Three fundamentally different circumstances occur in obtaining BACs from a driver in a fatal crash:
1) The driver dies at the crash scene.
2) The driver is taken to an emergency department or other medical facility for treatment; the driver may die later or survive.
3) The driver is uninjured or has minor injuries that do not require emergency transportation to a medical facility.

Each requires different processes and procedures for obtaining a BAC and reporting the BAC to FARS. Each has different persons in critical roles, different barriers, and different potential solutions. Each is outlined below, to provide context for the more detailed discussions of the following chapters.

Driver Dies at the Crash Scene

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Figure 2. BAC testing and reporting for drivers who die at the crash scene

At the Crash Scene (A)

When the driver dies at the crash scene, the coroner or medical examiner is responsible for investigating the death, including any BAC evidence relevant to the death. Law enforcement or emergency medical personnel typically notify the coroner or medical examiner of the death, though in some instances the coroner or medical examiner may require an official order from a judge or prosecutor’s office. Some States have laws requiring coroners and medical examiners to obtain BAC evidence from a blood sample from all fatally injured drivers. Similarly, some States or jurisdictions have a standard medical examiner and coroner practice of obtaining a blood sample and BAC from all fatally injured drivers.

Regardless of the presence of a law or standard practice, coroners and medical examiners may not choose to draw blood for BAC analysis. Some coroners and medical examiners will not draw blood if they do not suspect that the victim had been drinking. Many lay coroners do not have training on correct blood sample procedures: for example, an accurate BAC reading requires a sample of arterial blood from the chest. Blood samples must be drawn within three or four hours of the crash in order to obtain an accurate BAC reading, and in some instances, especially in rural areas, coroners and medical examiners may not obtain access to the victim within this time. Some medical examiners may not conduct autopsies on traffic fatalities if the cause of death is obvious, or if resources are limited, and without an autopsy may not may not obtain blood for BAC analysis.

At the Laboratory (B)

Obtaining a BAC reading from a blood sample in at the laboratory is a simple process which produces accurate and reliable BAC results. NHTSA has a free voluntary laboratory quality control and certification program to assure consistent quality.

Reporting the BAC to FARS (C)

Laboratories may have no standard procedures for reporting BAC results. Some States, especially those with centralized laboratories that analyze many blood samples, have established procedures for laboratories to forward BAC results directly to the FARS analyst. In other instances the BAC must be reported to the law enforcement agency investigating the crash, added to the information on the crash report, and then forwarded to FARS. BAC results at a law enforcement agency may be considered as evidence in a criminal case arising from the crash, so may not be available to FARS until the case has been resolved. Backlogs at laboratories may delay BAC analyses substantially, so that the BAC results are reported to the law enforcement agency after the initial crash report has been submitted to FARS. FARS analysts in most States must follow up with laboratories and law enforcement agencies to obtain BAC results that have been delayed.

Driver Taken to a Treatment Facility

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Figure 3. BAC testing and reporting for drivers taken to a treatment facility

At the Emergency Department or Hospital (A)

When the driver’s injuries require treatment at an emergency facility, there usually is no opportunity to acquire a breath or blood sample before the driver is admitted to the facility. Some facilities routinely draw a blood sample upon admission, for medical purposes, but many do not. In either case, law enforcement officers responding to the crash are responsible for requesting that the medical facility provide a blood sample for BAC analysis or provide a BAC value directly from the facility’s own analysis of a blood sample. Law enforcement must make this request promptly, so that blood may be drawn within three or four hours of the crash to provide an accurate BAC reading. Except in those few States where BAC tests are required for all drivers involved in fatal crashes, law enforcement must establish that the driver meets the State’s requirements, whether probable cause or some reduced standard, before making the request. Establishing probable cause may be difficult if emergency personnel remove the driver from the crash scene before law enforcement offices arrive at the scene.

Some States or medical facilities may require a warrant for a blood sample. In these cases, law enforcement must request and obtain a warrant and present it to the medical facility quickly enough to meet the three or four hour deadline. Some State laws or regulations allow insurance companies to deny payment for the entire medical treatment of intoxicated individuals. While this provision is invoked only rarely, medical facilities in these States still may be reluctant to draw a blood sample for fear that it may demonstrate that the driver is intoxicated. Some emergency facilities may not have blood test kits available. In these instances, the investigating officer must provide the test kit.

At the Laboratory or Hospital (B)

If the blood sample is sent to an outside laboratory for analysis, the process is identical to that described previously for drivers who die at the scene. If the emergency facility analyzes the blood sample, then law enforcement typically must obtain the BAC directly or request that it be transmitted to FARS. The medical facility may require a search warrant before releasing the BAC. Again, once the BAC is obtained, the process is the same as for drivers who die at the scene. Illinois law allows medical facilities to report BAC readings as “business records,” which considerably simplifies the process.

Driver Remains at Crash Scene

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Figure 4. BAC testing and reporting for drivers remaining at the crash scene

At the Crash Scene (A)

When the driver remains at the crash scene, either uninjured or with minor injuries that do not require immediate transportation to a treatment facility, investigating law enforcement officers are responsible for determining if a BAC test is appropriate and then administering the test. As with drivers taken to a medical facility, law enforcement must establish that a BAC test is allowed under the State’s requirements.

At the Testing Facility (B)

If a breath test is appropriate, then an officer administers the test, usually in a law enforcement station, under the standard procedures used for an impaired driving arrest. The results are recorded on the crash report and sent to FARS. If a blood test is appropriate, then the law enforcement officer is responsible for transporting the driver to a person authorized to draw blood and for obtaining a blood sample, which is then sent to a testing laboratory. The procedures for obtaining the BAC and forwarding it to FARS are the same as described previously.