Rain poured off the eaves of CALSTAR quarters, where we had been comfortably watching the Sunday afternoon football game. Tim shook his head doubtfully as he hung up the phone to the weather service. “Well, I don’t know if we can make it to Pacheco Pass, but we can go and try.” Both Sarah and I groaned. We struggled into our rain gear and trudged out to the helicopter.

We affectionately refer to Pacheco Pass as Blood Alley. It’s a two-lane, winding mountain road that connects the San Joaquin Valley to the south end of the Santa Clara Valley. The fifty-miles-per-hour speed limit is ignored by most vehicles, including hoards of monstrous semi trucks. The carnage has significantly decreased in the past several years with the placement of concrete barriers between the lanes of traffic, but there is still some pretty impressive trauma to be found there.

As we lifted off, Sarah rang up dispatch. “This is CALSTAR One. We are lifting at 13:32 hours en route to scene. Ready to copy information. Please advise CDF: Do not delay transport, as we’re not sure weather will permit us to get to the scene.” This was the usual drill when we flew in heavy clouds or fog. If the paramedics on the scene had the patient packaged, they would head to the hospital by ground rather than wasting precious time waiting for us. If we weren’t able to get to the scene in time, we sometimes met the ambulance halfway.

“CALSTAR One, will advise CDF,” dispatch replied. “You are going to Pacheco Pass, unknown exact location. No one is on scene yet. The reporting party is a passerby who is currently on cellphone with the CHP. Fire and medic are en route. You will be talking to Morgan Hill CDF on local net.”

We settled into the flight, keeping quiet as Tim maneuvered through the rain. We were meeting our minimums—an altitude of eight hundred feet and one mile visibility—but if it got any worse, we would have to abort the flight. This could be frustrating, but we weren’t going to do any good if we got in trouble and became an incident ourselves. I looked out at the threatening clouds and watched the altimeter discreetly—an extra pair of eyes always helps the pilot in rough weather.

We carefully threaded our way down the Santa Clara Valley, keeping CDF apprised of our progress. All we were told was the fire units and the medics were somewhere in the deep canyon of the pass, and we should be able to contact them as we approached. If we could see them below, that wouldn’t be a problem, but for the most part, Pacheco Pass was a radio dead zone. Radio signals can only transmit in a straight line, which is difficult or impossible in remote places surrounded by mountains. To get around this problem, transmitters are usually built on the tops of tall buildings or on mountain peaks, so signals traveling upward can be retransmitted outward and downward. At the time of this incident, however, Pacheco Pass didn’t have a transmitter, leaving us incommunicado.

To our surprise, we actually made it to the pass. Sarah began methodically making radio calls on the frequency the units were supposed to be using, but no one answered. She tried again, this time on the local frequency. Again, no luck. We discussed our options as Tim flew several large, lazy circles just below the pass, over Casa de Fruita, the last rest stop along the highway.

Finally, we agreed on a plan. “CDF, this is CALSTAR One. How do you copy?” There was no response. Sarah tried again. “CDF, this is CALSTAR One transmitting in the blind. We are currently over Casa de Fruita and have no radio contact with the ground units. We will proceed up the canyon until we either find the incident or become unable to proceed due to weather. In that case, we will return to Casa de Fruita and land in the field abeam from the rest stop and await the ambulance. Do you copy?” Some brief static was the only reply. “Well, we might as well go take a look. We can’t talk to anybody anyway.”

“OK,” said Tim. “Everybody with eyes out. We’re outta here if this gets any worse.” We all nodded and Tim turned the aircraft up toward the pass and followed the road, flying low and slow. The top of the pass was obscured by clouds, and none of us thought we’d get far. We searched the road for either the fire trucks or the ambulance, but saw no evidence of them. Sarah was broadcasting on the local frequency all along, but had no idea if anyone was hearing her.

About five miles up the canyon, we saw an overturned car in the ditch and a woman wildly gesturing. We were near a lookout point called Lover’s Leap, and there was no fire truck or ambulance anywhere. “This is the damndest thing,” Tim said. “Where could they be? We haven’t passed them, and yet here’s the accident.” He looked back at us. “What do you think? We can land in the parking lot for Lover’s Leap—there’s plenty of room.”

