22-YEAR HISTORY OF TREATING GOLDEN GATE BRIDGE FALL VICTIMS AT MARIN HEALTH MEDICAL CENTER John Maa, MD and Edward Alfrey, MD Over the 85-year history of the Golden Gate Bridge (GGB) since it opened on May 28, 1937, an estimated 1,800 victims have taken their lives through an intentional fall from the bridge walkway into the San Francisco Bay1. The bridge is 1.7 miles long and 90 feet wide, over which 40 million motor vehicles drive annually2. The GGB is reportedly the most photographed structure in the world, and also one of the most common destinations for suicides in the world. A fall from the GGB is one of the most effective ways to commit suicide, as the average rate of speed upon entering the water is 75 mph. The mortality from the 220foot fall has been estimated over the years from longitudinal studies around 98%3. For many years, victims recovered by the Coast Guard were transported to Letterman Hospital in the Presidio, until Letterman’s closure in 19914. After 1991, patients were transported to San Francisco General Hospital if recovered on the San Francisco side of the Bay, or to Marin General Hospital (MGH) if they were retrieved on the Marin County side of the Bay. More recently, a change in emergency medical services triage policy resulted in all patients being transported to MGH, as the sole receiving facility. MGH was renamed Marin Health Medical Center (MHMC) in 2019. MHMC is an American College of Surgeons (ACS) Level III verified trauma center with 24/7 neurosurgical coverage located in Greenbrae in Marin County. A trauma activation results in the in-hospital response by emergency medicine, trauma surgery, with the availability of surgical specialists, critical care, interventional radiology, blood banking, nursing services and support services. The institution has become adept at the resuscitation and care of this patient population, as the primary receiving facility for most of the past decade. Over the past 22 years, MHMC cared for 26 patients who still had signs of life after being recovered by the Coast Guard following a fall from the GGB. Of these, 14 survived, and 12 expired. There were seven consecutive deaths from 2002 to 2010, whereas 8 of the 9 most recently treated patients between 2017 and 2022 survived. Our survivors averaged 24
SAN FRANCISCO MARIN MEDICINE APRIL/MAY/JUNE 2022
nine years younger than those who died (24 versus 33). Ten of the fourteen survivors were aged 25 or younger. The injury severity score was significantly lower over the past decade (43.9 vs 22.8). For the entire 22-year period, the leading injuries were: hemo/pneumothorax 70.8%, spine fractures 62.5%, lung contusions 50%, and rib fracture 50%. Major cardiovascular injuries were associated with an 87.5% mortality, and intracranial injury with a 66.7% mortality. About half of the patients with a hemothorax, pneumothorax, or pulmonary contusion died. A spine injury was associated with death in 26.6% of cases. Five patients required transport to a higher level (ACS Level I) of care for treatment of either unstable pelvic fractures or advanced orthopedic injuries. Survivors were more likely to have injuries confined to the ribs, vertebral spine, and pelvis, which are associated with a higher survival. Massive intra-abdominal or intra-thoracic hemorrhage, cardiac injury or disruption of the great vessels, tension pneumothorax, flail chest and intracranial injury are less likely to be survivable. Associated injuries such as long bone injuries, friction burns, multiple contusions, and less complex orthopedic trauma were frequently noted, and more likely to be associated with survival. In the literature, three previous studies have focused on the traumatic injuries sustained after a fall from the GGB, through either autopsy series and/ or chart review. The largest published series of survivors (n=16) was from Letterman Hospital in 19954. As the hospital closest to the Golden Gate Bridge, Letterman cared for many of the GGB patients before its closure in 1991. In their comparison of survivors (n=16) to fatalities (n=281), they observed that major cardiovascular and intracranial injuries were uniformly lethal. The previous studies noted key patterns of death – some patients sustain minimal injuries from the fall, but then drown, or are attacked by sharks or other marine wildlife. Those who survive the initial fall and then brought to the hospital are noted to have a high rate of mortality, including delayed death after a period of initial relative stability after being admitted (most often from pulmonary contusion). A third category of patients WWW.SFMMS.ORG
