Applying concepts: A real-life example of a SAR incident in the Narrows of Zion National Park

In this second installment of our 3-part series exploring Search and Rescue, I’ll tell the story of a complex SAR incident in the Narrows of Zion National Park. Using what you’ve learned in part one "Foundations: What is Search & Rescue?" see if you can tease out the different stages of a SAR response throughout this story. Furthermore, consider what could have made this response go more smoothly, better mitigate risk, or require fewer resources. Then, we’ll “debrief” the callout in the final part of the series: “Lessons learned: Reflecting on the Narrows incident,” and discuss some strategies that could have improved the response.

I spent the summer of 2022 working in Zion National Park as an EMT on the park’s ambulance and on their search and rescue (SAR) team. The EMS/SAR staff for the park was small and scrappy; we had two full-time EMTs (including myself) and two full-time Paramedics, a handful of park law enforcement officers with EMT and AEMT certs, and a bunch of excited SAR volunteers from other park departments and local guide companies to help with transports. It’s an ideal place to learn by getting thrown into the action, and I loved it. It’s also a place where, given our limited resources and complex terrain, we had to get creative, try out new strategies, and continually reflect and learn from each call to make the next one better.

Let’s start at the beginning of the incident: the call. Our dispatcher received word that someone was hurt in the Narrows, “about a mile or two up from the main trailhead” around 4pm in the afternoon. The Narrows is an incredibly popular, aptly named section of the Virgin River canyon where day hikers walk up the river bed between stunning, sheer walls of sandstone only as wide as the water. Most of the hike is in ankle to knee deep water, more like walking up a babbling stream than what we imagine as a rushing river, but there are some sections with swift currents and surprisingly deep pools that require careful route-finding. Some folks choose to hike the entirety of the Narrows “top-down,” starting at a trailhead outside of the park and hiking a total of 14 miles in the river to the main trailhead in the park, which can be done as an overnight trip or a single, long day hike. The injured party apparently was attempting the latter, before injuring their lower leg, according to the reporting party. Unfortunately, the report came from a passerby, and they had no other information about the patient, who they were with, or what resources the injured person had at their disposal. Furthermore, there is no cell service in the Narrows, and even satellite devices sometimes struggle to get messages out from the depths of the canyon; our dispatch was unable to get any further reports or information about the patient.

At Zion, one of the law enforcement park rangers always took the role of Incident Commander (IC) - usually it was whomever was on duty and available at or near the dispatch center when a call came in. For the Narrows incident, the IC decided to send five rescuers as the hasty team: two medical rescuers (myself and a paramedic), one park ranger to serve as team leader, and two additional SAR volunteers solely for carrying gear. Since the initial report was unclear, IC cautioned us to prepare for a long, and possibly overnight, rescue and to pack accordingly. Packing for calls like this is difficult: Would we be out for a few hours, or well into the following day? What items were going to be essential, and where could we cut down? Our basic first aid kit was essential, of course. We also chose to pack an IV kit, a bag of fluids, and IV pain meds in the event of a severe injury paired with a long evacuation. We packed light on bulky splinting materials, only carrying a few SAM splints and mentally preparing to improvise from there if necessary. The rest of our packs were stuffed with overnight gear, both for ourselves and for the patient and possible companions. This included sleeping bags and pads, as well as additional dry layers since we’d be walking mostly in the river in the Narrows. Then there was food and water to haul, and we’d need enough for the five of us, plus the patient and companions, to get through the night and into the following day if necessary. In the backcountry, when supplies are carried on backs and patients may be miles from vehicle access, these decisions can be critical. We want to carry just the right amount – too much and the team will be bogged down and inefficient; too little and we might be missing essential gear that could greatly improve patient, and team, outcomes.

Once we cleared the first hurdle and our team was assembled and packed about two hours later, we headed up the Narrows as the day waned. We moved against the flow of traffic as most people were hiking out, downriver, for the day. Our patient had been on a through-hike of the Narrows, starting 14 miles up the canyon at a trailhead outside the park, and planned to exit at the main Narrows trailhead within the park. We hoped the report was true and she was only a couple miles out from the trailhead, but we all knew we might end up walking in the dark. Once night falls, the somewhat whimsical river walking becomes difficult to navigate, and requires good knowledge of the canyon, knowing where to avoid the deepest pockets and swiftest currents. It was an arduous and complex way to travel with heavy packs and methodically searching each bank of the river so we didn’t miss the patient. Sure enough, the miles began to tick by with no sign of the injured party, the sun sank behind the cavernous walls, and we picked our way up the canyon in deep darkness. As we walked, it was a constant negotiation between making forward progress and managing our team’s risk. At some points, people had to scout ahead for obstacles like log jams or rocks to find clear ways around them in the dark. At others, we had to pass packs through tight squeezes past boulders, or spot each other through deep pools. And at each of these stages, we also had to consider: keep going, or pull back and reassess? Is the risk still acceptable for the mission at hand?

