I witnessed someone, from a different hiking party, issue an SOS from SPOT 1 Gen some years back in a remote section of the Grand Canyon after dark.
A woman hiker had fallen on a steep trail, careened down a very steep dropoff,and was precariously lieing upside down. Luckily her pack was wedged against a rock outcropping, else she would have fallen a sheer 25 feet.
The obvious problem with the SPOT was the lack of a "handshake" response, so the group of us out there, me, my buddy, and the party of the injured hiker, had no way of knowing if the SOS call was actually received.
It turns out that it was received and the injured hiker was extracted, amazingly with minor injures, the next morning.
But it was a LONG sleepless night for all involved.
For hours in the cold and dark, we tried to get to her. We finally came to the conclusion that we would only do more harm to her or ourselves.
We debated long and hard about a midnight hike across 10 hard and difficult miles to the nearest ranger station, and came to the conclusion that this option was also too risky.
We were ready to hit the trail at first light, when we finally heard the helicopter. A SAR team out of Flagstaff worked for 3 hours setting up rigging to rappel down to her for the helicopter extraction.
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The above convinced me to buy a PLB device with 2 way communication capabilities.