T he health benefits of walking as a method of transportation include combatting the obesity epidemic by increasing physical activity [1] and reducing motorized transportation's contribution to air pollution [2]. In addition, walking provides an essential form of transportation for the estimated 9% of US households without access to a personal vehicle [3]. However, in the setting of non-pedestrian-centered transportation infrastructure, common in the United States, pedestrians are vulnerable road users who are more susceptible to injury and death in motor vehicle crashes. In 2018, 6283 pedestrians were killed in traffic crashes in the United States, the highest number since 1990 [4]. In 2018, there were 225 pedestrian fatalities in North Carolina, representing a 31% increase since 2014 [5]. MethodsThis study was approved by the University of North Carolina at Chapel Hill Institutional Review Board. Data Sources and Study PopulationIn order to understand the circumstances, patient characteristics, and health outcomes of pedestrians injured in police-reported motor vehicle crashes in North Carolina, we linked motor vehicle crash and North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) NC DETECT emergency department (ED) visit data.The University of North Carolina Highway Safety Research Center (UNC HSRC) provided records for all pedestrians involved in North Carolina police-reported traffic crashes for the year 2017. UNC HSRC maintains a copy of the crash report data from the North Carolina Division of Motor Vehicles' (excluding the names of the individuals involved). The UNC HSRC crash data file only contains information for traffic crashes reported to police and that involve fatalities, injuries, total property damage greater than or equal to $1,000, or result in a vehicle being seized [6]. UNC HSRC identified pedestrian crash records as records with a Unit Type listed as a "Pedestrian," a Person Type listed as "3-Pedestrian," or a Vehicle Type listed as "24-Pedestrian."The North Carolina Division of Public Health (NCDPH) provided ED visit records for all patients treated for injuries in 2017. These records are collected by NC DETECT, North Carolina's legislatively mandated statewide syndromic surveillance system [7]. NC DETECT includes ED visit records from all 24/7 acute-care hospital-affiliated civilian emergency departments in North Carolina. Patient ED visit records were identified as injury-related if the ICD-10-CM code started with an "S," "T," "V," "W," "X," or "Y." MeasuresFrom the UNC HSRC crash data, we examined race/ Hispanic ethnicity (crash data do not disaggregate the 2 characteristics), North Carolina county of crash, hour of

occurrence to hospital arrival, impact the accident fatality rates. Aim/Purpose To assess the relationship between fatal road accidents per county and accident response time. Methods/Approach Data were pooled across eight years (2010 -2017) from the Fatality Analysis Reporting System dataset. A total of 3,193 counties and county-equivalents were included in the study. The outcome variable was the fatality rate per county, defined as the yearly fatal counts per yearly county population. The predictor variables were the average duration of accident-to-notification, accident-to-EMS, accident-to-hospital, notification-to-EMS, notification-to-hospital, and EMS-tohospital arrival times. The covariates were rurality, county-level racial, gender, age, unemployment, gross domestic product, and hospital utilization proportions. Measures of association were determined with Mann-Whitney U and Kruskal-Wallis tests. A negative binomial time series regression model was used to estimate the relative risks with significance set at a 95% confidence interval.Results The median fatality rate per county was 6.90 per 100,000. There was a statistically significant difference in the median accident response times across the eight years (p<0.05). The average accident response times were significantly higher in rural counties compared to non-rural counties. In the unadjusted model, fatality rate increases by 1.9% (RR: