County of San Diego Division of Emergency Medical Services EMS Pedestrian Deaths and Injuries in...

County of San Diego Division of Emergency Medical Services

EMSPedestrian Deaths and Injuries in

0-14 Year Olds in San Diego County

Alan M. Smith, MPH

Barbara Stepanski, MPH

Edward Castillo, MPH

Leslie Upledger Ray, MA, MPPA

Patricia A. Murrin, RN, MPH

County of San Diego Health and Human Services Agency

Division of Emergency Medical Services (EMS)

Research Data Systems


EMSBackground

• In 1996, EMS began developing the Injury Surveillance System (ISS) for San Diego County. This system includes regularly collected emergency medical data and an integrated GIS system.

• In FY 96/97, 325 paramedic calls were due to MV vs pedestrian collisions with victims under 15 years of age.

• One out of every seven injury calls for paramedic assistance to a child under age 15 was for pedestrian related injury.

• With pediatric pedestrian injuries on the rise, investigators questioned the logistics associated with such crashes. It was hypothesized that hours in which children travel to and from school would have an increased number of pedestrian injury crashes.


EMSBackground

• Injury Surveillance System– SWITRS – Injury Crashes

• GIS

– Prehospital– Trauma Registry– Medical Examiner


EMSResearch Questions

• How does prehospital data compare with SWITRS data for child pedestrian crashes?

• How are child pedestrian injuries distributed– Demographically (age, gender, race/ethnicity)– Temporally (Day/night, day of week)– Geographically

• What were the actions of the driver and the pedestrian leading up to the crash?


EMSData Sources

• The analysis integrated

– San Diego County EMS Prehospital Patient Records

• paramedic/EMT calls in which a patient was transferred to a medical

facility or refused care

– Statewide Integrated Traffic Records System (SWITRS)• statewide database for motor vehicle related injury crashes in California

– SANDAG Population Estimates


EMSMethods

• For FY 96/97 through FY 99/00 countywide surveillance data were used to evaluate child pedestrian injuries and deaths according to age, gender, ethnicity, community (SRA), time call received/time of collision, location, day, month and pedestrian action.

• Events were geocoded (using ArcView 3.2A) to determine geographical distribution of child pedestrian injuries/deaths.


EMSSWITRS vs. Prehospital

Database: FY 96/97 – 99/00

286

424

537

304

602632

0

100

200

300

400

500

600

700

0 to 4 5 to 9 10 to 14

Prehospital SWITRS

Source: County of San Diego Health and Human Services Agency, Division of Emergency Medical Services, SWITRS database and Prehospital database, FY 96/97 – 99/00


EMSComparison of Gender

787 935

470 585

0%

20%

40%

60%

80%

100%

Prehospital SWITRS

Female

Male

DatabaseCounty of San Diego, Health & Human Services Agency EMS Prehospital Database FY 96/97, SWITRS FY 96/97-99/00.


EMSPedestrian Injury Rates by

Race/Ethnicity

24.87

121.28

49.16

33.46

0

20

40

60

80

100

120

140

White Black Hisp Asian/Other

Rat

e p

er 1

00,0

00

Source: County of San Diego Health and Human Services Agency, Division of Emergency Medical Services, Prehospital database, FY 96/97 – 99/00


EMSPedestrian Injury by Month

010203040506070

Janu

ary

Febru

ary

Mar

chApril

May

June

July

August

Septe

mbe

r

Oct

ober

Novem

ber

Decem

ber

1 to 4 5 to 9 10 to 14

Source: County of San Diego Health and Human Services Agency, Division of Emergency Medical Services, SWITRS database, FY 96/97 – 99/00


EMSPedestrian Injury by Day of Week

020406080

100120

Sunday

Mond

ay

Tuesd

ay

Wed

nesd

ay

Thurs

day

Friday

Saturd

ay

1 to 4 5 to 9 10 to 14



EMSPedestrian Injuries by Hour and Age:

Monday - Friday

0

20

40

60

80

100

12 a

.m.

6 a.

m.

8 a.

m.

10 a

.m.

Noon

2 p.m

.

4 p.m

.

6 p.m

.

8 p.m

.

10 p

.m.

1 to 4 5 to 9 10 to 14



EMSPedestrian Injuries by Hour and Age:

Saturday - Sunday

0

5

10

15

20

25

12 a

.m.

6 a.

m.

8 a.

m.

10 a

.m.

Noon

2 p.m

.

4 p.m

.

6 p.m

.

8 p.m

.

10 p

.m.

1 to 4 5 to 9 10 to 14


Pacific Ocean

Mexico

Impe

rial C

oun

ty

Riverside

POPULATION DENSITYSan Diego County by Subregional Area

Source: County of San Diego Health and Human Services Agency,Division of Emergency Medical Services, Medical Examiner Database

1996 - 2001

5 0 5 10 Miles

N

Population Density3.44 - 2004.952004.95 - 4006.464006.46 - 6007.986007.98 - 8009.498009.49 - 10011

Source: County of San Diego Health and Human Services Agency, Division of Emergency Medical Services, SANDAG Population Estimates, 1999.

