Should college students be transported to the campus nurse?

[brentoli]

Imagine: You're out on a weekend night with a new friend.

Your friend drinks too much, and you're concerned. Does he need medical attention? Are you in the position to call Emergency Medical Services for him without his consent?

Before the Rhode Island Division of EMS began in July enforcing its regulation that patients requiring ambulance transport must go to a facility staffed by a physician, the decision wasn't as hard. Calling EMS likely meant your new friend would spend the evening or night at Health Services, taken care of by a nurse. Your friend would not have a large bill to pay, nor would his parents necessarily be informed of the incident. You could make the safest decision without worrying about the consequences your call could have on a friend you may not know well.

But now, as you wonder whether your friend needs medical attention, your decision is made more difficult by the enforcement of the regulation. If you call EMS and your friend needs ambulance transport, you now have to consider two major complications.

Can your friend - whose bank account you've never seen - afford what will easily be an over-$1,000 bill for emergency service. If he can't pay this bill out of pocket and he draws on his health insurance, his family could find out about the incident. Could this pose a risk to your friend's relationship with his parents?

When Health Services could treat students for these types of emergencies on nights and weekends, there was much less hesitation for an onlooker to call EMS on behalf of a friend. But with these predicaments forefront in a student's mind, a well-meaning friend could easily make the least-safe decision - not to call at all.

Brown EMS should be the one making the decision if and what type of medical services your friend needs - not you. Of course, sometimes patients will clearly need a physician's care, and Brown EMS can take them to the hospital when they deem them in need of serious medical attention.

Few friends would not call EMS if they saw another in clear danger, but in borderline situations, most would also be hesitant to call and necessarily incur a large medical bill on behalf of their friend.

The University is right to appeal the state's regulation. The safest policy in this case is one that recognizes that college students will make mistakes that they are not yet fully able to be responsible for.

Health Services has served its students' needs in emergencies for years; putting students in the position that they are unsure if they should report an emergency is the greatest risk in the situation.

The Brown Daily Herald - Brown Univesrsity

Ran accross this while looking for some EMS news stories. Without knowing the background here, the way this reads, students used to be taken to the campus health services, unless it was very bad. Apparently RI has passed a state law requiring all ambulances to transport to a physician facility. What caused them to pass this law is unknown to me right now. I'll research it a bit later.

What are your thoughts on this? Does anyone work in a college town with this practice? Personally, I think if you are going to get so trashed you need medical attention, you should have to pay the price. Is there really going to be less students getting the help they need because of this?

[Ridryder 911]

I would imagine the reason they can only transport to a physician facility is they (physicians) are the only ones licensed to practice medicine. Yes, there are plenty of NP/P.A. facility but in realistic terms those are usually considered stand-by ER's.

The same as an EMS transporting to a minor ER clinic, etc. Most States also have laws in place for EMS to be able to receive proper reimbursements.

R/r 911

[brentoli]

What about the other question in this article, I made an aside note about the physician thing when I shouldn't have. Should students be allowed to be transported to their student clinic by campus EMS? Even if the clinic doesn't have a 24 hour physician.

[reaper]

I have worked many college towns. The drinking is getting out of hand on some campuses. I have taken in kids with level of .550 and higher. These are kids that cannot maintain their own airways. While I think we do not need to tie up the ED's with drunks, I think there is to many complications possible for health services to deal with.

Screw the bill or the parents finding out, that may be the best thing that could happen. It may wake then up a little. Drinking is not the problem, drinking to you pass out is the problem.

Our universities our getting out of hand themselves. They do nothing to combat these issues. Hell, look at the news, some college presidents are wanting to lower the drinking age to 18 again.

This is our educational leaders at work?????????????

[JPINFV]

Hell, look at the news, some college presidents are wanting to lower the drinking age to 18 again.

This is our educational leaders at work?????????????

Yes. Since underage drinking (which, for the record, is a federal mandate for highway funding, and is thus, just a hair away from being unconstitutional) is illegal, adults engaging in underage drinking have very little incentive to drink responsibly. The punishment for 0.01 BAC and 0.5 BAC is going to be the same. By lowering the drinking age, hopefully adult underage drinking comes out from the shadows and can be properly monitored.

Of course, I'm a little biased since I've had alcohol since I was a kid (wine with dinner on special occasions), and thus, while engaging in underage drinking, have learned that you can drink alcohol without getting plastered or drunk.

[Dustdevil]

...the way this reads, students used to be taken to the campus health services, unless it was very bad. Apparently RI has passed a state law requiring all ambulances to transport to a physician facility.

This is a very good thing. The average EMT or Paramedic simply does not have the educational foundation necessary to reliably determine what is "very bad" and what is not. Until that changes (don't hold your breath up north), there is no intelligent option other than to assure that all patients are taken to a physician staffed emergency facility for evaluation.

[brentoli]

Honestly, until I saw a discussion on this site, I didn't know there were places that would transport anywhere except to an ER on a 911 call.

So why can't the campus EMS transport to the infirmary and allow the staff nurse to make the call on the ER or not?[sup:de5bc0e312]1[/sup:de5bc0e312]

[sub:de5bc0e312]1. playing devils advocate[/sub:de5bc0e312]

[Dustdevil]

1. Because of the time delay involved.

2. Because the staff nurse cannot provide medical evaluation.

3. Because you're turning one ambulance run into two ambulance runs by having to go pick them up again and take them to the ER from the clinic.

[brentoli]

Brown University Emergency Medical Services (Brown EMS) is available 24 hours per day, 365 days per year. It provides Emergency Medical coverage to the Brown University community, including Advanced Life Support pre-hospital care and transport service.

Reasons to call EMS include but are not limited to:

Difficulty breathing

Major bleeding

Obvious or suspected major injury

Any injury that impairs mobility

Loss of consciousness or unresponsiveness

Diminished consciousness or mental confusion

Severe pain - of sudden onset, of unknown cause, or of long duration

Severe alcohol/other drug intoxication

Brown University EMS is staffed by paid, experienced advanced life support providers and student volunteer EMT's.

[hr:8dba2f8e66]

So... is there any diffrence transporting to the infirmary during the daytime, when an MD is on staff?

[Richard B the EMT]

I view school infirmaries, even university based ones, the same way I view the so called "Doc in a box" freestanding Emergency rooms: They are a nice stop gap measure that costs less than an ER attached, physically, with a hospital. However, if further care is needed, then you have the delay of calling 9-1-1 back to the clinic to transport to the at-hospital ER.

If I needed medical attention, I'd want to go to a regular ER, where, presumably, they have capabilities far beyond the clinics, rapidly, as needed, if needed.