 This is Think Tech Hawaii, Community Matters here. Welcome. This is Craig Thomas, your host on Much More on Medicine, part of Think Tech Hawaii's live stream series, and assisted, as always, thank you, by Rich and Ray, our engineers. And joining me today are Carol Mackley and Arke Kale from Mad Hawaii. And I'm delighted you're here. A theme of our spring has been the various elements, both within medicine, but in a larger community that impact health. And so we've talked about ocean safety, narcotics utilization, as well as some aspects of the pre-hospital and medical systems. And something I've learned over the years, if you could prevent an injury or illness, you're way ahead of the game. And huge progress has been made. I know that this has been a long struggle. But despite driving many more miles and having many more drivers, since I started, God help us, about 40 years ago, the number of junk driving fatalities has decreased by almost three-fold. That's fabulous. When I started, if you didn't spend a Friday night picking glass out of some drunk person's forehead where they went through the windshield, because A, they were drunk, B, they were unrestrained, and C, the windshields used to shatter in ways that put glass in foreheads. If you hadn't had this pleasure every Friday night, your week was incomplete. Those events are rare now. But we still see lots of people who are either drunk driving themselves or are injured by drunk drivers. And just this weekend, I overheard a conversation, a couple of young guys, young guys are always a problem, who are lamenting the fact that why only two beers might put them over the limit. You know what the trouble with only two beers is? You are not the driver you were before the two beers, but besides that, you feel like Superman. So I think that in a nutshell is the problem we're facing. And so I'm glad you're both here because you represented an opportunity to mitigate this. And I'd like to start with you, Carol, because I think it was about 20 years ago that you and I first met. And... At least. At least. And embarked on some legislative efforts of varying success. And I'd be honest, I've been a slacker. I sort of moved on to some other things, but I've always been aware of the problem that admired your effort and persistence. So I'm glad you're here. Well, I'm glad I'm here too. And thank you for using the word persistence. And I can remember back when we first started and another friend of mine who's been with Matt almost as long as I have. Well, the two of us would say, we'll just do one more year. We'll just give it five years. And that's it, we started this, but we're gonna walk away from it because all these other people are gonna come out and take it over and we're gonna solve all the problems and live happily ever after. Unfortunately, as you mentioned, this has not happened. And for me it was just impossible to walk away when you see what the crime of impaired driving does to people. We look at a lot of statistics, but so much of what Mad does is to support the victims. And when you do that and you see what happens when a drunk or drug driver causes a crash and there is a victim who is killed, leaving a family in grief or someone who's injured and taken to a hospital where they might never get better really, that's what gets your heart. And that's what creates the persistence because all of this started actually almost 35 years ago in Hawaii. We were the 200th Mad chapter established, chartered. And that was in 1984. And we really didn't know what we were getting into. And so it has been difficult, it has been frustrating, it has been challenging, but overall it has been a magnificent learning experience and we are grateful for the successes that we have had. You've had real successes. As I said, I'm a tremendous admiration of your persistence and your good humor in the face of many obstacles. And you did allude to something which I think is worth mentioning. We talk about deaths all the time and obviously that's the ultimate metric. But for every person killed, either a drunk driver, impaired driver, because it's obviously more than just alcohol themselves, or killed by one, there are multiple people injured. Never good to be injured, never good to come see me in the ER because it's hard to improve on healthy. So if you're injured, you may get back to baseline. Many do, some do not. And we routinely don't focus on those people but this is, so the people impacted by impaired drivers is much larger than the fatality number. And that's I think just something everyone should be aware of. And my real problem with this issue is often these people are just passers by. They're walking a side road, they're driving another vehicle, they're peripherally but permanently impacted. And so the other issue you also sort of alluded to is it's always easy to get money to impact some heroic save. It's much harder to get resource or engagement on making the save unnecessary. So there are many people today, possibly me, possibly either of us, walking around unimpacted by getting run into by an impaired driver. That's fabulous, that's the biggest success. But it's also under the radar. Well, and one interesting statistic that just came into my mind because of what you said is that evidently research has found that two out of every three Americans have been impacted by somehow by impaired driving. And I know that I have, I don't