April 12-13th, 2025

Background

It was 6:30pm, and Joelle, Michael, and I were 20 minutes from our planned campsite in the lower gorge of Phantom Creek, which would be the end of the off-trail portion of our Crystal Loop. This was day 3 of our trip, a very multifaceted day of slow but efficient travel through some challenging terrain and some lovely terrain. It was still warm enough that we were all enjoying the plentiful swims and wades in deep, delightfully clear pools. We were ready to be done, but far from exhausted.

*Squeamish? Be warned, pictures of a deformed ankle are below.

**Joelle gave full consent to her story being written and made public. We believe it's useful to document events and make lessons available.

Joelle was walking about 30ft in front of me, and Michael 30ft behind. We were in one of many sections where walking on a sloping slickrock bank was easier than wading through a shallow pool. This slickrock usually provided adequate grip. I imagine Joelle was enjoying the scenery and walking confidently on this surface. But suddenly, there was a small, slippery seep.

My heart shattered as I watched Joelle fall to the ground and cry out in pain. She was pretty hysteric and hyperventilating, so I made it a priority to breathe with her and help her feel safe and cared for. She was immediately in extreme pain, which to our devastation wouldn't be relieved anytime soon. 

Having recently done a WFR refresher and also with some previous experience, I finally felt competent in my patient assessment process. She had hit her head and it was forming a light bruise, but luckily we were able to determine it wasn't serious. The rest of her body was fine - the ankle was the obvious concern.

Michael is a very experience adventurer, also trained in wilderness medicine, and I was immensely grateful to have him as a partner in all of these  tasks and decisions. With the rapidly fading daylight and our proximity to the trail, he proposed the option of him leaving to go get help from Phantom Ranch. This was a useful proposition because the canyon was very narrow and we were not sure if we would have inReach connectivity.

We decided it was best if we not split up in a hurry. It was my goal to get Joelle into a more comfortable long-term position and I knew we would need both of us for that. Michael reminded me that we should exchange her wet clothes for something warmer first. I worked on that while he activated his inReach.

While using the inReach Michael had found some places flat enough for single sleeping pads about 100ft downstream. He had also generated the idea of using his packraft (more rigid and durable than ours) as a floating litter to help Joelle move. These were definitely our best options. It was a lot of work to carry/drag the packraft between pools, and it was very painful for Joelle, but it worked. The end goal was a site 15ft above the creek. Getting her there litter-style would be difficult, painful, and less secure. Butt-scooting with me supporting her leg was a better option.

It had occurred to me pretty quickly that any real solution wouldn't be possible until the morning. So it was a priority to get Joelle onto a sleeping pad and support and elevate her leg. I had already given her maximum dose of ibuprofen and acetaminophen, but they of course were inadequate. This is a good case for carrying strong opiate painkillers in a backcountry med kit, which we will try to do in the future with her leftovers. That being said, she would later receive fentanyl at the South Rim and find it inadequate as well. Dislocations are incredibly painful.

We all settled in for what would be the worst night of Joelle's life, and an unpleasant one for me as well. We made her dinner, but she wasn't able to eat. I was awake quite often to help comfort her and attempt to find more comfortable positions (there were none). I learned that quilts are much more user-friendly than zipperless sleeping bags for keeping a patient warm. I gave Michael Joelle's bag around midnight when it got colder.

Within 30 minutes of the accident we had received a reply from the Garmin SOS service and sent a barebones reply - "1 of our group of 3 hikers is 1 mile up Phantom Creek with severe unusable ankle injury. We are together and have overnight gear". Through a lot of inReach practice I've internalized the lesson that communication must first be kept to the essentials. In a gorge like Phantom Creek with a narrow view of the sky, we knew that messages would only go through when an Iridium satellite occasionally passed over. We ended up sending and receiving a total of 11 messages over the course of a few hours.

Through these messages, we were told that they planned to attempt a helicopter longline rescue at 9:30am the next morning. We were also told that a ranger who was stationed at Phantom Ranch would attempt to hike up and reach us earlier than that. We later learned that the ranger turned around shortly before our position, presumably due to the deep wades.

In a previous incident that required evacuation of one of my clients, Grand Canyon SAR told me that they would be sending a helicopter at "first light", which would've been around 6am. That helicopter didn't reach us until 9:30. I don't know why they seem averse to flying before 9:30, but I trust them to do what they think is best. At least this time they were honest.

As the above videos portray, the gorge we were in was generally quite narrow. On the first pass, a rescuer hung out the side of the heli and motioned for us to move upstream to where it was more open. It was super reassuring to see them forming a plan of action. I was genuinely unsure if it would even be possible for a longline operation to occur here, and worried that our next best option was a mile of difficult and painful packraft carrying with more people. Fortunately for us, the Grand Canyon SAR team are helicopter rescue experts.

I knew enough to understand that helicopters don't lower and raise lines, so I was unalarmed when the chopper disappeared for about an hour to rig their haul system. Remarkably, I only remember this time as about 15 minutes. We must've been busy and excited. 