“Well, we’re here, and we’ve got an LZ,” I said. “Sarah, you’ll have to stay with the helicopter for security until Tim can shut it down. Then bring all the packaging stuff and meet me over by the car. Tim, what do we do if the weather gets worse?”

“I’ll hit the siren if it looks like we’re about to get clouded in here, and we’ll do the best we can. If we can’t get out, at least you can have the patient in here getting care until the ambulance arrives or the weather lifts. I’ll keep trying to raise dispatch or CDF, or anybody else.”

After we landed, I stood outside the aircraft in the rain, pulling together as much of the packaging equipment as I could carry and tucking the portable radio into my jacket. I started for the four-lane highway, wondering how I was going to cross. We had attracted some attention from landing the helicopter, and the traffic had slowed down to take a look. I held up my hand, stopping traffic, and ran across the first two lanes. The opposite lanes were a different story—the cars and trucks were whizzing around a blind curve, oblivious to the rain. Then, when they saw the overturned vehicle, they would slam on their brakes, narrowly avoiding rear-ending the car in front. I waited for a break in the traffic, then made a treacherous run for it, crawling over the flimsy highway divider and nearly getting hit by a truck.

The woman was screaming as I headed down to the overturned car. “You have to get my babies! They’re hurt and I can’t get them out!” I got down on my knees and peered into the car. One little girl, who looked to be about four, was lying on what used to be the ceiling of the car, crying. A baby about six months old was still strapped in her infant seat, dangling upside down.

“What happened?” I asked, dumping all my gear on the ground.

“I came around this bend, and there was this car. I tried to swerve, but I lost control and rolled over. Oh, please, help my babies.”

“Are you hurt?” I asked, looking at a cut on her forehead. “How did you get out?”

“I’m fine, I crawled out a window,” she said.

I leaned down and peered into the car again. The four-year-old had a reassuring cry, but the baby was unnervingly quiet. I reached in and touched her. She had a pulse and was breathing, but didn’t respond to my touch, an ominous sign. What was I supposed to do? It was unusual for us to be the first and only EMS people on scene of an accident, and we had limited resources, but we’d have to make do. Across the road, Tim was shutting down the engines on the helicopter, and Sarah was about to cross the highway, loaded down with backboards and collars. When she saw the patients were children, she sped up to a trot.

By now, several drivers had stopped to help. Two of them were off-duty police officers, and as Sarah got over the divider, one of them hiked up the road to stop the traffic.

I spoke to the four-year-old. “Sweetie, you’re OK. I want you to just lie down, and we’ll get you and your sister out soon.” With the help of the other police officer and Sarah, we slid her gently onto the backboard and pulled her out of the car. “Now stay real still, OK?” We gently secured her onto the board and laid her on the roadway, now that the traffic had been stopped. Sarah then wiggled into the twisted car, and took a look at the baby, who was clearly the more injured of the two. Gently holding the child, we unlatched the seat belt and brought the whole car seat out with the little girl still strapped in.

“Should we leave her in the car seat?” Sarah asked. “At least she’s secure there. We can strap it directly onto the litter.”

“I’d like to, but I’m afraid we won’t have good access to her airway. Maybe we can carry her to the helicopter in the seat and package her onto the litter when we get there. At any rate, we need to get her out of here—she’s soaking wet, and this rain is getting worse.”

Sarah agreed and left to load the four-year-old onto the helicopter. I did a quick assessment while Sarah was gone. The baby had a lump on her head and dark bruising around the right eye, which can indicate severe hemorrhaging. But her airway was unobstructed, she was breathing OK, and had reasonably good pulses. There was really nothing we could do except package her, start an IV, keep her warm and get her to Stanford, the closest available pediatric trauma center. I got her ready to cross the road.

“Where do I go?” the mother asked. “Can I come with you?”

Although all we could see was a cut forehead, this woman needed medical attention. It was quite possible she had hidden injuries she was masking (she did, after all, flip her car at highway speed), which made her a major trauma patient despite appearing fine. We only had two litters and the children needed them, but we couldn’t leave this woman here in the rain with no transportation to Stanford, and we couldn’t appropriately treat her on the helicopter. Then I flashed on a plan.

