Once a BAC test is taken, the test result must be transmitted to FARS. Tables 1 and 9 show that this process is not as straightforward as it might seem. Nationally, in 2002, eight percent of fatally injured drivers and five percent of surviving drivers were known to have been tested, but the test results were not reported to FARS. The number of missing test results may be higher, if some persons who were tested were reported to FARS as “unknown if tested” or “not tested.”

Some individual States fared much worse than the national averages: nine States for fatally injured drivers, and seven States for surviving drivers, had more than ten percent unreported test results. Many States, though, had excellent reporting: 21 States had unreported test results for fewer than one percent of fatally injured drivers, and 17 States did the same for surviving drivers. This chapter examines the process by which test results are transmitted to FARS.

The ten study States were selected for the reasons outlined in Chapter II: to provide a variety of law types and testing rates, geographic diversity, and efficiency for the study. Testing and reporting for both fatally injured and surviving drivers were reviewed in all ten States, so the study was able to document both strong and weaker systems. Study staff also reviewed several NHTSA sponsored State alcohol testing workshop reports and the responses of FARS analysts to NHTSA queries about practices and problems. Detailed analyses of FARS data on BAC test rates also provided insights into potential problem areas.

Drivers Who Die at the Crash Scene

Drivers who die at the scene of their crashes or shortly thereafter (approximately two-thirds of all fatally injured drivers) are processed by death investigation systems that come into play because the death was not due to natural causes. All States have coroners or medical examiners who are required to establish and record the cause of death. Twenty States employ the medical examiner system, 11 States have coroner systems, and the remaining States have mixed coroner and medical examiner systems. Coroners in some States may be justices of the peace with no formal medical training. Law enforcement will also investigate fatal crashes intensively to document the crash and determine culpability, whether crimes have been committed, and causal factors.

States with Mandatory Testing Laws

Twenty-five States require coroners or medical examiners to test and report on alcohol in all motor vehicle crash victims. Among these States, the percentage of drivers recorded in FARS for 2002 as having been tested ranged from 43 percent to 91 percent (Table 5).

For the States with mandatory testing laws with testing rates above 80 percent, almost all the cases without a known BAC are reported as “test not given.” Since about

Table 9. BAC Testing Rates by State, Sorted by Percent Missing (click here to view Table 9)


20 percent of fatally injured drivers survive 12 or more hours after their crash, it is likely that these States have well functioning systems for obtaining blood test results for drivers who die shortly after their crashes.

Two issues may affect States with mandatory testing laws that have less than 80 percent known BAC rates. First, States with substantial numbers of “test not given” appear not to be enforcing their mandatory testing law in some circumstances.

Second, States with more than one or two percent of “test given, result unknown” or “unknown if tested” appear to have a breakdown in the reporting process. One State with a high percentage of “result unknown” cases determined that coroners were performing the tests, but some did not know where to send the test results. Better communications with the coroners and a special reporting form for them overcame much of the reporting problem.

States with Discretionary Testing Laws

Most of the States in this group have relatively high percentages of “test not given” cases, suggesting that tests are frequently not given despite the authority to do so. Many of these States also have high percentages of “result unknown” and “unknown if tested,” suggesting difficulties in data flow between test administration and FARS.

States with No Laws

As Table 5 shows, seven of the 14 States in this group had BAC testing rates for fatally injured drivers above 80 percent. This suggests that good coroner or medical examiner practice, as part of death investigation, can produce high testing rates without the authority of a mandatory testing law. On the other hand, several States in this group have high rates of “test not given,” suggesting that these practices are not universal.

Drivers Who Die after an Extended Period

Drivers who survive for some period of time after their crashes typically will be transported from the scene to a medical facility for treatment. When death does occur, various processing systems come into play that determine the extent to which BAC data reach FARS.

In some States, the coroner or medical examiner system will conduct the death investigation and have access to hospital records so that BAC data from clinical blood draws can be included. Some State laws specifically require hospitals to notify medical examiners when traffic deaths have occurred. Some State laws authorize accessing medical records; in others, there is voluntary compliance. In some States, law enforcement investigation continues and clinical BAC data are obtained from treatment facilities via subpoena.

