I help get Robby launched and the pop down into my little packraft. It is much like a little kayak with inflatable sides, if you've never seen one. I attach my spray skirt to the boat's cockpit and pull on my neoprene mittens. The guy I borrowed them from cautioned me to make sure I put them on last, as I would no longer be able to do a damn thing other than paddle once they are on. He sure was right. I push off and join Robby up river, in the little bit of flat water above the class III rapid Chukar. This particular run starts right off the bat with some pretty big water.

​

"After you, sir!" I scream to Robby, partly because we both have thin insulated headwear on under our helmets that covers the ears and hinders hearing, but mostly out of excitement.

​

"If you swim, are you planning on coming to me? We'll just get your boat after?" He calls in response.

​

"Sure. Sounds good." I respond, thinking that wasn’t exactly the mental image I wanted as I approached the rapid. 

​

     The next couple of river miles were excellent. The perfect mix of adrenaline caused by rapids that feel so big when you're in a little boat and the face-fulls of icy water to remind you that you're alive. I'm paddling along in the small stretches of flat water between rapids feeling thankful and fortunate. I'm excited to be here, remembering how much I love being on the water, especially on a run I've never done. I'm looking forward to connecting more with a friend that I've got plenty of room to get to know more fully. Its just one of those good days.

​

     Casually, I glide my way over closer to the big raft to share some of this with my friend when we hear "Help!" from somewhere down river. 

​

"Help me. HELP! I need Help." A strong male voice calls out from the river ahead once again.

​

"Where are you man? We're coming." I call back.

​

"He's there, on the left" Robby says to me.

​

     I still don’t see him, but I paddle over to the left side of the river, eyeing a small patch of land sticking off of the nearly sheer rock wall. Then I see him. His back is to the riverbank ledge of this little bit of land, his head draped over the water a bit as he tiredly holds it up, turned upriver towards us. His right eye is partially swollen shut, and the whole right side of his face is covered in blood. Some dry, some wet.

​
 

“Can you walk?” Robby shouts.

​

"No, I'm hurt. I broke my leg. Both my hands are messed up too. I need help."

​

"Let me get on shore. Hang tight." I instruct him. "I'll get ashore, toss me a line." I swivel and say to Rob.

​

     Once I've popped the spray skirt and clambered on shore, I grabbed a line from the front of the raft and secure it to the meager lone tree on this small patch of land. We both approach the downed man together. His left shoe is off, and left pantleg torn and bloodied. He is holding his hands limply in his lap, the reason is obvious. Both his wrists are twisted into shapes that take no training to recognize as "non anatomical". There is exposed bone peeking from his right wrist somewhat plainly. The swelling has already begun. His hands are puffing up as his body does its best to flood the area and create some natural splinting. Scanning further up, his face is bloodied as well. There is a large laceration above his right eye, which is also swollen. It'll swell shut soon, I think to myself as I try to decide if I can spot the white of exposed bone in the head laceration too.

 

"I'll jump on the trauma assessment if you want to start grabbing gear off the boat." Robby looks over to me and offers.

​

"Yeah, sounds good." I find myself saying without much thought.

​

     We are already breaking this scene down into digestible pieces. Without even realizing it or discussing it. And, I realized after the fact, with absolutely no hesitation from either of us as to if we should help or how involved do we want to get or any of the "self preservation" responses so many people have in stressful situations.

​

     I'm keeping an ear out to make sure Robbie isn't missing any important questions or steps in his head to toe, as I work on getting straps loosened enough to get some bags off the boat. With one knee on the tube and one foot on the bank, I'm a little unsteady, making the task harder than it had to be. I just wasn’t trusting the quick tie off I did on the bow line. Gotta get more confident in my knots, I think to myself.

​

     I've never worked with Robby before. He's an ER nurse at the VA. Don’t let that fool you, he has multiple trauma certifications and has worked in a level one trauma hospital in the past. I'm a Respiratory therapist that typically works ICU/ER. I cut my teeth at Grady Memorial Hospital in the heart of Atlanta. That place eats, sleeps, and dreams trauma. Rob and I just never ended up at the same hospital. But, from hearing his process through his questions for our patient, I'm reassured he knows what he's doing. I find myself put at ease with him on my team, much in the same way I feel better knowing he's on a river trip I'm on.

 

     The two big dry bags containing the lion's share of our collective gear now tossed on shore, I join back up at the "bedside". Robby gives me the quick fill in.

​

"This is Adam, he fell from up there, 45 feet or so is his guess. This left leg does look broken, and you can see his wrists. He has a laceration below his swollen right orbital, but the bleeding isn’t active. His pupils are equal in size and reactive. C-spine is clear, he is mentating normally, and CMS is intact to his hands and feet." Rob quickly replays.

​

     I'm thinking none of this is too bad. He's with it and not loosing blood in any life threatening way. He isn't hiking out, but he's actually pretty stable. I wonder out loud, "did I overhear correctly that he's got good CSM's?"

​

"Yep, both hands are good and his left foot has a strong pedal pulse too." Rob clarifies. He is almost certainly thinking the same thing I am about blood flow to those broken extremities.

​

"Adam, I know it may not feel like it, but that is all really good news. Can you tell me what is the worst thing you're feeling right now? Is it one of these obvious things we are talking about or is there something else?" I look to him and ask.

 

"Well, I'm getting pretty cold too. I've been laying here like 45 minutes before you guys came up" he said after giving a second's pause to think. "Can you get something under my head? I've been holding it up this whole time."

