Came across an injured Canyoneer in Imlay (what would you do)

[Deathcricket]

I need some armchair quarterbacking here guys. I had trouble sleeping last night based on the decision I made in a canyon yesterday. :(

So I did Orderville yesterday with some friends. 8 people in our group including two small children about 8 years old. We had a blast but didn't make the best time as you can imagine. Too many polywogs and other critters to play, took way to many pictures of us doing backflips into pools, got a late start, etc, etc, etc. No biggie though we arrived at the junction for Oderville and Virgin around 6:30PM. Again approx times, my cell was in my drybox, didn't have a watch on me, so I could be off a bit on my timeline.

Two people show up while we are inflating our floats for the Virgin and are in frantic mode, a person in their group just fell off the last rap in Imlay, leg broke, they are going to get help, how far do they need to go, who do they even talk to, yadda yadda. We give them info and they are on their way down. A couple of us head up to see if we can help. One guy in our group is a Red Cross First Responder (more on that later).

We arrive on the scene and our first responder guy takes over. Well maybe "takes over" is not the right words, but he starts asking questions and checking the person's wounds, we get her in a warm emergency blanket and we have some inflatable rafts that we were going to use to float down the narrows like this:



We blow 2 of them up and put her on one, get her out of her wetsuit, and under the emergency blanket, give her some Ibuprofin for the pain. Her boyfriend/significant other is hugging her and she is warmed, up and doing really good. Again I'm not a doctor I just play one in the bedroom. She had some shock obviously and her foot is killing her, but nothing else serious as near as I can tell. Again though, I freely admit I know nothing. Our First Reponder team member is evaluating her still. He is pushing on her leg "does it hurt here, here, can you point your toes?", etc.

So here is the prognosis. Her foot is not swollen at all under the neoprene socks. Never took them off though, that would be too painful. She feels no pain touching the top of her legs, even her ankles are fine. Very very tender underneath (pads of foot) though, but she also mentions she has a huge blister there and it could be contributing. She can point her toes up just fine, but pushing down on my buddies hand is very painful. His evaluation seems to indicate a small fracture or ankle sprain of some sort. She can't walk out of the canyon but nothing life threatening or dangerous like hemmoraging, bones poking out, or such.

I do a little discreet/casual asking the other members about what happened, not too much prodding cause they feel like shit right now, and this is not the time for them to relive this incident. Our main focus should be to survive this ordeal and think about it later. So as near as I can tell (again I didn't press far) she clipped on the wrong side of the biner block and took a 150 foot semi free fall, as fast as the rope can pull through the ring I guess. to the bottom. I've not done Imlay's last rap, but I guess it's a sketchy start and you can only have one person on the setup and she was first down. They say she was very experienced but probably fatigue just made her do a bad judgement call.

So I look over to where she fell and it is literally a miracle. There are huge 1-2 foot river rocks everywhere, but the spot where the rope drops is cleared for a 5 foot radius and there is maybe a foot of water puddle there. Not much to break a fall at all. She is lucky to be even alive. But this will factor into the decision later.

So hopefully I've described her condition enough. She looks perfectly fine except for a nasty sprained ankle basically. It's now approaching 7-7:30ish. I'm guessing the portion of her group that left will be hitting the paved section of the riverwalk by about now, if they were able to haul ass. Another 15 mins they will be able to reach the buses and call the calvary/heavy hitters in. So even factoring best response times ever, it will probably take them another half hour/45 mins to reach the end of the paved section, then another 45 mins to an hour to hike the 2 miles up this nasty, slippery, giant marble playground, carrying a heavy board/liter. So very best response time would put them an 1.5 hours and mediocre response time would put them there and 2.5 hours. And again, how long would it take 4 people to carry a super heavy cart up a well flowing river. I'm assuming 4 of them minimum? What if they had 6 responders? LOL. I'm trying to factor all the equation in my head and figure out crap I literally have zero clue about.

But my best guess is that there is no way they are going to be able to get her out of here before the sun goes down around 8:45. No way..... And it's a narrow canyon and it's already starting to get dark and chilly.

