Disclaimer: Four students asked to be referred to by their first initial due to discomfort speaking publicly about their experiences consuming alcohol.
Will Caraccio ’25 was getting ready for bed one night in October, 2022, when he got a text that his friend and former roommate, Kyle H. ’25, was drunk. Really drunk.
The news was alarming, but not totally surprising. Will and Kyle had been roommates throughout their first year. Halloween night was the first time Kyle needed an ambulance. Will came home around one in the morning to find vomit all over the room, a third of a handle of vodka gone, and Kyle, nearly unresponsive, unable to walk by himself––all the warning signs of a potential overdose he was taught to look for in Yale’s safety training. “The first time I saw it, I was terrified. I was like, this kid is going to die,” Will said. “It’s kind of traumatizing.”
That night, Will followed protocol. He called 911, listened for sirens, and talked with the paramedics as they loaded Kyle into the back of the ambulance. Will passed it off as a typical “Welcome to Yale” moment, a rite of passage nearly all college first years experience. But the situation repeated itself. Will kept calling for help, listening for the ambulance to pull up outside the gates of Old Campus, watching the paramedics wheel his friend out on a gurney.
As harrowing as the ambulance trips and overnight hospitalizations may have been for Kyle, both he and Will remember the problems really starting after Kyle left the hospital. Kyle would get a bill from the ambulance company that promised to suck up all the money he’d been saving up from his student job at––of all places––Yale Health. It meant signing up for more shifts at work, calculating how much credit he could afford to spend, cutting down on expenses, just to afford the following semester’s tuition. “I’m thinking, ‘there goes my entire savings,’” Kyle said. “[It] kind of starts a chain reaction that takes over my life.” Eventually, Kyle learned calling an ambulance was virtually out of the question.
“His life could be in jeopardy, or at least his health could be in jeopardy, whether or not it kills him. But at the same time he’s begging me, pleading with me not to call,” Will said. “So I don’t know what to do. I genuinely think if I were to call the ambulance every time…he would have dropped out.”
So when Will got that text in October of 2022, he knew the drill. It turned out a scared friend who worried for Kyle’s safety had already called 911, and an ambulance was on the way. Will sprang into action. “What I did essentially was to say, ‘I know you don’t want to go in the ambulance. You need to put on a really good performance for me,’” he said.
Will led Kyle to bed and turned off the lights. When the paramedics showed up, he lied and told them Kyle was fine; he was in bed, sleeping it off. When they demanded to see him anyway, Will told them to wait. He crept into the room and tried to prepare Kyle as best he could. He knew that the paramedics would ask Kyle some questions; he’d seen it enough times before to get the gist: Where are you? How old are you? How much money is seven quarters? Kyle, for his part, was terrified. He wouldn’t remember anything from that night, except this encounter with the paramedics. He knew if he failed to convince them he was okay, they would make him go to the hospital, and he’d get slammed with another bill. “I was telling myself, ‘O.K., sit up straight, speak slow, clear, annunciate’…It was very high pressure,” Kyle said. Both played their part well. With Will’s help, and the calming influence of the darkened room, they managed to persuade the paramedics to leave.
Representatives at Yale Health and the Yale Dean’s Office have told me they haven’t heard that ambulance bills present an obstacle to seeking medical attention, or have claimed outright that they do not. But students appear to disagree. Over the last six months, I spoke with twenty-one current and recently-graduated Yale students about experiences in which they personally hesitated to call for an ambulance, or witnessed someone hesitating to call one. Some of them had taken an ambulance trip at Yale already, and preferred to risk their health rather than experience it again. Others had heard what it would cost them or their friends, and figured it was safer to handle the situation on their own. These students spoke of other concerns that contributed to their hesitation, but one factor was far and away the most common and significant: the bill.
“I remember my friend was really drunk and really sick and was being wheeled out to the people that came with the stretchers,” said K. “And she was asking me, ‘Am I going to have to pay for this?’…That’s not something that you should be thinking about if you’re in that state.”
The dilemma of whether to call an ambulance during a true emergency, these students told me, is a threat to students’ mental and physical well-being, as well as their financial security. Many of these students claim that Yale has not meaningfully addressed or acknowledged the issue, leading them to doubt whether the University is upholding its fundamental responsibility to ensure the safety of its students.
“If you talk to any student, they’d agree that [ambulances] should be free,” Kyle told me. “And Yale knows it’s a problem, how could they not?…I’m sure they realize this is putting a financial burden on students. They’d just rather put the burden on me than pay for it themselves.”