Pacific Ocean

Mexico

Impe

rial C

oun

ty

Riverside

N

5 0 5 10 Miles Source: County of San Diego Health and Human Services Agency,Division of Emergency Medical Services, Medical Examiner Database

1996 - 2001

Median Income28400 - 3653036531 - 4466144662 - 5279252793 - 6092360924 - 69054

MEDIAN INCOMESan Diego County by Subregional Area

Source: County of San Diego Health and Human Services Agency, Division of Emergency Medical Services, SANDAG Population Estimates, 1999.

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Riverside County

Pacific Ocean

Mexico

Impe

rial C

oun

ty

Median Income by SRA28977 - 3786637867 - 4675546756 - 5564555646 - 6453464535 - 73424

Pedestrian Crashes$ Age 1 - 4$ Age 5 - 9$ Age 10 - 14

10 0 10 20 Miles

N

PEDESTRIAN CRASHES AGES 1 TO 14 YEARS

Source: County of San Diego Health and HumanServices Agency, Division of Emergency Medical Services,

August 2002

San Diego County FY 96/97 - 99/00

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Impe

rial C

oun

ty

Mexico

Pacific Ocean

Riverside County

10 0 10 20 Miles

N


August 2002

San Diego County

$T Crashes Age 5 to 9

School Districts

PEDESTRIAN CRASHES AGES 5 TO 9 YEARSSan Diego County FY 96/97 - 99/00

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Impe

rial C

oun

ty

Mexico

Pacific Ocean

Riverside County


August 2002

PEDESTRIAN CRASHES AGES 10 TO 14 YEARS

N

10 0 10 20 Miles

San Diego County$T Crashes Age 10 to 14

School Districts

San Diego County FY 96/97 - 99/00


EMSPedestrian Action by Age

0% 10% 20% 30% 40% 50% 60% 70%

Not Stated

Crossing in Crosswalkat Intersection

Crossing in CrosswalkNot at Intersection

Crossing, Not inCrosswalk

In Road, IncludingShoulder

Not in Road

Approaching/LeavingSchoolbus

1 to 4 5 to 9 10 to 14



EMSWhere and When?

Mid-City SRA• The highest incidence

– 99/100,000 for Prehospital– 135 /100,000 for SWITRS

• Hours of Day – high incidence of injuries occurred during school travel times (7-9am and 2-6pm)

– 45/100,000 for Prehospital– 66/100,000 for SWITRS

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Male-Non School Travel Hours

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Female-School Travel hours

Female-Non School Travel Hours

Ages 10-14

Ages 5-9





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Source: SWITRS FY 96/97County of San Diego Health and Human Services Agency, Emergency Medical Services, 1999

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Parks

I-8

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54th

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Source: SWITRS FY 96/97County of San Diego Health and Human Services Agency, Emergency Medical Services, 1999

0.3 0 0.3 0.6 Miles

Child Pedestrian Crashes in Mid-City Sub-Regional AreaBy Age Group, Gender, and School Travel Hours


EMSWhat Were They Doing?

(SWITRS Pedestrian Violations)

• 52% of the children injured were crossing the street outside of a crosswalk

• The proportion struck while crossing outside of a crosswalk decreased with increasing age (57% aged 0-4; 59% aged 5-9; 42% aged 10-14)

• 26% of the children injured were crossing the street at a crosswalk (55% were aged 10-14)

• Contrary to common belief, only 4 (<1%) of the 1234 students were injured while approaching or leaving a school bus


EMSResults

• 46% of the Prehospital and 51% of the SWITRS cases occurred in the hours children travel to and from school, which is 25% of the weekday hours.

• Mid City SRA made up 6.8% of the county’s population under age 15, but accounted for 14% of the Prehospital and 15% of the SWITRS pedestrian injuries in this age group.

• Victims were 60% male in Prehospital, 59% SWITRS


EMSConclusions

• At the county level, the distribution of pedestrian injuries mirrors population density patterns.

• Childhood pedestrian injuries tend to cluster in time according to when children may be walking to or from school.

• School bus associated injuries do not contribute to pedestrian injuries to the degree previously thought.

• Most childhood pedestrian injuries can be attributed to unsafe street-crossing behavior by the child.


EMSAcknowledgements

• The investigators would like to thank all of the Prehospital Agencies, Hospitals, and Paramedics for their data collection efforts and contribution to this research.


EMSContact Information

Alan M. SmithCounty of San Diego

Health and Human Services AgencyEmergency Medical Services

6255 Mission Gorge RoadSan Diego, CA 92120 (619) 285-6429 phone

(619) 285-6531 [email protected]

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