So I take a hard cold look at her. She is around 24-25ish, weighs maybe 125 pounds max. Between our two groups we have 7 more than capable guys who can carry her out of this canyon RIGHT frigging now. We have 2 inflatable rafts that we can use to float her through the easy sections. Yeah we'll go slow, but I think we can get her out of here (the paved section) in 2.5 hours, which would put us around 9:15-9:30ish, not too far in the dark and we have headlamps. Here is a random pic of the area, try to imagine spending a freezing night here.



I take a cold hard look at the surroundings. There is water everywhere. She is laying on an inflated raft and quite comfortable at this point. But there are 3 more guys in her group that are going to be miserable. Everyone has wetsuits. But there is not an inch of ground around that doesn't have river rocks on it, there is at least an inch of water everywhere, there is a little sandbar maybe 3 feet across and 7 feet long that has water running on both sides that would probably be the only place for them to sleep. And this water is freezing cold and the 100 degrees temps aren't sticking around for long with the sun going down. The Narrows is a cold and getting colder! I'm starting to shiver just sitting there without a wetsuit. Once the sun goes down there will be no time left to make a change in plans.

So I ask our first responder guy what he thinks, he is the closest thing we have to an expert around. He says he doesn't think we should mover her under any circumstances and we should just wait for help to arrive. And we (us) will make sure to get out before the sun goes down and makes the way impossible to travel. He had not done this route before but I tell him its about 3 miles and 2 miles of that are these nasty impossible conditions that makes it very slow going. We ask her what she wants to do and she says she doesn't want to move and wants to wait for help too.

But I just can't shake the fact they we have 7 very capable guys and 2 or 3 girls who could haul her skinny ass out of there. I feel that hypothermia is a very valid concern. They have matches to start a fire, but there is zero wood around and even if they did hike and find a couple logs, I doubt they could make a fire. The place they are staying in is absolute crap and maybe we can at least find a better spot, with sand and bushes maybe to keep them out of the wind. I know these spot exist from last years trip, I just can't recall how far down the river they actually were. I'm guessing the water temp is around 55ish and pretty soon the canyon is going to get to the same temp. And most likely rescue isn't coming due to the extreme lateness in the day. So I plead my case but very clearly state it's opinion more than fact. I would not want to spend the night in that place under any circumstances. In the end they decide to stay and wait for rescue. I leave and mentally beat myself up the whole way down the Narrows. Rolling the 2 choices in my head over and over again and the pro's and con's of each. It's like a no win situation really.

So we are cold, we left all our flotation devices with them, 2 matresses and a 4 inflatable donuts, which could maybe be used for pillows or a backrest or something, who knows. But something is better than nothing. We leave her wrapped in our emergency blanket and really quite comfy I think.

We make good time down the narrows and arrive at the bottom just as two rangers are getting there. One has a huge pack on her back. We talk to them and they are very capable, I immediately got a sense of ease that they would handle the situation well. My first responder buddy gives them all the details of his analysis of the victim in a factual manner. Ranger asks for an exact location and I tell her. I don't know this for a fact but it "seems" to me that they were under the impression that the injured party were stuck at the bottom of mystery! I honestly think the previous two that went to alert gave them the wrong information in their panic. The ranger played it cool but I detected many corrections being made once I gave her this information, a sense of dismay/disappointment on her part. As you may know Mystery is maybe 1/4 mile up the river and would have made a much easier rescue than this 2 mile trek from where they were.

We then asked if we could know their plans and they said that it was too risky in the dark for the narrows, they would most likely have a medic stay the night up there with them and then rescue in the morning. But since we still had 45 mins of daylight maybe they might have a couple other options still available and she was going to research those now with her team on the radio.

We walked the last mile to the buses and passed a lot of rangers coming up on the way with all kinds of rescue equipment. Got to the parking lot at 9:00. Went to Oscars and pounded some beers/burgers with my buddies, went home. I still don't know what the fate was or how it all worked out in the end.

So anyways, I still can't wrap my head around this and would appreciate advice. Yes moving an injured person down the narrows is very dangerous, but she was very light and not really that badly injured IMO. But maybe she had more injuries that could present themselves once the shock wore off and maybe she was worse off than the twisted ankle we detected. Maybe rescue has some backdoor entrance to use and us changing her location would totally screw them up. Maybe one us slips while carrying her down and she falls and smacks her head on the boulders going down, we actually jack her up worse than she is? Maybe she gets hypothermic from us floating her so much. But::::

What if we all carried/floated her down the narrows flawlessly, got her to the rescue crews waiting and it was a happy ending? Plus we would kinda feel like "heroes" instead of "erring on the side of caution pansies"? Maybe my ego is really big thinking we could have saved her from this awful situation and it could have had disatrous consequences. Maybe they all got hypothermia and died once we left them?

