REDUCING
DRUNK
DRIVING
DEATHS
in
HAWAii COUnTY
2012
Vision:
Hawaii County residents live in safe communities, and
always travel safely on island roads.
Goal:
To reduce the number of traffic-related deaths
and injuries in Hawaii County.
Alcohol misuse is now the leading risk factor for serious injury in the United States, and the third leading cause of preventable death. It accounts for more than 75,000 deaths annually.
Source: www.cdc.gov/ncipc/Spotlight/2003_Alcohol_Conference_Proceedings.htm
Disclaimer - While text citations and data for the indicators were, to the best of the author’s knowledge, current as the Reducing Drunk Driving Deaths in Hawaii County 2012 report was drafted, there may well have been subsequent data and developments, including recent legislative actions, that could alter the information provided herein. This report does not include statistical tests for significance and does not constitute medical advice. Indi-viduals with health problems should consult an appropriate health care provider. This report does not constitute legal advice. Recommendations are the opinion of the author and not necessarily the opinion of the sponsors. For more information, visit www.nhop.org. Please notify us at (808) 887-2425 if you believe there are any pos-sible data errors.
Summary... 1
The Problem Trail of Tears... 2-7 Drunk Driving... 8-9 National Recommendations... 10
Progress and More Action Needed... 11-12 Reduce Excessive Drinking and Underage Drinking... 13
Enforce DUI Laws... 14-15 Prosecute - Impose sanctions and treat DUI Offenders... 16
Control High BAC and Repeat Offenders... 17
Improve Traffic Safety Laws... 18-19 A Call to Action... 20-23 Appendixes Resources... 24
Young Driver Contract... 25-26 Hawaii Underage Drinking Law ... 27
Return on Investment for Motorcycle Helmets ... 28
Screening Tool for Problem Drinking... 29
Definitions and Abbreviations... 30
Hawaii Strategic Highway Safety Plan Recommendations ... 31
Potential Performance Measures... 32
Acknowledgements... 33
ALIYAH BRADEN December 2007 - May 2009
“It needs to be made very clear, drunk driving is unacceptable. There are no excuses for accepting this level of mayhem and deaths for a civilized people.”
SUMMARY
Too Many Innocent Victims Die from Drunk Driving Crashes
Too many innocent victims die from drunk driving traffic crashes in Hawaii County. Drunk driving is responsible for more than half of the fatal crashes in Hawaii County. Drunk driving deaths and injuries are 100% preventable.
Because so many people in Hawaii County have been affected by traffic deaths or se-rious injuries of family or friends, drunk driving has become a community issue. This has lead to strong island–wide collaboration to: reduce drinking and driving, increase enforcement of DUI laws, improve DUI laws, improve roads, bike paths, and pedes-trian walkways, and improve access to timely trauma care, by using evidence-based strategies.
The traffic deaths in Hawaii County decreased between 2000-2011 by 52%. Progress has been made. Unfortunately, traffic deaths in 2012 in Hawaii County have risen substantially to 32 as of 10/14/12, compared to a total of 23 deaths for all of 2011. More action is needed.
Reducing drunk driving deaths is a shared responsibility of: • Enforcement
• Emergency Medical Systems • Engineering
• Government (State and County) • Employers
• Restaurants, Bars, and Stores selling alcohol • Media
• Community and Advocacy
• Schools, Coaches, Parent Teacher Associations, and Drivers Education • Parents
• Families and Friends
Protecting our families and friends from becoming innocent victims of drunk drivers will require additional actions by each group of stakeholders, including you and me.
- Sharon H. Vitousek, M.D. Director, North Hawaii Outcomes Project
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North Kona
South Kona
Kau
Puna
South Hilo
North Hilo
Hamakua
South Kohala
North Kohala
Source: Injury Prevention & Control Program | For more information visit www.nhop.org or call (808) 887-2425
Trail of Tears...on Hawaii Island
Always Insist on a Sober Driver
Legend
(alcohol/drug impaired driving)#
#
#
impaired driving (189 crashes) 65% not tested/unknown (31 crashes) 11% no impairment (70 crashes) 24%
Location of Impaired
Driving Fatal Crashes
Too Many Innocent Victims
These innocent victims and too many like them died from drunk driving crashes in Hawaii County. All of the victims are deeply missed by their families and friends,
whose lives will never be the same.
THE PROBLEM - Trail of Tears
ANGELA APOSTADIRO November 1992 - February 2010
GARY “BABA” GONSALVES June 1992 - January 2010 ALIYAH BRADEN
THE PROBLEM - Trail of Tears
The traffic death rate in Ha-waii County between 2000-2005 was approximately three times higher than the traffic death rate for the City and County of Honolulu. However, the traffic death rate in Hawaii County im-proved in the second half of the decade and in 2011 was about two times higher than the City and County of Hono-lulu.
The traffic death rate in Ha-waii County improved 52%, between 2000 - 2011, which is more than in the other coun-ties. Hawaii County improve-ment is related to collaborative island-wide efforts of many traffic stakeholders. 7.4 8.8 7.5 8.8 7.7 8.2 9.5 7.2 4.6 5.6 6.3 5.3 25.5 19.8 18.1 20.8 25.2 23.8 22.5 21.4 16.0 14.7 16.7 12.3 10.9 11.4 9.6 10.6 11.1 10.8 12.3 10.5 8.0 8.1 8.3 7.3 0.0 5.0 10.0 15.0 20.0 25.0 30.0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
City & County of Honolulu Hawaii County State
Rate of Traffic-Related Fatalities
Chart: North Hawaii Outcomes Project - August 2012
Traffic fatalities include; motor vehicle occupants, pedestrians, motorcyclists, moped operators, ATV operators, and bicyclists.
Source: Numerator from Department of Transportation Denominator-Source: U.S. Census Bureau, Population Division, April1, 2010 to July 1, 2011(CO-EST 2011-01-15) Release Date: April, 2012
Hawaii County (2000-2011 reflects a -52% decrease) State (2000-2011 reflects a -34% decrease)
City & County of Honolulu (2000-2011 reflects a -29% decrease) 7.4 5.3 25.5 12.3 18.6 12.8 8.5 8.9 0.0 5.0 10.0 15.0 20.0 25.0 30.0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
City & County of Honolulu Hawaii County Maui County Kauai County
Rate of Traffic-Related Fatalities
Chart: North Hawaii Outcomes Project - July 2012
Traffic fatalities include; motor vehicle occupants, pedestrians, motorcyclists, moped operators, ATV operators, and bicyclists.
