Partners in reducing road trauma Road Safety Act - Blood Procedures 9 November, 2009 Traffic Drug and Alcohol Section 20 Dawson Street, Brunswick Vic 3056 Telephone: 03 9380 7224 Fax: 03 9380 7233 Traffic Drug and Alcohol Section Support Services Unit (This publication supersedes all previous instructions) Introduction A primary purpose of the Road Safety Act 1986 (RSA 1986) is to pursue road safety and reduce the incidence, impacts and costs of road trauma on the Victorian community. One key area in this strategy is to take alcohol and drug affected persons off the roads. Significant benefits can be achieved for all Victorians by reducing the road trauma caused by alcohol and drug affected drivers. The Road Safety Act places an obligation on medical professionals, including doctors and nurses, to help reduce the incidence of road trauma by taking blood samples from people involved in road crashes. The Traffic Drug and Alcohol Section receives many calls from doctors and nurses with regards to understanding their obligations under the Act. These notes are intended to provide some guidance and assistance in interpreting the legislation. It is not possible to cover every possible circumstance or scenario that medical professionals may come across in these notes, so additional advice may be obtained contacting the Traffic Drug and Alcohol Section on (03) 9380 7212. Alternately, contact can be made via email to tastusupportservices@police.vic.gov.au Taking Blood Samples Summary of Legislation – Road Safety Act 1986 There are a number of situations where a doctor or a nurse may take a blood sample from a person under the Road Safety Act 1986. 1. Any person of or above the age of 15 years who is involved in a motor vehicle accident and who comes in for examination or treatment to a hospital or place of medical treatment must allow a doctor (registered medical practitioner (RMP)) or an Approved Health Professional (AHP), which means a division 1 nurse, to take a blood sample from that person. (Section 56 RSA) The RSA defines an Approved Health Professional as a division 1 registered nurse, within the meaning of the Nurses Act 1993, or a person approved by the Director of the Victorian Institute of Forensic Medicine (VIFM). Victoria Police – Hospital Blood Procedures - 9 November 2009 page 1 of 14 2. A person who has been required by police to provide a blood sample after attempting: an evidential breath test, a random drug test (saliva test) or a drug impairment assessment (physical tests) must allow a doctor (RMP) or a nurse (AHP) to take a blood sample from them. The blood collection kits provided by Victoria Police meet all the relevant requirements under the Regulations, which are contained within the Road Safety (General) Regulations 2009 – Part 2. Victoria Police also provide certificate books (VP Form 811) to record samples that have been taken. Section 57 (3) of the Road Safety Act states that “a certificate signed by a registered medical practitioner (doctor) or approved health professional (nurse) is admissible in evidence and, in the absence of evidence to the contrary, is proof of the facts and matters contained in it.” This means that when a doctor (RMP) or a nurse (AHP) completes the VP Form 811 Certificate of the Taking of a Blood Sample, the certificate can be produced in court as evidence in lieu of having the doctor (RMP) or nurse (AHP) attend court to give evidence. Note: The current certificate book caters for being signed by either a registered medical practitioner (doctor) or an approved health professional (nurse). If an old version of the certificate book is still being used and the blood sample has been taken by a nurse (AHP), care should be taken to ensure the words 'approved health professional' have been inserted in lieu of ‘registered medical practitioner’ where it occurs on the VP Form 811 Certificate of the Taking of a Blood Sample. A line should also be drawn through the term 'registered medical practitioner'. Distribution of Samples - Accident Once the blood sample has been taken and a certificate has been completed, the blood sample vacuum tubes or bottles must be labelled with a ‘white’ label from the certificate book, placed in the plastic bags provided in the kit and distributed as per below. Police Sample – This part of the sample must have the green and pink VP Form 811 certificates included in the plastic bag labelled 'police sample' and is then lodged in the locked police safe located at the hospital; Patient Sample – This part of the sample is given to the patient or placed in their personal property. There is provision for the patient to acknowledge receipt of (sign for) the sample on the back of the hospital copy of the VP Form 811 Certificate of the Taking of a Blood Sample. Alternately, the back of the VP Form 811 can also be endorsed by the doctor or nurse where a patient refuses to take their part of the blood sample, or where it is placed with the patient’s personal property; Screening Sample – This part of the sample is either placed in police safe (where Traffic Drug and Alcohol Section provides a regular courier service), or