In the 2001 FARS final file, five States recorded known BACs for 70 percent or more of fatally injured drivers who died 12 or more hours after the crash, suggesting that
viable systems exist for FARS to obtain clinical BAC data. On the other hand, eleven States recorded known BACs for fewer than 40 percent of the drivers who survived for 12 or more hours.

In some States an attending physician can sign the death certificate, and the victim is turned over to a funeral home and the custody of the family. In such cases, the coroner or medical examiner may never enter the case and obtaining any clinical test results becomes problematic.

Surviving Drivers

Fatal crash scenes are often complex situations. Typically, first notification comes from citizen calls to 911. Law enforcement will be dispatched along with fire and EMS as the needs of the scene are clarified. The first responder usually will be the “beat” patrol unit. Backup and supervisory units may be dispatched as the nature of the crash becomes known. Some law enforcement agencies have dedicated fatal crash investigation teams that are dispatched to some or all fatal crashes in their jurisdiction, or as cooperative assistance to other departments. Response times and resources vary by location (urban/rural), by time of day, and other factors. In many States, the State law enforcement agency processes most fatal crashes. Metropolitan police agency traffic units typically respond to crashes in their jurisdictions.

As units respond, their first priority is to secure the safety of the scene. Once this has been accomplished, treatment of the victims becomes the main concern. When there are known fatalities, a coroner or medical examiner may be contacted to obtain permission to move the victims or to come to the scene to take custody. In some jurisdictions, other units such as EMS will transport fatalities to a morgue. Other authorities such as prosecutor’s attorneys may routinely be called to the scene to participate in or guide the law enforcement investigation.

Injured parties will be treated at the scene by EMS and, except for those with minor injuries, will then be transported to medical facilities for further treatment. Those seriously injured may be transported to a level-one trauma center, in some instances by medical evacuation helicopter. Trauma centers may be considerable distances from the crash scene, perhaps even in another State.

At the scene, one law enforcement officer will be designated the lead investigator who ultimately will complete and submit the crash report. Law enforcement officers will examine and measure the crash scene and collect any physical evidence related to the crash. Other drivers, passengers, and witnesses will be identified and interviewed.

The crash report itself typically is an extensive compilation of the results of the investigation. It will consist of the standard State crash report, together with any criminal offense reports, with various supplements such as witness statements, collision reconstruction findings, and photographs. The crash report usually is not submitted until it is virtually complete and has been reviewed by supervisors in the investigating department. However, in locales with long delays for receiving blood
testing results, the report may be submitted without the BAC results, which will be submitted as a report supplement when available.

Law enforcement interviews of the involved drivers are an important part of the crash investigation process. Many drivers can be interviewed at the crash scene. In other cases, a law enforcement officer must be dispatched to the medical facility and interviews may be delayed until the driver is physically able to respond. Where a driver has been transported beyond the immediate jurisdiction, other law enforcement agencies may be asked to assist in interviewing drivers.

Drivers remaining at the scene or transported to a medical facility may become the subject of a DWI investigation if a law enforcement officer has reason to suspect alcohol use. At-scene investigations will proceed much like any other DWI case, except that in many States a forced blood draw is authorized if the subject refuses an evidentiary test. These blood draws usually are accomplished by transporting the driver to a medical facility and requesting a qualified medical staff person to draw the blood. Medical personnel cooperation in drawing blood also is necessary when a driver being treated at a medical facility is being investigated for DWI. Some States require a medical facility to provide law enforcement officers with a sample of a driver’s blood if blood already has been drawn for medical purposes.

Among the law enforcement agencies contacted during the case studies, some reported high voluntary cooperation of hospital personnel, others reported that cooperation varied from hospital to hospital, some noted a recent trend toward lesser cooperation, and some reported having to threaten to arrest medical personnel in order to obtain a blood draw. Knowledge of applicable law among medical staff was also mentioned as affecting their cooperation. A few law enforcement agencies reported using contract phlebotomists to draw blood in DWI cases, with this approach overcoming the problems of having to use hospital staff to draw blood.

