 It’s a hot Saturday in July on the Lower Yough, the seven-plus mile Class III/III+ drop-and-pool run below Ohiopyle Falls. The river is crowded with rental rafts and commercial trips. At the entrance to Dimple Rapid, the raft caught a strong eddy line, and the bow dove. Two of the guests lose their balance, stop paddling, and fall into the water. One swimmer—Elena Márquez—flushes toward Dimple Rock’s undercut. She disappears in the aerated water, then surfaces coughing and gasping. A guide’s throw bag reaches her, and she is pulled to shore. You eddy out on river right. Elena sits upright on a riverside boulder, soaked and shivering. She coughs repeatedly, bringing up small amounts of river water. Her breathing is fast, and she pauses between sentences to catch her breath. She says it feels hard to take a deep breath. Her skin is cool and damp, and she leans forward, resting her forearms on her knees. There are scrapes on her right shoulder and forearm. She says she did not hit her head and remembers everything. Her chest discomfort is mild at rest but increases when she tries to take a deeper breath. What’s wrong with Elena, and what should you do? Interested in learning more about wilderness medicine? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.
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