we have not identified the environment as a cause of traffic fatality. we said, here is the system. we have designed it for moving cars faster which creates a risk for pedestrians, but what we have not identified is speed and that traffic flow is a cause of a hazard. it is either the pedestrian making a mistake or bad behavior, or the driver making a mistake or bad behavior. so culturally, we have not seen this as an environmental problem, as we should. so with all of these factors, it is very important we not look at one factor in isolation. is it just crosswalks, speed, flow, bad behavior? unfortunately, a lot of the ways research looks at this is one factor at a time. the federal highway has a best practice of analyzing collisions, looking a multiple factors using a regression model

to see what the independent effect of each factor was. that is the approach we have tried to take at the department of public health, so we can simultaneously look at the population factors, street design, and countermeasures. we have done preliminary research and that has helped us prioritize what the risk factors are in san francisco, and also help us evaluate differently the effect of different solutions. for example, this was work we did in 2007, published in 2009. we looked at several factors and said what explains the difference of collision rates -- frequencies in different neighborhoods? we looked at many different variables. we found their ranges of collision frequency is quite wide, from 20 per 100,000 in some neighborhoods, to 500 per 100,000 in others.

20% of the variation between census tract collisions can be explained by differences in traffic volume. 13% in differences of the employee population. 10% by never commercial zoning. 10% are cheerless streets. 9% by residential population differences. 7% by residential neighborhood commercial zoning. 7% by land area. 5% by poverty. 5% by age. so traffic volume and population factors are the dominant root causes. we are not proposing to reduce the population. i think the modifiable thing here is we can reduce flow, do things that reduce the flow of traffic where people are. for soma, the implications of this, they are obvious. this is the city's -- these are the major thoroughfares through

the city. soma is basically deliver the cars to and from the city from the freeway. i think to a lesser extent, many of the streets in the central downtown area are doing the same. these are the highest volume streets. it is no surprise we see the most collisions between pedestrians and cars on these streets. these are densely populated areas, areas where some of the most of all rural populations live. so this is not a surprise. i am going to switch from the causes of fatalities and serious injuries are different from the causes themselves. while the number of people and cars explain why a collision happened, the causes of why and injury is severe, why people die and are disabled it is much simpler. the causes of disability and severe injury or the mass of the vehicle, speed, and the physical

capacity of the individual to the door of the injury. there is nothing else. -- absorb the injury. we can see in concentrated downtown areas, a clear pattern of arterial streets where there is high volume and high speed traffic. serious injury will not happen at low speeds. speeds affect both collisions and and, as well, a fax how soon you can see a pedestrian, a patrol of the vehicle. a one filed by our change in speed can result in a 5 mile per hour change in the number of collisions. this has been shown through international research. in san francisco, and this is

important. 25 mile for our streets, 60% of people were speeding. culturally, many people would say that 26 miles per hour is not speeding. 56% of the people are going over the speed limit. every speed limit, a substantial portion are going over. that every speed limit, a substantial number are going 5 miles per hour above the limit. this is one of the causes of what people are dying in san francisco. i think this is a well-known fact, that the risk of pedestrian fatality is six times that at 30 miles per hour than at 20 miles per hour. many people do not think that 30 miles per hour is a dangerous speed, certainly not for the driver, but it is for a pedestrian. from a policy standpoint, it is

important to note there are statewide and countrywide legislative obstacles to reducing speed. we are told on certain streets speed must be set at the high end of the speed range. this is state law. there is no exemption for infill development or dense urban areas. this is something that might be considered. automated speed enforcement is a highly effective practice that is free, basically, to enforce the speed. this is a practice that is prohibited under california state law. we have known practices where within state law says we can do right now of. the current san francisco department of health focuses areas in pedestrian safety. i think this is where our strength is, coordinating and improving injury data collection and analysis. we want a full accounting of the injury. we are working on getting the data sources, hospitals,