[Canyonbug]

So anyways, I still can't wrap my head around this and would appreciate advice. Yes moving an injured person down the narrows is very dangerous, but she was very light and not really that badly injured IMO. But maybe she had more injuries that could present themselves once the shock wore off and maybe she was worse off than the twisted ankle we detected. Maybe rescue has some backdoor entrance to use and us changing her location would totally screw them up. Maybe one us slips while carrying her down and she falls and smacks her head on the boulders going down, we actually jack her up worse than she is? Maybe she gets hypothermic from us floating her so much. But::::

What if we all carried/floated her down the narrows flawlessly, got her to the rescue crews waiting and it was a happy ending? Plus we would kinda feel like "heroes" instead of "erring on the side of caution pansies"? Maybe my ego is really big thinking we could have saved from this awful situation and it could have had disatrous consequences. Maybe they all got hypothermia and died once we left them?

Your questions/concerns are valid, however your solutions are also valid. In any type of medical situation the logical and most common response to treating an injured victim is "Don't move them." I find that this response needs to have all other variables looked at in a Canyoneering scenario. Another common treatment response in Emergency Medicine is to not give the victim anything to eat or drink. Again in Canyoneering, this variable should be considered lightly.

From a standpoint in our area, rescue would be hours upon hours away. In a situation where the park service has rescuers that are full time, rescue may be a little quicker. This would be a consideration. The full time rescuers get into a rhythm of how to solve the rescue problems as they deal with them all the time. As you mentioned, had you moved her the whole scenario could have changed. It could have improved, or it could have gotten worse, you'll never know.

One of the older SAR guys who had been doing it for years in our area stated that he feels he should just start carrying a pair of crutches into the Black Hole and make the person walk out instead of dragging the whole litter system into there. Moving a victim is situational in a Canyoneering scenario. Sometimes it would be better to get them going and get them out, but I don't think anyone on this forum can give you a definite answer of what you should or shouldn't have done. The victim is also a key factor in what they are willing to do. It would do no good for you guys to have picked her up and started carrying her out if she didn't want to do it. I think you did the best you could and leaving it to the rangers to finish out was what the victim wanted to happen.

[Brian in SLC]

Tough call. I mean, if her group and her felt like they needed to wait for some litter transport, then, you're good to go. I wouldn't worry about it.

I guess I'd be pretty worried about moving anyone that fell from that height. Can't believe her back wasn't jacked up. Amazing. Must have had some rope friction whippin' through those rappel rings up top. Crazy.

I've helped carry out guys that were pretty hurt a couple of times. Not that hard, and, you can get it done quickly in daylight, that's a huge help. But, with a possible spine injury? Dunno. Tough call.

Good ol' biner block. Yikes. Easy to mess up any rappel at the end of a long day, regardless of the rigging, though. If she wasn't the first one down...or the last...hmmm....

Great photo of the narrows!!

[oldno7]

A fall from that distance has potential for major injuries, both internal and external. Your friend doing the evaluating was spot on imho. Huge risks involved with moving if "all" injuries might not be known.

I feel your pain in having to walk away, but I think the decision was prudent. If she had stepped over a boulder and twisted an ankle, different conclusion. Falling from 130', huge potential and defenitely lucky to be alive. Remember the part time ranger doing the same thing on the last rap in Pine Cr.?

[Iceaxe]

Interesting thread....

And while I'm here I might as well update my list.....

I Fell 106 Feet. And Lived
http://www.bogley.com/forum/viewtopic.php?t=15131

Heaps Accident
http://www.bogley.com/forum/viewtopic.php?t=7204

Pine Creek Accident
http://www.bogley.com/forum/viewtopic.php?t=13057

Englestead Accident
http://www.bogley.com/forum/viewtopic.php?t=17627

Pine Creek: SAR in Zion
http://www.bogley.com/forum/viewtopic.php?t=8285

Came across an injured Canyoneer in Imlay
http://www.bogley.com/forum/showthread.php?57250

All the accidents listed above were a result (at least partially) of complicating the rigging.... More parts.... more crap that can go wrong....

