If the ambulance and emergency staff who attend the scene of a motor vehicle accident threw away obvious items of evidence, such as a gun, or a bottle of alcohol, they would surely be roundly condemned.

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But there do seem recently to have been highly bothersome cases involving celebrities, where there was a failure to draw blood from which blood alcohol levels could be measured, before setting up a drip. And the effects may have been similar to the destruction of evidence, even if not at all deliberate.

After an intravenous drip has been set up, there can be problems being certain that subsequent early blood alcohol levels would be accurate, so there is apparently no attempt to do so.

The first case this year involved the actress Ashley Callie, who later died, after an accident in which it was established that, having left a party, she was driving on the wrong side of the road, and those in the car she hit were significantly injured. After the sad death of this pretty woman, the public reacted in a way that exaggerated her national importance and ignored the value of the other victims. Later police statements suggested that she was probably responsible for the accident, but many people seemed eager to blame the other victims of the crash.

No blood test for Mandoza?
More recently, the pop star Mandoza was in an accident after he had attended a party, in which he drive into the back of another car, which overturned, killing both the people in it. In this case, though a culpable homicide case was reported to have been opened, there has been more clear criticism of procedures, and the suggestion from some that perhaps some celebrities were being aided by EMTs by the rapid insertion of a drip in order to prevent blood alcohol testing.

In both cases, no blood alcohol tests were conducted on anyone involved, because the ambulance personnel/paramedics had already set up a drip. Police spokesmen in both cases defended this failure to obtain vitally relevant evidence. One is quoted as saying: "The first priority was to save lives. When patients have been put on to a drip, it's too late to test for alcohol"; and another said "It was not possible to take blood later for testing - once drips were put in the patients, this distorted the results."

Just not good enough
In the Callie case, it is understandable, given the extent of her injuries, that a drip was set up urgently. In the Mandoza case, things are a lot less clear-cut, as he is described as being able to walk around comfortably after the crash, and was apparently treated only for bruises and scrapes - not a situation in which one would normally consider it necessary to set up a drip at all. This had nothing to do with saving his life.

Even if in these particular cases there may have been no consideration at all of evading legal consequences, there are distinct possibilities that this defeatist rule, which the police seem to have adopted without proper debate or adequate expert input and advice, is ripe for such abuse. We have read elsewhere of people being advised, after a drunk-driving accident to hurriedly have a drink "to steady their nerves", so that the impact of this witnessed post-accident drink could mask pre-existing drunkenness.

A proposed solution
Firstly, there should be an immediate agreement that in every case of a traffic accident where there is any possibility of drugs or alcohol being involved, ambulance crew/EMTs/paramedics should be instructed to take a blood sample from the driver(s) before or as they are putting up a drip, thus preserving vital evidence which would be not only of medico-legal importance, but could provide other evidence later valuable for the proper management of the injured person.

The law should be clear, as it is in the United Kingdom, that blood may be drawn without permission from anyone involved in such an accident, even though they are unable to give consent at the time. If they are capable of consent, but refuse to allow it, at the very least this should be recorded and the court allowed and encouraged to draw the obvious conclusion from this refusal. Or perhaps we should consider allowing the collection and use of such samples even without consent, if the law is to become serious about the rights of victims rather than, as at present, giving precedence to the results of those who have victimised them.

Secondly, there surely needs to be some research on the actual effects on blood alcohol and drug level measurements of the presence of an IV drip. There has been a recent forensic paper suggesting that samples taken carefully even where a drip has been inserted, ought to be considered in court and evaluated as evidence. Especially as in many situations, only a small amount of fluid is being run through the drip, merely to keep the line open, and the blood levels may not be significantly altered. And of course, if even after a drip is running, if the blood alcohol levels are still significantly high, it can be understood that it will probably have been even higher before the drip was in place.

And finally, let's be sure that the reasons for setting up a drip for any victim of a car accident are agreed and implemented widely. There are some concerns that paramedics may be eager to set up a drip simply because more can be charged by their employers when this is done. There needs to be parsimony and caution - yes, if the person is clearly in shock, or seriously losing blood, and needs fluid urgently. Yes, too, if one wants to set up a drip early in someone where there's good reason to expect that they may go into shock (after which it may be much harder to set up a drip), and then run in only a small amount of fluid simply to keep the drip open).

But not in someone with only minor injuries, and not, except where there are clear grounds for medical urgency, before the police arrive and a proper blood sample is taken.

( Sources: Blood from a line – Is it admissible? Journal of Forensic and Legal Medicine, Volume 14, Issue 1, January 2007, Pages 46-48 )

(Professor M. A. Simpson, aka CyberShrink March 2008)
 

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