The newly enforced state regulation mandating that students who require emergency medical transportation go to a facility that has a doctor on staff, which Brown Health Services does not on nights and weekends, may be changing the way some students choose to use Brown's Emergency Medical Services.
The Rhode Island division of EMS informed Brown in July of its decision to enforce a longstanding Rhode Island law, which mandates that ambulances must transport passengers to a physician-staffed facility. While Health Services has a nursing staff around the clock, doctors are only present during working hours.
Residential Peer Counselors and Health Services have stressed to freshmen that being EMS'd is still punishment-free, according to Gabriela Camargo '11, a Women's Peer Counselor in Morriss Hall.
But some students said they are concerned with the nondisciplinary consequences of calling EMS in alcohol-related instances. The cost of emergency transportation to the hospital may force some students to choose whether to pay the large transport fee themselves and keep an alcohol-related incident secret, or use their health insurance to cover the cost but potentially having to explain the charge to their parents.
According to Health Education Director Frances Mantak '88, there is no charge for ambulance transport provided by Brown EMS, as that service is covered by the student health services fee.
For students who use health insurance to cover the cost of care at a hospital's emergency room, though, co-payments will vary among different health insurance plans, Mantak wrote in an e-mail to The Herald. Brown's health insurance policy would require a co-pay of $100, she added.
A representative from Rhode Island Hospital said the cost of emergency services for someone without health insurance can vary for any number of reasons - primarily because each case will require an individual medical plan determined by a physician at the time of arrival.
Because some students are only covered by a parent's health insurance policy, though, the co-pay is not the only consideration. For these students, an alcohol-related trip to the hospital may appear on a parent's insurance bill. Brown's health insurance bills directly to students, Mantak said, so parents are not part of the equation.
But, she added, each insurance plan works differently, so the way a charge is itemized varies from plan to plan.
For one female sophomore who was EMS'd last spring, before the policy had gone into effect, her trip to the hospital had come as a surprise.
For one female sophomore who was EMS'd last spring, before the regulation was enforced, her trip to the hospital came as a surprise. The sophomore, who asked not to be named in this story, had assumed she would be taken to Health Services.
"I didn't even know that being brought to the hospital was an option," she said.
She said that a regulation that increases the likelihood of a trip to the hospital instead of Andrews Hall could be a major deterrent to those who need to utilize emergency services.
On the night she was EMS'd, the sophomore said, she made her way back to her dorm after drinking what she estimated amounted to eight drinks in a matter of minutes. Once at her dorm, she said, she began vomiting. She said that her friends became concerned and called EMS when, 45 minutes later, she had not stopped vomiting.
Though she said that she understands why her friends made the decision to call EMS and harbors no hard feelings toward them, she hopes that in the future under similar circumstances, her friends will just put her to bed and call EMS only in an extreme emergency. She spoke with Health Services after the incident for a follow-up assessment, and said the experience wasn't a "punishment" and was "kind of a good thing, actually."
Though she ended up telling her parents the truth about her hospital visit, she said she thought the greater likelihood of parental notification might create a disincentive for students deciding whether or not to EMS a friend.
RPLs interviewed for this story acknowledged these concerns, but all said they felt that students have been using EMS responsibly. According to Camargo, the freshmen in her unit "have been using (EMS) when they've needed it."
The number of students who were EMS'd for cases of alcohol or drug intoxication in the first three weekends of the semester is slightly lower than the number of students EMS'd on those same weekends last year, down from 31 to 26, according to data provided by EMS.
According to Camargo, though the system might seem to create deterrents to using EMS, the fear that students will use EMS more selectively hasn't materialized.
Camargo said the small decrease in the number of students who have been EMS'd during the first several weeks of school may reflect differences that have little to do with enforcement of the regulation. The freshman class, she noted, requested a record number of rooms on substance-free and quiet floors.
Josh Singh '11, a residential peer counselor in Morriss, agreed with Camargo and said that the newly enforced policy hasn't dramatically affected students' incentives for calling EMS. The first-years in his unit, he said, "all have a pretty good understanding that (calling EMS) is OK," Singh said.
Singh also said that, according to statistics that Health Services distributed to the RPLs, the percentage of students who actually require hospitalization after an EMS call is similar to those in past years, despite the change in policy enforcement.
"It's a common myth that EMS just takes you to the hospital," said a sophomore RC, who asked not to be named to protect the privacy of her first years. Emergency medical technicians, she said, conduct an assessment that includes asking the intoxicated student basic questions to test their lucidity and looking at the student's surroundings and the intoxication level of the student's friends.
The RC said she thought the first years in her unit have been "really responsible" with EMS. But many students are still wary of implications for the EMS'd student, she said.
She said her first years woke her early one morning, hesitant to call EMS for a friend. She said the students knew even before they approached her that they should call EMS for their friend, but she added that it was "kind of scary" how hesitant they had been to make the call themselves.
But a male freshman who was EMS'd for intoxication earlier this semester said he thinks first years, for the most part, "are willing to call EMS."
He was "happy" that his roommate had called EMS for him, he said. After an assessment that included taking his blood pressure and pulse, the EMTs determined that he did not need further medical attention. "I'd rather be safe," he said.
Both the sophomore RC and Camargo said they thought that the regulation's enforcement has not affected freshmen as much as it has upperclassmen, who had been accustomed to the previous policy.
Upperclassmen, Camargo reasoned, know that it was formerly an option for EMS to transport students to Health Services instead of to the hospital, whereas freshmen may not even be familiar with the enforcement of this policy. "The general consensus is that upperclassmen are having the most reaction to it," Camargo said.
Aminy Ostfeld '11 thought that the possibility of going to the hospital rather than Health Services "probably would create less incentive to call" because there could be "more serious consequences" for the student EMS'd.
Ostfeld said she would probably still call EMS if she thought a friend was in danger. She added that she thought most students would likely do the same despite what may perhaps be perceived as a greater chance of hospitalization.
Camargo agreed, saying that the change in policy enforcement was less of a concern than some have perceived it to be. "Generally I don't think it's as big a deal as people have made it out."
- Additional reporting by Joanna Wohlmuth
