Unintentional Injury in San Diego County

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1 County of San Diego Health and Human Services Agency Chronic Disease and Injury Prevention Emergency Medical Services Unintentional Injury in San Diego County County of San Diego Board of Supervisors Greg Cox, District 1 Dianne Jacob, District 2 Pam Slater, District 3 Ron Roberts, District 4 Bill Horn, District 5 Walter F. Ekard Chief Administrative Officer Rodger G. Lum, Ph.D., Director, Health and Human Services Agency July 1, 1999 through June 30, 2000 August 2002 Nancy L. Bowen, M.D., MPH Public Health Officer Gwen Jones, Chief Emergency Medical Services

2 Unintentional Injury in San Diego County July 1, 1999 through June 30, 2000

3 We acknowledge the contributions of the following individuals for their work in the preparation of this report: Nancy Bowen, MD; Public Health Officer Adrienne Collins Yancey; Acting Chief, Chronic Disease & Injury Prevention and Health Promotion Gwen S. Jones; Chief, Emergency Medical Services Patricia A. Murrin, RN, MPH; EMS Coordinator, Emergency Medical Services Leslie Upledger Ray, MA, MPPA; Senior Epidemiologist, Emergency Medical Services Edward M. Castillo, MPH; Biostatistician, Emergency Medical Services Alan M. Smith, MPH; Epidemiologist, Emergency Medical Services Barbara M. Stepanski, MPH; Biostatistician, Emergency Medical Services Bruce Even; Health Information Specialist, Chronic Disease and Injury Prevention Additionally, this report would not have been possible without the hard work and dedication of our community partners. In particular, we acknowledge the invaluable contributions of the San Diego County Trauma System, particularly the six trauma centers: Children s Hospital and Health Center Palomar Medical Center Scripps Memorial Hospital, La Jolla Scripps Mercy Hospital and Health Center Sharp Memorial Hospital University of California, San Diego Medical Center We extend our thanks and appreciation to the hundreds of nurses, paramedics and emergency medical technicians and their hospitals and agencies who provided the information on emergency patients.

4 TABLE OF CONTENTS Introduction...1 Table 1 National, State, and San Diego County Rates of Unintentional Injury (1998)...3 Table 2 San Diego County Incidents and Rates of Unintentional Injury (FY 1999/00)...4 Leading Causes of Unintentional Injury Paramedic/EMT Responses Table 3a. Leading Causes of Unintentional Injury (Number and Rate per 100,000) by : Paramedic/EMT Responses...7 Table 3b. Leading Causes of Unintentional Injury (Number and Rate per 100,000) by Race/Ethnicity: Paramedic/EMT Responses...8 Table 3c. Leading Causes of Unintentional Injury (Number and Rate per 100,000) by MSA: Paramedic/EMT Responses...9 Severe Injury Table 4a. Leading Causes of Unintentional Injury (Number and Rate per 100,000) by : Severe Injury...10 Table 4b. Leading Causes of Unintentional Injury (Number and Rate per 100,000) by Race/Ethnicity: Severe Injury...11 Table 4c. Leading Causes of Unintentional Injury (Number and Rate per 100,000) by MSA: Severe Injury...12 Deaths Table 5a. Leading Causes of Unintentional Injury (Number and Rate per 100,000) by : Death...13 Table 5b. Leading Causes of Unintentional Injury (Number and Rate per 100,000) by Race/Ethnicity: Death...14 Table 5c. Leading Causes of Unintentional Injury (Number and Rate per 100,000) by MSA: Death...15 Transport Related Injuries Motor Vehicle Occupant (MVO) Table 6a Area by for Paramedic/EMT Responses: Motor Vehicle Occupant...17 Table 6b Area by Race/Ethnicity for Paramedic/EMT Responses: Motor Vehicle Occupant...21 Table 7a Area by for Severe Injury: Motor Vehicle Occupant...23 i

5 Table 7b Area by Race/Ethnicity for Severe Injury: Motor Vehicle Occupant...27 Table 8a Area by for Deaths: Motor Vehicle Occupant...29 Table 8b Area by Race/Ethnicity for Deaths: Motor Vehicle Occupant...33 Motorcycle Table 9a Area by for Paramedic/EMT Responses: Motorcycle...35 Table 9b Area by Race/Ethnicity for Paramedic/EMT Responses: Motorcycle...39 Table 10a Area by for Severe Injury: Motorcycle...41 Table 10b Area by Race/Ethnicity for Severe Injury: Motorcycle...45 Table 11a Area by for Deaths: Motorcycle...47 Table 11b Area by Race/Ethnicity for Deaths: Motorcycle...51 Pedalcycle Table 12a Area by for Paramedic/EMT Responses: Pedalcycle...53 Table 12b Area by Race/Ethnicity for Paramedic/EMT Responses: Pedalcycle...57 Table 13a Area by for Severe Injury: Pedalcycle...59 Table 13b Area by Race/Ethnicity for Severe Injury: Pedalcycle...63 Table 14a Area by for Deaths: Pedalcycle...65 Table 14b Area by Race/Ethnicity for Deaths: Pedalcycle...69 Pedestrian Table 15a Table 15b Table 16a Table 16b Table 17a Table 17b Area by for Paramedic/EMT Responses: Pedestrian...71 Area by Race/Ethnicity for Paramedic/EMT Responses: Pedestrian...75 Area by for Severe Injury: Pedestrian...77 Area by Race/Ethnicity for Severe Injury: Pedestrian...81 Area by for Deaths: Pedestrian...83 Area by Race/Ethnicity for Deaths: Pedestrian...87 Other Transportation Table 18a Area by for Paramedic/EMT Responses: Other Transportation...89 Table 18b Area by Race/Ethnicity for Paramedic/EMT Responses: Other Transportation...93 Table 19a Area by for Severe Injury: Other Transportation...96 Table 19b Area by Race/Ethnicity for Severe Injury: Other Transportation...99 Table 20a Area by for Deaths: Other Transportation Table 20b Area by Race/Ethnicity for Deaths: Other Transportation Non-Transport Related Unintentional Injuries Falls Table 21a Area by for Paramedic/EMT Responses: Falls Table 21b Area by Race/Ethnicity for Paramedic/EMT Responses: Falls Table 22a Area by for Severe Injury: Falls Table 22b Area by Race/Ethnicity for Severe Injury: Falls Table 23a Area by for Deaths: Falls Table 23b Area by Race/Ethnicity for Deaths: Falls ii

