Objective.-Caving is a demanding sport practiced throughout the world. Currently, there are no collective data analyzing injury mechanism or type in these austere environments. This study is a retrospective analysis of caving incidents documented by the National Speleological Society (NSS)-American Caving Accidents (ACA) annual publication. Methods.-This study retrospectively analyzes 877 incident reports collected between 1980 and 2008 by NSS-ACA. For each victim, the month, year, location, age, gender, incident type, injury zone of the body, injury type, the result of the incident, and time intervals for rescue were extracted. Results.-A total of 1356 victims were identified; 83% of victims were male, 17% were female. Ages ranged from 2 to 69 years old, with an average of 27 years. The greatest number of events occurred in summer months, peaking in July. The most common incident leading to traumatic injury was a caver fall (74%), also contributing to 30% of caver fatalities. Lower extremities were most commonly injured (29%), followed by the upper extremities and head (21% and 15%, respectively). Fractures comprised 41% of injuries, followed by lacerations (13%), bruise, hematoma, and abrasions (12%), and sprains and strains (7%). Conclusions.-The majority of injuries were not life threatening; however, over the course of 28 years there were 81 documented fatalities. Similar to other studies of wilderness injuries, fractures, soft tissue injuries, and lacerations were prominent in this study. In general, the overall precipitating event leading to injuries is falling, leading to orthopedic trauma. To better prepare cave rescue teams we have attempted to describe the characteristics of caving injuries in the United States.