Most administrators I reached out to declined or did not respond to requests for comment regarding the problems these twenty-one students described. Of the few administrators from whom I was able to obtain statements, none expressed prior awareness of the full scope of the issue.
“I think there definitely is a hesitation to call ambulances around here because of the prohibitive cost….I would say that probably everyone at Yale, specifically people at Yale who tend to go to events with alcohol or parties, probably knows someone who’s had to pay for an ambulance.” — Anna Tender ’23
When I was a first year, I learned quickly from friends and upperclassmen not to call an ambulance unless the situation was seriously life-threatening. It was part of my informal induction process to Yale, alongside how to sneak into the dining hall, or cram for my L1 final. In my experience as an undergraduate, Yale students who don’t hear the warning at first hear it eventually, and students who don’t hear it early enough often learn through painful experience.
“I think that’s something that was drilled into me. Never call an ambulance because you will be charged like $1000…I think it’s just like common knowledge,” said R.
High-ranking administrators at Yale, however, appear not to know this unwritten rule among Yale students. Dr. Jennifer McCarthy, Chief Medical Officer of Yale Health, told me she’d never looked into it. “Until you reached out to me, I hadn’t really thought of [cost] as an issue that would preclude people from calling,” she told me.
Shaun Heffernon, a prominent member of the Board of Advisors for Yale Emergency Medical Services (YEMS), and EMT instructor at Yale, said that, to his knowledge, worry about ambulance fees has never put a student at physical risk, nor have there been any internal discussions at YEMS about the problem of ambulance billing.
I reached out to many members of the Dean’s Office, including all fourteen residential college deans, Dean of Yale College Pericles Lewis, and Marichal Gentry, former Dean of Student Affairs and one of the founders of Yale’s Alcohol and Other Drugs Harm Reduction Initiative (AODHRI, pronounced “Audrey”). All either didn’t respond to requests for comment or redirected me to current Dean of Student Affairs, Melanie Boyd. Dean Boyd sent the following statement, after which she did not respond to subsequent questions:
“I understand that money can be a worry, but many students nevertheless call for help in life-and-death situations when they think their friends’ lives are at risk.” Dean Boyd did not comment on the high burden of ambulance payments, or elaborate on medical situations that were not life-and-death.
Hannah Peck, Assistant Dean of Student Affairs, echoed Dean Boyd’s comments. “When we’ve looked into this issue in the past, we’ve heard from students that in the moment of an emergency, worry about costs does not deter them from getting help for their friends.” She did not respond to follow-up questions about the collection of those students’ perspectives.
The Cost of Calling:
“Unless it’s like a life or death scenario and I know that the person is going to die if they don’t call an ambulance, then I would feel like my responsibility would be to provide as much non-medical support as I could without calling an ambulance.” — Lucy Santiago ’24
Most Yale policy makers say that in a medical emergency, there should be no hesitation in calling an ambulance. Safety comes first, finances second.
“As a physician and as a human,” Dr. McCarthy said, “you want them to call and deal with things like finance later.”
Yale does have a standard procedure for alcohol emergencies. AODHRI is a Yale program designed to minimize the “physical, psychological, academic, and social” harm of alcohol and drug consumption on campus. The AODHRI website urges students to seek medical help when they’re alarmed by their friends’ condition. They offer a page of emergency numbers to call; at the top of the list is the Yale Police. Yale trains incoming first years to call a First-Year Counselor (FroCo) or to call 911 when they feel unsure what to do, and instructs FroCos to do the same for their first year students. “Be willing to overreact to protect someone,” AODHRI admonishes.
But not all students heed this advice, especially if the situation involves alcohol. Josie Steuer Ingall ’24, told me there are no circumstances in which she would call an ambulance for a drunk friend, “because it’s gonna cost ten bajillion dollars.” Another student, A., said she’s been a lot more careful since an incident in which she had to pay an inordinate price for an emergency call. “Afterward, I told all my friends, ‘Never call an ambulance, just sleep it off, it’s not worth the cost.’…It’s the attitude of many Yale students, and it’s so dangerous.”
It may be hard at first to understand why someone would risk their health. But in the experience of some students who’ve had to cope with the aftereffects of a hospital stay, the “safety first” approach has created financial burdens that outweigh the health risks. Some students who have taken an ambulance, or know someone who has, say they will not call 911 without serious thought, no matter the potential danger.
“If I had known [about the cost], I would have begged my friends not to call, even when getting help may have been in my best interest,” said A.