posted via Australia Post to the Traffic Drug and Alcohol Section inside a secure ‘shipper’. The Traffic Drug and Alcohol Section provides ‘shippers’ at no cost and covers Australia Post charges. Victoria Police – Hospital Blood Procedures - 9 November 2009 page 2 of 14 Distribution of Samples - Other Circumstances The following applies where police attend the hospital and request that a blood sample be taken after or as a result of a police breath or a drug test procedure: Once the blood sample has been taken and a certificate has been completed, the blood sample vacuum tubes or bottles must be labelled with a ‘white’ label from the certificate book, placed in the plastic bags provided in the kit and distributed as per below. Police Sample – This part of the sample must have the green and pink VP Form 811 certificates included in the plastic bag labelled 'police sample' and is then handed directly to the attending police member; Patient Sample – This part of the sample is given directly and personally to the patient. There is provision for the patient to acknowledge receipt of (sign for) the sample on the back of the hospital copy of the VP Form 811 Certificate of the Taking of a Blood Sample. Alternately, the back of the VP Form 811 can also be endorsed by the doctor or nurse where a patient refuses to take their part of the blood sample; Screening Sample – This part of the sample must be handed directly to the attending police member along with the ‘Police Sample’. The police member may then request to place their part of the samples in the locked police safe at the hospital for security, or they may take the samples with them for processing. Notice to Police - Road Safety Act Blood Sample Not Obtained On some occasions a blood sample may not be taken for one of the reasons outlined in the “Code of Practice for Taking Blood Samples from Road Accident Victims” (copy attached) In summary: a person may refuse or fail to provide a blood sample when request by a doctor (RMP) or nurse (AHP); a preliminary breath test has been conducted by a doctor or nurse and that test indicated that there was no alcohol present in the persons breath; Where a blood sample has not been taken, a “Notice to Police - Road Safety Act Blood Sample Not Obtained” (example copy attached at rear) must be completed and forwarded to the Traffic Drug and Alcohol Section as soon as possible. Although the Code of Practice allows for a preliminary breath test, doctors and nurses are now encouraged to obtain blood samples where possible. All road crash blood samples are now routinely screened for both alcohol and drugs. A preliminary breath test will not identify someone who is affected by illegal drugs, as such, taking a blood sample is preferred. Victoria Police – Hospital Blood Procedures - 9 November 2009 page 3 of 14 Prepaid Post Containers – ‘Shippers’ (sometimes known as 'Labmailers') Paragraph 7 of the Code of Practice refers to the ‘screening sample’ being forwarded to the Traffic Drug and Alcohol Section in a LABMAILER provided. ‘Labmailer’ is a product name and this product is no longer used, hence the term ‘Shipper’ is now used instead. A Shipper will comfortably hold four (4) screening samples, but can hold six (6) samples at a pinch. Should there be a requirement to forward more than four samples at any one time, multiple shipping containers should be used. Screening samples must be forwarded as soon as possible after being taken. It is not necessary to fill a shipping container before forwarding it. When posting Shippers, Australia Post requires that the shipping containers have a Declaration for Dangerous Goods attached. Shipper containers must be lodged at a post office or postal agency for posting, they cannot be put in post-boxes. The shipping containers are supplied by the Traffic Drug and Alcohol Section and are preaddressed for convenience. Postage is at no cost to the hospital, being ‘pre-paid’ by the Traffic Drug and Alcohol Section. On receipt of the shipping containers at the Traffic Drug and Alcohol Section the blood screening samples are processed and the containers returned to the hospital for re-use via the local police station. Please note - Shipping containers are not provided where police couriers attend to collect screening samples. Victoria Police – Hospital Blood Procedures - 9 November 2009 page 4 of 14 Blood Sample Collection Kit Instructions Paragraph 6 of the Code of Practice refers to the procedures specified in the instructions with the kit. These instructions are: Approved Blood Sample Collection Kit Road Safety Act – Section 56 Road Safety (General) Regulations 2009 Blood sampling procedure Cleanse skin only with a 'non-alcoholic' swab (as provided) Use needle, safety holder and 3 vacuum container tubes provided for blood collection Complete Certificate in sextuplicate, commencing with GREEN certificate Remove the three labels from book and attach to each container Place the containers in the bags provided Place the green and pink certificate in the bag marked ‘Police Sample’. Deposit the ‘Police Sample’ in the Police Safe provided The sample in the bag marked ‘Patient Sample’ is to be given to the patient or placed with the patient’s personal property together with the Patient Instruction card The sample in the bag marked ‘Screening Sample’ is to be placed in the container provided for screening samples and forwarded to the Traffic Drug and Alcohol Section in the prepaid container provided. At locations where prepaid containers are not provided, a Police Courier will collect the Screening Sample. Instructions provided by Victoria Police Please note - The sixth copy (hospital copy) of the certificate should always remain in the certificate book. Care should be taken to ensure that it is not inadvertently torn out or removed. Calibration of PBT (Preliminary Breath Testing Device) The Traffic Drug and Alcohol Section, in agreement with the hospital, will assist with calibrating any preliminary breath test device purchased by the hospital and used for Road Safety Act purposes. However, the taking of a blood sample is preferred and strongly encouraged. Hospitals wanting their preliminary breath test device calibrated should contact the Traffic Drug and Alcohol Section to arrange. Calibration does not include repairs. The hospital will be notified if any fault is identified and it will be the responsibility of the hospital to pursue the repair. Victoria Police – Hospital Blood Procedures - 9 November 2009 page 5 of 14 Fatal Motor Vehicle Accidents – Persons to have a Blood Sample Taken The Coroner has instructed that all persons involved in a fatal motor vehicle accident and treated at a hospital, whether a driver, rider, passenger, pedestrian or cyclist, are to have a blood sample taken from them. Enquires: Further enquires regarding: Blood kits Shipping containers Certificate books Forms Posters or on any other matter relating to the taking of blood samples from road accident victims should be directed to staff at Support Services Unit, Traffic Drug and Alcohol Section on telephone (03) 9380 7224 or (03) 9380 7212. Alternately, contact can be made via email to tastusupportservices@police.vic.gov.au All hospitals that have been provided with shipping containers can also contact their local area police, who are responsible for providing local support. Victoria Police – Hospital Blood Procedures - 9 November 2009 page 6 of 14 Legislation Road Policing legislation, which includes the Road Safety Act 1986 (RSA) and the Road Safety (General) Regulations 2009 (RS(G)Rs) provide for the taking of blood samples from persons in certain instances. The Act provides the legislative authority and the Regulations outline the procedures to be followed. Below are some extracts which are relevant to medical staff. Road Safety Act 1986 Blood Samples - Road Accident Victims Section 56 (2) If a person of or above the age of 15 years enters or is brought to a place for examination or treatment in consequence of an accident (whether within Victoria or not) involving a motor vehicle, the person must allow a doctor or approved health professional to take from that person at that place a sample of that person’s blood for analysis. Comment: This means that a doctor or approved health professional should take a blood sample from all road crash victims who are brought into or attend at a hospital or other medical facility. Section 56 (8) No action lies against a doctor or approved health professional in respect of anything properly and necessarily done by the doctor or approved health professional in the course of taking any sample of blood which the doctor or approved health professional believes on reasonable grounds was required or allowed to be taken from any person under this section. Comment: This is an indemnity for doctors and approved health professionals who act in good faith in accordance with this legislation. Section 57 (3) A certificate containing the prescribed particulars purporting to be signed by a registered medical practitioner or approved health professional is admissible in evidence in any proceedings referred to in sub-section (2) and, in the absence of evidence to the contrary, is proof of the facts and matters contained in it. Comment: This means that where a doctor or approved health professional has completed and signed the VP Form 811 Certificate of the Taking of a Blood Sample then this certificate is admissible in court and minimises any need for the doctor or approved health professional to actually attend at any subsequent court hearing. Victoria Police – Hospital Blood Procedures - 9 November 2009 page 7 of 14 Blood Sample Associated with a Police Breath Test Section 55 (9A) The person who required a sample of breath under sub-section (1), (2) or (2AA) or 2(A) from a person may require that person to allow a registered medical practitioner or an approved health professional nominated by the person requiring the sample to take from him or her a sample of that person’s blood for analysis if it appears to him or her that(a) that person is unable to furnish the required sample of breath on medical grounds or because of some physical disability; or (b) the breath analysing instrument is incapable of measuring in grams per 210 litres of