Source: Numerator from Department of Transportation Denominator-Source: U.S. Census Bureau, Population Division, "CO-PEST2010-totals July 1, 2000 to July 1, 2011(CO-EST2009-01-15) Release Date: September , 2011 2000-2011 Rate Change: City & County of Honolulu: -29% Hawaii County: -52% Maui County: -31% Kauai County: 4%
State: -34%
High Traffic Death Rate in Hawaii County
THE PROBLEM - Trail of Tears
The average number of annual traffic deaths in Hawaii County declined by 39% between 2000 to 2011. During the same time period, the average number of traffic deaths for the state declined by 24%.
The annual number of Hawaii County traffic deaths
de-creased each year since 2004, however, the number is higher in 2012. 65 78 67 79 70 75 88 67 43 53 60 51 38 30 28 33 41 40 39 38 29 27 31 23 132 140 119 133 142 140 161 138 107 109 113 100 0 25 50 75 100 125 150 175 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Number of Traffic-Related Fatalities (2000 - 2011)
Hawaii County
(2000-2011) reflects a -39% decreae
City & County of Honolulu
(2000-2011) reflects a -22% decrease
Chart: North Hawaii Outcomes Project - February 2012
Traffic fatalities include; motor vehicle occupants, pedestrians, motorcyclists, moped operators, ATV operators, and bicyclists.
Source: Department of Transportation
State (2000-2011) reflects a - 24% decrease
Although the number of traf-fic deaths from 2000 - 2011 declined in Hawaii County, more than in the other coun-ties, a total of 397 people died from traffic crashes on roads in Hawaii County roads, between 2000 – 2011.
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 City and County of Honolulu 65 78 67 79 70 75 88 67 43 53 60 51 Hawaii County 38 30 28 33 41 40 39 38 29 27 31 23 State 132 140 119 133 142 140 161 138 107 109 113 100 Maui County 24 28 20 16 21 15 20 24 24 21 12 20 Kauai County 5 4 4 5 10 10 14 9 11 8 10 6 65 51 38 23 132 100 24 20 5 6 0 25 50 75 100 125 150 175 Num ber of Fatal iti es
Number of Traffic-Related Fatalities (2000 - 2011)
Chart: North Hawaii Outcomes Project - July 2012
Traffic fatalities include; motor vehicle occupants, pedestrians, motorcyclists, moped operators, ATV operators, and bicyclists.
Source: Department of Transportation
2000-2011 Change: C & C of Honolulu: -22% Hawaii County: -39% Maui County: -17% Kauai County: 20% State: -24%
Too Many Deaths in Hawaii County
Deaths and Injuries in Hawaii County 2007 - 2011
The injury pyramid below shows that for each death in Hawaii County there are many more injuries, hospitalizations and emergency room visits.
Source: Data from Department of Health, Injury Prevention and Control Program, Dan Galanis, Ph.D. Display by North Hawaii Outcomes Project
Traffic Deaths are Only the Tip of the Iceberg
493
People with non-fa-tal injuries requiring
hospitalizations
8,259
Major traffic collisions 2,169
Number of days in hospital from non-fatal injuries
6,623
Number of injuries requiring treatment in Emergency Department
???
People with injuries not reported and/or vehicle
dam-One death every 12 days
One new hospitalization every 4 days
One person remaining in hospital every day
4 ER visits for injuries every day 5 major traffic collisions every day 148 Deaths
While more than half of fatal crashes in Hawaii County are related to impaired alcohol and/or drugs, half of the Hawaii County traffic deaths, 50%, involved driv-ers with a BAC of 0.08 or greater between 2006-2010.
For the same years, the state av-erage was 38% and the national average was 32%, according to National Highway Traffic Safety Association and FARS data.
Alcohol and /or drugs were as-sociated with 60 - 95% of fatal crashes in Hawaii County from 2006-2009, according to De-partment of Health data.
(Alcohol/Drug status from 2010 fatal traffic crashes in Hawaii County unfortunately was not available at time of print).
Drunk Driving
59.5% 95.0% 63.3% 64.3% 35.6% 27.6% 18.2% 34.0% 59.1% 39.3% 56.5% 43.8% 47.1% 58.3% 56.3% 77.8% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% 2006 2007 2008 2009Proportion of Fatal Crashes that
were Alcohol-Related and/or Drug-Related( 2006-2009)
Hawaii County City and County of Honolulu Maui County Kauai County
Chart: North Hawaii Outcomes Project - June 2012 Source: Department of Health, Injury Prevention
Drunk Driving is Responsible for Half of the
Traffic Deaths in Hawaii County
54% 42% 45% 59% 52% 37% 29% 39% 48% 37% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2006 2007 2008 2009 2010
Proportion of Alcohol-Impaired Driving (BAC=.08+) Fatalities (2006-2010)
Hawaii County State
Drunk Driving Deaths and Injuries are 100% Preventable
Always Insist on a Sober Driver
Drunk Driving
Drunk Driving is Responsible for More than Half of Fatal
Traffic Crashes in Hawaii County
National Cooperation Highway Research Program Recommendations
Recommendations from Transportation Research Board NCHRP Report 500, Volume 16 Guide for: Reducing Alcohol Related Collisions 2005 Strategies
5.1 A—Reduce Excessive Drinking and Underage Drinking
5.1 A1—Increase the State Excise Tax on Beer (T)
5.1 A2—Require Responsible Beverage Service Policies for Alcohol Servers and Retailers (P) 5.1 A3—Conduct Well-Publicized Compliance Checks of Alcohol Retailers to Reduce Sales to
Underage Persons (T)
5.1 A4—Employ Screening and Brief Interventions in Health Care Settings (T)
5.1 B—Enforce DWI Laws*
5.1 B1—Conduct Regular Well-Publicized DWI Checkpoints (P)
5.1 B2—Enhance DWI Detection Through Special DWI Patrols and Related Traffic Enforcement(T)
5.1 B3—Publicize and Enforce Zero Tolerance Laws for Drivers Under Age 21 (P)
5.1 C—Prosecute, Impose Sanctions on, and Treat DWI Offenders
5.1 C1—Suspend Driver’s License Administratively Upon Arrest (P)
5.1 C2—Establish Stronger Penalties for BAC Test Refusal Than for Test Failure (T) 5.1 C3—Eliminate Diversion Programs and Plea Bargains to Non-Alcohol Offenses (T)
5.1 C4—Screen All Convicted DWI Offenders for Alcohol Problems and Require Treatment When Appropriate (P)
5.1 D—Control High-BAC and Repeat Offenders
5.1 D1—Seize Vehicles or Vehicle License Plates Administratively Upon Arrest (P) 5.1 D2—Require Ignition Interlocks as a Condition for License Reinstatement (P) 5.1 D3—Monitor All Convicted DWI Offenders Closely (P)
5.1 D4—Incarcerate Offenders (P)
Note: (P) indicates that a strategy is proven effective. (T) indicates that a strategy has been tried extensively but is not yet proven effective. Further explanation of (T) and (P) appears in Section V. *This national source refers to DWI laws, however, in this report we use the term DUI .