“The financial strain that this put on me was very intense,” said Lillian Broeksmit ’25. “The insanely high price makes me not want to call [an ambulance], for other people or myself.”
Tony Potchernikov ’24 remembers his ambulance bill costing between $500 and $800, which meant that he had to extend credit payments to afford a plane ticket home at the beginning of the pandemic in 2020. “I remember thinking, ‘I have no idea what the hell I’m going to do,’” he said. It took Lillian the entire semester to earn the funds to pay back the $994 she owed, using a lot of savings from previous jobs. Josie Steuer Ingall contested her bill with her dad’s private insurance and was able to get it reduced from around $500 to $200, or she might have had to skimp on things like groceries and personal expenses. “I legitimately would have been fucked,” she told me.
For students who can’t afford to pay, a bill in their online health portal means potentially having to go to their parents for help. Even if they can afford the cost on their own, some portion of the charge is likely to show up on their parents’ insurance bill, alerting them to their child’s excessive drinking. For students who come from families that do not tolerate underage drinking, the shame of confessing to a disapproving family may be as painful as emptying their own pockets.
“The first thing I was worried about was having to tell my parents about the whole situation.” said Lillian. “Probably second to the how-am-I-going-to-pay-all-of-this, is, this means I have to get my parents involved.”
It can be challenging for students to return to school and try to reinstitute a sense of normalcy with all this hanging over their heads. “The psychic stress of…getting that bill was like being punched in the stomach,” Josie told me. A few students said they had trouble focusing on their classes after receiving their bills, preoccupied with the stress of debt and effort of earning the money back. “It’s hell,” Kyle said.
That’s a lot on the line for a single night of drinking. So when members of the administration recommend that students seek medical help when they feel their health is in danger, without regard to cost, it can feel ingenuous.
“For some people, [the bill] is a drop in the bucket,” said Anna Tender ’23. “For other people, that’s an entire month’s worth of their rent.”
Let’s Talk About Insurance:
“If you have an emergency situation, you’re calling 911 wherever you are and who’s available is going to show up. So ideas like disclosing prices up front or giving people the opportunity to shop and compare don’t work in the ambulance space.” — Madeline O’Brien, research fellow at Georgetown University’s Center on Health Insurance Reforms
Every undergraduate at Yale has some form of health insurance––it’s a requirement for enrollment. Why, then, are students claiming to pay hundreds or even thousands of dollars for a five minute ambulance ride?
Even before insurance kicks in, the final cost of an ambulance bill can be nearly impossible to predict. It varies by the type of care provided, the mileage driven, and a host of other factors. However, many students I spoke with brought up the same number as a kind of benchmark for the average ambulance rate: $1000.
Charlotte Murphy, ’23, shared the view of many students I spoke to: “If I can help myself, and have a friend monitor me, it’s not ideal, but it’s better than paying a thousand dollars.”
One thousand dollars, before insurance, is on the low end for an ambulance ride. American Medical Response (AMR)––the designated ambulance service for New Haven, and one of the largest in the country––charges between $1005 and $2221, depending on the kind of life support they provide, and excluding additional fees.
A student with non-Yale insurance that covers their emergency transport will likely still need to pay some portion of this charge. There’s the copay: the flat rate every patient is required to pay for a service––and the deductible: the amount a patient is responsible for paying each year before insurance starts chipping in. This means that students who need an ambulance in January are likely footing the entire bill, while those who wait until December might get off easier. Often the costliest factor is the co-insurance, or the percentage of the bill that the patient is responsible for paying (if the co-insurance rate is 70 percent, the patient is on the hook for the remaining 30 percent). All this can leave a fully-insured patient with hundreds or more to pay out-of-pocket.
Often, however, an ambulance service is not covered by a student’s insurance at all, which leaves them vulnerable to “surprise billing.” A surprise bill can occur when a patient inadvertently receives emergency treatment from an out-of-network provider. In the case of ambulances, the dispatcher will almost always send whatever provider is available and nearby, whether or not they’re contracted with the patient’s health plan. Because patients don’t get to choose what service comes to get them, they have nothing to protect them from out-of-network billing rates. They can either get in whatever ambulance shows up, and risk having to pay an inflated bill, or refuse the care altogether.
A study conducted by the Kaiser Family Foundation (KFF), one of the nation’s leading sources of medical analysis and journalism, found that approximately 50 percent of national ground ambulance transports to emergency rooms ended in a surprise bill; another study by Health Affairs found that in Connecticut, that number balloons to 66 percent. I spoke with the lead author of the KFF study, Krutika Amin, who confirmed that ambulances result in the highest out-of-network billing rate of any medical service.