6 Fire-Burn-Scald Table 24a Area by for Paramedic/EMT Responses: Fire-Burn-Scald Table 24b Area by Race/Ethnicity for Paramedic/EMT Responses: Fire-Burn-Scald Table 25a Area by for Deaths: Fire-Burn-Scald Table 25b Area by Race/Ethnicity for Deaths: Fire-Burn-Scald Cut-Pierce Table 26a Area by for Paramedic/EMT Responses: Cut-Pierce Table 26b Area by Race/Ethnicity for Paramedic/EMT Responses: Cut-Pierce Table 27a Area by for Severe Injury: Cut-Pierce Table 27b Area by Race/Ethnicity for Severe Injury: Cut-Pierce Blunt Trauma Table 28a Area by for Paramedic/EMT Responses: Blunt Trauma Table 28b Area by Race/Ethnicity for Paramedic/EMT Responses: Blunt Trauma Poison-Bite-Sting Table 29a Area by for Paramedic/EMT Responses: Poison-Bite-Sting Table 29b Area by Race/Ethnicity for Paramedic/EMT Responses: Poison-Bite-Sting Table 30a Area by for Deaths: Poison-Bite-Sting Table 30b Area by Race/Ethnicity for Deaths: Poison-Bite-Sting Airway Obstruction-Suffocation Table 31a Area by for Paramedic/EMT Responses: Airway Obstruction-Suffocation Table 31b Area by Race/Ethnicity for Paramedic/EMT Responses: Airway Obstruction-Suffocation Table 32a Area by for Deaths: Airway Obstruction-Suffocation Table 32b Area by Race/Ethnicity for Deaths: Airway Obstruction-Suffocation Drown-Submersion Table 33a Area by for Paramedic/EMT Responses: Drown-Submersion Table 33b Area by Race/Ethnicity for Paramedic/EMT Responses: Drown-Submersion Table 34a Area by for Deaths: Drown-Submersion Table 34b Area by Race/Ethnicity for Deaths: Drown-Submersion Technical Notes iii

7 INTRODUCTION The Division of Chronic Disease and Injury Prevention The County of San Diego Health and Human Services Agency s Chronic Disease & Injury Prevention Division (ChDIP) was established as part of the County Board of Supervisors Health and Wellness Initiative in its Strategic Plan for ChDIP s mission is to promote the wellness, and prevention of illness, disability and premature death due to chronic diseases and unintentional injuries. ChDIP goals include increasing physical activity, healthy eating, safe behaviors and environments, and use of recommended preventive health care and quality of health care treatment, and reducing tobacco use and exposure. One component of the Division s efforts to promote physical activity and healthy eating is the Get Up San Diego initiative. The purpose is to increase knowledge, positive attitudes and healthy behaviors. ChDIP focuses on individuals, families, institutions (such as schools, healthcare systems, etc.), neighborhoods and communities. The Division of Emergency Medical Services The Division of Emergency Medical Services (EMS) is a component of the Health and Human Services Agency s Public Health Services group. It is the local EMS agency as defined in California law. EMS s purpose is to ensure that the quality of emergency medical services, which includes ambulance services, trauma care services, and non-emergency ambulance services, are of the highest quality. As the regulatory agency for emergency services, EMS designates participants in the county wide EMS system (base hospitals, advanced life support providers, trauma centers, prehospital training programs, etc.); monitors system activity with a large data network; develops the medical standard of care for emergency patients; and provides the framework for medical quality improvement activities. Additionally, EMS provides services within two ambulance districts (County Service Areas 17 & 69), oversees the County s medical disaster plan and implements numerous community education, prevention and research grants/projects. PURPOSE The purpose of this publication is to provide community level information of where and why people access emergency medical services in San Diego County and to help health professionals identify problems within their communities. LAYOUT This document provides an overview of injuries by level of severity based on data routinely collected by the Division of Emergency Medical Services. The Paramedic/EMT tables contain Cause of Injury as reported by paramedics/emergency medical technicians-1s (EMT-1s). The Severe Injury tables are based on San Diego County Trauma Registry data, which are obtained from the six trauma centers in the San Diego County Trauma System. Death tables are based on San Diego County Medical Examiner s records. 1