Source: http://safety.transportation.org/htmlguides/ARcrashes/default.htm
P
rogress
A
nd
PROGRESS and MORE ACTION NEEDED
Progress in Hawaii County
Progress reducing traffic deaths and injuries in Hawaii County from 2000 -2011 is shown by:
• The death rate decreased by 52%.
• The number of traffic deaths decreased by 39%. • The number of major collisions decreased by 38%.
These improvements were accomplished through collaboration, increased enforce-ment of DUI laws; increased testing of drivers involved in crashes; increased DUI training of police, prosecutors and judges; engineering interventions, community prevention efforts; improved trauma care, improved traffic safety
laws, and improved data.
However, traffic deaths in Hawaii County are higher in 2012. There is a substantial increase of motorcycle fatalities in Hawaii County for 2012. 2169 2,276 2,260 2,362 2,477 2,393 2,450 2,171 1,716 1,530 1,442 1,400 1,140 0 500 1000 1500 2000 2500 3000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 `
Hawaii County - Number of Major Collisions
Chart: North Hawaii Outcomes Project - September 2012
Source: Hawaii County Police Department *As of 10.14.12
Background
“Many persons arrested for DWI have some level of problem controlling their drinking. Alco-hol screening to identify individuals with alcoAlco-hol problems—followed when appropriate by brief, single-session interventions by health care professionals to encourage changes in drinking behavior—has proved to be effective for persons who are not seriously dependent on alcohol. Those who are dependent often require treatment.”
Source: NCHRP http://safety.transportation.org/htmlguides/ARcrashes/default.htm
Progress
All three Acute Hospitals are working to prevent Drunk Driving as well as improve trauma care, with support of the Department of Health, to become Level III Trauma Centers.
• Hilo Medical Center partnered with the Prosecutor’s Office and Waiakea High School through a Shattered Dreams Project April 2010.
• Kona Community Hospital partnered with the Prosecu-tor’s Office, and Kealakehe High School to do a Shattered Dreams Project in 2011 and has plans to implement an alcohol screening program.
• North Hawaii Community Hospital implemented a drunk driving prevention program for all 440 graduating high school seniors in North Hawaii prior to 2012 graduation. Additional efforts to prevent underage drinking in Hawaii County are being conducted by the Hawaii County Police, Hawaii County Prosecutor’s, Hawaii County Underage Drink-ing Prevention Initiative and Hawaii Strategic Prevention Framework-State Incentive Grant (SPF-SIG) MADD, and the North Hawaii Drug Free Coalition.
More Action Needed
• Increase the state excise tax on beer.
• Require responsible beverage service policies for alcohol servers and retailers.
• Increase publicity of compliance checks of alcohol retailers to reduce sales to underage per-sons.
• Employ screening and brief interventions in health care settings.
• Collaborate to help parents, teachers, coaches and alcohol retailers understand their role in preventing underage drinking and driving.
Enforce DUI Laws
Progress
The annual number of DUI arrests in Hawaii County increased by 33% between 2003-2011.
Clearly there has been substantial increased enforcement of DUI laws in Hawaii County.
The number of DUI arrests for driv-ers under 21 years of age in Hawaii County decreased by 33% between 2003-2011. Why adult arrests in-creased and under age arrests decreased is not clear.
Hawaii County police have taken an active role in increasing high visibility enforcement to prevent drinking and driving. High visibility enforcement of DUI laws is an evidence-based strategy which has a documented return on investment of $144 accord-ing to the Center for Disease Control (Source: http://www.nhtsa.gov).
Hawaii County Police Increased DUI Arrests
1,076 1,086 1,069 1,293 1,410 1,397 1,395 1,513 1,435 1,123 0 200 400 600 800 1,000 1,200 1,400 1,600 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Chart: North Hawaii Outcomes Project - September 2012 Source: Hawaii County Police Department*As of 10.14.12 Hawaii County - Annual DUI Arrests
161 137 111 151 145 158 127 135 108 84 0 20 40 60 80 100 120 140 160 180 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Nu m ber o f A rr est s
Hawaii County - DUI Arrests Under 21 Years of Age
Chart: North Hawaii Outcomes Project - October 2012 Source: Hawaii County Police Department *As of 10.14.12
17% 15% 10% 25% 25% 21% 26% 21% 21% 25% 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Proportion of DUI arrests of drivers involved in a traffic collision
Chart: North Hawaii Outcomes Project - September 2012 Source: Hawaii County Police Department As of 10.14.12
Enforce DUI Laws
2.1 2.2 2.7 2.5 2.5 3.0 3.3 3.2 3.2 3.5 3.3 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Hawaii County - DUI Arrests per Sworn Active Police Officers (2001- 2011)
Chart: North Hawaii Outcomes Project - August 2012 Source: Hawaii State Data Book 2011
More DUI Arrests per Police Officers
The average number of DUI arrests per active sworn police officer increased by 57% from 2001-2010.
Hawaii Statute 291 E-21 requires alco-hol testing of drivers involved in crashes with injuries. The proportion of crashes which are tested for alcohol and/or drugs is difficult to measure. However, in Hawaii County over the past decade an increasing proportion of DUI arrests are of drivers involved in traffic collisions, which suggests increased testing of driv-ers involved in collisions.
More Action Needed:
• Publicize and enforce zero tolerance laws for drivers under age 21.