ambulances, police records, and merging them together. we believe environmental factors should be assessed for every injury. we will be working with task force to figure out how to do that. we think the data should target investment, and we will be working with the task force to do that as well. we will the best practices and safety countermeasures' integrated in development plans. if we are tearing up the street or building and development, let's build it right in the first place. we want to continue to support safe routes to school and more funding. there is a lot of money going to transportation at every level. i think we have to think that what the balance our resources are going to be, directed within that i, too transportation safety. i'm going to turn over quickly,

and then i will come back to talk about some final obstacles. >> good morning, supervisors. i will tell you about some of the programs we are leading a health department. the first one is walker first. this is because of a grin that we got from the office of traffic safety. right now, the city does not have a systematic way of figuring out what are some of the key straits for walking and how to prioritize limited funding for capital improvements. so this is an interagency grant. dph is the lead but we are working with mta and the planning department, county transportation authority, and we have several objectives. we want to develop a city-wide map of where the ski zones are for pedestrians, establish a methodology for prioritizing

capital improvements for pedestrians, developing some case studies and getting a very preliminary capital project, which i will admit, when we wrote this, or ambitious and were a little naive and thought we could do all of this work in one year. mta just submitted two grant of occasions -- applications to do technical work and comprehensive coverage to pick up the project in the next coming here. so that is one of our efforts. the next one is safe routes to school. i believe you have probably heard about this. this is an international movement program to increase both safe and active walking and biking to and from school. 20 years ago we had almost half of our children walking and biking to school, now less than 15%. we are interested in making sure to bring those numbers back up

because there are a lot of public health benefits to walking and biking, not only by increasing traffic safety, but physical activity, air quality related to congestion, and this is a multi-partner effort. we have the police department, and mta, environment, the bike coalition, others very involved. we are currently working in 15 schools. they are only elementary schools at the unified school district. we made the application process open to every elementary school in the city. the district 6 school -- the only one that received an application was from marshall. we hope to work with them in the future. i will turn it over to meghan. >> hello, i have worked with the

department of public health as an epidemiologist. in addition to supporting the data that are shared earlier, i wanted to share some of the work we had done. as an appointed member of the western soma citizen task force, we have been participating since 2007 and providing health- based data and evidence in support of the planning efforts which included pedestrian safety recommendations for the plan. some of those recommendations to our traffic calming in the area, particularly, near residences, including crossings. we heard a lot of public need for that in earlier testimony. reductions in lanes. considering the new residences that are going in that area, thinking more thoughtfully about which streets are the designated truck routes. improving alleyways, a real

opportunity for safe pedestrian networks and just better pedestrian-oriented design in the market district. >> as she mentioned, on december 20, mayor gavin newsom issued an executive directive on pedestrian safety. this was a fairly bold action and establishes, i think we have the first and only city-wide goal for the mayor production of serious and fatal injuries in this state. i think it is surprising and telling them we never had one of these goals before. we have had goals for homicide reduction, other issues, but never a pedestrian injury reduction. he asked us to come together to

implement immediate short- term actions, as well as what is really needed, a long-term plan, one that is adequately resources, and addresses of the legislative and other cultural barriers. we are honored to be cochairing that task force with the mta. i do feel there is a lot of good energy and faith in that task force, and we will come together to come up with a serious plan. we will need everyone's help in moving that forward. i think, as you will also hear from the mta, there are many known, proven strategies. in europe, they have been successful in reducing injuries by 50% by doing this. there is no reason we cannot do it either. there are some serious cultural barriers to these improvements, not only in san francisco, but it is an opportunity for us to

lead in showing the way to what a sustainable city looks like. i want to highlight one best practice in dealing with these barriers. safety is viewed as an individual responsibility. in my view, walking is an essential, natural human activity. and walking should be safe, know where art -- no matter where you are. unfortunately, we have to keep people safe. if we read a newspaper and the blog accounts, comments in the newspaper, it was, who was stupider? that is that the attitude that is going to get as to the solution. there is an accounting for the ability of walkers and children in this paradigms'. we allow mistakes to have fatal consequences.