8 Data is presented in tables with community area (MSA and SRA) incidence and rate by age group for each cause of injury and level of severity. All rates are calculated per 100,000 residents by area and age/ethnicity as defined by San Diego Association of Governments (SANDAG). Rates were not calculated for categories with less than five incidents. Complete annual reports on these databases are available from Emergency Medical Services. DATA SOURCES The Divisions of Chronic Disease and Injury Prevention and Emergency Medical Services used three population based data sources for the preparation of the Unintentional Injury in San Diego 1999/2000 report. Prehospital Database: EMS receives a prehospital patient record (PPR) for every patient seen by a paramedic or emergency medical technician. The PPR contains information including demographics, incident zip code location, chief complaint, patient status, injury event information, restraint use, contributing factors, times and outcomes. Trauma Registry: EMS receives an abbreviated Trauma Registry for every trauma patient admitted to any designated trauma center hospital trauma service. A detailed Trauma Registry is received for every trauma patients who meets one or more of the following criteria: length of hospitalization of at least 24 hours, admission to intensive or intermediate care unit, death due to traumatic injuries, and/or transfer to or from another acute care hospital. Medical Examiner s Data: EMS receives an Investigative Summary and Autopsy for every individual who dies in San Diego County from a traumatic injury. Medical Examiner s records contain injury related information including date and time of injury, incident location, patient home zip code, external cause of injury (ICD9 CM E-code), age, sex, race/ethnicity, vehicle make and type, law enforcement agency, mechanism of injury and detailed narrative of injuries sustained. DATA STATISTICS This publication contains two types of statistics: incident and rate. An incident answers the how many question while a rate is used to compare risk between groups. Incident: The number of occurrences for the specific injury type. Incidents should not be used to compare different racial/ethnic groups, age groups or geographic areas. For these comparisons, use rates, which take into account differences in population sizes. Rate: Calculated as incidents per 100,000 population. Rates were calculated using January 1999 population estimates provided by the San Diego Association of Governments (SANDAG). Rates were not calculated for categories with less than five occurrences due to instability. 2

9 National, State, and San Diego County Rates of Unintentional Injury (1998) Rates of unintentional fatal injuries in San Diego County were generally lower than those of the United States and generally similar or lower than the rates of California. However, non-fatal rates in San Diego County were higher than those of California for motor vehicle occupant (MVO) crashes, motorcycle, pedalcycle, pedestrian, falls, suffocation, and drown-submersion (United States data for non-fatal injuries were not comparable due to differences in data sources). Many of these differences can be explained by the temperate climate of San Diego in addition to the many recreational activities available to residents and visitors alike. Of these, the rate of falls were the highest of non-fatal injury (281.89/100,000) followed by MVO crashes (78.69/100,000) in San Diego County. Table 1. National, State, and San Diego County Rates of Unintentional Injury, 1998 National California San Diego Cause of Injury Fatal Non-Fatal Fatal Non-Fatal Fatal Non-Fatal Motor Vehicle Occupant (MVO) Motorcycle Pedalcycle Pedestrian Fire-Burn-Scalds Unintentional Firearm * 1.45 Cut-Pierce * Fall Poison Suffocation Drown-Submersion Source: Center for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System (National), California Department of Health Services (State and Local) Note: National Non-fatal data is estimated from Emergency Department surveys and therefore is not comparable to State and Local hospital discharge data *Rates not calculated for incidents less than 5 Table 1 in the Unintentional Injury in San Diego Report 1999/2000 To ensure comparable rates for injury categories, 1998 data was used for Table 1 because it was the most recent data available using the ICD9 E-Code coding system. Injury grouping for the ICD10 is substantially different. As of 1999, all nationally reported death data utilize the ICD10 coding system. Presently, non-fatal data is still coded using the ICD9 coding system. The fatal injury rates for San Diego listed in Table 1 and Table 2 vary slightly because of this difference in reported years. 3

10 San Diego County Incidents and Rates of Unintentional Injury (FY 1999/00) Prehospital, trauma, and medical examiner patients predominantly suffered MVO crashes and fall injuries. The rate of prehospital pedalcycle and cut/pierce injuries were relatively high, however the rates for trauma and medical examiner data were lower than that of other injuries. This indicates that many pedalcycle injuries were not as severe as many other unintentional injuries. It is reasonable to suggest, based on the mechanism and sites of injuries sustained by pedalcyclists, that the most severe of these injuries are to the head and are in patients not wearing appropriate equipment such as helmets. The majority of cut/pierce injuries are to extremities, and although these injuries may require medical attention, they are less frequently life threatening. Table 2. San Diego County Incidents and Rates of Unintentional Injury, FY 1999/00 Prehospital Severe Injury Deaths Cause of Injury Incident Rate Incident Rate Incident Rate Motor Vehicle Occupant (MVO) 12, , Motorcycle Pedalcycle 1, Pedestrian Other Transportation Related Fire-Burn-Scald ** Unintentional Firearm * Cut-Pierce Blunt Trauma ** - ** - Falls 12, , Poison-Bite-Sting 1, Airway Obstruction-Suffocation ** Drown-Submersion ** Other 1, No Cause Indicated 4, Total 38, , Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services Prehospital Database, Trauma Registry, Medical Examiner's Data, FY 1999/00 *Rates not calculated for less than 5 incidents **Not collected in Trauma Registry or Medical Examiner s Database Table 2 in the Unintentional Injury in San Diego Report 1999/2000 4

11 Motor vehicle crashes and falls result in significantly more deaths and injuries than other unintentional causes. While the death rate is significantly higher for poison/bite/sting injuries, this category includes all drug overdose deaths that are not specifically identified as suicides. Drug related overdose deaths are not typically considered unintentional injuries. However, bites, stings, and poisonings from toxic substances such as household chemicals are considered unintentional injuries. Leading Causes of Unintentional Injury (FY 1999/00) The leading causes of unintentional injury in San Diego were predominantly fall and MVO crashes. Falls were more prevalent among young children and older individuals, whereas MVO crashes occurred most often among young adult and middle age injury patients for prehospital, trauma, and those individuals who died. Overall, MVO crashes were the most common type of injury among all races. However, falls were more common among white prehospital patients and patients who died, which is primarily due to a higher proportion of older individuals in this category. Trauma patients were predominantly injured in MVO crashes. There were differences between the rates of MVO crashes and falls between major statistical areas (MSAs), but these differences were small. 5

