Students Helping Students: Collegiate Emergency Medical Services

An often-overlooked aspect of a comprehensive campus safety program is the provision of Emergency Medical Services (EMS). Colleges and universities of all types generally have some shape or form of full-fledged campus public safety, police, security, health, and parking enforcement services.

However, when it comes to EMS, not all administrators and executives may be aware of the potential benefits for providing this service in-house. Higher education institutions across the nation are establishing a growing trend in providing EMS from within the institution, often with student-based volunteers. According to the National Collegiate EMS Foundation (NCEMSF — an advocacy group for collegiate EMS), more than 250 such college-based EMS services exist, with more than 25 currently forming.

Almost all colleges and universities have some current formal or informal pre-existing arrangement for emergency medical transportation. Generally, one or some combination of three scenarios exist: 1) the institution has a formal arrangement with a private ambulance service; 2) the institution, either by default or by agreement, relies on a municipal or other local provider (either fire department-based or other so-called “third service” independent EMS departments); or 3) like a growing number of institutions, the college or university provides the service in part or entirely themselves. This article will survey the third scenario, and also look at the varying degrees of service options available.

Why Provide EMS Service?
Financial Considerations. In the case of an institution that has an agreement with a private or municipal provider, there is almost always a financial cost involved, whether direct (contractually) or, in the case of a public institution, payment in lieu of taxes. What the institution may not know is that unless the contract expressly prohibits it, these providers may be billing students’ health insurances and then billing any remainder to the student.

Many institutions try to minimize the total costs associated with campus life and therefore, administrators should consider the “true cost” of this third-party arrangement. In-house service provides the administration with flexibility in billing.

Almost all colleges require that students have health insurance. The charges related to emergency ambulance service may not increase the insurance premium burden to the student. Yet billing for service may provide some revenue to recover costs associated with the transport. The administration can then decide how to handle the billing situation with students. Some choose not to bill students, some discount the service to students, and some bill students the entire amount.

According to NCEMSF, about 35 percent of college services even go so far as to provide service outside the college to the local communities, either by mutual aid agreements or even as the primary community EMS responder. This may also allow the service additional revenue to offset costs.

Looking at it from a risk management perspective, the institution might also be able to justify lower insurance premiums or other incentives for offering quicker on-campus EMS response.

Low Cost of Service. Overall, the cost of providing EMS service at these institutions, even if not subsidized by cost recovery, can be very negligible compared to other public safety and health services, especially utilizing the volunteer model. The initial costs may include some medical equipment, vehicle(s), and building space.

Recurring costs may include medical equipment and medications; however, most EMS services have agreements or regulations that allow them to restock these at a local hospital, thus eliminating some recurring costs. Other recurring costs may include appropriate insurance coverage, or building or vehicle maintenance and fuel, etc.

With a combination of such a low operating cost and potential for revenue, the attractive yield of on-campus quick response may be realized more readily than the administrator might think.

Intrinsic and Academic Value. Above financial considerations, the potential for leadership roles, integrating into service-learning curricula, internships, and the enhanced probability for future career opportunities all are the real benefits for the student volunteers.

Some institutions are even able to incorporate the EMS training into curricula in degree programs including Paramedicine, Kinesiology, Allied Health, or others.

Experiential Value. A volunteer-based service provides students with a unique opportunity to learn in a “real-world” environment.

“The unique experience provided by this type of opportunity can be invaluable to the student volunteers,” said George J. Koenig, D.O., president of NCEMSF. “Very few student groups can say they provide service back to their community, and even fewer can say they provide a life-saving service in times of emergency.”

Lindsay Bradley, a 2008 graduate of the University of Rhode Island and now a paramedic in New Haven, CT, agrees.

“I really enjoyed my time there, it helped me decide what I wanted to do professionally and, at the same time, I was able to develop my own professional style,” she said. Bradley is currently applying for a Clinical Nurse Leader (CNL) program at Yale University. She served on the command staff of the University’s EMS group while an undergraduate.

Service Learning. With the increasing competitive nature of many post-baccalaureate programs, applicants with experiential and service-learning backgrounds may be considered in favor of those who lack this experience.

“There is no doubt that we have had more successful applicants for physician assistant’s programs than students at the University who have not had a similar experience,” said Charles Henderson, director of Health Services at the University of Rhode Island. Henderson’s department oversees the campus EMS operation.

The training is not valuable only to students in the medical field. “The leadership skills acquired and the teambuilding that occurs naturally in these groups provides students of any background with a great understanding for the real world,” Henderson said. “We have had members with majors including music, math, business, communications, nursing, and engineering, among others."