Finally, at about midnight, we found our patient. She was situated on a gravel bar at the confluence of the Virgin River and Deep Creek. We were perfectly in the middle: seven miles from the trailhead we came in from and also seven miles from the trailhead at the top of the Narrows. She had one companion, uninjured but unprepared to spend a night out, who had managed to build a small fire. Some other hikers had left them with a few jackets. The night was cool, and their hiking clothes (and ours) were wet from walking in the river. The patient’s ankle was obviously deformed and very swollen. They both were hungry, thirsty, and getting cold. The paramedic, Tim, and I quickly got to work assessing the patient, taking vitals, and asking questions about medical history. We started working to get them both warm, dry, fed, and hydrated. It was clear we’d need to improvise a splint for the ankle using the SAM splints we had packed. It was also clear the patient was in a lot of pain. Tim decided he’d like to start IV pain meds - Fentanyl - to ease her pain levels so she could hopefully sleep. Starting IV pain meds in the backcountry on a gravel bar is tricky: you have to be exceedingly careful to keep everything clean. You also need to monitor the patient carefully, especially with opiates, because they can suppress respiratory drive if the dose is too high. We were the sole medical care for this patient until she reached a hospital, which likely wouldn’t be until the next day at this rate, so we were in it for the long haul. Tim and I set up a sleep shift schedule, one hour on, one hour off, so we could try to rest while also keeping an eye on the patient’s pain and vitals through the night.

Meanwhile, our team lead, Erin, was in contact with IC, notifying them of our location and the patient’s condition. We had already discussed as a team that evacuating at night would be too risky both for us and the patient, so Erin notified IC that we wanted to hunker down for the night and wait for IC to organize an evacuation in the morning. The options for evacuation were either a seven-mile litter float back down the Narrows, in which we strap the patient into a litter, which we rig onto a small raft, that we then walk down the river by hand; or a possible helicopter hoist, if the canyon walls proved to be wide enough at our location. The litter float was a common evacuation procedure in the Narrows for shorter distances, but a seven-mile float would likely take a team of at least 15 additional rescuers, probably more, and it risked taking so long that we could get benighted again the following night, which would render the rest of the float to be quite dangerous. The helicopter wasn’t an easy shot either though, since the canyon walls were so narrow that we weren’t sure if a helicopter could even access the patient. Our IC decided to begin mobilizing both in the morning, and organized a helicopter recon flight as well as a team to start packing for a possible float out.

While we waited for evacuation the next morning, our task was to move the patient to the widest, most accessible spot on the sand bar for a possible helicopter hoist. We had sleeping bags and pads as well as a few hiking poles, so we improvised a stretcher. All five of us had to help move the patient onto the stretcher, and then carry her down the gravel bar. We only had to carry her 100 yards or so, but it’s amazing how tricky that can be over uneven terrain!

Eventually, the helicopter flew by and the pilot decided they would attempt a hoist. The helicopter hovered, rotors spinning only a couple yards away from the canyon walls, as we all watched in total awe.

Cool as cucumbers, they dropped one of their crew members down to start rigging the patient. For the patient, the story was nearly over. The helicopter was not medically equipped, but they quickly flew her to an ambulance rendezvous where she was then transported to the nearest hospital. She was admitted for ankle surgery within hours.

But for us, we had a long day ahead. We were still seven miles from any trailhead, with loads of gear to haul and the clock ticking for when we’d run out of food or water. Time to move! We decided it would be easier walking, less hazardous, and faster, to continue upstream where the river was shallower and slower-moving rather than return the way we came. Finally, after about three more hours of river trudging, we reached the trailhead, tired but accomplished. Fellow team members picked us up, with a pile of burritos at the ready, and hauled us back to headquarters for clean up and debrief. 

This story is an example of how a real-life SAR incident unfurled. Referring back to the first installment in the series, “Foundations: What is Search and Rescue?” see if you can identify all the parts of the incident following the P-LAST acronym. Which parts seemed the most challenging during the story? Which parts were the simplest? Furthermore, consider what information, planning, or actions might have improved the response. In the final installment of this mini SAR series, “Lessons learned: Reflecting on the Narrows incident” we’ll debrief the story and discuss what would make a smoother response for next time.

If you have insight to share from your own experiences working with a SAR team, leave us a comment, we’d love to hear from you!

About the author: Zoey is a licensed provider for WMTC and owner of Headwind Backcountry Medicine, LLC. She’s spent many seasons exploring outdoor education, recreation, and wilderness medicine from a variety of angles, and she’s excited to share pieces of her experiences here with you. Thanks for reading!

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