Having popped through the JEMS site today looking at the the news feed, this article about EMS taking blood samples on intoxicated suspects.

http://www.jems.com/article/news/ohio-law-allows-ems-draw-blood

Although I appreciate that phlebotomy is a long standing part of paramedic practice in the US it is relatively new to the UK and is not yet performed in the field. 

Currently in the UK, samples can only be taken by a physician where it is intended to be used as evidence and is normally done at the hospital after the patient is stabilised. Police officers can perform a breath test on patients following clearance by the paramedic and I've had many patients strapped to a long board blowing into a breathalyser. 

The JEMS article tends to suggest that it will only be used in the field in rural settings. 

I guess I'm thinking about the ethical ramifications of EMS taking blood samples. Should we be separate from law enforcement? Would it as the article suggests delay care on scene, blow cannula's???? Would this see a conflict of interest, create a stereotype (the drunk driver) that might have a negative impact on the provider delivering quality care?

What are your thoughts? 
Would you take the sample?

Tags: DUI, accident, bloods, car

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EMS blood samples cannot be used for DUI lab tests in South Carolina. There is no chain of custody training or enforcement. It is considered an illegal search, since it isn't performed by trained law enforcement officers or crime scene technicians. Also, there's not practical way to do the testing, since we don't carry the right kind of lab tubes for the BA testing.
Here the process is PBT. By Police on random stops or Booze buses with mass testing. If a PBT is refused- arrest. If a positive PBT- then a definitive BAC via breath is taken. Blood is collected on all crash patients in hospital or on those refusing breath testing. Previously only collected by doctors, now RNs are now also permitted to collect. Blood can be collected at Booze Buses by forensic nurses. I don't see a need for us to collect pre- hospital under our system it isn't needed. I haven't even done any as a RN yet ( there is a prescribed process for collection recording and storage of samples).

People know that police and ambulance go hand in hand, but we are different entities. Especially evident with heroin ODs where we treat and release without PD. We often assess patients under arrest at scenes as safe to be processed / interviewed so in the end I don't think there is an actual need, if there was I probably wouldn't purely from a resourcing point of view- I have enough to do and it doesn't dictate my care. In hospital there are plenty of staff around. Even now on scene police consult with us as to whether our patients are able to have a random breath test- if we say no then they are ok with that or if we give them the opportunity then they appreciate the offer and the patient unchanged in their perception of us.
While they are a patient first, if the cop has the warrant.... I got the vial. I used to work for a county service where it wasn't unheard of for the JP to show up, paperwork in hand and have you draw. She especially did this if there was a death. Thankfully she was smart enough to make sure it didn't interfere with our job. If we could do it, we would. If we couldn't... she wouldn't push it on us.
Here in ohio they just past a law enabling paramedics to draw blood for the police for DUIs. Catch is the paramedic has a choice and it has to be in protocols from medical director. Not sure hows it is going to go down but I know my answer would be "No!"

Also if you draw that blood your butt will be in that court room as well.
In North Carolina state law requires that paramedics draw blood on the request of an LEO. We (EMS) were asleep when this went through the legislatur unopposed.
Given that it would appear that most challenges to DUI are to the correctness of procedure under legislation, why would you put your backside in that sling?
There's a state somewhere that recently started letting trained police officers to do the phlebotomy, which, to my way of thinking, is the perfect way to do it. Personally, a courtroom is the absolute last place I want to be (Dammit, Jim, I'm a doctor, not a lawyer!)...and doing things like this basically sets you up for it. Collection of evidence really isn't EMS' (or any section of health care's) bailiwick, except accidentally (as when you come across abuse or a shooting scene).

Of course, the whole system of DUI is screwed up anyway. Seriously: incriminate yourself with a breath test, or be punished for failing to incriminate yourself? Yet it survives fifth amendment challenges....
Coming from New Zealand - this is something we do not do. But I think we should. If the Police request this - I should think - that we all should take a blood sample. The more scumbags - who think it is acceptable to drive drunk, drive under the influence of drugs - we get off the road - the better. I think this should also be done under the suspicion of other substances such as drugs - marjunana for example - can impair driving ability.

In New Zealand - driving under the influence of drugs - now warrants for the same procedures as alcohol.

