Statement of Purpose California coastal cliffs are known for scenic views, natural beauty inviting the public to explore, but are also known for environmental risks. An increase of falls from cliffs with severe outcomes, combined with risky behaviors, was identified. A review describing cliff-related falls from two geographically different coastal regions was done.

Methods/Approach All trauma admissions 2010–2018 from two trauma centers (TC) was reviewed for unintentional falls at coastal cliffs. Study sites have coastline catchments with distinct differences. North TC (NTC): higher cliffs with trails towering over the beach; South TC (STC): lower shoreline cliffs. All injury event data available were reviewed from both sites, including prehospital and media. Medical record and registry data collected include demographics, diagnoses, procedures, outcomes.

Results 159 trauma patients treated at sites were identified. Males comprised 67%, mean age 31.5 years. 48% occurred between 2014–2016. NTC had more events (54% vs 41%), younger patients (29 vs 34 years) and more complex injuries. Mean length of stay was similar (8 vs 7 days) but differences in gender, age and injuries were evident between sites. Activities prior to injury included hiking, hang gliding and intentional jumping into ocean. 47% with positive alcohol. Fall distance ranged 10–300 feet. 75% discharged home, 4 hospital deaths, 10 at scene.

Conclusions Coastline cliffs continue to change with erosion and development. Communities continue to fight to preserve natural beauty while ensuring public safety. Incidence increase corresponded with documented surge of social media for gathering and intentional cliff jumping but has since subsided slightly. Visitors, unfamiliar with the environment were common, as well as alcohol use combined with poor judgment; potentially fatal combinations.

Significance and Contributions to Injury and Violence Prevention Science There exists common behaviors, severity and outcomes demonstrating opportunities to develop education and prevention interventions, and still enjoy that sunset.