know about Arche, I don't know about other people in this room, but if you really start thinking, is there a friend, is there a relative? I mean, you yourself maybe have been in some kind of crash. Maybe no one was killed, but was someone injured or just emotionally impacted by having someone crash into you or nearly crash into you even. So yes, with that kind of a statistic, it is so important that MAD is here and all the highway safety partners we work with, I must say, MAD does not work in a vacuum. We do not work by ourselves. We have an extensive group of highway safety partners. Many of the years we've had task forces, especially to strive to pass legislation that is really significant. And that brings me to the kinds of things that MAD has done working in collaboration with task forces. And we did this right from the beginning. MAD never worked by itself, but things like raising the drinking age, reducing the legal blood alcohol level, I actually should say illegal, from 0.10, which it was until 1980, then it was reduced to 0.08. And many, many other things, including ignition interlock, which we're gonna talk about a little bit later, getting that that is the most recent piece of significant legislation that has been passed. And again, we had a whole task force that worked for, let's see, from 2007 to 2011 before that bill got passed. We did that in stages because of its complexity. So it takes more than a village to make change. But in addition to the legislative work, the public policy work that has been done, MAD has also done a great deal of education. And part of our mission is to prevent underage drinking. So we like to start that education with people, children and teens and youth who are still in school and then go on from there with general education for the whole public. And then of course it's also supporting the victims. And that's its own education and to get the word out that we have that program and encourage people to call MAD when there has been a tragedy. And there's been a lot of publicity about all that's going on, on the Leeward Coast, the YNI Coast, which has a high level of impaired driving crashes in that region. So we're very busy because we do have a four prong mission that includes all those things that I have mentioned. And in fact, now we're even starting to look at the specific problem of driving under the influence of drugs. Other substances, yes. So that's something that is coming into our future. Starting now. Sadly, there are many ways to be impaired. So I'm glad that you talked about the spectrum of this because that's what I become convinced also that it's changing culture is really difficult. And that's actually what's required. And protecting people in that process, convincing people that tools and various kinds of legislation are required. And then if they are implemented that they're actually utilized, all those things are challenging. Well, you know, I think about the term designated driver. That's something we all know about. We all think about that now. Back in 1980, when MAD started nationally and even in 1984, when we started here, that was not a term. It came, someone I think was the chapter in Orange County, California came up with that term and it went viral, within MAD it went viral, although that wasn't even a word that we used. No, but you're right. And that's a good example of a cultural change. Yes. And it's also a cultural change. You should have zero tolerance as the designated driver have drunk at all. Whereas they used to have this formula, you couldn't drink 1.8 depending on how fat you are or whatever, the problem is once you drunk 1.8, you don't care, you're Superman. We're gonna discuss some specific strategies after the break. And so we'll look forward to seeing everyone in about a minute. This is Think Tech Hawaii, raising public awareness. You can be the great host of Asian review here on Think Tech Hawaii. Join me every Monday afternoon from five to five 30 Hawaii Standard Time for an insightful discussion of contemporary Asian affairs. There's so much to discuss and the guests that we have are very, very well informed. Just think we have the upcoming negotiation between President Trump and Kim Jong-un. The possibility of Xi Jinping, the leader of China remaining in power forever. We'll see you then. Sounds like scuba divers are the poor man's astronaut. At Dive Heart, we believe that to be true. We say, forget the moment. Dive Heart can help children, adults and veterans of all abilities escape gravity right here on Earth. Search diveheart.org and imagine the possibilities in your life. Hi, I'm Ethan Allen, host on Think Tech Hawaii of Pacific Partnerships in Education. Every other Tuesday afternoon at 3 p.m., I hope you'll join us as we explore the value, the accomplishments and the challenges of education here in the Pacific Islands. Do you want to be cool? Watch my show on Tuesday, The Comfort Zone. I sang this song to you because I think you either are cool or have the potential to be seriously cool. And I want you to come watch my show where I bring in experts who talk all about easy strategies to be healthier, happier, build better relationships and make your life a success. So come sit with the cool kids at Out of the Comfort Zone on Tuesdays at 1. See you there. Living in this crazy world. So far up in the confusion. Nothing is making sense. Welcome back. This is your host, Craig Thomas, much more on medicine. And as you can see during the break, we replaced the pretty much irreplaceable Carol McNamee. It took two to do it. I'd like to welcome Joanne Hamagioto and Amy Scrantz, who both are involved with interlock interfaces, designed to prevent people who are impaired from operating a vehicle and putting themselves at others at risk. Before we actually address you folks specifically, Arke, I'd like you to talk a little bit about sort of how we got here, what the strategy is, and then we'll demonstrate the advice and talk about where we go from here. Yeah, thanks very much, Craig. As Carol mentioned, the law that we worked on for four years and finally got passed in 2011, the so-called ignition interlock law, the ignition interlock, by the way, if you prefer, you can call it an in-car breathalyzer. That's really what it is, an in-car breathalyzer. And Joanne and Amy are gonna show us exactly how it works, because it's a very fascinating operation. And the first thing that when you see one of these, first thing you start doing is asking questions, well, how can I cheat it? And they're gonna explain how you can't cheat it. So it's a very useful thing. They're gonna talk about how much it costs. It's been in effect now since 2011, and as you know, your car won't start if you blow anything above a trace of alcohol. Your car won't start. Now, since 2011, there have been close to 90,000 episodes, incidents, where people fail to start their car because they had liquor on their breath. And that is an incredible number. That's 90,000 potential drunk driving episodes avoided, and translate that into how many drunk driving episodes, how many crashes, and possibly how many lives have been saved by that. So with that sort of a framework, I'd like to have them demonstrate and explain in more detail the device. They're also gonna demonstrate a non-car breathalyzer, a portable breathalyzer that you carry around with you, which is becoming used by more and more jurisdictions around the country for people who for one reason or another cannot get the interlock, don't have a car or cannot get the interlock on their car, and that's a very effective thing also. And they'll show that after they demonstrate this, I would like to take a few seconds just to show the future, the long-term future, work that the government is doing and the automobile manufacturers are doing on making it impossible for anybody to drive drunk, period, maybe 20 years from now. Let's hope it's not 20 years from now, but sooner, but you may be right. This is a big process. Well, anything you do that's in car manufacturing, it's gonna take 20, 30 years just to get rid of all the old cars. There's that. I'm delighted you're here. I am thrilled at the idea. We can keep people from even starting their vehicle. I would point out that ultimately, maybe we can keep people from horseback riding drunk. That was recently the news. A patient I'm not gonna name for confidentiality reasons. Precision riding is bicycle drunk. So we really need to stop people from imbibing and driving anything. And as the paper demonstrated recently, front page story on Monday regarding delays in court and the whole sort of process and almost industry around this, we need to get past that. I think this is one of the ways. So thank you. Thank you for having us. And thank you also to Ark and Carol for inviting us to join them on this segment. We are with Smart Start and we are headquartered in Great Wine, Texas. And we are the state's contracted vendor to install ignition interlock as well as provide portable alcohol breath devices. We've been saving lives for over 25 years and have prevented drunk driving from getting behind the wheel. To date, we've serviced over one million clients and have prevented 11 million alcohol-positive prevented starts. Ark mentioned close to 90,000 that is just in the state of Hawaii alone that we've stopped drunk drivers from starting their vehicles. So that's wonderful since the law was implemented in 2011, the interlock law. We are, we have over 2,000 service locations in the United States as well as in 18 countries. With that being said, we are continuing our mission in setting the standard in alcohol monitoring technology. The interlock, this is how it looks like. It's about the size of a cell phone, a little bit larger than a normal cell phone. But this is installed into the vehicle and what it does is that in order for you to start the car, you have to provide a passing breath test. If it reads alcohol, then it will not allow you to start the vehicle. It is installed in the ignition only. You have to remember it is an interlock. It's an ignition interlock, not an engine interlock. So even if it, as you're driving, even if it reads a positive alcohol reading, it will not shut the engine down in any way. You can continue driving. So that's one of the myths a lot of people ask us, will it stop my car while I'm driving? And this is the only device that will prevent someone that have consumed alcohol from starting their car. It separates drinking from driving. As we've been discussing, clearly that's the goal. And if you can prevent one of these, drinking and driving from occurring, you maximize the chance of safety for both the driver and all the rest of us. And clearly, there's a whole process that people end up in the situation where if they're going to drive, they are obligated to use