EMTs worry students aren't calling
By Richard Nieva
After head EMT senior Dan Stepan reached for his two-way pager to respond to a call from Campus Safety, he and his partners hurried to the emergency site.
When he got to the Swig lawn, he remembered seeing a boy passed out on the grass after drinking at several parties. It was the sibling of a student, visiting his big brother at college for the weekend.
"He looked like he was sleeping really hard," recalled Stepan, who began to try and revive the boy.
He resorted to what he called "painful stimuli" and administered a "trap pinch" -- a pain-inducing pinch of the top of the trapezius muscle, located on the back between the neck and the shoulders.
He didn't budge, remembered Stepan.
"It's always a little scary when people are unconscious and you can't wake them up," he said. "You're not sure if there's anything else going on with them."
This is just one of the incidents that stood out in Stepan's mind, looking back on his time spent in Santa Clara's Emergency Medical Technician program, thus far blemish-free -- meaning there has not been a single fatality while an EMT has been on duty.
Stepan, a senior, said he would like to maintain that blemish-free record.
This is why he and fellow EMT Nick Pontrelli are attempting to implement a program called "medical amnesty" in which a person would not get himself or herself and the patient into trouble for calling the EMTs in an alcohol-related emergency.
"It makes alcohol a medical emergency, not something you'll get disciplined for," said Pontrelli.
EMTs have had 68 calls thus far this year -- including alcohol, trauma and medical emergencies -- the most ever during the first four weeks, said Stepan.
Sixteen of those calls have been alcohol calls, which is about consistent with previous years during fall quarter, he said. Campus Safety reports at least 30 alcohol violations this quarter, including five students so excessively ill they were transported to the hospital by paramedics.
Last year, however, the EMTs experienced a large drop in alcohol calls from fall to winter to spring quarter -- from 38 to 20 to five -- though a study in their proposal suggested that most peoples' drinking habits remained the same.
Stepan voiced concern over the stricter alcohol policy instituted by the university at the start of last year's winter quarter, in which an alcohol-related emergency would be considered a "high-risk" situation, and thus yield more severe consequences.
Under the new policy, first-time "high-risk" violators receive an educational sanction and parental notification for any student under 21. After a third "high-risk violation," an on-campus student will face disciplinary probation or housing cancellation.
"We wouldn't want to see anybody jeopardize their health, or their friend's health, just to get out of a fine or community service or writing a paper," said Stepan.
Medical amnesty
Stepan and Pontrelli came up with the idea for a medical amnesty program in an upper-division English class last spring quarter with professor Stephen Carroll, in which students were asked to come up with an idea that would benefit the Santa Clara community.
The medical amnesty program has been shown to work at Cornell University, Stepan said, and he said they are looking into how effective it might be here.
He and Pontrelli wrote a 20-page proposal which outlined the specific guidelines of the medical amnesty protocol, examined students' drinking habits and included a cost analysis of alcohol fines versus the legal costs of a fatality.
Stepan and Pontrelli have taken the idea to the Office of Student Life, working closely with Associate Dean for Student Life Matthew Duncan to see if implementing a medical amnesty program at Santa Clara would be possible.
The medical amnesty protocol was actually considered by the university last spring, but the decision was put on hold until more information was available, said Duncan.
Now the university is studying student alcohol use over the course of a full academic year and will make a decision this spring, said Duncan.
Should the policy pass, it would be implemented next fall.
"We're aware that other universities have adopted it, but we're not at a point to make a decision," Duncan said.
Stepan said it is common for personal friends of EMTs to call them when they are off duty to come check on students in danger, so the student ill from excessive alcohol consumption won't get into any disciplinary trouble.
EMTs have to refuse because it puts them in a dangerous position, considering that they could be help liable should something happen to the patient later on.
EMTs continue to record the number of these personal calls. In the winter and spring quarters of the 2006-2007 year, 43 off-duty calls were made, as opposed to the seven made in the fall, before the new alcohol policy.
Some EMTs worried the stricter policy would deter students from getting the help they need, said Stepan.
Student EMTs are working with the administration to create an alcohol policy that benefits the students' health and safety while still upholding the rules on campus, said Stepan.
The effects of alcohol
As EMTs, Stepan and Pontrelli see firsthand what alcohol does to a person who drinks to excess, to the point that it becomes dangerous for the body.
Alcohol is a depressant, Stepan said, explaining what EMTs are taught as a part of their training and EMT coursework. Because alcohol is a depressant, it may seem odd that it usually produces the effects often associated with a stimulant. Sometimes a patient will be very aggressive and combative, and other times, he or she will be hilarious, cracking jokes, said Stepan.
Science author Stephen Braun's 1996 book, "Buzz: The Science and Lore of Alcohol and Caffeine," states that "alcohol depresses the 'higher' cognitive abilities, such as the ability to control emotions, thus allowing our more unruly, carnal sides to emerge."
But that's not all alcohol does to the brain.
Braun writes that every time a person takes a drink, alcohol molecules, called ethanol, are pumped into the brain, where they infiltrate synapses.
The alcohol then binds to neurotransmitters called "glutamate receptors" and slows down many other parts of the brain. For example, if the neurons that are slowed control muscles, the result is relaxation and incoordination, Braun explains in his book.
Alcohol can also suppress the ability to make new memories if a specific glutamate receptor is disabled. This explains why someone may "black out" after a night of excessive drinking and not recall the evening's events.
If the neurons suppressed control bodily functions, then heart rate and breathing are impaired.
In the worst case scenarios, alcohol suppresses drinkers' respiratory functions, which can bring them to respiratory arrest, and in turn can lead to cardiac arrest, which can cause loss of consciousness, or even death.
For this reason, EMTs closely monitor patients' breathing and use a machine called a pulse oximeter to read the amount of oxygen saturation in their blood.
Stepan said that he's dealt with many cases that were severe enough to be considered alcohol poisoning, defined as the condition in which there is enough alcohol in a person's body to start doing actual bodily harm.
EMTs employ a simple system that dictates whether or not a person is intoxicated enough that they need the assistance of the fire department. They ask a series of four "alert and oriented" questions: What is your name? Where are you? What day is it? What time of day is it?
If the patient answers two or more questions wrong, they call the fire department.
Though the majority of people don't reach that level, EMTs do deal with their fair share of alcohol poisoning cases, said Stepan. Five out of his 45 calls last year involved people with alcohol poisoning, he said.
And though this is a dangerous level to reach, it is more dangerous not to seek help, said Stepan.
"We are happy when people call us," said Stepan. "It shows how responsible they are, even if they may not have been responsible earlier."
Contact Richard Nieva at (408) 554-4546 or rnieva@scu.edu.