If you live in King Cove, Alaska, your access to emergency medical care can depend on the weather.
In the tiny Aleutian town at the tip of the southwest Alaskan peninsula, almost everyone has a horror story about a family member or friend who suffered a serious or traumatic injury that required near-heroic efforts to address because severe weather cut the town off from the rest of the world.
And sometimes the only way out of this remote fishing town near the Bering Sea is by helicopter as part of a Coast Guard medevac operation whose pilots and crew risk great danger in an area that is infamous for some of the world's most sudden and extreme weather.
Lonnie Brandell, a commercial fisherman who has lived in King Cove most of his 42 years, remembers the day four years ago when his father had a severe case of pneumonia and nearly died.
Blizzard conditions had rolled into the King Cove area, and Brandell's 69-year-old father needed to get to a hospital in Anchorage. But to do that, they had to get to nearby Cold Bay's all-weather airport, and because of the weather, the conditions were not safe to fly out of King Cove; what's more, the federally funded hovercraft that was designed to cross Cold Bay could not operate in the choppy waves.
"We had to save his life," Brandell said.
Desperate, he enlisted the help of a friend who had a 58-foot boat capable of crossing the bay. It was a stomach-churning three-hour trip, as the waves rocked the boat up and down. And once the boat arrived at the dock at Cold Bay, he said, the chopping waves made it almost impossible to dock.
Because his father was too frail to climb up the ladder at the dock, Brandell said, "They had to tie a rope around him and pull him up. The boat was surging up and down, and I had to go behind the ladder and help to guide him up.
"It was not a good scenario all around," he said. "But if we had stayed here one more day, even 10 or 12 more hours, he would not have lived."
Brandell's story is not unusual in King Cove. Indeed, the Fish and Wildlife Service, in the final environmental impact statement (EIS) analyzing a proposed road through the heart of the Izembek National Wildlife Refuge, noted that passengers who are able to reach the Cold Bay dock "either have to climb a steel ladder, or are lifted to the deck of the dock via a winch system used to load/unload cargo from fishing boats."
Brandell said the situation with his father was demeaning as well as dangerous. Like many residents, he believes federal regulators are willing to endanger human lives in exchange for "the flight of a bird."
"It's crazy, just crazy," he said. "I just don't understand it."
But there are other reasons to reject the road project beyond wildlife concerns.
It's debatable whether the road through Izembek would be able to remain open during heavy snowstorms and hurricane-strength winds.
Critics of the road project note that the same wind gusts and blizzard conditions that make it dangerous to fly or cross Cold Bay by boat would also make it extremely difficult to drive on a single-lane road on a spit of refuge land hugging Kinzarof Lagoon, which drains into Cold Bay.
"Combined with darkness, avalanche conditions, and ice-glazed roads, an attempt to travel the proposed road would be foolish beyond any reason, regardless the emergency or business," Peter Mjos, the former Eastern Aleutian medical director for the U.S. Public Health Service, wrote in a May 2012 letter to Fish and Wildlife. "Any attempt to maintain the road for travel in such conditions would clearly jeopardize life."
Cold Bay Mayor John Maxwell, in a 2008 email to the House Natural Resources Committee, said the same weather that grounds planes over Cold Bay would also render the road impassable. "During a storm the blowing and drifting snow would keep any proposed road closed or make it so incredibly expensive to try and keep it open the borough would not be able to afford it," he said. In areas of heavy drifting, travel is expected to be about 3 mph, he added.
But Gary Hennigh, the King Cove city manager, said he believes the road would be navigable at least 90 percent of the time, which is enough to save lives and significantly improve the quality of life for hundreds of King Cove residents.
"We're very optimistic people, but the reality is there is no other known logical solution to this issue that we can point to at this time," Hennigh said. "It's one of the few places in rural Alaska where a transportation issue can be solved."
'The risk is real'
Until then, options are limited. Sometimes the only way out is a Coast Guard helicopter medevac, and even that provides no guarantee of a timely exit.