12 LEADING CAUSES OF UNINTENTIONAL INJURY 6

13 Table 3a: Leading Causes of Unintentional Injury (Number and Rate per 100,000) by : Paramedic/EMT Responses Overall 1 Fall 669 (285.22) MVO 409 (183.04) MVO 428 (209.22) MVO 1902 (985.21) MVO 1929 (862.16) MVO 2451 (555.44) MVO 2012 (426.37) MVO 1453 (404.97) Fall 917 (407.28) Fall 1399 (797.72) Fall 2813 ( ) Fall 2322 ( ) MVO (440.64) 2 MVO 342 (145.81) Fall 392 (175.43) Fall 405 (197.98) Fall 344 (178.19) Fall 362 (161.79) Fall 709 (160.67) Fall 991 (210.00) Fall 1069 (297.95) MVO 751 (333.55) MVO 536 (305.63) MVO 423 (367.34) MVO 114 (256.44) Fall (427.28) 3 Poison-Bite- Sting 84 (35.81) Pedalcycle 145 (64.89) Pedalcycle 252 (123.19) Poison-Bite- Sting 167 (85.50) Motorcycle 139 (62.13) Poison-Bite- Sting 270 (61.19) Poison-Bite- Sting 360 (78.20) Poison-Bite- Sting 223 (62.15) Poison-Bite- Sting 62 (27.54) Pedestrian 56 (31.93) Pedestrian 33 (28.66) Poison-Bite- Sting 17 (38.24) Poison-Bite- Sting 1447 (49.70) 4 Fire-Burn- Scald 71 (30.27) Pedestrian 119 (53.26) Other Trans 158 (77.24) Other Trans 139 (72.00) Poison-Bite- Sting 138 (61.68) Motorcycle 198 (44.87) Pedalcycle 169 (35.81) Pedalcycle 136 (37.91) Pedestrian 58 (25.76) Other Trans 36 (20.53) Poison-Bite- Sting 24 (20.84) Pedestrian 12 (26.99) Pedalcycle 1178 (40.46) 5 Pedestrian 63 (26.86) Other Trans 55 (24.61) Pedestrian 112 (54.75) Pedalcycle 133 (68.89) Other Trans 114 (50.95) Pedalcycle 156 (35.35) Motorcycle 144 (30.52) Motorcycle 109 (30.38) Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, Prehospital Database, FY 1999/00 Pedalcycle 40 (17.77) Poison-Bite- Sting 32 (18.25) Cut-Pierce 23 (19.97) Other Trans 12 (26.99) Pedestrian 977 (33.56) 7

14 Table 3b: Leading Causes of Unintentional Injury (Number and Rate per 100,000) by Race/Ethnicity: Paramedic/EMT Responses White Black Hispanic Asian/Other Total 1 Fall 8540 (491.24) MVO 956 (550.85) MVO 2791 (386.36) MVO 1517 (547.90) MVO (440.64) 2 MVO 5791 (333.07) Fall 517 (297.90) Fall 1406 (194.64) Fall 500 (180.59) Fall (427.28) 3 Poison-Bite-Sting 745 (42.85) Pedestrian 112 (64.53) Pedestrian 284 (39.31) Pedestrian 71 (25.64) Poison-Bite-Sting 1447 (49.70) 4 Pedalcycle 648 (37.27) Poison-Bite-Sting 101 (58.20) Pedalcycle 221 (30.59) Poison-Bite-Sting 59 (21.31) Pedalcycle 1178 (40.46) 5 Other Trans 518 (29.79) Pedalcycle 84 (48.40) Poison-Bite-Sting 210 (29.07) Pedalcycle 56 (20.23) Pedestrian 977 (33.56) Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, Prehospital Database, FY 1999/00 8

15 Table 3c: Leading Causes of Unintentional Injury (Number and Rate per 100,000) by Major Statistical Area: Paramedic/EMT Responses Central North City South Suburban East Suburban North County West North County East East County Total 1 Fall 2630 (417.86) MVO 3104 (441.07) MVO 1020 (325.63) Fall 2429 (495.46) Fall 1477 (392.16) Fall 2075 (552.03) Fall 182 (815.49) MVO (440.64) 2 MVO 2613 (415.16) Fall 2504 (355.81) Fall 904 (288.60) MVO 2091 (426.51) MVO 1345 (357.11) MVO 2073 (551.50) MVO 179 (802.04) Fall (427.28) 3 Pedestrian 284 (45.12) Pedalcycle 283 (40.21) Poison-Bite- Sting 191 (60.98) Poison-Bite- Sting 510 (104.03) Poison-Bite- Sting 240 (63.72) Poison-Bite- Sting 178 (47.35) Motorcycle 86 (385.34) Poison-Bite- Sting 1447 (49.70) 4 Pedalcycle 260 (41.31) Pedestrian 197 (27.99) Pedestrian 118 (37.67) Pedalcycle 200 (40.80) Other Trans 190 (50.45) Pedalcycle 155 (41.24) Poison-Bite- Sting 29 (129.94) Pedalcycle 1178 (40.46) 5 Cut-Pierce 199 (31.62) Blunt Trauma 181 (25.72) Pedalcycle 88 (28.09) Other Trans 183 (37.33) Pedalcycle 136 (36.11) Pedestrian 109 (29.00) Other Trans 26 (116.50) Pedestrian 977 (33.56) Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, Prehospital Database, FY 1999/00 9