air the concentration of alcohol present in any sample of breath furnished by that person for any reason whatsoever and for that purpose may further require that person to accompany a member of the police force to a place where the sample is to be taken and to remain there until the sample has been taken or until 3 hours after the driving, being an occupant of being in charge of the motor vehicle, whichever is sooner. Comment: This means that police may bring a person to a hospital or other medical facility in order to obtain a blood sample from a person suspected of drink driving. The police have a time limit and any prompt assistance by hospital staff is appreciated. Section 55 (9B) The registered medical practitioner or approved health professional who takes a sample of blood under sub-section (9A) must deliver a part of the sample to the person who required it to be taken and another part to the person from whom it was taken. Comment: This means that when a blood sample is taken in these circumstances the samples must be handed to the attending police member and also the patient. This is unlike road crashes where the samples are normally placed in a safe (or shipper container.) Section 55 (9E) No action lies against a registered medical practitioner or an approved health professional in respect of anything properly and necessarily done by the practitioner or approved health professional in the course of taking any sample of blood which the practitioner or approved health professional believed on reasonable grounds was allowed to be taken under sub-section (9A). Comment: This is an indemnity for doctors and approved health professionals who act in good faith in accordance with this legislation. Victoria Police – Hospital Blood Procedures - 9 November 2009 page 8 of 14 Blood Sample Associated with a Police Drug Impairment Assessment Section 55B (1) If a person undergoes an assessment of drug impairment when required under section 55A to do so and the assessment, in the opinion of the member of the police force carrying it out, indicates that the person may be impaired by a drug or drugs, any member of the police force may require the person to do either or both of the following(a) allow a registered medical practitioner or an approved health professional nominated by that member to take from the person a sample of that person’s blood for analysis (b) furnish to a registered medical practitioner or an approved health professional nominated by that member a sample of that person’s urine for analysis and for that purpose may further require that person to accompany a member of the police force to a place where the sample is to be taken and to remain there until the sample has been taken or until 3 hours after the driving, being an occupant of being in charge of the motor vehicle, whichever is sooner. Comment: This is similar to the alcohol breath test situation above and means that police may bring a person to a hospital or other medical facility in order to obtain a blood sample from a person suspected of drug driving. The police have a time limit and any prompt assistance by hospital staff is appreciated. In rare situations, a urine sample may be obtained where a blood sample is unable to be taken (for example the patient has collapsed veins). Section 55B (2) The registered medical practitioner or approved health professional who takes a sample of blood or is furnished with a sample of urine under this section must deliver a part of the sample to the member of the police force who required it to be taken or furnished and another part to the person from whom it was taken or by whom it was furnished. Comment: This means that when a blood sample (and on rare occasions a urine sample) is taken in these circumstances the samples must be handed to the attending police member and also the patient. This is unlike road crashes where the blood samples are normally placed in a safe (or shipper container.) Note also that urine samples are not obtained for road crash victims unless police have requested a urine sample after a drug impairment test procedure. Section 55B (4) No action lies against a registered medical practitioner or an approved health professional in respect of anything properly and necessarily done by the practitioner or approved health professional in the course of taking any sample of blood, or being furnished with any sample of urine, which the practitioner or approved health professional believed on reasonable grounds was allowed to be taken from, or be furnished by, any person under this section. Comment: This is an indemnity for doctors and approved health professionals who act in good faith in accordance with this legislation. Victoria Police – Hospital Blood Procedures - 9 November 2009 page 9 of 14 Blood Sample Associated with a Police Oral Fluid (Drug) Test Section 55E (13) The person who required a sample of oral fluid to be provided under subsection (2) or (3) may require that person to allow a registered medical practitioner or an approved health professional nominated by the person who required the sample to take from him or her a sample of that person's