• Further increase mandatory testing of injury causing crashes.
• Enforce current motorcycle/moped laws requiring license for all riders and helmets for those under 18. • Enforce and track Hawaii County law
authorizing towing and immobiliza-tion, Aliyah’s Law.
Background
“DUI laws and enforcement are empty threats without effective prosecution, adjudication, and punishment for offenders. The consequences should be swift, certain, and appropriately severe. Swiftness and certainty are more important than severity. The strategies within this objective will help states increase the swiftness and certainty of DUI offender punishment. In addition, because many drinking drivers have an uncontrolled problem with drinking, it is important to identify those individuals and to ensure that they complete treatment for the problem before they are allowed to regain unrestricted driving privileges.”
Source: NCHRP http://safety.transportation.org/htmlguides/ARcrashes/default.htm
Progress
Suspend Driver’s License Administratively Upon Arrest.
• Hawaii does suspend driver’s licenses administratively upon arrest through the Admin-istrative Driver’s License Revocation Office (ADLRO) program at http://www.courts. state.hi.us/courts/administrative/adlro_links.html
• Hawaii County prosecutor’s office is working collaboratively with the (ADLRO) to in-crease effectiveness of administrative suspensions.
Establish Stronger Penalties for BAC Test Refusal Than for Test Failure.
• Hawaii has met this recommendation for years, with administrative penalties that are generally about twice the severity of the penalties for the person who takes the test and fails. Right now, with ignition interlock, a first offender who takes and fails the test, will get a one year license revocation (but can also install an interlock device if he or she is eligible) whereas the person who refuses gets a two year revocation of license and can also install interlock. The penalties for offenders who refuse continue to be twice that for the offenders who take the test and fail.
Eliminate Diversion Programs and Plea Bargains to Non-Alcohol Offenses.
• This has not yet been implemented in Hawaii, however there is currently an effort to train both courts and police in state-of-the-art DUI judicial processes and to develop DUI courts.
Screen All Convicted DWI Offenders for Alcohol Problems and Require Treatment When Appropriate.
• Hawaii does have a mandated alcohol assessment and treat-ment program. However data on what proportion of offenders are screened and treated, in what time frame and with what outcomes was not readily available.
More Action Needed
• Review data on ADLRO effectiveness, diversion programs and on court mandated alcohol screening and treatment effectiveness. • Implement DUI courts (SHSP recommendation).
Prosecute, Impose Sanctions and Treat DUI Offenders
Control High BAC and Repeat Offenders
Background
“Some individuals drive repeatedly while impaired by alcohol in spite of the threat of being arrested and punished. Many of them have been convicted of DWI [DUI] more than once; many have a very high BAC at their first arrest. The strategies within this objective provide methods to control their drinking and driving behavior. Many persons whose driver’s license has been suspended
or revoked continue to drive. The next step to stop their driving is to apply measures to their vehicles by taking the license plate or by immobilizing or impounding the vehicle. These pro-cedures are generally quite effective when applied, but courts rarely use them. They are more effective when applied administratively by the motor vehicle licensing agency.”
Source: NCHRP http://safety.transportation.org/htmlguides/ARcrashes/default.htm
Progress
Seize Vehicles or Vehicle License Plates Administratively Upon Arrest.
• Hawaii County did pass Aliyah’s Law, authorizing police to tow and immobilize vehicles driven by convicted DUI offenders who continue to drive with a suspended license. Imple-mentation has not yet begun.
• Hawaii State failed to pass the proposed immobilization laws in 2012, however an immobi-lization task force has been appointed to recommend this type of legislation.
Require Ignition Interlocks as a Condition for License Reinstatement
• Hawaii has made progress by implementing Ignition Interlock through Acts 171, 88, 166, and 327.
• Approximately 1,045 interlocks devices were installed statewide and168devices in Ha-waii County since as of July 2012.
Monitor All Convicted DUI Offenders Closely
• Currently Hawaii does not have probation for convicted DUI offenders. A DUI court task force has been appointed.
More Action Needed
• More action is needed at the state level to seize vehicles or license plates when appropri-ate, and monitor convicted DUI offenders more closely. Barriers to both includes lack of resources and Hawaii does not currently have probation for convicted DUI offenders. • Data from ignition interlock violations could provide an opportunity to monitor convicted
offenders more closely.
• Track arrests under Aliyah’s Law in Hawaii County.
Photo courtesy Braden F
Progress
1997
• Act 101 mandates health care providers to report to police the results of a blood alcohol level greater than the legal limit, if they have reasonable belief that the person may have been a driver in a motor vehicle collision causing injury.
Bills endorsed by Hawaii County Crash Reduction Group and signed into law:
2003
• Act 069 establishes Social Host Liability Law created as a civil liability for adults serving or providing alcohol to persons under the age of 21, resulting in death or injury to a third party.
2005
• Act 72 establishes Graduated Drivers Licensing Program for drivers under 18 years of age.
2006
• Act 202 prohibits the Consumption of Liquor by Minors.
• Act 203 “Use and Lose” requires judges to impose a 180 day drivers license suspension for minors under 21 when the person has violated laws related to underage drinking.
2007
• Act 175 requires Child Safety Seat or Booster Seat usage for children over four years, but less than eight years old.
• Act 201 increases sanctions for driving with a High Blood Alcohol level > to 0.15.
• Act 129 establishes the offense of Excessive Speeding and increases the penalty for this violation.
• Act 63 mandates Safety Helmet use for Moped drivers under the age of 18 years. • Act 64 helps to streamline the process for a DUI arrest.
2008
• Act 171 establishes task force for Ignition Interlock.
2009
• Act 88 establishes Ignition Interlock improvements.
• Act 46 mandates drivers of commercial vehicles are legally drunk when their blood alcohol level is 0.04% or greater.
2010
• Act 166 enacts implementation recommendations of the Ignition Interlock Task Force.
2012
• Act 318 Move Over Law requires motorists to move over for an emergency vehicle. • Act 327 Ignition Interlock improvements.
Improve Traffic Safety Laws
More Action Needed
Additional traffic safety laws are still needed as recommended by the Strategic High-way Safety Plan and Motor Vehicle Crash Reduction Group:
• Pass state law to seize vehicles or vehicle license plates administratively (Vehicle Immobi-lizations) for repeat DUI offenders.
