County of San Diego Division of Emergency Medical Services EMS Pedestrian 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

County of San Diego Division of Emergency Medical Services EMS Background 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.

County of San Diego Division of Emergency Medical Services EMS Background Injury Surveillance System –SWITRS – Injury Crashes GIS –Prehospital –Trauma Registry –Medical Examiner

County of San Diego Division of Emergency Medical Services EMS Research 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?

County of San Diego Division of Emergency Medical Services EMS Data 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

County of San Diego Division of Emergency Medical Services EMS Methods 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.

County of San Diego Division of Emergency Medical Services EMS SWITRS vs. Prehospital Database: FY 96/97 – 99/00 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

County of San Diego Division of Emergency Medical Services EMS Comparison of Gender Database County of San Diego, Health & Human Services Agency EMS Prehospital Database FY 96/97, SWITRS FY 96/97-99/00.

County of San Diego Division of Emergency Medical Services EMS Pedestrian Injury Rates by Race/Ethnicity Source: County of San Diego Health and Human Services Agency, Division of Emergency Medical Services, Prehospital database, FY 96/97 – 99/00

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

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

County of San Diego Division of Emergency Medical Services EMS Pedestrian Injuries by Hour and Age: Monday - Friday Source: County of San Diego Health and Human Services Agency, Division of Emergency Medical Services, SWITRS database, FY 96/97 – 99/00

County of San Diego Division of Emergency Medical Services EMS Pedestrian Injuries by Hour and Age: Saturday - Sunday Source: County of San Diego Health and Human Services Agency, Division of Emergency Medical Services, SWITRS database, FY 96/97 – 99/00

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

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

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

County of San Diego Division of Emergency Medical Services EMS Where 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

County of San Diego Division of Emergency Medical Services EMS What 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

County of San Diego Division of Emergency Medical Services EMS Results 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

County of San Diego Division of Emergency Medical Services EMS Conclusions 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.

County of San Diego Division of Emergency Medical Services EMS Acknowledgements The investigators would like to thank all of the Prehospital Agencies, Hospitals, and Paramedics for their data collection efforts and contribution to this research.

County of San Diego Division of Emergency Medical Services EMS Contact Information Alan M. Smith County of San Diego Health and Human Services Agency Emergency Medical Services 6255 Mission Gorge Road San Diego, CA (619) phone (619) fax