“Listen, I have an unusual idea.” I explained to her the lack of space on the helicopter, and why we couldn’t transport her as a patient. “If you’re willing, what we’ll do is sign you out against medical advice, then you can ride in the front seat with the pilot as a passenger rather than a patient. You can check yourself into ER when we get to Stanford.”

This was highly unorthodox, and something a flight nurse really shouldn’t do. I was asking her to sign a piece of paper acknowledging that she was declining care, releasing us from liability. If she ended up having a serious injury, she could probably have taken us to court to argue that she wasn’t in a rational frame of mind. But alone on the scene in the driving rain, with two pediatric patients, I decided to play the odds.

“Of course I’ll do that,” she said. “Really, I’m fine.” We started across the roadway, carefully carrying the baby in the car seat. Sarah was watching me quizzically, not sure why the mother was with me. I explained my plan and checked with Tim to make sure we could do it with weight and balance. He did some quick calculations and assured us it would work. Then, as we were moving the baby onto the litter, an ambulance pulled up.

“Where the hell have you guys been?” we asked the medics as they ran over.

“You’re not going to believe this, but there is another accident just up the road, which is where everybody is. There’s already one ambulance there—we’re the second unit to respond. They’re worried about you ’cause you never made it. Last they heard was you were at Casa de Fruita, and when the CHP looked for you there, you were gone. Everybody’s looking for you. And what’s all this?”

We filled them in and they agreed to our scheme—they needed to get up to the other accident and didn’t have time to take the mother to Stanford. We were still in the radio dead zone, so we couldn’t let anybody know the strange turn of events, nor could this ambulance. We quickly loaded everybody into the aircraft and, after strapping mom in the front seat, got airborne.

The baby was in worse shape than we had thought. She was quite shocky and needed fluids quickly. We started lines and hooked her up to the monitors, trying to keep calm, since her mom could hear everything we said on the intercom. My anxiety grew as we worked on the baby.

Suddenly the beeper on my belt began to vibrate. I quickly looked down, and saw the pager code we never wanted to see: 911. This was a company-wide page that indicated that one of our three aircraft had gone down. As in crashed.

My heart dropped in my shoes. I knew CALSTAR Two was off on an interfacility flight, so it could only have been them. “Oh my God, you guys. Harry and J.B. are in trouble. I just got a 911 page.” Everyone grew very somber, very quiet.

Tim was the first to speak. “We can’t do anything about that right now. We have to get out of this pass, and you guys have a sick little kid to deal with. Let’s keep ourselves in the ball game till we can get out of this, OK?” Sarah and I looked at one another and returned to our small patient.

As we emerged from the pass, Sarah was able to finally reach CDF Morgan Hill. “CDF, this is CALSTAR One. We are unable to contact our dispatch. We are currently en route to Stanford with two pediatric patients on board. Could you please notify Stanford of our ETA? And could you please contact our dispatch and let them know of our route?”

“CALSTAR One, this is CDF. Are we glad to hear from you. We will certainly advise both your dispatch and Stanford. Give us a call when you get there.” None of us had connected the dots yet; we were entirely too busy with our patients.

After we landed at Stanford I called dispatch, dreading what I was about to hear. As I was waiting to be connected, one of the unit clerks came into the room. “Hey, CALSTAR, you have a call on line two. She seems pretty upset.”

We all looked at each other, and I slowly picked up the phone. It was Beth, the administrator on call. “Where in the hell have you guys been?” she demanded. “I almost had a heart attack. We thought you had crashed on Pacheco Pass. I have the whole company, including the board and the president, headed for the office right now. What happened to you guys?” She seemed close to tears.

I still hadn’t quite gotten the picture. “Are J.B. and Harry OK?” I asked. “Where are they? Were they hurt? How bad was it?”

“What are you talking about?”

It took almost a day to sort out what had happened. Two fire engines, a CHP patrol car, and an ambulance had entered Pacheco Pass and lost all radio contact with their bases. They activated CALSTAR, as there were reports of major injuries. As we approached the pass, CDF was able to hear our last transmission: that we would proceed up the pass, and if weather became bad, we would turn around and meet the ambulance at Casa de Fruita. We were unaware that the message had reached them.