What Type of Service Should Be Provided?
There are many considerations to discuss when considering the establishment of in-house EMS service. Following are a few of the factors.

1.    BLS vs. ALS. EMS services usually provide service at either the Basic Life Support (BLS) level or the Advanced Life Support (ALS) level. The difference is in the medical procedures that providers are allowed to perform and the medications they are allowed to administer. A good portion of the country operates with BLS ambulances locally and regional ALS “intercept” services in the form of Quick Response Vehicles (QRVs — for example, an SUV with ALS medications and equipment). Larger populations may be served by all ALS ambulances, and some systems have a mix, depending on the call.

2.    QRS or Transport. One popular option available to special EMS services, such as colleges and universities, is Quick Response Service (QRS) with a QRV to initiate care early and then transfer to a transporting ambulance arriving from the local community. This can often mean lifesaving care is delivered in a timely manner (the American Heart Association recommends that defibrillation, when required, be initiated within three to five minutes), well before a local provider arrives on scene. Other non-transport service options available are bicycle response, ATVs/specialized utility vehicles, Segways, etc. While a minority of institutions operate without any vehicle at all, this may only be recommended for institutions with a small footprint and few buildings.

3.    Emergency, Standby, and/or Special Events. Colleges are also community activity centers, with sports venues and other forms of entertainment that often attract large crowds. Event-based EMS is a growing specialty, and college EMS providers are in the best position to handle this service. With the inherent ability to recruit and retain quickly, effectively, and efficiently, colleges can usually rely on a large number of volunteers to meet the sometimes demanding needs that large crowds bring. Some colleges provide this type of service exclusively.

4.    Volunteer and/or paid. On a larger scale, EMS has grown out of a volunteer atmosphere, with EMTs often responding from work or home to provide emergency ambulance transportation service to patients in their community. While most larger communities have shifted over to paid models (with some notable exceptions, such as the Virginia Beach EMS, the largest all-volunteer rescue system in the nation), the National Volunteer Fire Council (NVFC) estimates that 72 percent of America’s firefighters and EMTs are volunteers. Since many of these volunteers start at very young ages, it is only natural to extend this opportunity to the collegiate environment.

While the benefit of utilizing volunteers may be obvious in financial terms, there are also many other benefits, such as the unique social environment. Most EMS providers and firefighters will agree that the volunteer environment and atmosphere is unlike the same work in a paid scenario. Very rarely will you find a professional field where people go from working during the day to doing the same job for free at night. However, according to the NVFC, 30,000 career firefighters across the nation do exactly this.

Some colleges utilize a combination of volunteer students and a paid department head, or even paid shift supervisors. In Providence, RI, Brown University EMS utilizes this model, where paid ALS personnel supervise volunteer drivers and BLS providers. It allows for some consistency in care and also continuity in the service while providing an excellent learning opportunity for newer EMTs.

5.    Operating Schedule. Some institutions provide 24/7 service year-round, some only during the school year, some during peak hours during the school year, and some only provide service for special events. The schedule that is selected should be decided upon after discussions on sustainability, feasibility, and discussions with local providers. Sometimes, laws or regulations may dictate the operating schedule.

Some institutions, such as the University of Rhode Island, may provide students with incentives such as free or discounted housing during the summer in exchange for agreeing to volunteer a specified number of hours during that time. Other incentives include meal plans, tuition discounts, academic credit, etc.

A Growing Trend
Where do other universities and colleges that provide student volunteer EMS service stand? NCEMSF records indicate (as of 2009) that 60 percent of the 250+ groups that exist provide emergency service at least with a QRV, 28 percent operate full transporting ambulances, and 13 percent operate at the ALS level. 66 percent of all services operate 24/7.

Many more services have been upgrading their service as they mature and realize the full potential benefits of added capabilities.

Most college EMS services fall operationally under one of three areas: Student Life/Student Activities, Health Services (Clinic), or Public Safety.

Koenig advised, “There are advantages and disadvantages to each, however NCEMSF recommends that whatever relationship is selected, those three functions should interact closely with the EMS group for each stakeholder’s interests.”

Cmdr. Shad U. Ahmed is the director of the National Institute for Public Safety Research and Training and chief of Emergency Medical Services at the University of Rhode Island. He serves as the Disaster Preparedness Chair for the National Collegiate EMS Foundation. He is the principal investigator on a Homeland Security project developing a national training curriculum for colleges and universities in emergency planning and mass evacuation. Cmdr. Ahmed may be reached at [email protected]