Madeline O’Brien, research fellow at Georgetown University’s Center on Health Insurance Reforms, emphasized the bind that surprise billing puts on students. “This is a situation where students do not have choice,” she told me. “In the vast majority of cases, people who are calling an ambulance need to be in an ambulance. And we don’t want [them]… being in a situation where they can’t make it to the hospital or they’re stuck waiting in the emergency room…because they were worried about cost.”
Yale Health offers undergraduates two levels of insurance: Basic, and Hospitalization/Specialty Care. The Basic plan is free for every enrolled student, and does not cover the cost of ground ambulances. The Specialty plan (costing $2,756 for a full term) does cover ambulances, with no copay. Yale Specialty is offered free of charge for every student on full financial aid, and is currently owned by 52 percent of the undergraduate body, according to Dr. McCarthy. The remaining 48 percent have some other form of insurance––usually provided through their parents or guardians’ plans. It’s this half who are most susceptible to the crushing costs of ambulances.
In January, 2022, the No Surprises Act went into effect, which largely protects patients from paying out-of-network rates for doctors and treatment facilities they did not get to choose. “Millions of hard-working Americans will no longer have to worry about unexpected medical bills,” President Biden announced in February, 2022. But this was not entirely true. While the No Surprises Act kicks into action once a patient is in the hospital, it doesn’t account for the costs incurred on the drive over. In light of this vulnerability, ten states have taken proactive steps to pass some level of protection for surprise billing from ground ambulances. Connecticut is not one of them.
The only bulletproof way to avoid a surprise bill: don’t call an ambulance in the first place. It would seem this is the route many Yale students opt for.
Getting Peace of Mind:
“If we were to be able to expand that basic plan to emergency coverage… then a student can have the peace of mind knowing that, ‘hey, if I need an ambulance’ or ‘hey, if my friend needs to go to the E.R.,’ the bill is not something I’m going to have to worry about.” — Andrew Du ’24, Deputy Chief of Operations for Yale Emergency Medical Services
What could Yale do to protect its students from ambulance billing?
“I think the solution would be some type of financial assistance,” Shaun Heffernon, member of the Yale Emergency Medical Services board of advisors, told me.
Dr. McCarthy agreed. “I feel like it’s an insurance question,” she said. “So the question is, should Yale––not Yale Health because that’s a different thing–– should they cover ambulance transports?”
As of the latest public disclosure, Yale has 41.4 billion dollars in its endowment. As administrators persistently point out, spending that money is not as simple as writing a check. There’s a process required to free up money for university expenses. At the same time, the fact that Yale has more resources than all but one other educational institution on the planet, and more than a few countries, has led some students to wonder if the institution should not brave its own bureaucracy and make the funds available.
“One trip to the emergency room is enough to put you in debt and wipe out your savings,” said Kyle. They’re basically saying it’s O.K. for me to go through this, it’s ok for all these other students to go through this, just so they can save a buck.”
Using some simple back-of-the-envelope calculations, the amount of money required to cover emergency ambulance costs for students would be, for Yale, relatively little. The cost of an AMR ambulance providing basic life support is about $1000. An ambulance providing Advanced Life Support can reach nearly $1700, not including mileage fees.
Neither Yale Health nor AMR disclosed to me how many ambulances are taken by Yale students every year, but it is possible to reach a rough estimate by looking at a comparable institution that does. Brown University’s free ambulance program, according to publicly available data, receives approximately one thousand calls a year. Brown has about six hundred more undergraduate students than Yale, so the number of rides at Yale College (assuming an equivalent amount of partying) would presumably be somewhat lower. But even if Yale students made exactly the same number of calls as Brown students; every one of those calls ended up in a transport; and every one of those transports incurred nearly the maximum charge of $2000, the total cost for the school would come out to two million dollars.
Two million dollars is 0.0048 percent of Yale’s endowment; 4.7 percent of what Yale spent on library acquisitions in 2018; and 3.5 percent of what the University spent on athletics the same year.
Presumably, if Yale were willing to reimburse the full bill, it would have no issue contracting with AMR or any other ambulance service. But even if Yale were unable to formally cover ambulances under its Basic insurance, there are institutional funds like Safety Net––a system designed to reimburse Yale students for unexpected funds related to their education––which could pay back the full ambulance cost directly to students. Safety Net representatives told me they offer “generous support” for high-need students who experience unexpected medical bills, but did not respond to requests for more information.
