Rows of scaffolding are seen beneath the Golden Gate Bridge as crews work to install struts used as part of a planned suicide net sit underneath the east side of the Golden Gate Bridge in San Francisco, Calif. Wednesday, Dec. 11, 2019. Marin doctors analyzed more than two decades worth of data related to bridge jumps. Their findings showed a slight improvement in survival rates, potentially credited to a number of factors.

As engineers gradually expand a suicide net beneath the Golden Gate Bridge, trauma surgeons in Marin are wrapping up what they hope will be the last report on people who survive a brutal 220-foot fall from the structure.

Their research, which is undergoing peer review, offers a glimpse into the grim but intricate triage system used to pull people from the water and keep them alive. Few can withstand a crash at freeway speeds into the frigid waters of the bay, but doctors and emergency responders have managed to boost the odds of survival — from 2% historically to 3% since 2010.

Over the past 22 years, 26 people have exhibited signs of life after plummeting from the rail and breaking the water’s surface at 75 mph. Fourteen of those victims survived, according to the report, written by physicians at MarinHealth Medical Center, the hospital that now treats people rescued after a bridge suicide attempt.

Its authors pointed to significant improvements since 2010, a year after the American College of Surgeons verified the Marin hospital as a trauma center. That designation required extensive site visits to ensure the facility had adequate staffing, services, equipment, expertise and case loads.

Eight of the hospital’s nine most recent patients overcame their injuries. Though no one knows exactly why more people are surviving and recovering, surgeons credit a faster and more sophisticated emergency response paired with comprehensive medical care.

“Maybe it’s the standardization of the rescue effort, the protocols, the way it’s all done,” said John Maa, the report’s lead author and the immediate past chief of general and acute care surgery at MarinHealth Medical Center. He described a multipronged intervention that begins with traffic enforcement patrols dropping flares in the water to show where a victim fell. Members of the U.S. Coast Guard then follow the current and attempt to pull the person out.

Ambulances transport survivors to the hospital in Greenbrae, where they receive trauma surgery and other care from an array of specialists.

“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,” the report states.

Still, even the most senior doctors say they are perplexed and devastated by the jumping that continues, at a rate of two or three a month. Since it opened in 1937, the Golden Gate has magnetized people with its rich orange hues and elegant suspension cables, but also lured distraught and despondent souls. Roughly 1,800 people have died by leaping from the side, according to data from the nonprofit Bridge Rail Foundation, which monitors progress on the net.

“It’s a monumental issue,” Jonathan Levin, a longtime doctor at MarinHealth Medical Center, said of the trend. He’s watched odds-defying rescues and heartbreaking retrievals from the bay since the mid-1980s, and helped care for several jumpers who lived to tell their stories.

National Suicide Prevention Lifeline: Call 800-273-8255 to reach a counselor at a locally operated crisis center 24 hours a day for free.

Crisis Text Line: Text "Connect" to 741741 to reach a crisis counselor anytime, for free.

They include Kevin Hines, who jumped from the Golden Gate in 2000, when he was 19 years old. Hines told The Chronicle he vividly remembers landing in the water where a creature circled beneath, keeping him afloat. Bystanders later said it was a sea lion.

“The Coast Guard, they were flabbergasted to see me alive,” Hines said, recalling each bit of luck he had that day, from the compassionate sea mammal, to a passing motorist who saw him vault over the rail and called her friend in the Coast Guard, to the doctors who “invented a new form of surgery” to rehabilitate his body after Hines shattered three vertebrae and missed severing his spinal cord by 2 millimeters.

To this day, Hines, who is now a prominent speaker on suicide prevention, said he suffers excruciating back pain, though his psychological wounds are much deeper.

“I have night terrors” about the jump, he said. “But I did what I did. I’m lucky to be alive. I’m glad that I exist.”

Among the main challenges for those who research bridge suicides is the paucity of survivors. Edward Alfrey, director of trauma at the MarinHealth Medical Center and chair of the Department of Surgery, acknowledged that although his department’s analysis traces 22 years of data, the sample size was small.

“There’s so few survivors that it was hard to put together the numbers,” Alfrey said.

Nonetheless, they drew some conclusions, including that patients who lived were about nine years younger than those who died, at 24 versus 33. Those who survived also had significantly milder injuries.

The report’s most detailed observations came from those who died from their falls. Doctors cited cardiovascular injuries as the leading cause of death, associated with 87.5% of fatalities, while 66.7% of the deceased patients had suffered intracranial injuries, and about half had bruised lungs.

“It’s like hitting cement,” Levin said, referring to the moment a body slams the rumpled surface of the water. “You can only imagine what happens to you.”

Maa and Alfrey applauded the ongoing construction of the suicide barrier, confident that once its steel web flanks all 1.7 miles of the span on both sides, the jumping will end. For years, the project was hobbled by political and aesthetic debates, engineering quandaries and construction delays.

Now, officials at the Golden Gate Bridge, Highway and Transportation District, the governing body that oversees the bridge, ferries, and transit linking San Francisco to Marin County, anticipate finishing the long-delayed net next year.

With that timeline, the surgeons at MarinHealth Medical Center view their report as a closing chapter on the somber legacy of the Golden Gate.

“This has been going on for so many years, this dialogue about whether we should have a barrier, whether the barrier ruins the view,” Alfrey said. “To me, it’s the sooner the better. (The net) is so critically important. We’re hoping nobody ever has to write about this again.”

Rachel Swan is a San Francisco Chronicle staff writer. Email: rswan@sfchronicle.com Twitter: @rachelswan

Rachel Swan is a breaking news and enterprise reporter. She joined the Chronicle in 2015 after stints at several alt weekly newspapers. Born in Berkeley, she graduated from Cal with a degree in rhetoric and is now raising two daughters in El Cerrito.