EMTs are now authorized to obtain blood samples on DWI stops

[VentMedic]

It wouldn't take much for (CLIA) Clinical Laboratory Improvement Amendments to get involved in this. CLIA is one of the reasons why lab specimens are not being drawn in the field by Paramedics in many areas now. The training for handling the specimens was not adequate. Many specimens brought in from the field were hemolyzed, improperly labeled and not handled correctly. There is sometimes also the attitude: "well I got blood anyway...give us credit for that". Those that draw 30 specimens a shift will have some idea immediately if the sample is going to be good. CLIA could also have a problem with the word "sanitary" being stricken from the document.

A good lawyer could use the argument that due care was not exercised by the Paramedics when starting that line to get the fluids running. They may not have waited for the prep from the LEOs kit. Thus, the specimen gets thrown out of court.

Yes, there are LEOs that certify to draw blood and many of them actually get more practice in doing it correctly than Paramedics since documentation of their clinical sticks can be proudly presented in court as can their regular recertification. Their training programs for blood draws do meet CLIA standards. There are areas where some Paramedics may not do that many sticks especially where everybody is a Paramedic or the call volume doesn't warrant it.

[reaper]

AK,

I agree that there should not be a law mandating that we collect samples. Everyone that we did in FL, we chose to do. If it was a major trauma, we told them no. They would then get it at the ED. We did them more out of a courtesy to the LEO.

Like I stated, we only drew if we had the time and an IV was being started anyway. I never started an IV, just to draw blood.

Ter,

I am with AK there. LEO transported the samples. I have no clue how they did or what lab they went to. I was told by a lab tech that BAL could be tested on blood that was up to a week old. I do not know it that is true or not. Just what he said when I asked him about it.

[firepatrol]

Being someone who will be directly effected by this proposed bill I have several questions that the language in the bill do not clarify.

First, are we going to transport since they are in our care at the time of the draw, and should they have a medical emergency at the hands of law enforcement we are negligent since we did not perform a complete assessment and to avoid any liability we should transport.

Secondly, who is going to pay for this? Are we going to bill the subject, or the agency who requested the procedure? Money is a huge component of any conversation these days and if they start pulling units out of service to perform these draws are the law enforcement agencies going to disperse portions of their budgets to EMS or Fire/EMS to hire additional personnel, and purchase additional equipment to already challenged areas that are already seeing problems in providing service due to increases in population and no increase in funding over the years.

Thirdly, this bill seems written poorly with little research and planning. The bill leaves out the Licensed Paramedic as someone who is required to perform these draws, and as minute and ridiculous as this third point is, it does raise the question on how much research was done prior to this bill being submitted. I understand the social dilemma that DUI has become these days, but without effective punishment it is going to continue.

I have responded and treated several persons who appeared to be DUI with a suspended license and multiple convictions. How is the thought of EMS performing these draws going to change the situation. If the representative wants to clearly impact the situation they should look at a corrections system that is overcrowded and overburdened, and a judical system that is collapsing under the weight of frivolous cases and proceedings that are taking years to see the light of a court room.

I feel the spot light should be changed and start with prevention first and secondly look at repairing the judical and correction systems before mandating an additional liability and burden upon EMS.

[VentMedic]

The bill leaves out the Licensed Paramedic as someone who is required to perform these draws, and as minute and ridiculous as this third point is, it does raise the question on how much research was done prior to this bill being submitted.

Again:

Per the link I posted earlier from HB 509:

(5) a licensed or certified emergency medical

technician-intermediate or emergency medical

technician-paramedic.

Drawing blood for DWI suspects will not be the responsibility of just those in EMS.

EMS providers are just a few of the medical professionals that can draw blood as specified by the bill. This might even include Paramedics working in an ED or outpatient clinic that LEOs use. The bill only outlines who can and where for the blood to be drawn. A more detailed P&P is available as to how.

EMS will not be burdened by all the calls for drunk drivers. It is highly unlikely that PD will be calling for an ambulance just to draw blood since their agency or the DA may be responsible for the payment. This may be only if you are called to the scene for the MVC and there are not other patients with injuries that need your care more. This may also prevent the suspected DWI person from being taken to a crowded ED and taking time away from other patients. Some in EMS have always wanted more responsibility to expand. Here it is as a little service to the community and PD. Do it well.

[Richard B the EMT]

(Once again,) I have vague memories of a mobile blood alcohol testing lab, manned by LEOs cross-trained as at least EMT-I level personnel, can do both the blood draw, and the actual Blood Alcohol Level from that draw.