blood for analysis if it appears to him or her that(b) that person is unable to furnish the required sample of oral fluid on medical grounds or because of some physical disability or condition; or (b) the prescribed device is incapable of testing for the presence in the sample of a prescribed illicit drug for any reason whatsoever and for that purpose may further require that person to accompany a member of the police force to a place where the sample of blood is to be taken and to remain there until the sample has been taken or until 3 hours after the driving, being an occupant of or being in charge of the motor vehicle, whichever is the sooner. Comment: This is similar to alcohol breath tests above and means that police may bring a person to a hospital or other medical facility in order to obtain a blood sample from a person suspected of drug driving. The police have a time limit and any prompt assistance by hospital staff is appreciated. Section 55E (14) The registered medical practitioner or approved health professional who takes a sample of blood under subsection (13) must deliver a part of the sample to the person who required it to be taken and another part to the person from whom it was taken. Comment: This means that when a blood sample is taken in these circumstances the samples must be handed to the attending police member and also the patient. This is unlike road crashes where the samples are normally placed in a safe (or shipper container.) Section 55E (17) No action lies against a registered medical practitioner or an approved health professional in respect of anything properly and necessarily done by the practitioner or approved health professional in the course of taking any sample of blood which the practitioner or approved health professional believed on reasonable grounds was allowed to be taken under subsection (13). Comment: This is an indemnity for doctors and approved health professionals who act in good faith in accordance with this legislation. Victoria Police – Hospital Blood Procedures - 9 November 2009 page 10 of 14 Patient Consent NOT required Section 57 (9) Except as provided in sections 55 (9A), 55B, 55E (13) and 56, a blood sample must not be taken and evidence of the result of an analysis of a blood sample must not be tendered unless the person from whom the blood has been collected has expressed consent to the collection of the blood and the onus of proving that expression of consent is on the prosecution. Comment: This means that patient consent is NOT required when a blood sample is taken for the purposes indicated in these notes. Road Safety (General) Regulations 2009 Regulation 10 - Procedures for Taking Blood Samples If a blood sample is taken by a registered medical practitioner or an approved health professional for the purposes of the Act, the site of the puncture must be cleansed with a swab taken from a container which (a) appears to be sealed against contamination; and (b) bears a label stating that the container holds an aqueous solution of chlorohexidine and cetrimide and no methylated spirits, alcohol, tincture or iodine or other substance containing alcohol. Regulation 11 - Procedure after Taking Blood Samples (1) A registered medical practitioner or an approved health professional who takes a blood sample must ensure that(a) the sample of blood is placed in 3 dry containers, each containing approximately the same amount of blood; and (b) each container is vacuum sealed or sealed with a septum seal; and (c) each container in which the sample is placed bears a label stating(i) (ii) (d) that the container holds a specific anti-coagulant and preservative such as potassium oxalate and sodium fluoride; and the name of the chemist, laboratory or pharmaceutical organisation that prepared it; and each container has attached to it a label bearing the signature of the registered medical practitioner or approved health professional the date and the time the sample was taken, and the name of the person from whom the sample was taken or, if the name of the person is not known, sufficient information to enable the sample to be identified with the person from whom it was taken. Victoria Police – Hospital Blood Procedures - 9 November 2009 page 11 of 14 (2) If a blood sample is taken under section 55 or 55B of the Act, the registered medical practitioner or approved health professional must give one of the containers to a member of the police force and another to the person from whom the sample was taken. (3) If a blood sample is taken under section 56 of the Act and has, in accordance with this regulation, been placed in containers which have been sealed and labelled, the doctor/approved health professional must ensure that – (a) one container is placed in a locked receptacle provided for the purpose at the place at which the sample was taken; and (b) one container is placed and sealed in a container labelled “screening sample”; and (c) one container is delivered to the person from whom the blood sample was taken or placed with that person’s personal property at the place at which the sample was taken. Regulation 12 - Certificate under