[Deathcricket]

Cool responses so far guys! Makes me feel a heck of a lot better, seriously. I didn't get any sleep worrying about those poor guys freezing, while I'm comfy in my bed, and I truly had the power to get "maybe" get them outta there. I guess I have to agree though it was the right decision to leave them. Hopefully we hear about the ending though.

@brian - It's not my pic, just some random one I found hehe. I got lots of pics of Orderville but none of the Narrows, party was over and time to go home by then. But I always feel a visual helps to see exactly what the conditions were like and that pic is very accurate. I was also tempted to take pics of the scene, but that didn't seem fair to the victims. I did notice they had a GoPro helmet hero and the leader of the group did say he was filming when the accident took place. So a video may surface if they choose to release it.

So I have a little bit of an update after talking with a very observant member of our team. I'll quote myself for the corrections.

We make good time down the narrows and arrive at the bottom just as two rangers are getting there. One has a huge pack on her back. We talk to them and they are very capable, I immediately got a sense of ease that they would handle the situation well. My first responder buddy gives them all the details of his analysis of the victim in a factual manner. Ranger asks for an exact location and I tell her. I don't know this for a fact but it "seems" to me that they were under the impression that the injured party were stuck at the bottom of mystery! I honestly think the previous two that went to alert gave them the wrong information in their panic. The ranger played it cool but I detected many corrections being made once I gave her this information, a sense of dismay/disappointment on her part. As you may know Mystery is maybe 1/4 mile up the river and would have made a much easier rescue than this 2 mile trek from where they were.

So the feeling is that the 2 people who went for rescue (initially) were NOT part of the original group. They were random Narrows hikers who just stumbled upon the scene when it first occurred and then went to get rescue. So the entire canyoneer party was only 4 people. Again just an educated guess. I don't have those as facts. Apparently they had ZAC walking sticks (when we spoke with them) and that is a dead giveaway they are not canyoneers. This would explain how bad info got to the rescue team (if indeed bad info was passed). But they would have had no clue as to the location of the accident, just that it was upriver and some lady fell off a rope. So at least that part makes sense. In the future though it might be wise to make sure the people getting help know exactly where you are.

[middlefork]

Because of the mechanism of injury it is wise to suspect spinal injury. In this case once you verify the ABC’s you should have applied manual stabilization of the head and shoulders until the victim can be secured to an immobilization device. Was this done?

It sounds like you had plenty of material to stabilize with. Pads, packs, rope extra gear. Once they are stabilized you can the take the time to determine the extent of other injuries and if the scene is safe to prevent further injury to the victim or rescuers.

It sounds as if there was a probability of hypothermia along with the onset of shock that would suggest moving her to a better location. Again if she is stabilized it would make that decision much easier.

If she was not stabilized on the outset any movement had the potential to create greater harm. That being said it did not sound as if she showed any signs of neurological distress.

That being said I think being trained in first aid is a great first step in being prepared to deal with wilderness emergencies.

[Don]

Yeah tough to walk away and leave someone in that situation. Sounds like you made the right call though.
I agree with Canyonbug that some common advice like 'don't move the patient' can sometimes be ignored in remote areas. It's a simple equation that comes down to 'will this person be in more danger if they stay in this location?'
But in this case you have a stable patient and your main concern, hypothermia, seemed manageable (yeah, they'd be uncomfortable all night but unlikely to die of exposure).
And as middlefork said, given the mechanism of injury you have far more to worry about than hypothermia if you move this patient without immobilization. If she had jumped from a boulder and sprained an ankle it might have been better to carry/float her out, but in this case there are too many other problems that may have gone undiagnosed, that could be made worse by moving the patient.
Stabilize and get help was the best you could do. Offering up some comfort items like a mattress, emergency blanket, and ibuprofen make the stabilization easier and earn mad karma points.

[JONBOYLEMON]

I am no expert, in fact I dont know the 1st thing about this situation, but I would think that spending a cold night anywhere after almost falling to your death, or watching it happen to a friend, just aint that big a deal.

