J. O. Thomas, Chief Inspector, Q.P.M.* and G.W. Trinca, Dr., O.B.E., MBBS, F.R.A.C.S., National Chairman**

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1 THE FATE OF DRIVER CASUALITIES FOUND TO HAVE A RAISED BLOOD ALCOHOL CONCENTRATION J. O. Thomas, Chief Inspector, Q.P.M.* and G.W. Trinca, Dr., O.B.E., MBBS, F.R.A.C.S., National Chairman** * Victoria Police ** Road Trauma Committee, Royal Australasian College of Surgeons The high incidence of alcohol related road trauma is a major community problem in all States of Australia. The area of the State of Victoria is approximately equal to that of England and has a driving population of almost 2,000,000 in a total population of 4,000,000. In 1979, as a result of road accidents involving motor vehicles, some 843 persons were killed and more than 20,000 injured. Breath testing of drivers for alcohol has been part of the way of life since 1961 and until 1974 blood test evidence was permissible only when an offender gave consent for the taking of a blood sample. In the early 1970's, the Royal Australasian College of Surgeons through its Road Trauma Committee, campaigned for the compulsory taking of a blood sample for alcohol estimation from all road crash casualties attending hospitals for treatment. To support its campaign the Road Trauma Committee argued that the legislation would: 1. Make available blood sample results to be used to prosecute drinking drivers injured in road crashes. (The 137

2 hospital would no longer remain a haven of escape) 2. Free doctors who obtained blood alcohol estimations from the threat of litigation. 3. Improve management of casualties by having the early availability of blood alcohol estimations. Approaches were made to the Ministers of the Crown responsible in this area, individual members of Parliament and the Parliamentary Road Safety Committee. Support was sought from representatives of the legal profession, the Australian Medical Association and the Council of Civil Liberties. More importantly, there was wide media support for the campaign and a public opinion poll early in 1973 revealed a 2/3rd support for compulsory blood tests on road crash casualties. The result of this activity was the introduction in 1973 of legislation for the compulsory taking of a blood sample for alcohol estimation from all persons involved in a motor car accident, 15 years of age and over, who attended a hospital for treatment of injuries received in the accident. Aims of the Legislation 1. To identify and prosecute drivers with a raised blood alcohol concentration (3.A.C.) above the legal limit. 2. To provide information to hospitals to assist in the medical cars and assessment of road crash casualties. 3. To provide statistical information of the involvement of alcohol in injury producing road crashes, such data to be used as part of the surveillance of the effectiveness of existing measures for controlling the 138

3 drinking driver and to provide material for the development of new initiatives. Introduction of the Law and the Problems Essentially, the law required a blood sample taken from a casualty to be divided into 3 parts - one for the Police, one for the patient and one for screening purposes to ascertain whether alcohol was present or not. If the screening sample of a driver casualty was found to be positive, the police sample would be collected from the hospital and analysed at the Forensic Science Laboratory for court purposes. Initially great difficulty was encountered in making the law operational due to shared departmental responsibility (Law, Health, Police), poor communications and a lack of understanding of the problems of law enforcement by medical personnel involved in obtaining the blood samples. liajor problems in logistics and documentation made the law unworkable after its proclamatin in April, Details provided by doctors were incorrect and there was a large proportion of incorrect labelling of samples. The Law Department was unable to cope with the work load of screening samples resulting in long delays in the collection of positive samples for forensic analysis. There was a lack of care by Police in the handling of samples and forwarding to the Forensic Laboratory. As a result, by 1975 only alleged driver samples were being screened and all other samples were discarded. This wastage of samples brought a howl of protest from the opponents of the law. In addition, no reliable information was available to hospitals and medical personnel became disenchanted with the value of the law and its aims. 139