​

     So our next tasks have pretty clearly presented themselves. We've cleared all the life-threatening emergencies we can. He is in pretty stable shape, so we can now turn to the things we'll have to do beyond the immediate. I'm turning it over in my mind as we work to prop up his head. Its actually a little difficult, as there really isn't much land under it to put anything on.

 

"We've got to move you" I say, more for Robby's sake than Adam's. The first rule of rescue flashes through my mind, “Don’t become a victim yourself.” It’s about 1:30 and we are not even a quarter of the way down river. Plus, how are we going to get help to this island. Landing Zone? We would have a tough time getting a rock climber to where we’re at. Robby nods in agreement to me. "We've got to do what we can to check your back for injuries too, before we do much moving."

 

"Oh man, my back is ok. I can tell." Was Adam's response.

 

     Knowing that we can't formally or officially "clear the spine" due to his "distracting injuries", but that we have to at least need to look for step-offs and deformations, Robby and I both persist.

 

"We've got to man. Its apart of this whole thing. Just bear with us." Rob and I say in tandem.

 

     With nothing worrisome found on his back (somewhat to my surprise, honestly) it was time to address moving him. We had to get him down river. Partly because it would be near impossible for search and rescue to get him from here, but mainly because it was only going to get colder. I'm wearing a mid weight base layer top and long johns, a fleece top, waterproof insulated socks and a drysuit… and I'm none too warm. The life threatening condition he has left is impending hypothermia. His torn jeans, t-shirt and flannel on top of that isn't going to make much difference in that war. We have to move him.

 

     First, we put him into Logan's sleeping bag as best we can. Yes, Logan tossed a 0 degree sleeping bag in his gear as an "oh shit" measure in case one of us swam. Thank you Logan. Working his injured legs in gingerly, we're able to work it up to about his waist. We'll have to do something about those wrists. I imagine them flopping and banging around during our transfer and the miles of river and rapids between us and the take out.

 

"Lets get him splinted and moved onto your boat" I recommend to Rob.

 

"How's your splinting?" he responds.

 

"I got it." is all I can think to say.

​

     Robby starts to rig the boat in order to form a make shift gurney. I grab one of Logan's spare paddles off the boat I try to separate it to use as the rigid portion of my splint. I cannot for the life of me get them apart. Did they freeze together? Robby helps twist and pull. They don’t budge. Thanks Logan (just kidding). Ok, fine. I grab the blade from Robby spare oar and remove it. It'll serve nicely as an armboard. I'll have to splint both his arms stacked on top of each other, I-dream-of-genie style. With the oar blade, some clothing for padding and insulation, a bundle of small sticks and an ace wrap, I make a rudimentary splint. More of a method of keeping them stable for transport than a proper splint. Part of me wants to spend more time making one I can "be proud of", but this is perfectly adequate for what we need it to do. Now to get him to the boat.

 

"Lets use my boat to transfer him… what do you think?" I say.

 

"Yeah, great idea. Lets do it. Ill bring the boat up here and tie off the other side," my partner in misadventure agrees.

 

     I deflate my boat and flip it upside down beside Adam as Rob secures a line to the other end of the boat, brings it around so one tube is nearly under his head and then ties it in position. We've been talking Adam though our thoughts and plans on and off, to keep him aware and to function as periodic neuro checks. With the hit he took to his head (and elsewhere), there's always a chance that more is going on internally that is hard to assess externally. I reason that if he continues to be as alert and oriented throughout the day, he isn't loosing too much blood internally or experiencing swelling inside his head.

 

     We coach him through a log roll, allowing me to get the boat underneath him when we roll him back down onto his back. This allows us to heave him on to the boat in a much more controlled and supported manner. With a few moves, we brought him on board- by getting his shoulders to the tube with his hips still on land, then hips on board with legs on land, then fully on board. We got him across the back of the raft, just behind the seat, nestled on my packraft and ontop of Logan's ducky. He's loaded up just like our gear was. It was a tough call to make here. Strap him in or not?

​

     If we flip, it could mean a death sentence for him. But if we dump him out, its likely the same. We decide to strap him in, but I'm going to ride right back there with him. If we get in trouble, I tell myself that Ill get him out. In reality, it could be an impossible feat. C'mon Robby, don't flip.

​

     Robby was a professional river guide for Arkansas River Tours about ten years ago and now just runs private trips. He has ran this section multiple times, but he guided in a different gorge.

​

     Well, at this point we have quite a few more miles to go, rapids to run and then get him to help. We were already feeling pressed for time… Just before we push off, we spot a couple hikers on the bank just downstream.

​

"We need help! Stay there! We'll come to you!" Robby screams out to them before I really even recognize they are there.

​

Right then, three kayakers come paddling up on our right!

​

"You need help? What's up?" one of them asks.

​

      From the position we've got Adam in, swaddled in all the spare fleece and down we can muster, and semi piled with the remaining gear, they don’t even recognize it’s a person. We quickly fill them in and form a plan for them to go get word out for help and have it meet us downriver. Two of the kayakers will go on ahead and run the river to the take out as fast as possible and get help mobilized.

 

"You just want and ambulance at the take out?" One asked      

 

"No. We need a helicopter." Robby quickly corrects him.

 

"And I'd recommend Ute park, not Pleasure park." One of the kayakers throws in. He turns out to have gone through EMT training, although he never worked as one. His name is Ben.

 

“Tell them we will meet them at the BLM ranger station.” Robby yells.