“I can’t imagine there’s anyone who [hasn’t hesitated to call an ambulance for a drunk friend]. I think anytime anybody seems too drunk, anytime anybody seems ill…whatever anybody will encounter, [they] really have to stop and think, should I call 911?” — Josie Steuer Ingall ‘24
There are a myriad of reasons someone might need to go to the hospital––two of the students I talked to were involved in bike accidents, another experienced an allergic reaction. But overwhelmingly, students told me they considered calling an ambulance due to acute intoxication.
On every college campus in every state in the country, students are going to drink. The question is not how to prevent students from drinking altogether, but how to ensure they do so safely. This has been Yale’s stated goal for over a decade: to reduce not just the physical harm of alcohol consumption on campus, but the financial, social, and mental harm as well.
But Yale has so far made no move to address the prohibitive price of an ambulance. In some students’ opinions, this oversight has not only placed them in danger, but violated Yale’s own stated intention of mitigating alcohol-related harms.
“I do think that Yale should cover ambulance costs, especially considering that they teach freshmen students to call their FroCos and they teach the FroCos to call Yale Health,” said Lucy Santiago.
In addition to AODHRI, a one-stop shop for substance use education and resources, Yale has a number of other strategies to minimize the consequences of alcohol consumption. There are mandatory educational seminars during Camp Yale (Yale’s orientation week) to teach first year students about safe drinking. There is Yale’s medical emergency policy, which ensures a student will not face disciplinary action if they call for medical attention. And there is Yale’s First Year Counselor (FroCo) program, which––operating with the the understanding that a first year student new to campus life is usually more vulnerable than an upperclassman––is designed to pair younger students with a trusted older figure to help with the college transition, and in whom to confide.
The formula Yale has worked out is intuitive. If they can educate their students on the danger of severe intoxication ––thereby limiting the number of dangerous alcohol emergencies––and reduce barriers for accessing help, then students are positioned to navigate the complications of alcohol consumption at college with a full measure of protection.
But there is a gap in Yale’s harm reduction measures––a gap of no more than a mile or so, which separates a very drunk student from the safety of Yale Health or Yale New Haven Hospital. That half of a mile can represent hundreds or even thousands of dollars; it can span the distance between happy parents and parents threatening sanctions. Most crucially, it can measure the difference between calling for emergency help, and braving it alone.
So long as this gap exists, some students believe, no combination of other Yale initiatives will fully protect them from the snowballing consequences of a single night’s binging. “It’s all bullshit,” said Will. “I didn’t feel like there was actually as many options as they say…and it feels a little bit deceitful.”
Online data from Yale’s Office of Institutional Research shows that 62 percent of Yale students, or approximately four thousand undergraduates, report binge drinking––that is, they consume four or more drinks (for women) or five or more drinks (for men) in a night. When someone binge drinks, they rapidly increase their risk of alcohol poisoning or alcohol-related injury, according to the National Institute on Alcohol Abuse and Alcoholism. Despite this, only sixteen students were seen at Yale Health Acute Care in 2021 with the diagnosis “intoxication”.
“It’s like a catch-22. If you call the ambulance, you’re risking completely setting him back in many different spheres in his life. Emotionally. Financially. Socially. If you don’t call, you are placing yourself as essentially God…. You [feel like] you have his life in your hands.” — Will Carracio ’25
In many scary medical situations, it can be hard to parse degrees of emergency––is this something I can sleep off, or is it life-threatening? This is especially true for intoxication. Two people who’ve had the same amount to drink, exhibiting the same symptoms, can suffer vastly different consequences.
This creates a quandary: the bystander’s dilemma. The psychological burden of deciding whether to call an ambulance for someone else––the potential consequences of a wrong decision––adds to the overall mental cost associated with ambulance billing.
On the one hand, there may appear to be an imminent threat to someone’s health, or even their life. “When you’re scared and he’s vomiting or saying things that are scary and there’s adrenaline and it’s all happening at once, you don’t have a clear head,” Will said. “Your mind automatically goes to the worst scenario, which is this kid is going to die in my suite, and it’s going to be my fault.”
But sometimes calling for help might feel like the most threatening option. “I just would not want to put that cost on someone not knowing if they were going to be able to pay it,” said Lucy Santiago.