During the last few months of the year, the Coast Guard stations two helicopters at Cold Bay because of the large number of commercial fisherman in the area during red king crab season. But for most of the year, the helicopters are stationed at St. Paul Island about 300 miles away from King Cove.
And the weather conditions are as dangerous for the Coast Guard's H-60 "Jayhawk" helicopters to deal with as for the mostly single-engine propeller planes that use the King Cove airfield.
Sometimes the weather is so severe, the Coast Guard is reluctant to fly into King Cove unless it's a life-or-death scenario, said Coast Guard Lt. Cmdr. Vincent Jansen, H-60 assistant operations officer at Coast Guard Air Station Kodiak, who has flown numerous rescue missions in the Cold Bay area and across the state.
"The wind, that's really a game changer," Jansen said. "I have seen winds up to 120 miles per hour, and unfortunately, I've had to fly into those conditions. It changes your life."
If a decision is made to fly into King Cove, it requires a lot of pre-flight planning, he said. Coast Guard medical experts also access the condition of the patient, and if the weather conditions are too dangerous and it is not life-threatening, "sometimes the medical folks recommend against flying in."
The Coast Guard flew five medevac rescue missions into the King Cove-Cold Bay area last year.
"We certainly assume quite a bit of risk to save a life," he said. "The risk is real. The residents in King Cove are not exaggerating their situation."
But he added, "If it means the difference between saving a life and losing a life, we will launch."
Not all medical emergencies, however, involve a life-or-death situation.
Joshua Gould, a lifelong King Cove resident, recalls with horror the Friday afternoon three years ago when his stepson fractured his leg while sledding with friends near his home.
Gould, 36, said he took Jason, who was then just 8 years old, to the King Cove clinic, where his broken leg was placed in a splint and Gould was told to get him on the first plane or boat out of town to Cold Bay.
But the weather turned bad and no planes could get out of King Cove. What's more, the waters of the bay were too choppy to cross using the hovercraft, Gould said.
"They just treated him for the pain and we took him home," he said, adding that the best he could do for his stepson was to give him Tylenol and try to make him as comfortable as possible.
"It was a pretty tough deal, especially at that age and not knowing if he's going to be taken care of," Gould said. "He kept asking, 'When is my leg going to be fixed?'"
Gould said they were eventually able to fly to Cold Bay three days later, on Monday, and from there they caught a commercial flight to a hospital in Anchorage, where Jason's leg was finally placed in a cast. If the Izembek road had been in place, Gould said, they could have driven to Cold Bay days earlier.
"There are many stories like mine to support the need for a road," Gould said. "We're only asking for a very small piece of land for us to use."
The facility referred to as King Cove Airport is really little more than an airstrip.
The airfield, owned and managed by the Alaska Department of Transportation, consists of a single 3,500-foot-long gravel runway nestled in a valley between two volcanic peaks about 4 miles northeast of King Cove.
The last 5.2 miles of the descent into King Cove must be navigated visually, and even on the clearest days, it tests the most experienced pilots with sudden wind shears racing through the valley that are known to bring down the mostly Cessna Skyhawk and Piper Cherokee single-engine propeller planes that use the strip. The largest airplane likely to use the airstrip is the Beechcraft E-1900, which can hold 19 passengers.
There is no air control tower, and there are no hangars for airplanes to be housed out of the fierce winds that whip in opposite directions on either side of the runway. The gravel runway gets soft during spring snowmelt and after heavy rains, according to a Federal Aviation Administration description of the airstrip.
"It can be extremely hazardous," said Paul Schaack, an Alaska Department of Transportation and Public Facilities equipment operator and former pilot who supervises employees who help maintain the King Cove airfield and the runways at Cold Bay Airport.
Even in the worst weather, DOT doesn't close the King Cove runway. Rather, Schaack said, the department leaves it up to the individual pilot. "It's the pilot's decision on what he wants to attempt to do."
Pilots, according to the final EIS, "described flights between the King Cove and Cold Bay airports as 'very tricky,' 'a risk,' 'pretty violent,' and 'the scariest plane ride of your life.'"
