A Prescription for a Stronger Fight Against Substance-Impaired Driving

Dr. Mary Pat McKay

Blood alcohol level chartAs an Emergency Medicine physician, I have witnessed first-hand the horrible consequences of substance-impaired driving, from minor injuries to multiple fatalities.  I also understand all too well the frustrations that can occur when trying to test crash-involved drivers for alcohol or drugs.  Laws and practices vary significantly from state to state on who can test a driver’s blood; when and where blood can be tested; what substances are tested for; and how test results are reported and used.  Often, injured but surviving drivers aren’t tested at all, and these are the ones who may drive again.  This means that information about substance-impaired driving crashes isn’t as consistent or reliable as it could be, making the fight against this deadly problem more difficult.  After all, how can we find a cure if we can’t properly diagnose the disease?

In November 2012, the NTSB made several recommendations that focused on the collection of data about substance-impaired driving.  At first glance, collecting data may not seem that important when it comes to getting impaired drivers off the road.  But as a doctor and researcher, I know that without high-quality data, it’s impossible to identify and evaluate solutions to any problem.  If I don’t have a reliable way to measure the temperature of my patients, I can’t accurately diagnose them.  Similarly, if we don’t have a way to reliably measure aspects of impaired driving, we can’t implement the right countermeasures to fight the problem.

The four NTSB data recommendations that address both blood alcohol concentration (BAC) testing and drug testing are the following:

  • The National Highway Traffic Safety Administration (NHTSA) develop and share with the states guidelines for testing and reporting BAC of drivers involved in fatal crashes;
  • NHTSA develop and share with the states a common standard of practice for drug toxicology testing related to impaired driving.  This includes standards on the circumstances under which tests should be done, the minimum set of drugs for which testing should be done, and the cutoff values for reporting test results;
  • States increase collection, documentation, and reporting of BAC test results;
  • States work to achieve BAC reporting rates of at least 80% of fatally injured drivers and at least 60% of surviving drivers involved in fatal crashes.

When implemented, these recommended actions will significantly improve the quality of information about substance-impaired driving, leading to better, more appropriate countermeasures.

On Monday, I had the opportunity to speak about these data-related recommendations to the Alcohol, Drugs, and Impairment Division of the National Safety Council at its meeting in Seattle.  Like the NTSB, this group makes recommendations for addressing substance-impaired driving, including recommendations on legislation, enforcement, education, chemical testing equipment, training of testing personnel, and other aspects of alcohol countermeasures programs.  Our hope is that by working with groups like this one, we can build support for our recommendations and see life-saving actions taken more quickly.

I’d really like to go the rest of my Emergency Medicine career without ever seeing another death or injury that resulted from substance-impaired driving.  I also know that’s not likely.  It’s going to take time to eliminate this deadly problem from our highways.  But I believe that with better data to diagnose the problem, we will eventually find the cure.


Dr. McKay is a Board Certified Emergency Medicine physician with almost 20 years of academic experience doing transportation safety and injury prevention research – in addition to teaching medical students and residents and taking care of patients.  She came to the NTSB in December, 2012 as the Chief Medical Officer.

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