16 Table 4a: Leading Causes of Unintentional Injury (Number and Rate per 100,000) by : Severe Injury Overall 1 Fall 130 (55.42) Fall 63 (28.19) Other Trans 51 (24.93) MVO 198 (102.56) MVO 254 (113.52) MVO 305 (69.12) MVO 229 (48.53) MVO 178 (49.61) MVO 102 (45.30) MVO 94 (53.60) Fall 133 (115.50) Fall 77 (173.21) MVO 1598 (54.89) 2 Pedestrian 41 (17.48) MVO 52 (23.27) Fall 49 (23.95) Fall 33 (17.09) Fall 43 (19.22) Fall 104 (23.57) Fall 141 (29.88) Fall 118 (32.89) Fall 79 (35.09) Fall 94 (53.60) MVO 76 (66.00) MVO 29 (65.24) Fall 1064 (36.55) 3 MVO 39 (16.63) Pedalcycle 46 (20.59) Pedalcycle 44 (21.51) Motorcycle 31 (16.06) Motorcycle 41 (18.32) Motorcycle 75 (17.00) Motorcycle 53 (11.23) Pedestrian 45 (12.54) Pedestrian 25 (11.10) Pedestrian 20 (11.40) Pedestrian 15 (13.03) Pedestrian 6 (13.50) Pedestrian 356 (12.23) 4 Pedalcycle 9 (3.84) Pedestrian 41 (18.35) MVO 40 (19.55) Other Trans 27 (13.99) Pedestrian 30 (13.41) Other Trans 62 (14.05) Pedestrian 52 (11.02) Motorcycle 36 (10.03) Motorcycle 21 (9.33) Other Trans 8 (4.56) Pedalcycle 4 (*) Other Trans 1 (*) Motorcycle 281 (9.65) 5 Other Trans 4 (*) Other Trans 15 (6.71) Pedestrian 22 (10.75) Pedalcycle 23 (11.91) Other Trans 30 (13.41) Pedestrian 39 (8.84) Other Trans 38 (8.05) Pedalcycle 30 (8.36) Other Trans 19 (8.44) Motorcycle 5 (2.85) Motorcycle 1 (*) Pedalcycle 1 (*) Other Trans 281 (9.65) Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, San Diego Trauma Registry, FY 1999/00 10

17 Table 4b: Leading Causes of Unintentional Injury (Number and Rate per 100,000) by Race/Ethnicity: Severe Injury White Black Hispanic Asian/Other Total 1 MVO 804 (46.24) MVO 82 (47.25) MVO 505 (69.91) MVO 174 (62.84) MVO 1598 (54.89) 2 Fall 686 (39.46) Pedestrian 47 (27.08) Fall 259 (35.85) Fall 62 (22.39) Fall 1064 (36.55) 3 Motorcycle 220 (12.65) Fall 45 (25.93) Pedestrian 123 (17.03) Pedestrian 31 (11.20) Pedestrian 356 (12.23) 4 Other Trans 208 (11.96) Pedalcycle 14 (8.07) Pedalcycle 60 (8.31) Pedalcycle 23 (8.31) Motorcycle 281 (9.65) 5 Pedestrian 150 (8.63) Motorcycle 13 (7.49) Other Trans 42 (5.81) Other Trans 18 (6.50) Other Trans 281 (9.65) Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, San Diego Trauma Registry, FY 1999/00 11

18 Table 4c: Leading Causes of Unintentional Injury (Number and Rate per 100,000) by Major Statisitical Area: Severe Injury 1 Central Fall 195 (30.98) North City Fall 125 (17.76) South Suburban MVO 67 (21.39) East Suburban MVO 120 (24.48) North County West MVO 83 (22.04) North County East East County Total MVO 159 (42.30) MVO 29 (129.94) MVO 1598 (54.89) 2 MVO 140 (22.24) MVO 120 (17.05) Fall 50 (15.96) Fall 59 (12.03) Fall 69 (18.32) Fall 106 (28.20) Motorcycle 19 (85.13) Fall 1064 (36.55) 3 Pedestrian 64 (10.17) Pedestrian 31 (4.40) Pedestrian 29 (9.26) Motorcycle 35 (7.14) Motorcycle 25 (6.64) Motorcycle 25 (6.65) Fall 9 (40.33) Pedestrian 356 (12.23) 4 Pedalcycle 35 (5.56) Other Trans 22 (3.13) Pedalcycle 15 (4.79) Pedestrian 33 (6.73) Pedestrian 24 (6.37) Pedestrian 20 (5.32) Other Trans 8 (35.85) Motorcycle 281 (9.65) 5 Motorcycle 14 (2.22) Pedalcycle 21 (2.98) Other Trans 9 (2.87) Pedalcycle 22 (4.49) Pedalcycle 18 (4.78) Pedalcycle 17 (4.52) Pedalcycle 1 (*) Other Trans 281 (9.65) Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, San Diego Trauma Registry, FY 1999/00 12

