27 Caving

Deep, tight caves are found both near to civilization and in very remote areas, the latter adding to the logistic difficulties. In some parts of the world, especially south-east Asia, accessing caves may be hazardous because landmines and other munitions from past conflicts may be strewn around outside, or abandoned inside. When searching for entrances in heavy undergrowth, beware of snakes and other venomous animals.

Caves are dangerous places. Lighting can depend upon torches, ceilings and floors are often uneven and may be slippery. Flooding is a possibility. Communications with the surface may be very limited. You are unlikely to survive a significant accident, and therefore take care, as rescue is likely to be limited to helping out the ‘walking wounded’. However, caves are amongst the last unexplored areas on Earth and there are some great places to find!

Colonies of bats and birds, as well as ground creatures like to live in caves. They can spread disease to humans, while humans may be vectors aiding the spread of animal diseases.

Caves usually have a fairly constant low temperature of 5–8°C. Hypothermia ( Hypothermia, p. 622) is a significant risk especially where running or falling water creates high humidity, spray, and cave draughts, all of which intensify the chilling effect. It is a particular risk if you have to wait around for some time, or if you have to make an unanticipated bivouac; a space blanket kept in your pocket or helmet could be a life-saver.

Cave exploration often involves diving (see Cave diving, p. 793 and Chapter 24).

Caving expeditions may be:

Typical cave clothing is impermeable and traps perspiration, so a prolonged wait at a pitch head after a vigorous climb can be very cold; the combination of a wet shell garment with damp undergarments leads to rapid heat loss. Up to half the heat loss from an otherwise well-insulated person is from the head, so keep a silk or fleece balaclava in your pocket and put it on when stationary. Cold injury, either hypothermia ( Hypothermia, p. 622) or non-freezing peripheral cold injury (trench foot Non-freezing cold injury, p. 632), is a risk during prolonged trips, especially in wet caves. Modern materials offer significant improvements; ensure that expedition members unfamiliar with the subterranean environment—e.g. scientists accompanying the trip—receive appropriate advice on gear.

Strict food handling and sanitation arrangements are essential underground. Latrine arrangements vary depending on the nature of the cave; many modern underground camping expeditions will bring out solid matter in plastic bags. Alcohol gel hand lotion should be available at the camp, but may not protect against viral gastroenteritis. When washing is impractical, baby wipes are useful for personal hygiene.

(See Wounds, p. 268; Wound types and management, p. 272.)

‘Crutch rot’, split fingers, and minor foot injuries, blisters, and the like are common. Experienced cavers have their own views on how to deal with what are usually just minor irritations. Tissue superglue, used to repair skin splits on fingers and feet, is a useful addition to the underground first-aid kit.

Caving has a fatal accident rate twice that of climbing accidents in the UK (although the risk is still much lower than climbing in the Greater Ranges), but a relatively low non-fatal accident rate.¹ Some accidents, e.g. those caused by rock falls, may be unavoidable, but others are preventable. Be careful ‘pushing the cave’ when tired or cold. The low non-fatal accident rate indicates that there is a low margin for error and that death is common if something goes wrong. A relatively minor injury is likely to be fatal if the victim is unable to assist during the extraction. Small independent expeditions are usually incapable of mounting a major rescue without outside help.

An excellent cave rescue ropework manual, currently in the second edition, is available at  http://www.lifeonaline.com. If planning to explore vertical caves, purchase and download the manual, and practise the techniques before departure.

If someone is immobile upright in a harness for some time, the usual muscle pump in the legs ceases and venous return to the heart is impeded. This can lead to syncope with loss of consciousness. Usually when someone faints, they fall to the ground, venous return is restored, and cerebral perfusion resumes. However, in a harness this correction cannot occur, and the resultant loss of cerebral blood flow may be rapidly fatal. Cavers are particularly at risk when they are immobile in a harness on a rope, especially if unconscious. The first priority if you have an unconscious companion hanging on a rope, maybe knocked out from a falling rock, is to swing them horizontal, so that their legs, heart, and head are all at the same level. This will probably mean moving the point of suspension down to their waist, obviously taking suitable precautions to ensure that they don’t come off the rope. You may only have a few minutes, so act quickly, but get them either horizontal, or ideally off the rope as soon as possible.

Bad air is an issue in some caves, although you should usually be aware of the risks beforehand. The gases in question result from decaying organic matter, including guano, in caves with poor ventilation. Carbon monoxide monitors and supplementary oxygen may be required. Important gases are:

Since 2006, bats in the northeastern USA and Canada have been dying in vast numbers as a result of white nose syndrome (WNS), a condition associated with fungal growth (Geomyces destructans) around the muzzles and wings of hibernating bats. European bats carry the fungus, but appear resistant to its effects. Direct bat-to-bat contact appears necessary for transmission, but the role of humans in its spread is debated, and Europeans caving in North America should ensure all their clothing and equipment has been carefully cleaned.

(See also Chapter 24.)

Scuba diving in caves is notoriously dangerous, with a significant number of fatalities amongst both inexperienced divers and those pushing the limits of exploration. The clarity of water in cave sumps can distort depth perception, subterranean currents may drag divers, while silt can suddenly reduce visibility. Safety can be enhanced by:

Cavers are at risk of catching some specific infectious diseases. If you consider that any of these pose a risk in the area that you plan to visit, seek expert advice before you go.

(Chagas disease; see American trypanosomiasis (Chagas’ disease), p. 493.)

Protozoan infection transmitted by faeces of tritomine bugs; widespread in South America. Infection develops through contamination of skin.

A fungal infection inhaled from infected bats’ droppings. It results in chronic malaise and, as it is usually diagnosed following chest X-ray (which may resemble sarcoid), it is not readily diagnosed in the field. Symptoms of severe pneumonia which are unresponsive to antibiotics would merit evacuation for a chest X-ray and investigation (treatment is with IV amphotericin). Although it may resolve spontaneously, specialist treatment with antifungals is likely to be required.

(See Leishmaniasis, p. 490.)

Transmitted by sand flies, especially in China.

(See Leptospirosis, p. 471.)

Transmitted by exposure to water contaminated by rodent urine. It presents with an acute generalized febrile illness, usually with jaundice, and specialist investigation may be needed to distinguish it from other febrile illnesses in the tropics.

(See Rabies, p. 461.)

Transmitted by cave bats. If visiting caves in areas where it is prevalent, ensure the party has been immunized pre-departure. European bats carry bat lyssaviruses 2, a rabies-like infection. The only case of UK-acquired rabies since 1902 was in a licensed bat handler bitten by an infected bat. There have only been four documented cases of humans being infected by a European bat lyssavirus in the past 25 years.

(See Ticks, p. 288.)

Caused by a Borrelia spirochaete and transmitted by tick or louse. Tick-borne relapsing fever is prevalent on the west coast of North America and is common in caves, with an intermediate animal host. It results in a relapsing fever (!), together with headaches, abdominal pains, and myalgia. Treatment is with tetracycline, but this can result in a Jarisch–Herxheimer reaction (a severe allergic reaction due to the antibiotic killing large numbers of the organism).

Occurs in epidemics in the southern USA, and may be of particular risk to cavers as the intermediate host includes bats.

Siopel^® silicone cream is recommended for macerated skin produced by prolonged contact with wetsuits.