"Some days it's fun, and some days it's not so fun. Let's just say it's challenging," said Guy Morgan, 66, a Cold Bay resident and commercial charter pilot who has flown into and out of the King Cove airfield for decades.
He knows the airfield and surrounding mountainous terrain as well as anyone, but he said the winds whipping around the mountains can blow hard in different directions at opposite ends of the runway. He said he won't fly into King Cove if the wind speeds are greater than 25 knots.
"Unfortunately, I like challenges, so I don't mind going in there," he said. "But sometimes it's like we're trying to be aerobatic pilots when we're not aerobatic pilots. It's not for the faint of heart."
The dangers of flying into the King Cove airstrip, with its sudden weather changes and dangerous winds, are well-known.
A 1999 Alaska DOT assessment of transportation needs in King Cove and Cold Bay noted that the "King Cove Airport itself is not unsafe," but rather, the "hazardous combination" of severe weather and surrounding mountains makes it more challenging.
Since 1980, 11 people have been killed in airplane crashes taking off or landing into King Cove. All but one of those deaths occurred in two plane crashes in 1980 and 1981, according to state statistics.
The December 1980 crash killed four people after the pilot of a Piper PA-32 taking off from King Cove during blizzard conditions misjudged his altitude and slammed into a mountain during a medical emergency. The flight was attempted after a local fisherman severed his foot in an accident, and local health officials determined the man would bleed to death if he did not get to a hospital.
The July 1981 crash that killed six people involved a Beechcraft 200 flying into King Cove from Kodiak, Alaska. The pilot was unfamiliar with the mountainous terrain surrounding the airfield and slammed into the ground. The third fatal crash in February 1990 occurred when the pilot of a Piper PA-31-350 also misjudged his altitude while flying in poor weather conditions and slammed into a mountainside.
Yet the Alaska DOT travel assessment noted that flying conditions for the residents of King Cove are not uncommon in remote Alaskan communities. The assessment noted that many residents in the state frequently fly in the small single-engine and twin-engine planes used at King Cove Airport, which "are involved in more accidents nationwide" than larger aircraft, according to the assessment.
"King Cove is no different than other Alaska communities in this regard," according to the assessment. "It is different only in the combination of notoriously bad weather, mountainous terrain, and small aircraft. Statistically, it is not clear that King Cove residents are in greater danger than other Alaskans who rely on air transportation, but it is clear that they are no better off."
King Cove and Cold Bay are less than 20 miles apart, but conditions are much better across the bay at Cold Bay Airport, which was built by the Army in 1942 as part of the Fort Randall Army Base, which housed 60,000 troops during the height of World War II. The FAA in 1963 handed over ownership and responsibility for managing the airport to the state of Alaska, which has managed it ever since.
Cold Bay Airport has two asphalt runways, the largest of which is one of the five longest runways in the state, at 10,415 feet long and 150 feet wide. This runway runs north-south, and a second intersecting "crosswind" asphalt runway runs in an east-west direction, though it is only about 6,500 feet long.
The asphalt runways and modern facilities make it an all-weather facility, and Cold Bay Airport serves as a regional hub for passengers, cargo and mail service linking Anchorage and Fairbanks to Cold Bay, King Cove, False Pass and Nelson Lagoon. The airport is also an emergency landing site for commercial jet flights crossing the Pacific Ocean.
Della Trumble, spokeswoman for the Native Alaska-owned King Cove Corp. and Agdaagux Tribal Council of King Cove, said most residents will only fly out of Cold Bay Airport and are terrified of the King Cove airfield.
Trumble said she doesn't blame them. Nearly three years ago, she watched in horror as the small plane carrying her 21-year-old daughter, Trisha, hit a strong downdraft on approach to the airstrip that violently pushed the plane down on the runway. Though none of the four passengers was injured, Della Trumble said the incident had a lasting impact on her daughter.
"She is so petrified about flying now that she's basically a basket case," Trumble said. "She's just so afraid to fly, even on big planes."