The accident Friday afternoon in Terra Linda also revealed a vulnerable spot in Marin County's trauma care system.

Civkulis was airlifted to John Muir Medical Center in Walnut Creek because there was no neurosurgeon available in Marin.

The lack of a full-service, round the clock trauma center in Marin has long raised the ire of critics.

Friday's accident occurred just as county health officials prepare to release a plan to close what some see as gaps in the trauma care system.

Civkulis, a Berkeley resident, remained at John Muir in fair condition Tuesday.

She reportedly was walking on the sidewalk on Northgate Drive near the mall when she was struck by the Buick LeSabre.

Novato resident Chris VanLoan saw the accident while on a smoking break from his job at Sears.

"I heard the car go up on the curb. I saw a lady fly through the air and land on her head and I saw (the driver) hit a tree" VanLoan said.

Civkuiis, who was knocked unconscious, landed about 30 feet away in the Sears parking lot.

"I ran over and saw the lady on the ground and I told my friend to call 911." VanLoan said.

Civkniis regained consciousness after five to 10 minutes, VanLoan said, but appeared dazed and was bleeding heavily from her head. She could not speak or rise.

"It was the most disturbing thing I've ever seen," he said.

The driver, a 17 year old Terra Linda High School senior, reportedly told police he was trying to clear his windshield when he lost control of the car. He was driving approximately 25 miles per hour.

His friends said he was stunned by the crash.

"He told me he couldn't even see the lady," said Nathan Cohen, 17.

"He's a great guy. He's not the type of guy you'd expect this to happen to."

The driver's friends said he was coming home from school, where he had just completed the last of his finals. A physics text lay in the back seat of the heavily damaged Buick.

After hitting civkuris, the car plowed into a small tree. The driver, who was wearing his seatbelt, was uninjured in the crash.

Paramedics were callled at 12:18 p.m., and a REACH helicopter touched down shortly before 1 pm. It left with Civkulis about 10 minutes later.

Although Civkulis was minutes from Kaiser, there is no neurosurgery department at the Terra Linda hospital.

Normally, two fuIl-time Marin neurosurgeons are on call at at Marin General Hospital for head trauma emergencies.

A third neurosurgeon, who puts his practice between Marin and Sonoma counties, was recruited by Marin General in August. He is on-call part time.

On Friday, there was no neurosurgeon available from 7 am to 7pm.

Marin General spokeswoman Kathie Graham said there has only been "a couple of times this past year," when there is no neurosurgeon available.

"It's very infrequent at this point that there's no neurosurgery coverage, but it does happen," Graham said.

When the hospital knows that neurosurgeon will not be available, it alerts all other agencies, including fire departments and paramedics.

Such was the case Friday.

"When the paramedics got there, it was pretty obvious it was a head injury They assessed that on the spot. The system worked. They called for a helicopter and did the best thing for the patient," Graham said.

"Everybody in the system knew in advance there was no head trauma services in Marin They were prepared, and they got that lady to John Muir, which is an excellent trauma center."

John Muir Medical Center is about a 20-minute helicopter ride from San Rafael.

Graham said Marin's small number of residents can not sustain a full-scale trauma center.

"The fact is, Marin County has a small population and can't support more neurosurgeons We just don't have the cases.

"There arc major efforts being made in Marin County to resolve what kind of trauma services are best for Marin County. It's a challenging situation and obviously it's an active issue in our community. There's no short answer to these questions."

The county began working on a trauma plan last year, following outcry over a young car accident victim who died after a three hour trip from the San Rafael crash scene to Sutter Medical Center in Santa Rosa.

Also in the works is a Sonoma County trauma center - complete with a helipad - planned for Santa Rosa. That center, which is facing opposition from residents who don't want helicopters flying over their homes, will eventually be able to handle cases from Novato.