Yes to blood samples!!!!!!! Get these scumbags off the road. Its unacceptable and they deserve what they get!
Texas allows LEOs to do it. And its a double wammy, cause if you resist, it's assault on an office with a deadly weapon (the needle).

dr-exmedic said:
There's a state somewhere that recently started letting trained police officers to do the phlebotomy, which, to my way of thinking, is the perfect way to do it. Personally, a courtroom is the absolute last place I want to be (Dammit, Jim, I'm a doctor, not a lawyer!)...and doing things like this basically sets you up for it. Collection of evidence really isn't EMS' (or any section of health care's) bailiwick, except accidentally (as when you come across abuse or a shooting scene).

Of course, the whole system of DUI is screwed up anyway. Seriously: incriminate yourself with a breath test, or be punished for failing to incriminate yourself? Yet it survives fifth amendment challenges....
"There's a state somewhere that recently started letting trained police officers to do the phlebotomy, which, to my way of thinking, is the perfect way to do it."

Yes Yes, Let's undermine health care even further. In fact let the cops drive the ambulance too. Who needs Ambos? Collection of a sample by a prescribed person eg doctor is exactly that, a sample. It's a police officer who turns it into evidence.

"But I think we should. If the Police request this - I should think - that we all should take a blood sample........
.....Yes to blood samples!!!!!!! Get these scumbags off the road. Its unacceptable and they deserve what they get!"


Collection by Ambulance of blood sample which can deteriorate between a scene because of incorrect handling, collection and storage will not improve conviction rates. If we do not transport a DUI, does that mean that we collect the sample for Mr Plod in an uncontrolled environment allowing for it to be tainted? (Remember too that is is prescribed that the patient is to receive a tube of the sample for his own testing)

Will we not attend real emergencies just so we can be mobile phlebotomists?

Yep lock up all the bad guys, however lets not let that drive us towards inappropriate skill abuse.
So I guess what I end up tripping over in all of this is where does the confirmation of cause come from.

Lets take for arguments sake a Liver Function Test (LFT) may be ordered by a health professional for a patient that presents with chronic alcoholism or a patient who is on a regularly prescribed medication and is having a medication review. There is a cause to investigate a legitimate reason for conducting the invasive procedure.

In a DUI the cause is likely to be based on assumption and where the problem lies is whose assumption should order the test, should it be the police or should it be the EMS provider who is going to undertake the procedure. I ask this because as a healthcare professional taking care of a patient in a medical emergency our first priority is to their best interests and only undertaking skills that are of absolute necessity. Is it simply a case of going..."i think i smell alcohol here, best get a sample for testing" Should we act as EMS professionals or subcontracted police professionals.

I should think - that we all should take a blood sample. The more scumbags - who think it is acceptable to drive drunk, drive under the influence of drugs - we get off the road - the better
And that response worries me about who we can protect the patients best interests. Yes drink driving is an awful problem for so many, in particular innocent motorists that inevitably get caught up in it all. More devils advocate than anything, can we be seen to be loosing our objectivity, will our index of suspicion be skewed as a result of assessing road accident victims for alcohol during the airway assessment.

If taking a sample was to become standard EMS practice to do it properly, label it at the patients side and take two samples (1 for processing and 1 for the patient), Handle the samples correctly is going to take a significant amount of time. Say 10 minutes (having experience of phlebotomy in an ER setting and in the community) would be a comfortable limit. Can we justify this at a crash scene?

Will we not attend real emergencies just so we can be mobile phlebotomists?
This is what I see as being the issue, not just attending crash scenes but someone gets pulled over in the street after swerving all over the road and Law enforcement want a sample.... 90 minutes for an on call physician or nurse practitioner, 10 minutes for EMS response....

But custody medicine is a big kettle of fish in the UK, physicians not wanting to be police surgeons anymore, not wanting to be called out day or night and the burden is falling to paramedic practitioners and EMS.
Are you saying that patients have no right to refuse the blood draw? In the absence of a court order (probable cause plus a search warrant) that sounds improbable to me. What about the 4th Amendment?

Tom

John Gaines said:
Texas allows LEOs to do it. And its a double wammy, cause if you resist, it's assault on an office with a deadly weapon (the needle).

dr-exmedic said:
There's a state somewhere that recently started letting trained police officers to do the phlebotomy, which, to my way of thinking, is the perfect way to do it. Personally, a courtroom is the absolute last place I want to be (Dammit, Jim, I'm a doctor, not a lawyer!)...and doing things like this basically sets you up for it. Collection of evidence really isn't EMS' (or any section of health care's) bailiwick, except accidentally (as when you come across abuse or a shooting scene).

Of course, the whole system of DUI is screwed up anyway. Seriously: incriminate yourself with a breath test, or be punished for failing to incriminate yourself? Yet it survives fifth amendment challenges....

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