I do however know alot about aviation and aviation accidents, and its almost always not the 1st problem that kills people.

[oval]

I think it all depends on if you suspect a spinal cord injury.

Without any of you being really qualified to discern that, I think playing it safe and leaving her lying down is the safest choice.

Ultimately, it sounds like she was in a good enough mental state to make the call herself. Was she sitting up (sounds like it if her boyfriend was hugging her)? Squirming around? Repositioning herself to get the inflatable under her? If so, she might have been fine, or had a fracture that wouldn't be bad enough to worry about.

Ultimately, you probably did the safer thing for her since you couldn't tell if the spine was involved or not. Better to wait for a real stretcher, imo. That hike out of the Virgin isn't that bad for rescue crews compared to some other areas in zion that would be horrible.

[nonot]

Maintaining anonymity of the group involved:

"While doing a full Imlay, a buddy slipped on a down climb and came down real hard and broke his ankle Sat afternoon. Camped above the crossroads, next morning we left [someone else] with him and the rest of us pushed on to report the accident. On the final 140ft rappel, i ran ahead to report the accident but a gal behind me made a rappelling mistake (clipping into the wrong side of the biner block) and fell the whole distance of the rappel down to the narrows. By some crazy miracle, as the rope was whipping thru the anchor it slowed down near the very end and greatly slowed her crash into a few inches of water. SAR hauled her out last night and she ONLY sustained a broken heel?!?!? Her BF sprained his ankle running over to her, but we way able to still hike out. The other two are still stuck up in the canyon and were waiting for them to be air-evaced out... Nothing short of Epic, in such an amazingly beautiful and rugged canyon and SO glad they were only leg injuries!!!"

later:

"Everyone is now out of the backcountry and being treated..."

[spinesnaper]

Interesting scenario. The difficulty here is extremely limited first responder knowledge. Doing no harm is the watch word. In a cold water environment, I would not be in a rush to strip off the wetsuit. The wetsuit is critical to prevent hypothermia. No rescue blanket will ever be as warm as that wet suit. It is critical to talk to the victim if they are coherent. What exactly happened? Where do they hurt? Do they have any medical conditions or allergies to medications? Even through a wetsuit one can perform a cursory examination, investigating tender area in more detail. Assuming the victim is coherently able to answer questions, determine if there is any tenderness over the spine. Can the person move their fingers and toes?

While it is great to be able to evacuate on your own, assess the capability of your party to perform the evacuation. In the narrows, help is not that far away. Weigh self-rescue against the ruggedness of the the travel corridor and the fact that search and rescue personnel will have appropriate resources to keep the injured victim warm and comfortable until it is safe to carry out an evacuation. If you had determined the injury was limited to the ankle and were able to stabilize the ankle, it might have been possible to carry out the evacuation given the size of the group. Bear in mind, that river in high flow conditions is very difficult to walk in even when nothing is injured. I think under the circumstances, keeping the victim warm,comfortable, and in good spirits until help arrived was the right call here.

Ken

[accadacca]

Maintaining anonymity of the group involved:

"While doing a full Imlay, a buddy slipped on a down climb and came down real hard and broke his ankle Sat afternoon. Camped above the crossroads, next morning we left [someone else] with him and the rest of us pushed on to report the accident. On the final 140ft rappel, i ran ahead to report the accident but a gal behind me made a rappelling mistake (clipping into the wrong side of the biner block) and fell the whole distance of the rappel down to the narrows. By some crazy miracle, as the rope was whipping thru the anchor it slowed down near the very end and greatly slowed her crash into a few inches of water. SAR hauled her out last night and she ONLY sustained a broken heel?!?!? Her BF sprained his ankle running over to her, but we way able to still hike out. The other two are still stuck up in the canyon and were waiting for them to be air-evaced out... Nothing short of Epic, in such an amazingly beautiful and rugged canyon and SO glad they were only leg injuries!!!"

later:

"Everyone is now out of the backcountry and being treated..."

Man the story keeps getting better...