While a few States authorize BAC testing of all drivers involved in fatal crashes, most do not. In some States without such a law, the State law enforcement agency and other law enforcement agencies have adopted the practice of requesting voluntary tests from all drivers involved in fatal crashes as a part of the crash investigation process. These agencies report high degrees of compliance. The voluntary request approach accounts for the high rates of surviving driver testing in these States.

FARS System

FARS analysts or supervisors in each of the study States described how they learned of fatal crashes, how BAC and other data were obtained, what kinds of follow-ups were necessary, and what they felt contributed to missing data.

Initial Crash Identification

FARS analysts usually first learn of a fatal crash from the law enforcement. In some jurisdictions, the analyst is notified by telephone or teletype. Analysts also use other sources: reports from coroners or medical examiners, death certificates, or press clipping services. Some States create a case file as soon as they are notified of a traffic fatality. Others wait until they have received official crash reports.

Most FARS operations are located either in the State Highway Safety Office or in the State unit responsible for motor vehicle crash reports. The latter arrangement places FARS directly in the flow of crash reporting. The former arrangement provides designated management responsibility, but requires cooperative agreements for FARS to receive crash reports.

BAC Data for Fatally Injured Drivers

BAC data on fatally injured drivers are received through various processes. In States that mandate testing and reporting, the organization housing FARS operations may be the designated recipient of coroner or medical examiner periodic reports or may receive copies of received reports. Other States request specific test results from the coroner or medical examiner system. The most workable arrangements occur when there is a central State laboratory that conducts all death investigation blood testing. Systems where testing is done locally, for instance using contract laboratories, may require greater follow-up efforts to obtain comprehensive data.

In at least one State, highway safety funds are used to pay for blood testing in fatal crashes. This ensures that the tests are conducted and the results reported. In at least one other State, the fatal crash investigation team is the driving force in obtaining BAC test results by requesting test results directly from coroners or medical examiners.

BAC Data for Surviving Drivers

In some States, the law enforcement crash report contains a field for recording BAC test results, so that these data are directly available to FARS. Other reports may be received with “test pending” noted, as can happen when there are extensive delays in receiving blood test results from laboratories. This requires a crash report supplement containing the test results. In other States, crash reports do not contain BAC results, but supplemental forms are used to report results to FARS.

Another possible source of BAC data is direct reporting from a central laboratory (for example a State crime laboratory) that tests blood samples submitted by law enforcement agencies.

Finally, some FARS analysts can obtain BAC test data directly when necessary. One State indicated that when its FARS analysts read a fatal crash report that has any indication that alcohol was involved but that has no BAC report, the analysts contact the investigating law enforcement agency to obtain any BAC test results. This State
believes that this process allows the FARS analyst to obtain complete test results.

In another State, the procedures manual instructs FARS analysts that when BAC results for surviving drivers have not been received, they are to call the records section of the reporting department to request the result and, ”if the agency does not have the information, or is unable to release it due to legal constraints, call the District Attorney handling the case.”

Work Environment

Some FARS analysts work in environments with well-documented procedures and written interagency agreements for obtaining data. Others work in less formal settings where job tasks are well-known by the analysts, but not necessarily documented in detail, and where personal relationships are used to obtain data. While either approach can work well, personal relationships must be re-established when a cooperating individual leaves and there is no “institutional memory” to continue providing the data.

One relatively new FARS analyst indicated that there was little documentation to describe the tasks to be performed or whom to contact for necessary data. The result was that for the analyst’s first year, known BAC rates in FARS dropped by more than one-half from the prior year.

FARS operations differ from State to State in terms of the data on BAC (and other items) that are routinely provided and the data that the analyst must actively seek. In some States, relatively complete information is routinely obtained so that little follow-up is needed. In other States there are many gaps in routine reporting that must be filled by follow-up mail or phone contacts. In these States, management must emphasize BAC reporting and must commit resources in order to attain a high reporting level.