• Pass state law to mandate motorcycle helmets (See Return on Investment for Motorcycle Helmet Use on page 28).
A CALL TO ACTION
Reducing Deaths and Injuries from Drunk Driving is a Shared
Responsibility of:
• Enforcement
• Emergency Medical Systems
• Engineering
• Government (State and County)
• Employers
• Restaurants, Bars, and Stores selling alcohol
• Media
• Community and Advocacy
• Schools, Coaches, Parent Teacher Associations, and
Drivers Education
• Parents
• Families and Friends
Progress has Been Made and More Action Needed
Enforcement (Police)
• Can increase high visibility enforcement of all DUI laws.
• Can increase focus on high visibility enforce-ment of zero tolerance laws for drivers under 21.
Enforcement (Criminal Courts)
• Can increase conviction rates and decrease processing time by improving processing of DUI offenders, especially repeat offenders.
• Can assess and improve effective links to alco-hol assessment and treatment programs. • Can implement DUI courts.
Enforcement (ADLRO - Civil Courts)
• Can collaborate with police and prosecutors to decrease rescission (dismissal) rates.
Engineering (DOT& County DPW)
• Can collaborate to improve access to timely, accurate crash location data to guide allocation of resources by engineering as well as enforcement.
• Can implement engineering improvements including center line rumble strips, milled rumble strips and SafetyEdge, etc.
• Can track impact of engineering improvements on high crash locations.
Emergency Medical Systems
• Can strengthen appropriate medical and legal testing for possible drivers suspected of OVUII.
• Emergency Rooms can implement screening, brief intervention and referral to treatment for trauma patients with risky alcohol or drug use in the Emergency Room. See http://sbirt. samhsa.gov/about.htm, or www.alcoholscreening.org.
Medical Systems
• Chemical Dependency Programs - can collaborate with enforcement to reduce wait times for OVUII offenders to obtain assessments and treatment, and to decrease recidivism rates. • Primary Care Providers - can improve identification and treatment of patients with alcohol
and /or drug problems, as well as co-occurring illnesses such as depression.
Government (State)
• Can pass legislation mandating universal motorcycle/moped helmets.
• Can pass legislation to control high BAC and repeat offenders through vehicle sanctions. • Can authorize and fund DUI court pilot in Hawaii County.
Government (County)
• Can track implementation of Count ordinances for traffic safety including the cell phone
A CALL TO ACTION
A CALL TO ACTION
Progress Has Been Made and More is Needed
Employers
• Can review the Guide for Employers to Reduce Motor Vehicle Crashes drinking and driving
policies. See www.osha.gov/Publications/motor_vehicle_guide.html
Restaurants, Bars, Stores Selling Liquor (Alcohol)
• Can implement increased server training for alcohol servers. See Training for Intervention
Procedures (TIPS) at http://gettips.com/ and Servers and Managers Alcohol Responsibility
Training (S.M.A.R.T.).
Media
• Can highlight the impact of alcohol-related deaths and injuries, the efforts to reduce drunk driving deaths and the resources to help.
• Can increase awareness of high visibility police enforcement of DUI laws.
Schools, Coaches and Parent Teacher Associations
• Can set clear expectations for adults working with students to follow all traffic safety laws.
• Can develop clear policies regarding student alcohol use. See http://www.stopalcoholabuse.
gov/media/GuidetoActionforEducators.pdf
• Can help students and parents understand the risks of drinking and driving, as well as, the DUI laws, especially social host liability laws and “Use and Lose Laws.” See Underage Drinking
report http://hawaii.gov/ag/quicklinks/LoRes%20UnderAgeDrinking%20Tab%20Full.pdf
• Can distribute the Young Driver Contract to students and parents.
• Can share the Shattered Dreams DVD’s done by Waiakea and Kealakehe High School with parents and students by calling the Prosecutor’s Office, Mitch Roth at (808) 934-3508. • Can encourage students to participate with existing efforts to reduce drunk driving by calling
MADD Hawaii County at (808) 934-3400 or the Impaired Driving Taskforce, Dieter Blatter at (808) 961-2226 or NHOP at (808) 887-2425.
• Can work with driver education teachers to distribute the Young Driver Contract.
• Can review evidence-based curriculums to prevent drinking and driving. See http://www.
toosmarttostart.samhsa.gov/Start.aspx and/or www.stopimpaireddriving.org/toolkits.html
Parents
• Can understand and follow traffic safety laws especially, graduated licensing, social host li-ability laws, and “Use and Lose Laws.”
• Can communicate clear prevention messages to their children. See Power of Parents at
http://www.madd.org/underage-drinking/the-power-of-parents/
• Can require their teenage children to sign the Young Driver Contract, see page 24-25.
Families and Friends
• Can Always Insist on a Sober Driver.
• Can encourage family and friends who drink, to take a survey to assess, “how much is too
What You Can Do Now
Support improved traffic safety laws to:
• Mandate motorcycle/moped helmets
• Seize vehicle or license plates administratively for repeat DUI offenders. • Authorize and fund DUI courts in Hawaii County.
Learn more:
• Understand your role in reducing drunk driving deaths (see pages 21-22). • See additional resources in Appendices page 24-31.
• See http://nhop.org/communityhealthpriorities/trafficsafety/
Join others:
• Hawaii County Impaired Driving Task Force Coordinator Dieter H. Blattler (808) 961-2226.
• Mothers Against Drunk Driving (MADD), Hawaii County office at (808) 934-0300 or visit www.madd.org/local-offices/hi/ or call State office (808) 532-6232.
• Hawaii State Strategic Highway Safety Plan, Impaired Driving Emphasis Area Chair, Arkie Koehl (808) 529-0908.
• Underage Drinking Prevention - Hawaii County Office of the Mayor (808) 961-8860.
A CALL TO ACTION
Always insist on a sober driver.