19 Table 5a: Leading Causes of Unintentional Injury (Number and Rate per 100,000) by : Deaths Overall 1 Pedestrian 4 (*) MVO 1 (*) Pedestrian 4 (*) MVO 36 (18.65) MVO 28 (12.51) MVO 21 (4.76) MVO 31 (6.57) Fall 20 (5.57) Fall 12 (5.33) Fall 25 (14.26) Fall 43 (37.34) Fall 43 (96.73) MVO 174 (5.98) 2 MVO 2 (*) Fall 1 (*) Other Trans 2 (*) Pedestrian 3 (*) Pedestrian 9 (4.02) Pedestrian 10 (2.27) Pedestrian 22 (4.66) MVO 15 (4.18) MVO 11 (4.8 9) MVO 12 (6.84) MVO 10 (8.68) MVO 6 (13.50) Fall 156 (5.36) 3 Other Trans 2 (*) Pedestrian 1 (*) Fall 1 (*) Motorcycle 2 (*) Motorcycle 9 (4.02) Fall 2 (*) Fall 8 (1.70) Pedestrian 9 (2.51) Pedestrian 7 (3.11) Pedestrian 5 (2.85) Pedestrian 5 (4.34) Pedestrian 3 (*) Pedestrian 85 (2.92) 4 Fall 1 (*) Pedalcycle 1 (*) --- Other Trans 1 (*) Other Trans 2 (*) Motorcycle 2 (*) Motorcycle 3 (*) Motorcycle 6 (1.67) Other Trans 2 (*) Other Trans 1 (*) Motorcycle 22 (0.76) Pedalcycle 1 (*) --- Other Trans 1 (*) Other Trans 3 (*) Pedalcycle 4 (*) Pedalcycle 1 (*) Pedalcycle 1 (*) Other Trans 17 (0.58) Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, Medical Examiner s Data, FY 1999/00 13

20 Table 5b: Leading Causes of Unintentional Injury (Number and Rate per 100,000) by Race/Ethnicity: Deaths White Black Hispanic Asian/Other Total 1 Fall 129 (7.42) MVO 8 (4.61) MVO 55 (7.61) Pedestrian 7 (2.53) MVO 174 (5.98) 2 MVO 101 (5.81) Pedestrian 5 (2.88) Pedestrian 31 (4.29) MVO 6 (2.17) Fall 156 (5.36) 3 Pedestrian 41 (2.36) Fall 2 (*) Fall 18 (2.49) Fall 5 (1.81) Pedestrian 85 (2.92) 4 Motorcycle 20 (1.15) Motorcycle 2 (*) Pedalcycle 3 (*) Other Trans 1 (*) Motorcycle 22 (0.76) 5 Other Trans 16 (0.92) --- Fire-Burn-Scald 1 (*) --- Other Trans 17 (0.58) Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, Medical Examiner s Data, FY 1999/00 14

21 Table 5c: Leading Causes of Unintentional Injury (Number and Rate per 100,000) by Major Statisitical Area: Deaths Central North City South Suburban East Suburban North County West North County East East County Total 1 Fall 24 (3.81) MVO 45 (6.39) Pedestrian 17 (5.43) MVO 30 (6.12) Fall 22 (5.84) MVO 29 (7.72) MVO 9 (40.33) MVO 174 (5.98) 2 MVO 23 (3.65) Fall 37 (5.26) Fall 13 (4.15) Fall 24 (4.90) MVO 12 (3.19) Fall 18 (4.79) Other Trans 3 (*) Fall 156 (5.36) 3 Pedestrian 16 (2.54) Pedestrian 13 (1.85) MVO 10 (3.19) Pedestrian 12 (2.45) Pedestrian 11 (2.92) Pedestrian 11 (2.93) Motorcycle 2 (*) Pedestrian 85 (2.92) 4 Motorcycle 2 (*) Other Trans 3 (*) Pedalcycle 3 (*) Motorcycle 6 (1.22) Motorcycle 5 (1.33) Motorcycle 4 (*) Fall 1 (*) Motorcycle 22 (0.76) 5 Other Trans 1 (*) Motorcycle 2 (*) --- Other Trans 2 (*) Other Trans 5 (1.33) Other Trans 2 (*) --- Other Trans 17 (0.58) Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, Medical Examiner s Data, FY 1999/00 15

22 TRANSPORT RELATED INJURIES 16

23 Table 6a: Area by for Paramedic/EMT Responses: Motor Vehicle Occupant Area Number Rate Number Rate Number Rate Number Rate Central MSA Central San Diego Peninsula 1 * 0-3 * Coronado 3 * 3 * 2 * National City Southeast San Diego Mid-City North City MSA Kearny Mesa Coastal University 4 * Del Mar-Mira Mesa North San Diego 2 * Poway 1 * Miramar 0-1 * 1 * 3 * Elliott-Navajo 4 * * South Suburban MSA Sweetwater 3 * 3 * 3 * Chula Vista South Bay East Suburban MSA Jamul 4 * Spring Valley Lemon Grove * La Mesa * El Cajon Santee 2 * Lakeside 4 * Harbison Crest 4 * 4 * 3 * Alpine Ramona 2 * N. County West MSA San Dieguito 3 * Carlsbad Oceanside Pendleton 1 * 1 * N. County East MSA Escondido San Marcos Vista Valley Center 4 * 1 * 4 * Pauma 2 * 0-3 * Fallbrook East County MSA 3 * 1 * 2 * Palomar-Julian * Laguna-Pine Valley * Mountain Empire 3 * 1 * Anza-Borrego Springs Out of County Unknown Total Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, Prehospital Database, FY 1999/00 17

24 Table 6a: Area by for Paramedic/EMT Responses: Motor Vehicle Occupant (Continued) Area Number Rate Number Rate Number Rate Number Rate Central MSA Central San Diego Peninsula Coronado National City Southeast San Diego Mid-City North City MSA Kearny Mesa Coastal University Del Mar-Mira Mesa North San Diego Poway Miramar * Elliott-Navajo South Suburban MSA Sweetwater Chula Vista South Bay East Suburban MSA Jamul Spring Valley Lemon Grove La Mesa El Cajon Santee Lakeside Harbison Crest Alpine Ramona N. County West MSA San Dieguito Carlsbad Oceanside Pendleton * N. County East MSA Escondido San Marcos Vista Valley Center Pauma * Fallbrook East County MSA Palomar-Julian * 4 * Laguna-Pine Valley 1 * 2 * 2 * Mountain Empire Anza-Borrego Springs Out of County Unknown Total Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, Prehospital Database, FY 1999/00 *Rates not calculat ed for fewer than five incidents 18