one of these devices. And honestly, I'm delighted that this is here as an alternative. We are, for better and worse, a culture where driving is integral to most people's lives and to be able to facilitate that happening in a safe way so they don't end up coming to see me is great. What are the next steps in demonstrating this? I'll go ahead and take a test, but we did want to talk a little bit about the anti-circumvention features for this device. So one of them would be a camera. Let me see. That would be here. So it would capture the picture of the person taking a test and that helps us to find out if they're having someone else take the test for them to start up the vehicle while they continue to drive while drinking. So that's the camera that's installed in the vehicle as well. I can't quite see it on the screen. I'm gonna go ahead and take it off. So don't worry about it. So the device is designed to take a picture of who's blowing in the tube, so to speak. And that is the only time it's turned on when someone is requested to take a test from the device, the camera will turn on and capture a picture of the person taking the test. And that way we can find out if perhaps they were having someone else take the test for them while they continue to drink and drive. So that's one anti-circumvention feature. Another one is there's a random rolling retest. So once they've passed their car and their vehicle's on the road, the device will randomly ask for rolling retest. And that's again to ensure that they didn't have someone take the test for them while they continue to drive while they're drinking. So those are some anti-circumvention features within the device. You also have to hum, so it's detecting that it's a human breath taking the test and not maybe an air mattress pump. So I'll go ahead and test it. When you're required to take a test, it does beep and the LED screen will say blow. It's about a six second blow. It says analyzing. Analyzing and pass. So our device will show the BAC levels, but the clients, it won't show, it'll just say pass or violation. Got it. And it's calibrated to the legal limit, I assume. And every 30 days, the client will bring the device into the shop and have it calibrated by service. One comment I'd like to make is we all talk about the legal limit as if below that, you're fine. The truth, of course, is that the risk of crash goes up as soon as you start drinking. There are, of course, other reasons to be impaired. If you're really tired, I'm a shift worker, driving home in the morning, that's dangerous. I'm legal, but I'm dangerous. And of course, as Carol alluded to at the end of the last segment, there are certainly other impairing substances. So this is a challenge for all of us, but I'm delighted that the device exists and it seems a great tool for prevention. Let me add one thing, sorry to interrupt. This, the device is paid for by the offender. It costs the state absolutely nothing. The offender pays an amount that's pretty much the cost of one drink per day in a bar. So if they got caught because they were drinking, and frequently they say, well, I can't afford to install one of these things, but they damn well can because that's what they've been spending on drink. And that's the same for the portable device as for the interlock, hard breath. Okay, and so that's good news and very clearly since it's mitigating the number of people driving impaired, there are a number of other cost savings, which of course are more difficult to quantify, but we shouldn't forget that overall, the number of fatal events since these efforts, including this one, were implemented, have dropped to about a third. So very clearly there are large savings. And the biggest savings is not dollars, it's people still alive, or people able to walk or think or whatever. I will tell you, we all know this, anybody over 18 knows it's better to been uninjured at all than to be recovered. And life among other things is the accumulation of injuries and I've had plenty. And I'm not quite the same as a result. And so that's the other big goal. We talk about this long range thing? Yeah, I think now's a good time. Okay, I just, as I mentioned at the head, the government, many foreign governments, as well as the United States, National Highway Traffic Safety Administration, and most of the major U.S. automobile manufacturers are in a coalition to develop the ultimate weapon. And that is what's called a passive detection device, meaning nobody has to do anything, nobody has to blow, nobody has to install anything. Cars will be built with a built in one second detection of your alcohol content. And rather than me trying to explain it, we have a 45 second video if you could. Actually, I think we're gonna have to wrap up without being able to see the video, I'm sorry. But it's clearly a fascinating topic and as we discussed earlier, there are many ways of impairment. So I'm hoping as the technology evolves that we'll be able to detect alcohol impairment, my post night shift impairment, and all the substances people are experimenting with. And I'd like to thank you all for coming and Carol also, because an injury or death prevented is the goal for health. And I'd like to thank all of you for joining us. And we'll see you next week. We're gonna be talking about care coordination about health systems across health systems, which is also a key element in health. Thank you.