Hawaii County
• Hawaii County Police – www.hawaiipolice.com
• North Hawaii Outcomes Project – Traffic Safety -
www.nhop.org/communityhealthpriorities/trafficsafety
State
• Hawaii Strategic Highway Safety Plan 2007-2012 – http://hltap.eng.hawaii.edu/shsp/
• MADD - www.maddhawaii.com
National
• American Association of State Highway and Transportation Officials / – Strategic Highway Safety Plan Implementation Guides for National Cooperative Highway Research Program Report 500 - http://safety.transportation.org/guides.aspx
• Centers for Disease Control and Prevention – Motor Vehicle Safety - http://www.cdc.gov/motorvehiclesafety/
• Centers for Disease Control and Prevention – Alcohol Screening -
http://www.cdc.gov/injuryresponse/alcohol-screening
• County Health Rankings & Roadmaps - What Works for Health, Alcohol - http://www.countyhealthrankings.org/programs/all/all/3357
• Governor’s Highway Safety Association Countermeasures That Work
-http://www.ghsa.org/html/publications/countermeasures.html
• Mothers Against Drunk Driving - www.madd.org
• National Center for DWI Courts - www.dwicourts.org
• National Highway Traffic Safety Association - Community-Based Driving-Impaired Programs 2012 - http://www.nhtsa.gov/Impaired
• National Institute of Health - Alcohol Policy Information System -
http://www.alcoholpolicy.niaaa.nih.gov/
• Students Against Destructive Decisions - www.sadd.org
• The Guide to Community Preventive Services - Motor Vehicle Related Injury Prevention - http://thecommunityguide.org/mvoi/AID/index.html
• The Substance Abuse and Mental Health Services Administration - Screening, Brief Intervention and Referral to Treatment Resources
-http://www.samhsa.gov/prevention/sbirt/
International
• Halving Roadway Fatalities: A Case Study from Victoria, Australia 1989-2004 - http://international.fhwa.dot.gov/halving_fatalities/index.cfm
TO SUPPORT OUR COMMON GOAL TO BE SAFE DRIVERS
We, ______________________________________ and ____________________________________ (Names of Parents or Guardian) (Name of Young Driver)
agree to the following conditions: 1. Young Driver Responsibilities Initial all that apply:
____ I will not let anyone else drive or use the vehicle entrusted to me.
____ I will not break driving laws. Any violations may result in a loss of vehicle privileges. ____ I will not consume drugs or alcohol in the vehicle or operate any vehicle under the
influence of alcohol or illicit drugs. Any violation will result in the loss of vehicle privileges. ____ Everyone in the vehicle must wear a seat belt and keep it fastened at all times.
____ I will state my destination and time of return prior to using any vehicle. I will notify my parents if I think I will be more than 30 minutes late.
____ I will drive in a manner not to endanger my life, the lives of my passengers, or anyone else on the road.
2. Cost and Maintenance of Vehicle
___________________________________________________ will be responsible for the following: (Name of Young Driver)
3. Driving Privileges
This portion of the contract may be used to outline any additional conditions or limits on the use of the vehicle as agreed to by teens and parents:
___________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________
APPENDIX -Young Driver Contract
Indicate dollar amount or percentage of cost:
____Cost of vehicle ____Cost of fuel
____Damage to the vehicle ____Insurance costs ____Vehicle registration ____Maintenance costs ____Fines and penalties ____Other
Check all that apply:
____Checking the fluids regularly
____Inspecting tires and checking air pressure ____Reporting unusual performance
____Keeping the interior and exterior clean ____Other
____Do normal maintenance ____Clear or clean all windows
4. Parental Responsibilities Initial all that apply:
____ I will listen in a respectful manner to explanations or concerns expressed by my young driver regarding the operation of a vehicle or the terms of the contract.
____ I will provide respectful feedback when accompanying my young driver in a motor vehicle.
____ I will serve as a good role model when operating a vehicle and teach good driving skills and habits to my young driver.
5. Operator Impairment as a Result of Alcohol and Illicit Drugs
A. Young Driver’s Responsibility. I will not get into the vehicle of a driver who has been drink-ing or usdrink-ing illicit drugs. I will seek alternative transportation or I will call you for advice and/or transportation at any hour from any place.
______(Initial, Parent or Guardian) ______(Initial, Young Driver)
B. Parent or Guardian’s Responsibility. I (We) agree to come and get you at any hours, from any place, with no questions asked and no argument at that time, or I (we) will pay for a taxi to bring you home safely. I (we) expect that a discussion of such an incident would follow at a later time. Likewise, I (We) as you parent or guardian, agree to seek safe, sober transportation. I (we) will not drive if I (we) have been drinking, nor will I (we) ride with a friend who has been drinking.
______(Initial, Parent or Guardian) ______(Initial, Young Driver) Legal Penalties
Under current Hawaii law, all new drivers under 18 years of age operate first with an instruc-tional permit followed by a provisional license, before they are eligible for a full license. Moving violation such as speeding, failure to obey traffic lights or stop signs, and other reckless driving offenses will result in the loss of the provisional license as follows:
First offense Loss of license for 6 months Second offense Loss of license for one year
Drivers under 21 years of age who operate a vehicle after consuming a measurable amount of alcohol (0.02) are subject to the following penalties:
First offense Loss of license for 6 months Second and subsequent offenses Loss of license for one year 6. Liabilities
All drivers are legally responsible for their own actions as a driver and vehicle owners may be legally liable for damages caused by any person operating the owner’s vehicle.
Parents and young drivers should understand that insurance coverage and rates may be affect-ed by any damages that result from the inappropriate use of the owner’s vehicle.
We agree to the terms of this contract, which may be revisited or revised at a later time.
______________________________________ _____________________________ Signature of Parent or Guardian Signature of Parent or Guardian ______________________________________ _____________________________ Signature of Young Driver Date
Hawaii Social Host Liability Law
Hawaii’s Social Host Liability Law holds adults financially liable for hosting underage drinking on property they own, lease, or otherwise control.
The Hawaii Social Host Liability Law establishes criminal penalties of up to one year in jail, fines of up to $1,000 or both for persons who furnish alcoholic beverages to anyone younger than age 21 (The previous law only prohibited adults form buying alcohol for minors). Under the new law, passed in 2003, adults who knowingly provide liquor to someone younger than age 21 or have knowledge of underage drinking on their property and could have prevented it can be held financially responsible for any third party injury that may occur from their provision.
Use and Lose Law for Under 21
The law states that any person under the age of 21 found to have consumed, possessed, or purchased alcohol shall have his/her driver’s license, provisional license, or instruction permit suspended for a period of 180 days. The law applies also to the situations where youth falsify identification or use false identification to buy or attempt to buy alcohol. Under this law offend-ers are required to perform 75 hours of community service and undergo 8 -12 hours of alcohol education and counseling at the offender’s or their parents’ expense.