25 Table 6a: Area by for Paramedic/EMT Responses: Motor Vehicle Occupant (Continued) Area Number Rate Number Rate Number Rate Number Rate Central MSA Central San Diego Peninsula * Coronado * 4 * 0 - National City * 0 - Southeast San Diego * 1 * Mid-City North City MSA Kearny Mesa Coastal * University * 2 * Del Mar-Mira Mesa * North San Diego * Poway Miramar 4 * 2 * 2 * 0 - Elliott-Navajo * South Suburban MSA * Sweetwater * 2 * 0 - Chula Vista * South Bay East Suburban MSA Jamul * 1 * Spring Valley * 2 * Lemon Grove * * La Mesa El Cajon Santee * Lakeside * Harbison Crest * 1 * Alpine * 2 * 0 - Ramona * N. County West MSA San Dieguito * Carlsbad * Oceanside Pendleton 0-1 * 0-1 * N. County East MSA Escondido San Marcos Vista * Valley Center 4 * 3 * 2 * 0 - Pauma 2 * 0-1 * 0 - Fallbrook East County MSA * 2 * 4 * Palomar-Julian 1 * 0-2 * 1 * Laguna-Pine Valley 1 * Mountain Empire * 0-2 * Anza-Borrego Springs 3 * 1 * 0-1 * Out of County Unknown Total Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, Prehospital Database, FY 1999/00 19

26 Table 6a: Area by for Paramedic/EMT Responses: Motor Vehicle Occupant (Continued) Group Unknown Total Area Number Number Rate Central MSA Central San Diego Peninsula Coronado National City Southeast San Diego Mid-City North City MSA Kearny Mesa Coastal University Del Mar-Mira Mesa North San Diego Poway Miramar Elliott-Navajo South Suburban MSA Sweetwater Chula Vista South Bay East Suburban MSA Jamul Spring Valley Lemon Grove La Mesa El Cajon Santee Lakeside Harbison Crest Alpine Ramona N. County West MSA San Dieguito Carlsbad Oceanside Pendleton N. County East MSA Escondido San Marcos Vista Valley Center Pauma Fallbrook East County MSA Palomar-Julian Laguna-Pine Valley Mountain Empire Anza-Borrego Springs Out of County Unknown Total Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, Prehospital Database, FY 1999/00 20

27 Table 6b: Area by Race/Ethnicity for Paramedic/EMT Responses: Motor Vehicle Occupant Race/Ethnicity White Black Hispanic Area Number Rate Number Rate Number Rate Central MSA Central San Diego Peninsula Coronado National City Southeast San Diego Mid-City North City MSA Kearny Mesa Coastal University Del Mar-Mira Mesa North San Diego Poway Miramar * Elliott-Navajo South Suburban MSA Sweetwater * Chula Vista South Bay East Suburban MSA Jamul * Spring Valley Lemon Grove La Mesa El Cajon Santee * Lakeside * Harbison Crest Alpine * Ramona N. County West MSA San Dieguito Carlsbad Oceanside Pendleton N. County East MSA Escondido San Marcos Vista Valley Center * Pauma Fallbrook * East County MSA Palomar-Julian * Laguna-Pine Valley * 1 * Mountain Empire Anza-Borrego Springs * Out of County Unknown Total Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, Prehospital Database, FY 1999/00 21

28 Table 6b: Area by Race/Ethnicity for Paramedic/EMT Responses: Motor Vehicle Occupant (Continued) Race/Ethnicity Asian/Other Unknown Total Area Number Rate Number Number Rate Central MSA Central San Diego Peninsula Coronado National City Southeast San Diego Mid-City North City MSA Kearny Mesa Coastal University Del Mar-Mira Mesa North San Diego Poway Miramar Elliott-Navajo South Suburban MSA Sweetwater Chula Vista South Bay East Suburban MSA Jamul Spring Valley Lemon Grove La Mesa El Cajon Santee Lakeside Harbison Crest Alpine Ramona 2 * N. County West MSA San Dieguito Carlsbad Oceanside Pendleton N. County East MSA Escondido San Marcos Vista Valley Center Pauma Fallbrook East County MSA Palomar-Julian 4 * Laguna-Pine Valley 1 * Mountain Empire Anza-Borrego Springs Out of County Unknown Total Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, Prehospital Database, FY 1999/00 22

29 Table 7a: Area by for Severe Injury: Motor Vehicle Occupant Area Number Rate Number Rate Number Rate Number Rate Central MSA 0-4 * 2 * Central San Diego 0-1 * Peninsula Coronado National City 0-3 * 1 * 3 * Southeast San Diego * 2 * Mid-City North City MSA 2 * * Kearny Mesa 1 * 3 * 1 * 1 * Coastal University * Del Mar-Mira Mesa * North San Diego 1 * 1 * Poway 0-1 * 0-2 * Miramar Elliott-Navajo * 0 - South Suburban MSA 2 * 1 * 1 * Sweetwater * Chula Vista 2 * 1 * 1 * South Bay * East Suburban MSA 3 * Jamul 0-2 * 1 * 0 - Spring Valley 1 * 1 * 0-1 * Lemon Grove * 1 * La Mesa 1 * El Cajon 0-1 * 1 * 0 - Santee * 2 * Lakeside * Harbison Crest 1 * 2 * 0-2 * Alpine * Ramona 0-1 * 0-2 * N. County West MSA 0-1 * 1 * San Dieguito * Carlsbad 0-1 * Oceanside * Pendleton * N. County East MSA 4 * 2 * 3 * Escondido * San Marcos * Vista 2 * 2 * 1 * Valley Center 1 * 0-1 * 3 * Pauma * Fallbrook 1 * East County MSA 1 * 2 * 1 * Palomar-Julian * 1 * Laguna-Pine Valley Mountain Empire 1 * 2 * Anza-Borrego Springs * Out of County Unknown Total Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, San Diego Trauma Registry, FY 1999/00 23

