gal recovered. It felt like what
people do when they lose someone they love. Even though she was
still with us. It had healing qualities, this talking and we did it
daily and nightly, often until the middle of the night. You go round
and round about the event, but you also cover all the bases of
everyone’s assembled life with each other. A kind of review and
inventory. It binds and eases the trauma.

On the night I spent dangling from a flake, with a flash flood
roaring below, with my friends, it was us that stayed for many days
afterward and talked it all out over and over again who seemed to
heal quickest and reestablish our bond together. Some good friends
and I who didn’t go through that process are only now drawing as
close as we were before that trauma, two plus years later.

From the moment I heard about the accident, it felt like I was
punched in the stomach. That place. I hate that place. Then to find
that I had friends who knew the folks, and that members of the party
often have posted here, and that I have enjoyed reading their
thoughts…..It just feels so empty. Then I get angry or frustrated.
What the hell are we doing? Crawling all around big drops and
sliding down ropes and entering freezing water and exposing
ourselves to all these dangers? For what? It seems so futile when
someone, pays the ultimate price. Someone that has someone that love
and depend on them. It’s bullshit! It’s not worth it.

I am scheduled in Zion come Monday night. I have lost the heart for
it. I haven’t even packed and I am always packed 1 to 2 weeks early.
My son is psyched. I have a series of partners who I haven’t seen
for a while, with a trip of hard days in a row, to work conditioning
and weight loss, in preparation for the alpine season. I suppose I
will go and keep my promises. Obligations are good for motivation
and once we go, we will be happy we did. And we will talk. Talk
about the accident. Talk about other things and if we are lucky,
heal a bit more. I wonder if I will be tentative? I feel more
nervous than normal about all these “exposures to risk” that are
coming.

Then I think about the family and no there is no healing for a long
time for them and maybe never entirely. Children never understand
why a parent goes away and I fight back the tears now. It’s
bullshit! I don’t know what to say except thanks for listening and
if you are feeling anything like I am, find someone to talk with.
Let it out. Condolences to the family, friends, partners and really
to the whole stupid community of risk takers. Be careful.
-Ram

Be careful indeed. Not only with your logistics and techniques, but with your head and ego.

7 responses to “The meaning of accidents”

  1. Caving in 2000 down in TN had a camper fall inside a cave we had on property… Concussion and compound fracture of the femur…It was youth and messing around that caused it to happen and me as the counselor not paying as much attention as I should have. It was a long 11 hours underground. I was lucky it turned out a ok but I have never been as terrified for another person as I was that trip into that Cave!Maybe thats why I’m kinna of a fan of this solo thing. Just mainly have to worry about my own bacon =)

  2. For what it’s worth, here’s the most relevant extract from the third party members take on the accident.”Adonis’ description of the final rap sequence is a bit skewed from howI would describe it, including the radio communication. Apparently Ialmost died…I do not believe this is the case. I was heading downin pitch black at a reasonable fast pace to get it over with, when Isuddenly noticed the ground was about 20 feet below me. I wasdefinitely coming in hot but was ready to land, I WAS under my owncontrol. I tried to come to a stop but I was only able to slow myselfdown a bit in the three second notice I had. Thankfully adonisbrought my to a safer halt.I spent nearly an hour up at the bird’s perch with Keith, we thoughteverything was set. It was dark, Keith was noticeably exhausted. Istill felt pretty good, considering the situation. The mood was grim.We spoke very little. I could feel something was not right. Radiocommunication with Adonis was difficult, he kept cutting out and wecould not understand him very well. Miscommunication is a very realand likely possibility.”

  3. And Dave, I here you about that. Cultivating partners in whom you can place a lot of trust isn’t easy or simple.

  4. Great write up. Thanks for the photo explanation of a biner block.Interesting that my first thought on being exposed to canyoneering (your Imlay post) was how close to death you are simply due to equipment malfunction/weather/one bad decision. Lots of things are out of one’s hands.I think you are doing the right and clear thing. Analyze the accident, find the cause, then publish it so others don’t repeat it (although doubtless they will.)Surgery and aviation have similar high stakes to bad judgement or mistakes. Surgeons and pilots are constantly talking about what went wrong, how they would have done it better/different. The older aviation journals would always publish at least one crash story to learn from, and the surgery journals are the same. All training programs have a weekly “morbidity and mortality” conference where every death and complication is presented to all your peers and analyzed.Part of the problem is that canyoneering is a high stakes game without necessarily clear intensive training programs suitable to the sport. I don’t know because I am ignorant of what training is out there, but maybe any fool with a rope can get going on it.Even well trained, experienced folks can be foiled, however. Alex Lowe comes to mind.

  5. Good analogy w/r/t surgery and flying. The American Canyoneering Association has existed for about half a decade, and runs a comprehensive series of courses. As with anything, their record has been mixed as they work out the kinks, but in the last year or so I know their courses have been full which is encouraging. Outdoor sports, especially climbing from which canyoneering in the US springs most directly, have an ethos of trial and error learning. I had a few moments when I was learning to trad climb that could have ended in death or dismemberment had it not been for luck and a whole lot of climbing gym-bred strength.The Socratic search continues……

  6. It is interesting that your friend writes about “not having the heart” to go on a upcoming trip. I watched Bill Corliss die on a Utah road after a freak accident put him under a passing truck. It’s been over a year since then, and I don’t think I have ridden my road bike more than 15 times in the time that has passed.I lost the heart for it. And found more solace in the mountains than ever before.

  7. Great post! yesterday i found another great video post about accidents. Here is the linkworkplace incidents

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