Motorcycle Helmets Save Lives and Money
“Despite the overwhelming evidence, some motorcyclists refuse to wear helmets and op-pose helmet use laws. Their argument is that helmet laws represent government interfer-ence and these laws thwart an individual’s freedom to take risks and to gamble against death and permanent injury.
Unfortunately, the families of the injured, as well as society as a whole must bear the tremendous economic, psychological, and social costs involved in deaths and injuries to un-helmeted cyclists.
In November 2002, NHTSA reported that 25 studies of the costs of injuries from motorcycle crashes ‘consistently found that helmet use reduced the fatality rate, probability and sever-ity of head injuries, cost of medical treatment, length of hospital stay, necesssever-ity for special medical treatments, and probability of long-term disability.’
Hospitalization costs are higher for motorcycle crash victims who don’t wear helmets, com-pared to those who do. Numerous studies have comcom-pared hospital costs for helmeted and un-helmeted motorcyclists involved in traffic crashes. These studies revealed that un-helmeted riders involved in crashes are more likely to have higher hospital costs than helmeted riders involved in similar crashes and less likely to have health insurance. Only slightly more than half of motorcycle crash victims have private health insurance coverage. For patients without private insurance, a majority of medical costs are paid by the govern-ment. [Ultimately, paid by state tax players.]
NHTSA estimates that more than $7.5 billion was saved from 1984 through 1995 because of the use of helmets. An additional $6.8 billion would have been saved if all motorcyclists had worn helmets. Helmet use laws, like safety belt use and many other traffic safety laws, make good sense for motorcyclists.”
Source:
http://trafficsafety.org/safety/sharing/motorcycle/motor-safety-everyone/mot orcycle-helmets-for-all-riders
APPENDIX - Screening Tool for Problem Drinking
How Much is Too Much?
NIAAA QUANTITY AND FREQUENCY QUESTIONS
• On average, how many days per week do you drink alcohol? • On a typical day when you drink, how many drinks do you have?
• What is the maximum number of drinks you had on any given occasion during the last month?
CAGE (IN THE LAST 12 MONTHS)
• Have you ever felt you should Cut down on your drinking?
• Have people Annoyed you by criticizing your drinking? • Have you ever felt bad of Guilty about your drinking?
• Have you ever had a drink first thing in the morning to “steady your nerves” or get rid of a hangover (Eye Opener)?
SCREEN IS POSITIVE IF:
• A positive response on 1 or more questions from CAGE and/or
consumption:
Men > 14 drinks/week or > 4 drinks/occasion
Women > 7 drinks/week or > 3 drinks/occasion
Over 65 years old > 7 drinks/week or > 3 drinks/occasion
THEN ASSESS FOR:
• Medical problems: blackouts, depression, hypertension, injury abdominal
pain, liver dysfunction, sleep disorders
• Laboratory: Liver function tests, macrocytic anemia • Behavioral problems
• Alcohol dependence
INTERVENE:
If at-risk/harmful drinker:
• Advise patient of risk. • Set drinking goals.
• Provide referral to primary care.
If alcohol dependent drinker:
• Assess acute risk of intoxication/withdrawal
• Negotiate referral (i.e. detoxification, AA and primary care).
Reference: The Physician’s Guide to Helping Parents with Alcohol Problems. National Insti-tute on Alcohol Abuse and Alcoholism. NIH Publication No. 95-3769 and the ASAM reference
SCREENING FOR ALCOHOL PROBLEMS IN THE ED
• These same screening tools can also be used by families and friends to identify people who may have a problem with drinking .
• A confidential online screening tool is available at www.alcoholscreening.org
• For advice and resources on how to help friends with their drug and alcohol use see http:// www.theantidrug.com/pdfs/resources/teen/Step_Up_Brochure.pdf
• TRAFFIC-RELATED FATALITY - traffic-related fatalities include: motor vehicle occupants, pedestrians, motorcyclists, moped operators, ATV operators and bicyclists.
• ALCOHOL-RELATED FATALITY – is a death that occurs in a crash involving at least one driver, pedestrian, or pedal cyclist with a BAC of 0.01 or above (National Highway Traffic Safety Asso-ciation, Traffic Safety Facts, August 2007).
• ALCOHOL IMPAIRED FATALITY - is a death with a BAC of 0.08 or above (National Highway Traffic Safety Association).
• BAC - alcohol content in the body, originally measured using alcohol in blood (BAC stood for Blood Alcohol Content, expressed in milligrams of alcohol per 100 milliliters of blood), now typi-cally measured using alcohol in breath (NHTSA, 2012).
• DUI-RELATED FATALITY – is a death that occurs in a crash involving at least one driver or motorcycle operator who was legally intoxicated (BAC=0.08+ (National Highway Traffic Safety Association, Traffic Safety Facts, August 2007).
• ALCOHOL-RELATED TRAFFIC CRASHES - are defined by the U.S. National Highway Traffic Safety Administration to include any and all vehicular (including bicycle and motorcycle) ac-cidents in which any alcohol has been consumed, or believed to have been consumed, by the driver, a passenger or a pedestrian associated with the accident (alcohol-related traffic crashes in the United States (September 24, 2007).
• ADLRO - Administrative Driver’s License Revocation Office
• BAC - Blood Alcohol Content
• DUI - Driving under the Influence
• DWI - Driving While Impaired, Driving While Intoxicated, and/or Driving Under the Influence
• SHSP - Strategic Highway Safety Plan
• IID - Ignition Interlock Device
• NCHRP - National Cooperative Highway Research Program
• OVUII - Operating a Vehicle Under the Influence of an Intoxicant
• DWS / DWR - Driving while License Suspended or Revoked
APPENDIX - Definitions
Hawaii State Strategic Highway Safety Plan Recommendations for:
Combating Impaired Driving
• Utilize ignition interlocks to prevent drinking and driving by DUI offenders. • Continue high-visibility sobriety checkpoints and media campaign.
• Urge police departments to adopt a mandatory blood draw policy for serious vehicular crashes.
• Provide specialized training for police, prosecutors and judiciary to keep up with latest trends and legal issues.
• Set up special courts within the Judiciary to provide a systematic and coordinated approach to prosecuting, sentencing, monitoring and treating DUI offenders.
