The key differences are that in Pacific Coast Highway the road and water segments are split into separate, alternating, screens and it allows two-player simultaneous play.

The first screen is the highway from the title, with eight lanes of traffic to avoid, divided in the center by a median strip (called a "rolling sidewalk" in the manual).

In later levels the median strip and life preservers move, first in one direction only, then randomly switching.

Getting hit by a vehicle results in an ambulance taking the character away (or a rescue boat for the water sequence), and the level restarts for both players.

The manual describes the second screen as crossing a beach of hot sand by jumping on towels and surfboards, but this isn't present in the game itself.