The pilot deposited the guy on the rope with great precision, he unclipped, they flew off, and he walked over with a small haul bag. He was only on the ground for 12 minutes (felt like 5 to me), and in that time we wrapped Joelle's ankle in the inflatable pillow and got her in a nice chair-style harness that supported her legs well. We had already packed her backpack with things we didn't want to carry, and that went into the haul bag. He was willing to let me help with liftoff, wearing Michael's helmet, but declined my offer to grab the end of the line and bring it to him. It only took a moment for the pilot to deposit the tip directly into his hand. I like to think they do this as a display of their incredible competency, to put people at ease.

Joelle wasn't the slightest bit concerned about their competency - she was psyched to get out of Phantom Creek! She was still in a lot of pain, but by her account managed to put it aside and enjoy the view. We were hoping she would get to dangle all the way to the rim, but she was only on the rope for a few minute ride to the flat terrain above. There, another team member was waiting on the ground to help set her down. Then she was loaded into the helicopter.

In national parks like Grand Canyon, recipients of search and rescue service are not billed to patients. Ambulance rides from the rim to Flagstaff Medical Center, however, are. Via inReach, they had already given us the opportunity to decline the ambulance ride. We decided, however, that she had already been through enough and deserved comfortable and safe transport to medical care. We are still waiting to learn the cost of this ride and if insurance will cover it, but we believe it was the right decision.

Remarkably, the ambulance only took her by ground 30 minutes to Valle, because they decided it was emergent enough to have her flown by Guardian Air to FMC instead of drive another hour. Even more remarkably, my friend Scott was the flight nurse! Scott is a very nice man, and only works like 6 days a month so the coincidence was pretty cool.

Michael and I hiked to the North Kaibab trail in 30 minutes, and made it out of the Canyon within 5 hours of liftoff. Then we drove directly to FMC. Joelle beat us there by a long shot, but Michael's partner Ali was there to meet her. Ali would've been on the trip but was taking care of their dog who had also recently had surgery. Joelle was really glad to see Ali and she took great notes.

Upon arrival, Joelle was sedated and her orthopedic surgeon relocated her ankle. More than anything else, that was the medicine she needed to help with the pain. Scans determined that her only fractures were in the upper half of her ankle, which is the base of the tibia and fibula. She had 2 small fractures and the tip of the tibia, and the fibula (skinny one) was completely snapped. 

These bones would need to be screwed back together for proper healing, but unfortunately due to the time since injury the swelling was too significant. If stretched skin is sliced open, it doesn't stitch back together well. She also had "fracture blisters" - layers of skin dying from being rapidly stretched by the pokey bone ends - which also complicate incision. 

We were told the final screws might be doable tomorrow, or it could take over a week. But she needed something to stabilize her ankle in the meantime. So when Michael and I arrived at the hospital (my parents had just arrived from Phoenix, too), Joelle had just gone back for surgery. This was the installation of an "X-fix" - an assembly of pins and rods.

To help with pain management, wound care, and general care, they wanted to keep Joelle in the hospital overnight. Things were decent on Monday, but she was still on IV medication, unstable when standing, and generally needed a lot of help. So they wanted her to stay another night. She got an email from her insurance a day later stating that her overnight hospital stays were unnecessary and would not be covered. But, in the policy attached to the email was a section about reasons to justify overnight stays. "Broken bone requiring surgery" was the third item on the list. Health insurance is just lovely, isn't it? This should be an easy battle to fight, but why are they allowed to make us fight battles?

On Tuesday, she was in good spirits and able to move around, so we got to go home at 3pm. Ironically, we had a a small party at our house planned for that night. She had been getting plenty of rest, and it seemed like some positive social energy would be better than being sad and alone, so we kept the party plan in place. My parents were still around and helped me prepare food.

With modern medicine, the outlook for simple bone healing is very good, so Joelle will make a full recovery. Her final surgery was delayed until April 29th,  but from there it is just 2 weeks in a wrapped splint, then PT for flexibility, with walking resuming in mid-June. For a person who has already had 3 too many lower leg injuries, it's a sad place to be again. But it's nice to know that with some effort she'll be her normal self again soon.

The lessons that I want to make available are imbedded throughout this report. They are lessons about wilderness first response, inReach use, SAR capabilities, and American healthcare. I believe that it's useful for backcountry enthusiasts to understand and spend time thinking about how all of these systems work, so that we can be prepared to help each other when incidents occur in remote settings.

Additionally, this incident serves as a reminder for me about the inherent severity of the backcountry environment. I have witnessed multiple lower leg injuries in remote settings, and for all of them my group was equipped with backpacking gear, which doubles as survival gear. Lately I've begun visiting more remote places on day trips with minimal running gear. What would happen if I had an accident late in the day on one of those?

On my recent Animas River trip, I left camp at 4pm to hike 6 miles into the Weminuche Wilderness, alone, with snow on the trail. I grabbed my inReach, but stared at it for a moment, thinking of this experience, and realized it wasn't enough. I grabbed a lighter, too.

We shouldn't let fear prevent us from doing things that are within our ability. Any time we go outdoors, there is inherent risk involved, but that risk comes with reward, too. What we should do is think through our plans, identify potential problems, and try to prepare for them.