Police Often Fail to Recognize Head Injuries as Cause of Symptoms of Impairment

By:  William C. Head

Many DUI defense attorneys have too little experience fighting DUI-accident cases to understand that these cases can be some of the easiest to win at trial.  Accidents cause symptoms that MIMIC "drunk" behavior.  Classic symptoms of a "closed head injury" (concussion) are:
 
1. Unsteadiness on Feet
2. Confusion or Disorientation
3. Repeating Questions or Statements
4. Slurred or Obtunded Speech Patterns
5. Red, bloodshot eyes
 
As any lay person knows, these "symptoms" are consistent with 90% of all DUI arrests.  Officers are generally not trained or marginally trained to identify a closed head trauma victim.  Police training discourages attempting to administer field sobriety tests to someone suffering the effects of an accident, but many officers (in their overzealous quest for a DUI arrest) push forward anyway, usually getting bogus or highly suspicious "results" from the dazed driver of the vehicle. 
 
If the officer smells an impairing substance (e.g., alcohol or marijuana), they will ASSUME that the symptoms they are seeing are being caused by the person's drunkenness.  When car accident suspects are arrested and not given proper medical treatment, a very real chance of death or severe debilitating condition (i.e., paraplegia) can occur in a few hours after the car crash.
 
Some courts have recognized this flaw in police training and have granted defense motions to suppress the DUI arrest (and all evidence gathered after arrest, such as breath tests or blood tests).  The critical importance of having knowledgeable defense counsel can be seen in reviewing three of my Client Case Histories:  01, 02 and 03.
 
Don't assume that an accident and the smell of alcohol equals a conviction.  Even where breath machine numbers or blood test results look daunting, a well-trained criminal defense attorney MAY have an answer to your legal dilemma.
 
See the following medical link information discussed symptoms of a significant closed head injury, and some of the fatal or devastating medical conditions that can follow a brain trauma episode.

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General Approach to Head Injury

The presence of significant intracranial injury should be obvious from the mini-neurological exam of the initial survey. The secondary survey may reveal a decreasing level of responsiveness or localized neurological deficits. When you find evidence of neurological injury, detailed testing such as Doll’s eyes and caloric testing can be left to the neurosurgical consultant.

The hallmark of cerebral injury is decreased level of consciousness. The differential diagnosis of decreased consciousness is “TIPPS on the VOWELS:”

     T = Trauma
     I = Infection
     P = Psychological
     P = Poisons
     S = Shock

     A = Alcohol
     E = Epilepsy
     I = Insulin
     O = Opiates
     U = Urea (metabolic)

Careful examination of the skull and facial bones may reveal evidence of an impact that makes intracranial injury more likely. Any patient who has some degree of minor head injury, who you do not x-ray or CT scan, should be reexamined before leaving the emergency department. Mastoid swelling and discoloration, widespread scalp hematoma, periorbital ecchymosis, and other “classic” signs of skull fracture often do not develop for hours.

Vital signs may reflect intracranial pathology. Increased intracranial pressure (ICP) often causes a slowing of respiration, then an increase with further elevation of ICP. The combination of systolic hypertension (widened pulse pressure), with slowed pulse is called the “Cushing response” to increased ICP. It often indicates a surgical lesion. Elevated temperature is common with cerebral injury. Tachycardia in the presence of head injury, unless due to some other injury, is a bad prognostic sign.

“Fancy” reflexes such as eyelid reflex, corneal reflex, Doll’s eyes, and calorics are of little value acutely, and are best left to the neurosurgical consultant. The patient is best followed using pupil signs and a general scale of responsiveness such as the Glascow Coma Scale.