Every year in the early autumn, like clockwork, a small, unassuming white cardboard box shows up in my mailbox. I wait for it like a child on Christmas. I know full well the shape, heft, and value of the objects inside. I don’t have to shake it to know. But as much as I know, it also contains 100 times that in mystery. Inside are two volumes that make up the greatest compendium of climbing knowledge and experience from the previous calendar year. Inside are the American Alpine Journal (AAJ) and Accidents in North American Climbing (ANAC). The AAJ is a wonderful publication, filled with tales of triumph, defeat, heroism, and unfathomable skill, played out in mountain ranges around the world. But the book I await, with a good cup of coffee and my morning calendar cleared, is ANAC. This book, published faithfully for more than 73 years is the hard work of dozens of dedicated individuals. From the reporting parties, to the local rescuers, editors, and the AAC (American Alpine Club) staff, this work is undertaken for our benefit, and for those of us who practice medicine in the mountains, I submit that it should be required reading. For me, ANAC is one of the talismans that help me ward off evil spirits in the hills. Reading it puts credits in my little black box. If you’re not familiar with the Black Box Theory, you ought to be. John Vigor, a prolific writer in the nautical realm, posits that every sailing vessel has a little black box, and acts of seamanship add credits to the box. When the weather’s rough, and your fate is largely out of your control, credits are withdrawn from the box and may provide you with some protection, if you have amply supplied the box. Mountaineering is no different. From sharpening your ice tools, to checking the expiration dates in your SAR kit, to reading ANAC, a good climber puts credits in their box at every opportunity. Here are some gems from just this year:

• Page 8 initiates Know the Ropes, a yearly feature that takes a deep dive into a specific risk mitigation area; in 2020, it focused on avalanche danger, with a follow up featurette on avalanche hazards in ice climbing terrain, which are often overlooked. 

• Page 22 describes an accident that involves climbers on Denali caring for a frostbitten colleague at a 14,200’ camp for three days before he could be flown off the mountain by NPS. I think my frostbite game is pretty good, but reading this story encourages me to at least run through a mental exercise of all the things I can anticipate needing to do for a patient with severely frostbitten hands while pinned down in a snowstorm high on one of the seven summits.  

• Page 50 contains not only the account of a lifesaving wilderness needle decompression performed before formal SAR response, but also a six-hour-long rescue ordeal from the Black Canyon of the Gunnison.

In addition to the print version of ANAC, there’s now also a monthly dose of accident beta delivered right to your inbox known as The Prescription as well as The Sharp End podcast that covers accident reports in detail. No matter your preference, schedule, or preferred media, you can regularly put some credits in your black box. 

    One of the things I appreciate most about ANAC is the sober format of both the accident reports, as well as the analysis. The editors do a great job of attempting to convey small learnings, especially from significant accidents. In this way, ANAC is like the mountaineering world’s morbidity and mortality conference (M&M). In Complications (another book I highly recommend), Atul Gawande writes: “The M&M sees avoiding error as largely a matter of will—of staying sufficiently informed and alert to anticipate the myriad ways that things can go wrong and then trying to head off each potential problem before it happens.” This is entirely the role of ANAC. He continues, “the very existence of the M&M, its place on the weekly schedule, amounts to an acknowledgment that mistakes are an inevitable part of medicine.” I see ANAC very similarly. I will make mistakes in the mountains, as will other adventurers there. Reading ANAC keep us informed of those “myriad ways that things can go wrong.”

    If you want to know how to treat injuries in the mountains, there’s no better place to begin than with knowing what kind of accidents happen, what actions lead up to them, and what the conditions are like surrounding those incidents. When you’re done with the narrative portion of ANAC, don’t miss out on the data tables in the back. These volumes and percentages should inform what skills we practice, and what goes in our SAR/ first aid kits. 

    No matter where a WMS member finds themselves in the wilderness medicine world, behind the desk providing oversight, or in the field administering care, reading this tome year in and year out reminds us when our vision should become a bit more acute, our ears more attuned to the slightest changes in wind and pressure. It gives us both objective and subjective data regarding what we need to be prepared for in the mountains.

    Go out and read ANAC each year, but don’t stop there. Search out the crusty old climber who has fifteen years of them on their shelf and read one every couple of months. There’s no doubt it will make you a better risk manager, and a better mountain rescuer. While there’s no substitute for experience, learning from other people’s, coffee in hand looking out the window, is an awfully close second.