Mountaineering and rock climbing have become increasingly popular in recent years and involve an estimated 100,000 participants; accordingly, the number of climbing-related injuries has also increased. We analyzed 127 climbing-related injuries reported to the US National Park Service in 1981 and 1982, 36 (28%) of which were fatal. Falls accounted for 75% of all climbing-related injuries; median length of fall was 91 m for fatal injuries and 9 m for nonfatal injuries. The majority of injuries (69%) occurred while ascending. Falls on snow or ice were longer than falls on rock, and injuries on snow or ice were more likely to be fatal. We discuss considerations and strategies for the prevention of climbing-related injuries. A new conceptual model suggests that the methods of traditional mountaineering safety programs may be of limited efficacy in further reducing the number of climbing-related injuries.