Section 57(3) A certificate under section 57(3) of the Act must contain the following particulars(a) a statement by the registered medical practitioner or approved health professional that the requirements of these Regulations for the taking of blood samples have been complied with; and (b) the name of the person from whom the blood sample was taken; and (c) the time and date the blood sample was taken; and (d) the name and signature of the registered medical practitioner or approved health professional who took the blood sample. Code of Practice: A Code of Practice for taking blood samples from road accident victims was established in the early 1990s. At that time little was known of the prevalence and impact of drug impaired drivers in road trauma. Current research indicates that drugs are now a significant issue in road safety and road trauma reduction. Road crash blood samples are now routinely screened for ‘prescribed’ illicit drugs. While the Code of Practice allows for the use of preliminary breath alcohol tests, doctors and approved health professionals (nurses) are encouraged to take blood samples from road crash victims where practical. Breath alcohol tests should no longer be considered as an option. The Code of Practice will be reviewed and updated in due course. Victoria Police – Hospital Blood Procedures - 9 November 2009 page 12 of 14 Code of Practice for Taking Blood Samples from Road Accident Victims It is organisational policy that blood samples are taken from all drivers and motorcycle riders brought to or presenting for treatment or examination following involvement in an accident involving a motor vehicle, unless there are compelling medical reasons for not doing so. Where there is any doubt about the person concerned is in one of these categories or not, a blood sample is taken. In practice all persons presenting are treated as possible drivers or motorcyclists unless police or ambulance personnel provide written advice to the contrary. Blood samples are not taken where police/doctor/approved health professional advise in writing that a blood sample has already been given, or that a preliminary breath test has been conducted and the result indicated that in that person's blood alcohol concentration was less than the prescribed concentration. Co-operation in obtaining blood from pedestrians and bicyclists over agreed time periods for purposes of devising and evaluating programs involving these groups is encouraged, subject to the availability of resources. Where a person refuses or fails to provide a blood sample, information to this effect is noted in the person's Medical Record, and the Victoria Police form "Notice to Police - Road Safety Act Blood Sample Not Obtained" is to be completed and forwarded to Traffic Drug and Alcohol Section * (form may be forwarded in Labmailer or deposited in the Police Safe). If necessary Traffic Drug and Alcohol Section may be contacted by telephone. Where a sample is taken, the sample and accompanying certificates are dealt with using the material in the kit provided by Victoria Police, in accordance with procedures specified in the instructions with the kit. The sample in the bag marked `screening sample', is placed in the LABMAILER provided for screening samples, and forwarded to the Traffic Drug and Alcohol Section. At locations where LABMAILER containers are not provided, place the sample in the `Police Safe' and a Police Courier will collect the screening sample. Deposit the `police sample' along with the green and pink certificates, in the police safe provided. The sample in the bag marked `patient sample' becomes the property of the person from whom the sample was taken, and is to be given to the patient or stored for them with their personal property. ________________________ * Victoria Police, Traffic Drug and Alcohol Section, 20 Dawson Street, Brunswick Vic 3056. Telephone: (03) 9380 7212 Victoria Police – Hospital Blood Procedures - 9 November 2009 page 13 of 14 Please forward to: Traffic Drug and Alcohol Section 20 Dawson Street Brunswick Vic 3056 Notice to Police Road Safety Act Blood Sample Not Obtained I, _______________________________________________________________________________ (Name of doctor / approved health professional) of _______________________________________________________________________________ (Name of hospital) did not take a blood sample from ______________________________________________________ (Name of patient) ______________________________________________________ (Address of patient) who entered or was brought to ________________________________________________________ (Name of hospital) for examination or treatment in consequence of an accident involving a motor vehicle because:a negative preliminary breath alcohol test (PBT) was conducted or that person did not allow me to take a blood sample; Please provide a brief description of circumstances:_________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Date: ____/ ____/20____ _______________________________________ (Signature & Qualifications) Victoria Police – Hospital Blood Procedures - 9 November 2009 page 14 of 14