• Develop a Statewide DUI Task Force to increase focus on alcohol and drug strategies that include implementation and evaluation phases. Task Force sub-committee can be setup to track legislation, education, enforcement, technology and treatment issues.
• For full report see http://hltap.eng.hawaii.edu/shsp/SHSP2007-2012.pdf
Reducing Motorcycle Deaths and Injuries
• Pass state law to mandate motorcycle helmets. • Increase drunk driving prevention efforts.
• Increase awareness of current motorcycle/moped laws requiring license/”endorsement” and, helmets for moped riders under 18.
• Increase enforcement of current motorcycle/moped laws.
• Develop public information programs to encourage sharing of the road and how to drive safely around motorcycles and mopeds.
• Improve data for motorcycle-specific crashes in order to identify key areas for prioritizing re-sources.
Improving Data and Safety Management Systems
• Improve traffic safety data to be more timely, accessible, integrated, accurate, complete and usable by traffic safety stakeholders.
ENFORCEMENT: Police Data
Source Performance Measures (per calendaryear)
Enforce DUI / OVUII laws
Police
# of DUI /OVUII arrests (total for county & by district, if possible) # of DUI arrests with prior arrest in past 10 years
# of arrests for OVUII - drugs Publicize and enforce zero tolerance laws for
under 21 # of DUI arrests (<21 years old) # of "use & lose" citations # of "social host" citations
Control high BAC and repeat offenders # of arrests for driving while license is suspended or revoked
Conduct regular well-publicized DUI
check-points # of sobriety check points per year # of arrests from sobriety checks
# of sobriety check points which had media coverage
Increase appropriate alcohol & drug testing of
crashes involving injuries # of police ordered tests for alcohol: breath tests and blood tests# of police ordered tests for drugs: urine tests and blood tests
Increase Drug Recognition Evaluation (DRE)
Staffing # of current officers with DRE training as of December# of police officers who received DRE training during year Implement vehicle sanctions for repeat
offenders and driving with license revoked # of vehicle sanctions for repeat offenders# of vehicle sanctions for driving with license revoked Conduct well-publicized compliance checks
of alcohol retailers to reduce sales to
under-age persons Control / Liquor
# of compliance checks
# of citations from compliance checks
# and type of citations/sanctions on liquor outlets
Increase alcohol server training # of server trainings
# of liquor outlets which participated in training
Increase penalties for motorcycle unlicensed,
speeding, or impaired drivers Judiciary # of citations for inadequate motorcycle license# of citations for motorcyle speeding ENFORCEMENT: Courts (Civil)
Suspend driver's license administratively upon arrest
ADLRO
# of administrative driver license revocations # of rescissions (dismissals)
Require ignition Interlock for license
rein-statement # of ignition interlock permits issued.
ENFORCEMENT: Courts (Criminal) Prosecute, Impose sanctions on and treat DWI offenders
Prosecutors Judiciary
# of DUI cases prosecuted # of DUI dismissals (# not served)
# of DUI convictions / arrest (conviction rate)
Reduce processing time for DUI arrests # of days for average DUI process (from arrest to disposition of case) # of cases meeting 90 day goal
Control high BAC and repeat offenders Implement: 1) DUI court 2) Separate tracking of repeat offenders
Screen all convicted DUI offenders for alco-hol problems and require treatment where appropriate
# of DUI referrals for alcohol/ drug assessment
# of cases screened within 30 days of referral # of treatment referrals for which treatment completed within 30 days
EMERGENCYMEDICALSERVICES
Support police departments to adopt manda-tory blood draw for injury causing crashes
ER
# of legal blood draws per year for alcohol & for drugs by ER # of medical draws for alcohol and/or drugs by ER
# of requests to police for legal draws by ER Employ screening and brief interventions in
Health care settings # of ER's using alcohol screening and brief intervention tool
ENGINEERING
Pursue on a priority basis, projects identified in the Hawaii Safety Improvement Program
with known histories of crashes County DPWDOT/
# of high crash locations which had analysis and number with a plan developed
Interventions based on timely, accurate crash
location data # of high crash locations with engineering improvements implemented
DATA & SYSTEMS
Improve traffic safety data to be more timely,
accessible, integrated, complete and usable NHTSA [NHTSA review?]
Legend: = NCHRP Recommendation = SHSP Recommendation =MVCRG Recommendation
APPENDIX - Potential Performance Measures
Many individuals and organizations contributed to this work and report. The authors wish to express special appreciation to:
OUR FUNDERS:
The Earl and Doris Bakken Foundation
Hawaii State Department of Transportation – Hawaii Safety Section OUR PARTNERS:
HAWAII STATE DEPARTMENT OF HEALTH - INJURY PREVENTION AND CONTROL PROGRAM Dan Galanis, Ph.D.
Kari Benes
HAWAII COUNTY POLICE DEPARTMENT Chief Harry Kubojiri
Retired Captain James Sanborn Randy Apele Robert Pauole Denise Erickson-Smith Brent Foster Dieter Blattler Winnie Cabral
HAWAII COUNTY PROSECUTOR’S OFFICE Charlene Iboshi
Mitch Roth
HAWAII COUNTY MASS TRANSIT Tom Brown
HAWAII FIRE DEPARTMENT, BUREAU OF EMERGENCY MEDICAL SERVICES Lance Uchida
Jesse Ebersole
EMERGENCY MEDICAL SERVICES Linda Rosen, M.D., MPH Sherry Lauer R.N.
BIG ISLAND TRAUMA ADVISORY COMMITTEE Louise Fincher
Wendy Wagner Lynn Witte
HAWAII STATE DEPARTMENT OF TRANSPORTATION Glenn Okimoto, Lee Nagano
Sean Hiraoka, Scott Haneberg
RETIRED EMERGENCY PHYSICIAN AND COUNTY COUNCIL MEMBER Fred Holschuh, M.D.
MADD
Abigail Nickell Carol McNamee Arkie Koehl
FAMILIES OF TRAFFIC VICTIMS The Braden Family
The Apostadrio Family
North Hawaii Outcomes Project | 65-1241 Pomaikai Place #7 | Kamuela, Hawaii 96743 | Phone: (808) 887-2425 | Fax: (808) 887-1474 | Website: www.nhop.org
