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Sarah Sarfaty, AEMT and FAWM Candidate, tells the harrowing story of running into a canyoneering trip gone wrong where she was able to put to practice her wilderness medicine and technical rescue skills. Permission was obtained to use names, photos, and videos for this article.

 On October 9, 2022, Vickie Rupprecht was participating in a guided canyoneering trip at Angel Slot Canyon outside of Hanksville, UT when she was injured while being the last of her group on the first rappel. She was adventuring with her husband, three other participants, and one guide. The rappel, approximately 25m, has an unusual start which requires the person to drop off a ledge directly into a short free hang. Many blogs and public information sites note that “the start is tricky”. While rappelling, Rupprecht caught her foot on the ledge, inverted, trapped her foot against the rock, and fractured her ankle in four places (Video 1).

Image 1: Rappel 1 where the victim was injured. Photo credit: Sarah Sarfaty

Behind Rupprecht, our group of six was waiting to enter the slot canyon. I ran this canyon in 2020 and offered to lead a trip for a group of friends looking to experience canyoneering for the first time. After the incident took place, I offered to help with the rescue since I have wilderness medicine and rope rescue training. We rigged a system with mechanical advantage to haul Rupprecht back up to the ledge. Afterwards, the guide hiked the rest of his party up an alternate, nontechnical route. In the meantime, I assessed the patient, aligned and splinted her injured ankle, and built a litter (Video 2, Image 2) to carry her back to the parking area (Image 3).

Image 2: Building an improvised litter with climbing rope and backpack hip belt. Photo credit: Vickie Rupprecht

Image 3: Carrying the victim across a flat section of trail, about halfway through the evacuation. Photo credit: Sarah Sarfaty

Although the approach is listed as a 10 minute hike from the trailhead, it took us approximately 2 hours to return to the vehicles. When traveling back up a narrow wash, we encountered an unknown species of rattlesnake blocking the trail (Image 4). Unable to safely displace or circumnavigate the rattlesnake, the guide used a rock to trap it and allow us to pass. We rotated through litter carry positions, except for the two youngest members: one supported the victim’s head and the other supported the injured extremity. At a later point, the trail became too narrow to carry the victim due to a steep drop off on either side; she was forced to sit upright and briefly crawl backwards up the trail as someone supported her ankle before returning back into the litter to finish the last stretch back to the trailhead. The group discussed calling for an evacuation, as the guided group had a satellite communication device, but we decided that the response time would be too long, she was medically stable, and that we had the skills and tools to safely evacuate her back to her car.

Image 4: Rattlesnake, sheltered and camouflaged just out of sight along our evacuation route. Photo credit: Vickie Rupprecht

Vickie was driven to Castleview Hospital in Price, UT approximately three hours away. She was diagnosed with a displaced trimalleolar fracture of her ankle and required multiple surgeries for repair; her most recent was in April 2023, removing the hardware from her ankle. Vickie has already booked her return trip to Utah this September, when she plans to complete Angel Slot canyon.

Canyoneering differs from rock climbing and mountaineering

While there are many transferable skills between rock climbing, mountaineering, and canyoneering, the application of each requires specific considerations. The least practiced of the three, canyoneering has historically relied heavily on word of mouth and locals’ knowledge to run canyons, especially in the red rock canyons of southern Utah. The American Canyoneering Association (ACA) has made important steps to legitimize the sport; however, it is a surprisingly young organization (founded in 1999) compared to other more established groups such as the rock-climbing and mountaineering-focused American Mountain Guides Association (AMGA) formed in 1979.

One example of the difference in rope skills can be seen in the guidelines around anchor building. Rock climbing focuses on accounting for forces applied to the anchor; canyoneering prioritizes environmental considerations. This is illustrated by the mnemonics used for building anchors.


Rock Climbing and Mountaineering


SERENE mnemonic

ERNEST mnemonic

DEAR mnemonic

Solid (or strong)










Solid (or strong)





Rope Retrievability


 Slot canyons popular with canyoneers can also be remote and are known to have poor cell tower reception, making contact with rescue services difficult if not impossible. Accounts such as the film 127 Hours highlight the importance of notifying others of the proposed expedition location and expected date of return. News articles covering similar stories from the Salt Lake Tribune, Canyoneering USA, and others highlight these important safety considerations.

Southern Utah Canyoneering Hazards




Anchors and technical gear

Marginal anchors, changing rock conditions, rope retrieval considerations, outdated/inaccurate information

ACA Skills Checklist

CUSA Technical Skills


Flash floods

Runoff from rain collects and travels along flood plains, can cause flash flooding without any direct rainfall over the area

NOAA flood forecast

Temperature-related illnesses

Arid conditions, temperature extremes, little access to shade and water

Wilderness medicine courses

WMS Canyon Country Courses


Flat desert landscapes are challenging to navigate using landmarks, entrances/exits to canyons require exact route finding, GPS trackers can be inaccurate in a slot canyon

USGS maps



Blog sites

Water obstacles

Swimming, jumping, waterfalls

ACA Rating System


Those looking to get involved in canyoneering should avoid assuming they have the skills necessary without training or practice with more experienced partners, even if they are competent in similar disciplines.

Training for backcountry rescues

Angel Slot canyon usually takes approximately 90 minutes to complete, followed by a 45-minute exit hike. During the canyon section, three rappels are mandatory and those do not include the downclimbs, scrambles, potholes, slots, and other obstacles encountered along the route (Image 5). Two key types of training were utilized during this accident: rope-rescue and wilderness medicine.

Image 5: The canyon from above. Photo credit: Sarah Sarfaty

Navigating this canyon with an injured ankle would have been technically difficult, exacerbated suffering, and greatly increased time to definitive medical care. It was crucial that the victim was able to be hoisted up and out of the canyon, rather than complete it as initially planned (Image 6). This reverse route extraction required the ability and additional gear to create a 3-1 haul system, as lifting the victim above the ledge without a mechanical advantage would have been challenging, if not impossible. Specialty gear, such as pulleys, a VT prusik, and a progress capture device (like a tibloc) were all used to create the system required. Although I am also a rock climber and mountaineer, many of the rope rescue skills and equipment I used were particular to canyoneering-specific rescue training.

Image 6: The top of rappel 1, hauling the victim back up. Photo credit: Vickie Rupprecht

This accident also highlighted the importance of wilderness-specific medical training. In my opinion, one of the most important technical skills I offered in this rescue was building an improvised litter, which was covered in my WFR and WLS:MP class. The evacuation required navigation of uneven terrain through washes and ascending approximately 60 m in elevation before arriving back to the trailhead. This was made easier because we had ten people available to help, who all rotated through spotting, carrying, and resting. Completing this extrication without a litter system or extra hands to help would have resulted in a significantly longer extraction time and increased the risk of further injury for both the victim and the rest of the group.

With retrospect, I believe the most important part of the rescue was the attitude of everyone in attendance. This attribute is both trainable, and luckily, in the case of many of this group’s members, innate. Vickie was the patient everyone wishes they could have during an accident: calm, able to take direction, and willing to participate in her own rescue. The other members of both groups were helpful, also able to take direction, and provided valuable opinions throughout the extrication. Their support was invaluable and we were all grateful for one another’s presence. As stated by Vickie after the injury occurred, “This was a day when ONE thing went wrong but everything else went right!”

Parting Shot: Our group of six and Sam (our canyoneering-capable canine) after the rescue was complete. Photo credit Janna Dean.

Readers interested in learning more about management of similar incidents should refer to the Journal of Wilderness and Environmental Medicine's Consensus Guidelines on Management and Transport of Canyoning Accidents.