there is no other situation where a child not making -- making a simple mistake could die by not seeing the car. we have laws and policies like the 85% rule, a ban on automated speed enforcement that creates barriers to speed enforcement. these are things that we really need to get around. in europe, starting in sweden, they implemented a best practices and cultural change, division movement. this was a cultural change practice, not a particular engineer strategy. they said ultimately the system designers and owners, and i think what is hard here is -- we as a city are the system designers. ultimately, we bear the responsibility for the transportation. but the system should be designed to prevent levels of violence intolerable to the human body. in my view, i do not think the

goal should be preventing cars and bicycles and people from bumping into each other. we should make it so that when those bonds happen, that nobody loses a life or is disabled. system designers should account for the expected behaviors and abilities of road users. these are some principles that could shake the system and enable the changes and strategies that are already available to us. we are very happy to work with you on this. we will make the materials available to you and this presentation on the website. happy to share our e-mail with anybody as well. thank you for your time. [applause] supervisor mirkarimi: thank you. supervisor kim, who would you like to bring up next? supervisor kim: next we have the

ucf injury center. >> good afternoon, everybody. i am a research fellow at san francisco general hospital. i wanted to begin by thanking the committee, chair, and supervisor kim for allowing us to discuss our work. as supervisor kim highlighted some of the important dimension to this problem, part of the problem is cost. there is clearly a human dimension to this problem but

there is also cost and budget constraints that have to be dealt with. we feel we have a unique perspective to share on how we might find agreement on that matter. just to explain more of who we are, i work for the san francisco injury center, one of 13 nationally-funded cdc's centers. we are housed at san francisco general hospital. we have a diverse professional staff and a full focus on research, prevention, policy, and education. san francisco general hospital, if you will permit some informality, at a deer second home to me. we are also a trauma center. we get about 90% of injured patients in this city regardless of their ability to pay. we see about 100,000 people a

year. given that this is the only trauma center in this city, this is a unique opportunity to study pedestrian injuries. to echo the doctor and department of public health, the scope of the problem is very wide. during 2008, in san francisco, 92 injuries for every 100,000 people. we had had previous work done through collaborations with other groups. we mentioned to the injury center. 650 to 750 pedestrian injuries are seen at the san francisco general hospital every year. so i would like to go through the day of an injured pedestrian. not to put a price tag, but to

highlight the cost to mention to compound the human injury in this matter. they are involved in a collision with a vehicle. then in ambulance is sent to the scene. this carries a price tag of $1,200 for transport. the third thing in the series is the patient is taken 2 san francisco general hospital, if the accident occurs within the city. visits to the emergency room cost about $6,400. the patient is then treated or well enough to go home the same day or is further admitted for more care. if they are admitted, the average for that is about $72,000. so a great deal of this cost is incurred during a mission in the hospital. we used our hospital diagnostic codes to identify patients who came in with pedestrian injuries related to automobiles. particularly, for residents of

san francisco, excluding a small number of intentional injuries. this is just about 3600 cases in the years that we look at data. and there is a large cost difference between patients that were treated and released and those who were admitted. the overall population study was over 1000 patients who were treated. as has been highlighted, it is an injury pattern that we see in all walks of life. everyone from children to the elderly. unlike other patterns of traumatic injury, this is something we see in everybody. everybody walks in the city at some point. just to highlight the overall costs to the city in cases where the patient is admitted or not admitted. the general cost was over $75 million, $90 for every person using the 2008 population. half of this was charged to

metical and medicare. what was striking about this is even though admitted patients accounted for a total of the number injuries, they accounted for three-quarters of the cost. so we were interested in identifying where this cost was coming from. most of the costs came from the hospital length of stay, about 12 days. one-third of the patients admitted required icu-level care, and most of those people stay for about three days. only about half of them recover from their injuries to be sent home. a quarter of folks needed extra care or transfer to another hospital or rehabilitation or skilled nursing facility. 9% of the patients died. looking at the human scale of things, looking at the years of potential life lost, assuming the average life span of one of these folks injured is about 75, it is 1700 years loss.