30 Table 7a: Area by for Severe Injury: Motor Vehicle Occupant (Continued) Area Number Rate Number Rate Number Rate Number Rate Central MSA Central San Diego * Peninsula 1 * 0-1 * 1 * Coronado * 0 - National City * 3 * 0 - Southeast San Diego * 1 * Mid-City 2 * North City MSA Kearny Mesa * 4 * Coastal 4 * * 1 * University 2 * 2 * 1 * 1 * Del Mar-Mira Mesa 4 * 3 * 2 * 2 * North San Diego 0-1 * 1 * 0 - Poway 3 * 3 * 2 * 2 * Miramar * 0 - Elliott-Navajo 3 * 3 * South Suburban MSA Sweetwater 3 * 2 * 0-1 * Chula Vista 4 * * South Bay 4 * * 2 * East Suburban MSA Jamul 0-2 * 2 * 1 * Spring Valley 0-1 * 3 * 3 * Lemon Grove 0-2 * 0-1 * La Mesa 2 * 2 * 0-2 * El Cajon 2 * 2 * * Santee 1 * 0-2 * 1 * Lakeside 2 * 2 * 3 * 0 - Harbison Crest 0-3 * 2 * 1 * Alpine 0-3 * 0-1 * Ramona 3 * 3 * 4 * 4 * N. County West MSA San Dieguito 1 * 3 * 3 * 3 * Carlsbad 4 * 2 * Oceanside Pendleton 4 * 1 * N. County East MSA Escondido * San Marcos 2 * * Vista 3 * 4 * * Valley Center 3 * 4 * 1 * 3 * Pauma 2 * 2 * 3 * 0 - Fallbrook * 4 * 3 * East County MSA 3 * * Palomar-Julian 1 * 1 * Laguna-Pine Valley Mountain Empire 2 * 3 * 2 * 3 * Anza-Borrego Springs 0-1 * 1 * 2 * Out of County Unknown Total Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, San Diego Trauma Registry, FY 1999/00 24

31 Table 7a: Area by for Severe Injury: Motor Vehicle Occupant (Continued) Area Number Rate Number Rate Number Rate Number Rate Central MSA * Central San Diego * 3 * 1 * Peninsula * 0 - Coronado 0-1 * National City 3 * 1 * Southeast San Diego * 0 - Mid-City 4 * 3 * 3 * 2 * North City MSA * Kearny Mesa 3 * 2 * 1 * 0 - Coastal 1 * 1 * 3 * 0 - University 1 * Del Mar-Mira Mesa 1 * North San Diego 1 * 2 * 1 * 0 - Poway 1 * 2 * 2 * 0 - Miramar Elliott-Navajo 1 * 0-1 * 3 * South Suburban MSA * 0 - Sweetwater 0-1 * Chula Vista * 3 * 0 - South Bay 0-1 * East Suburban MSA * Jamul 0-1 * 1 * 0 - Spring Valley 0-1 * Lemon Grove 0-1 * 3 * 0 - La Mesa 1 * 1 * 1 * 0 - El Cajon 1 * 3 * 1 * 0 - Santee * 0 - Lakeside 0-4 * 1 * 1 * Harbison Crest Alpine Ramona 4 * * N. County West MSA 3 * 4 * 3 * 4 * San Dieguito 0-2 * Carlsbad 1 * 1 * 2 * 0 - Oceanside 2 * 1 * 1 * 3 * Pendleton * N. County East MSA Escondido 3 * * 1 * San Marcos 0-3 * 0-1 * Vista 1 * 2 * 2 * 0 - Valley Center 1 * Pauma Fallbrook 0-3 * 2 * 3 * East County MSA 2 * 2 * Palomar-Julian Laguna-Pine Valley 1 * 1 * Mountain Empire Anza-Borrego Springs 1 * 1 * Out of County Unknown Total Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, San Diego Trauma Registry, FY 1999/00 25

32 Table 7a: Area by for Severe Injury: Motor Vehicle Occupant (Continued) Unknown Total Area Number Number Rate Central MSA Central San Diego Peninsula Coronado 0 2 * National City Southeast San Diego Mid-City North City MSA Kearny Mesa Coastal University Del Mar-Mira Mesa North San Diego Poway Miramar 0 1 * Elliott-Navajo South Suburban MSA Sweetwater Chula Vista South Bay East Suburban MSA Jamul Spring Valley Lemon Grove La Mesa El Cajon Santee Lakeside Harbison Crest Alpine Ramona N. County West MSA San Dieguito Carlsbad Oceanside Pendleton N. County East MSA Escondido San Marcos Vista Valley Center Pauma Fallbrook East County MSA Palomar-Julian 0 4 * Laguna-Pine Valley 0 2 * Mountain Empire Anza-Borrego Springs Out of County Unknown Total Source: County of San Diego, Health and Human Services Agency, Division of Emergency Medical Services, San Diego Trauma Registry, FY 1999/00 26

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