The vehicle manufacturer/body conversion agency actually called it the BATmobile, for Blood Alcohol Testing Mobile. Talk about a sales gimmick!

[VentMedic]

(Once again,) I have vague memories of a mobile blood alcohol testing lab, manned by LEOs cross-trained as at least EMT-I level personnel, can do both the blood draw, and the actual Blood Alcohol Level from that draw.

The vehicle manufacturer/body conversion agency actually called it the BATmobile, for Blood Alcohol Testing Mobile. Talk about a sales gimmick!

BATmobiles are great since they also are heavily involved in community education.

Examples:

http://www.nhtsa.dot.gov/people/outreach/s...TSD%20final.pdf

http://www.albany.ga.us/apd2/apd_batmobile_facts.htm

http://www.krdotv.com/Global/story.asp?S=8023367

Here's another article from Texas.

http://www.dui.com/dui-library/texas/news/...xas-dwi-arrests

Blood Tests Increasing During Texas DWI Arrests

Posted Tuesday, January 06, 2009

Search warrants to take a blood sample used in fight against drunk driving in Texas.

Law enforcement agencies are increasingly using a controversial tactic in their fight against drunk driving. Arresting officers are relying on search warrants to demand blood samples from motorists suspected of driving while intoxicated in Texas.

The effort is in reaction to motorists who refuse to submit to a breath test to check blood alcohol content. Such refusal is permissible under state law, though it hinders prosecution of Texas DWI cases because of a lack of evidence. The Texas DWI law states that a blood draw is appropriate for testing motorists who have a prior DWI conviction who have caused an accident with injury. However, both county sheriff’s departments and municipal police departments have implemented ‘no refusal’ programs in their crackdown on drunk driving in Texas. Judges are available for the issuance of search warrants that forces motorists to comply with the request for a blood sample.

Central Texas Police Chief Art Acevedo has used such a tactic to check for driving while intoxicated in Austin. In 2005, the Fort Worth suburb of Dalworthington Gardens was the first to train officers in blood draw procedures. Harris County has used evidentiary warrants about 300 times during the past 16 months.

The American Civil Liberties Union has questioned the programs from a number of perspectives. Besides being an expansion of what the law outlines, the group has found that warrants are often rubber stamped without probable cause and they are a violation of privacy as protected by the constitution. The actual person and facility in which a blood draw can be taken is also clearly outlined by Texas law because it is considered evidence in a criminal case. In apparent contrast to the law, in some cases police officers are being trained to perform blood draws in jail facilities rather than using a phlebotomists or trained nurses in hospitals.

Police say that the blood draw policy is part of an on-going campaign against Texas DWI, and that it is gaining acceptance from law enforcement agencies and prosecutors across the state.

[Richard B the EMT]

Wow! I was just recalling an ad in JEMS or EMS magazines, from something like 20 years ago, for the vehicles, with an accompanying article,and then you find 3 postings from newspapers within the last calendar year?

Good work!

[n0ssb]

We have been allowed to do that for years here in Colorado- that why teach that as part of the iv course

Have Fun Boys and Girls Be a Happy Vampire

[joansghost]

Input from a former Texas District Atty and NREMT-P and taken from another public site:

"I have debated whether or not to weigh in on this discussion since I'm now a

permanent resident of Arizona, not Texas. However, it might be useful for

you in Texas to know Arizona's experience with field blood draws for DUI (here

it's called Driving Under the Influence rather than Driving While Intoxicated

(DWI).

Legally, anybody can draw blood in Arizona. However, typically, EMS

services and EMS certificants have not been involved in DUI blood draws. Usually,

suspects are transported to a hospital for the blood to be drawn. However,

for a number of years certain counties have trained police officers to draw

blood for DUI investigations.

Although they have a big van that's outfitted as a phlebotomy lab, and they

use it during their "DUI sweeps where they block the road and stop every car,"

most blood draws are done in the back seat of a squad car or with the arrestee

leaning against the car.

Which has led the DUI attorneys to develop special tactics and weapons to use

against blood draws. Among them: Attacking the sanitation of the blood

draw site. Wouldn't it be great to have a bunch of lawyer's investigators

going over our ambulances pursuant to subpoena, doing swabs and looking for

microbes? That is sure to happen if we get involved. The blood drawers will be

subjected to cross examination on every aspect of their actions, in court.

The cops go through a 5 day course in phlebotomy and a minimum of 100 blood

draws here. Can you imagine the questions that might be asked of an EMT-I

about training, number of draws, and so forth? Can you imagine the subpoenas

for training records, patient records, and such? Imagine it.