4 Undaunted, the members of the Victoria Police involved and the Road Trauma Committee battled to solve the problems with government and hospitals. A special government committee was set up to draft regulations to make the law workable and by mid-1976 steps were taken to reorganise the whole system. Regulations were simplified and the documentation required to be done by hospital doctors greatly reduced. The Forensic Laboratory became the single centre for analysis of both screening and police samples. Results were sent to the hospitals more promptly. With greater co-operation and efficiency improved results were reflected in an increase in prosecutions of drinking drivers even though the lav; restricted police to prosecute only those drivers whose blood samples were taken within 2 hours of the road accident. It is important to record that late in 1978 the Supreme Court ruled that evidence of readings of blood samples taken outside 2 hours was admissible as evidence and the weight to be placed upon the evidence was left to the presiding magistrate. Results Because of the difficulties already described the figures for 1974, 1975 and 1976 are incomplete but from 1977 when the system was streamlined and made more effective results became more reliable and a clear picture has emerged. 140

5 TABLE 1 DRIVER POSITIVE B.A.C. - CONVICTION RATE Year No. of Drivers Convicted Dismissed 1976 * ** 802 ** 42 * In there was no information as to how many of the alleged positive drivers were later found to be non-drivers. ** In 1979 some 536 have been approved for prosecution and cases are pending. TABLE 2 DRIVER POSITIVE B.A.C. - APPROVED FOR PROSE- CUTION Year Not Approved Convicted Unable to Trace f TABLE 3 DRIVER POSITIVE B.A.C. - REASONS FOR NON APPROVAL Year Total Defective Exceed 2 hour Labelling limit or other ['ABLE 4 DRIVER POSITIVE B.A.C. - LEVEL OF BLOOD ALCO- HOL CONCENTRATION Year 150 mqm% & over Less than 50 mgm' ~ KD CO These results show a great improvement in accurate labelling of samples by casualty doctors thereby permitting a greater number of drivers with a B.A.C. in excess of the legal limit to be proceeded against. The number of positive drivers outside the 2 hour limit and therefore in the notapproved category still permits a significant number to 141

6 escape prosecutions. Nevertheless, the conviction rate rose from 19.5% of Dositive drivers in 1977 to 39.6% in The figures for 1979 are incomplete but using the dismissal rate of the previous year for the approved pending figures of 536, 54.5% will be convicted for There is evidence that increased enforcement of drinking driving lav/s by the Police, media publicity and education programmes have produced a significant change in the type of driver being involved in alcohol related motor car casualty accidents. Positive drivers with a B.A.C. 150 mgm% and over made up 10% of the total in 1977, 20% in 1978 and 41.3% in At the same time, there was in increase in the number of positive drivers with a B.A.C. less than 50 mgm% (the legal limit) % % % CONCLUSIONS li'ith all the initial difficulties the legislation is now going a long way to achieving its aims. 1. Drinking drivers are being identified and convicted in increasing numbers (19% in to 54% in 1979). 2. Information provided promptly to the hospital is assisting in assessment and treatment of alcohol affected road crash casualties. The information in some hospitals is being used to assist at an early stage 142

7 of intervention in the counselling and rehabilitation of road crash casualties whose high level of blood alcohol indicates a major alcohol problem. 3. Reliable statistical data on drink driver casualties is available to the Government Road Safety & Traffic Authority and the Road Trauma Committee of the Royal Australasian College of Surgeons for the monitoring of the effect of the legislation. The community at large has accepted the legislation and there is little if any evidence of a road crash casualty risking aggravation of the injuries by not seeking medical treatment at hospital. The initial fears by hospital authorities and medical personnel of an unnecessary increased work load have not been realised and by and large the medical profession supports the legislation. Hot surprisingly, there has been the emergence of a number of "experts" in biochemistry ready to be exploited by a few lawyers for the purpose of defeating the legislation. The mood of the community and the attitude of the Courts will not permit such action to succeed too often. Police involved in this activity now fully appreciate the implication of the legislation and briefs are being prepared and submitted for authorization in some instances as soon as 4 weeks after the crash compared with a delay of 6-9 months in the past. The Compulsory Blood Sampling of road crash casualties is but one element in the legislative and educative methods used to combat the influence of alcohol in causing road crashes. This Victorian experience shows that this legislative measure has been accepted by the community, is workable and has played a significant part in reducing the road toll in this State. 143