[Deathcricket]

Maintaining anonymity of the group involved:

"While doing a full Imlay, a buddy slipped on a down climb and came down real hard and broke his ankle Sat afternoon. Camped above the crossroads, next morning we left [someone else] with him and the rest of us pushed on to report the accident. On the final 140ft rappel, i ran ahead to report the accident but a gal behind me made a rappelling mistake (clipping into the wrong side of the biner block) and fell the whole distance of the rappel down to the narrows. By some crazy miracle, as the rope was whipping thru the anchor it slowed down near the very end and greatly slowed her crash into a few inches of water. SAR hauled her out last night and she ONLY sustained a broken heel?!?!? Her BF sprained his ankle running over to her, but we way able to still hike out. The other two are still stuck up in the canyon and were waiting for them to be air-evaced out... Nothing short of Epic, in such an amazingly beautiful and rugged canyon and SO glad they were only leg injuries!!!"

later:

"Everyone is now out of the backcountry and being treated..."

Did I meet you at the buses and were you wearing a blue shirt? I heard this exact story from a guy there. But I immediately dismissed it because there is no way that could be true. What are the chances of two people breaking ankles on the same trip from the same group? Oh man! If this is true though. I am so glad she made it out that night and everyone from your group is ok. That is really good news! Totally appreciate the update man.

[Iceaxe]

Man the story keeps getting better...

x2

[Felicia]

Too many SARs...not good. :-(

It's good to hear that all are OK.

[Bo_Beck]

What are the chances of two people breaking ankles on the same trip from the same group?

Add a broken ankle 2/3 of the way down the entrance into Mystery on the same day! Hmmmmmmmm?

[Jaxx]

Here is a picture of the anchor at the last rap. It is set up with a long piece of webbing anchored about 6 feet back from the edge and it runs to the rap anchors. It worked perfectly to clip the safety line in there and safely make your way around the corner to the anchor chains and set up the anchor/rope/biner block. Our 200 footer wasn't long enough (as expected) and so we had to biner block. I tested and weighted my rap device before unclipping my safety line.



It took us about 2 hours to rap from the last rap to the buses when we did Imlay. Crappy exit for a rescue.

I don't think there is much more you could have done. Getting her out would probably take you twice as long atleast. That puts your group in some discomfort at best, danger of other injuries at worst. I think you handled it well. With little kids with me I wouldn't have hesitated to leave the other group. Im a jerk I guess but those kids are my 1st responsibility.

I have to disagree with spinesnaper on the wetsuit though. The wetsuit makes me feel colder. It holds the water for a long time. Without the wetsuit atleast your skin can dry out. Hopefully the clothes are quick dry also.

[Deathcricket]

Here is a picture of the anchor at the last rap. It is set up with a long piece of webbing anchored about 6 feet back from the edge and it runs to the rap anchors. It worked perfectly to clip the safety line in there and safely make your way around the corner to the anchor chains and set up the anchor/rope/biner block. Our 200 footer wasn't long enough (as expected) and so we had to biner block. I tested and weighted my rap device before unclipping my safety line.

It took us about 2 hours to rap from the last rap to the buses when we did Imlay. Crappy exit for a rescue.

I don't think there is much more you could have done. Getting her out would probably take you twice as long atleast. That puts your group in some discomfort at best, danger of other injuries at worst. I think you handled it well. With little kids with me I wouldn't have hesitated to leave the other group. Im a jerk I guess but those kids are my 1st responsibility.

I have to disagree with spinesnaper on the wetsuit though. The wetsuit makes me feel colder. It holds the water for a long time. Without the wetsuit atleast your skin can dry out. Hopefully the clothes are quick dry also.

I love you man!

I was hoping to see what the start looked like, thank you. And yeah I worded that "wetsuit" portion poorly. She had some quick drying clothes I believe. We all turned our backs and gave them privacy to change, but I do know for sure she had a fluffy dry plaid sweater on, and a welmade furry hoodie over her head. Plus a nice emergency blanket over all that to really keep the heat in. So she just left her wetsuit socks on because that was the injured area. So it wasn't like she was wet and half naked under this thin metalic 1/16th inch emergency blanket with air mattress under.

Sorry bad explaining on my part. I'm typing sentences in between tasks at work and I see it wasn't the most well written documentation haha.

[Deathcricket]

Add a broken ankle 2/3 of the way down the entrance into Mystery on the same day! Hmmmmmmmm?

When we were waiting for rescue, I was thinking to myself "If it was Bo, they might be here in half the time. I hope I see him any second now..."