Unless the defendant agrees to the blood evidence being admitted in evidence

(fat chance of that ever happening) the person who drew will have to be called

to testify. She/he will be asked every question the lawyer can think of

about the training, experience, procedures, and so forth. Every step in the

procedure will be gone over in an attempt to prove contamination. The chain of

custody will be attacked.

When one is called to testify in a criminal case, generally speaking the

subpoena requires the witness to be present at the start of the trial. Some

experts who are VERY important get the courtesy of being called an hour prior to

the time they will testify, but for other witnesses, that just doesn't happen.

You can expect to be sitting in the hall all day for one or two days for

each case. Who will pay for that? Not the state. Witness fees are generally

$10 or $15 dollars. If the state calls you, you don't get anything. Who

pays for your time? What if it's overtime? What if your appearance causes

another employee on overtime to have to cover your shift?

Suffice it to say that if EMS folks in Texas are required to draw the blood,

the defense attorneys will apply the same arguments and techniques to them as

they have to police officers who draw blood.

Next, what happens when you get sued? There is currently a case in the

courts in Tucson filed by a man who claims that he got an MRSA infection in his

arm as the result of a sheriff's deputy drawing his blood in the field. He

claims disability, medical expenses, and asks for lost wages, medical expenses,

future medical expenses, future wages, and $500,000.00 in punitive damages.

What if it takes multiple sticks for the EMT to get the blood? What if

she/he sticks himself and gets hepatitis or HIV because the defendant becomes

uncooperative? What happens if the stick goes badly and there's an arterial

stick, et cetera? This is an invitation to lawsuits.

Who will pay for the defense of such cases? I do not believe that

malpractice policies as currently written will cover these cases, since they do not

involve medical care. Therefore, the medic individually and/or the service will

have to pay for the defense of such cases. This can be huge. If there's a

judgment against you, who will pay that? Your insurance won't.

We have also discussed the disruption it will cause to EMS if cops can call

us out to draw blood, or worse yet, order us to draw blood when it would

interfere with patient care. The law seeks to prevent this, but when emotions are

high such as at the scene of a horrible MVC, the law doesn't always get

carried out to the letter.

Last, we should not become involved in moral and emotional issues as

healthcare providers. Our job is to render prehospital medical care to patients, not

to become law enforcement surrogates. Once we cross that line, we will lose

our perspective, our independence, and our neutrality.

I have no objections whatsoever to a law that PERMITS EMS certificants to do

the blood draws voluntarily. If one wants to sign on as an employee or

contractee of law enforcement to do this, he should have that right. But it

should be outside the EMS system. Just as we each have our own notions about

unpopular patients, we nevertheless treat them equally well (I hope) and put our

personal feelings aside. We are starting down a slippery slope if we use

emotional and moral issues as a reason to begin doing a procedure that's best left

to others.

This is an emotional issue for some, and I recognize that. I have been in

law enforcement as a District Attorney and prosecuted many DWI cases. They

need to be prosecuted. But the methods do not need to involve EMS. There are

other and better ways to do it than tying up EMS personnel and causing them

the extra burden of cost and expenses that this will inevitably bring.

People mention "the CSI" factor in criminal cases. There is no doubt that

it exists. But, when one looks carefully at the law, the limits set are only

"prima facie" evidence of intoxication and can be overcome by testimony. In

fact, one does not even have to be over the limit to be charged with DWI or

driving under the influence of drugs. One of the best tools is the video tape

of the defendant's actions. It requires no expert testimony. It allows the

jury to see the same thing the officer saw and come to the same conclusion.

Videotape evidence is not something that can cause reversal in a case easily.

Blood and breath evidence can and does.

All in all, I believe that law enforcement should be left to law enforcement

and medical care left to medical professionals. I recognize that others will

strongly disagree. I have attempted to state some of the events that we can

expect to happen if we allow EMS to become involved in DWI blood draws. I

am sure there are others as well.

Gene Gandy, JD, LP, NREMT-P"

[Just Plain Ruff]

Thirdly, this bill seems written poorly with little research and planning. The bill leaves out the Licensed Paramedic as someone who is required to perform these draws, and as minute and ridiculous as this third point is, it does raise the question on how much research was done prior to this bill being submitted. I understand the social dilemma that DUI has become these days, but without effective punishment it is going to continue. Quoted from a previous post

Again, politicians did little research which is par for the course. I'll bet this bill won't pass muster in court. If it does, then I fear that other states will follow. Slippery slope if you ask me.

It would be cheaper if they trained LEO's to do this.