the other thing about our admitted patients, using a couple of different models, i feelwe looked at ems reports. any report that did not list an actual location for the injury we use the statewide integrated trafficked record to find that. using these methods, we are going to identify three quarters of the 931 patients admitted to the hospital. then we use the san francisco geographic information to map out by supervisor oriole district. the number one offender in terms of cost for injuries is district 6, $13.7 million over the course of the study. this is almost sevenfold than the district responsible for the least amount of cost. so it is clearly a striking problem targeted for district 6.

looking at some analysis of test patients who were injured in district 6, in number of injuries per year ranged from 35 to 50 in the total five years of our study, a total of 220. the median age is about 51. that is middle of the range. that emphasizes it is a lot of years of productivity and families of four lost by fatality in particular and injury, loss of productivity. total interest cost for the five years of our study, $13.7 million. depending on what year you look at, three-quarters of these costs are charged to public funds such as medicare, metical, and help the san francisco. looking at the industry, 700 pedestrians injured in the city live somewhere in the city. there is a large commuter and

working population that is moving through district 6 that is at risk. so is not only the folks that live there. 36% of those folks injured live elsewhere in san francisco. the other thing is we were able to map locations for patients admitted to the hospital, but those who were injured, where a police report may not have been filed or the person was not injured enough to require hospital care at that time, we have no ability to map that patient. in district 6, the number of pedestrians injured his success -- exceptionally larger but we were not able to map that. in summary, but a string injuries in san francisco is a clear is problem in terms of both human and economic cost. district 6 having the highest cost of possessing industry -- injury is an ideal target for saving measures, particularly, as we have a constrained budget to find the places where we can

do the most good. i think what is highlighted by this study of not addressing these issues is economically overwhelming. our recommendations are in line of what the doctor mentioned with the department of public health. we would endorse full funding and time support for the pedestrian safety initiatives outlined in the mayor's directive. we are excited about the possibility for collaboration with the other groups working on this, enhanced coordination, and hopefully do of that matter with data sharing and surveillance so that we have good data to analyze. we hope that our unique perspective on the ability to assess cost from injury in san francisco is helpful to other folks working on this as well. thank you for your time very much. if anybody would like a copy of the presentation, i would be happy to e-mail it to them. [applause]

supervisor kim: thank you. next we have a presentation from the captain from sfpd traffic. we also have captain gary of the tenderloin station. sgt phil pot as well. >> thank you, supervisors for holding this hearing. i would like to echo the comments that the department of public health mentioned. if all the initiatives were implemented and the legal barriers at the state level were released -- removed, crime would also go down as a result of our work. from the police department's standpoint, we are fully committed to working with all the agencies, as a partner, and

as a support order to most of the agencies. we believe the department of public health is the lead agency. i cannot disagree with the data that was presented by theater of the presenters. we, at the police department, and view our traffic duties as being involved in engineering, education, and enforcement. our engineering function is when we take a police report, we are trying to look at the environmental factors. what we have started this year is the mta engineers are coming over and they are trading the accident investigators on what to look for, what to include in the report, so we can have better data. with their education functions, we are working and officers are assigned to all the groups, bicycle coalition, what san francisco, senior action network, and are participating

with them. our enforcement is going on. looking at the education portion, we are a community- based organization, senior action network, walk san francisco, and any other organization working on pedestrian safety. we are assigning officers so that we can have full communication with them at all times. our traffic safety partnerships with the department of public health, sfmta, engineering division, liveable streets division, and participated and drew up the grant applications. on the accident investigation, again, as i previously mentioned -- looking at the engineering, working with the engineers has been tremendous.