How does one measure the relative value of these factors, pummeled by a whirlwind of secondary considerations––family relationships, emotional and legal liability, an obligation to respect their friend’s wishes––while trying not to dwell on the knowledge that the decision they make could impact their friend’s long term physical or mental health?
These decisions––they’re often not only upsetting, but incredibly perilous. A first-year undergrad with a semester of Biology 101 and access to WebMD is not able to properly triage a patient. A CDC report on binge drinking from 2015 found that 113 people between the ages of 15 and 24 die of alcohol poisoning every year, though the number that die of alcohol-induced injuries and accidents is much higher (approximately fifteen hundred college students per year, according to the National Institute on Alcohol Abuse and Alcoholism).
It only takes one mistake––that decision to put a friend in bed instead of picking up the phone––to cost someone their life. Every moment of hesitation, weighing unknown probabilities and balancing the possibility of physical cost against the guarantee of financial cost, raises that likelihood.
“If they’re not arousable and they’re in a pool of vomit and the friends are really concerned. Yeah, absolutely…that’s a medical emergency, they could die from that,” said Jennifer McCarthy.
“The culture that surrounds this at Yale… calling an ambulance for someone is really a last resort.…I would say it’s a dilemma that pretty much every student at Yale will go through at least once, if not deciding as a FroCo figure, then at least as a friend.” –J. ’22, former FroCo
Few people are placed in a graver and more confusing situation regarding acute intoxication than Yale’s FroCos. Since Yale trains FroCos to err on the side of caution when one of their first years is in need of medical attention, many students know that in certain situations, contacting a FroCo is the same as contacting the paramedics. In the experience of more than a few students, this Yale policy serves to further isolate them from the people best equipped to provide help, and can compound the danger of an emergency.
But FroCos are students themselves. They know first-hand what it’s like to worry about the cost of an ambulance. At one point, they might have had to conceal their intoxication from their own FroCos. For J. ’22, a former FroCo, these memories are all too fresh.
“We didn’t really realize how difficult things could be very quickly if you didn’t have a specialty health care coverage,” she told me, referring to a time her first year when she called an ambulance for her friend. “And so that kind of influenced when I was a senior and I called an ambulance for someone, the first thing I asked was, ‘Are you for sure under specialty coverage?’”
FroCos who encounter emergency situations involving alcohol find themselves in an especially agonizing bind, J. told me. On the one hand, they have close bonds with students and want to save them the expense of an ambulance ride that may well be unnecessary. On the other hand, they are in positions of authority, and choosing not to call would deliberately flout protocol.
“I remember during training they told us that we had to call the ambulance if the student was unresponsive,” said J. “I remember after that talk the [FroCo team] came together and were like, ‘No, that’s ridiculous. If someone is not able to pay for it, we will Uber them there.’”
Uber is an option for some students, but comes with its own host of limitations. Many students do not feel safe taking a non-emergency vehicle to the hospital––having to obey traffic laws and risk sickness en route; and many drivers do not feel comfortable carrying a sick student.
For Matt Chin ’22, former Berkeley FroCo, the paramount concern is safety.
“At the end of the day as a FroCo we don’t have professional medical experience. So a lot of the times when we go into situations, it’s a judgment call,” he told me. “And for me personally, I think that really the anxiety around those situations comes from just wanting to do the best I can to uphold the safety of everyone.”
Despite this, Chin says he dislikes Yale’s policy, which for him was one of the most frustrating parts of being a FroCo: “It was baffling to me where there was policy in place [that] almost counteracted that trust students had in FroCos,” he said. “[It] almost seemed counterintuitive to what FroCos are in place for and the guidance that we received.”
Some students have found strategies to work around Yale’s FroCo policy. Will resorted to talking to one FroCo in code. “One time I called the FroCo and I said, ‘hey, hypothetically, if my friend is really drunk, can I explain some hypothetical symptoms to you, and you can tell me what you think?’” Will told me. “That’s sort of a way of getting around the red tape, and the FroCo was fine with doing that.”
Developing an Ambulance System:
“I think that whenever Yale sets a cap on their resources for emergent situations, it’s going to lead to issues.” – Erin Bailey, ’24
There is another way that Yale could ease the burden of ambulance fees on students: operate its own emergency transport service.
It is relatively common for universities to run ambulance systems out of their student EMS programs, at little to no cost to the student body. Self-reported data on the National Collegiate Emergency Medical Service Foundation website––an organization that encompasses student-run EMS programs on college campuses across the world––shows that thirty-eight of the 261 represented U.S. colleges supply ambulance services to their students.
From my conversations with EMS captains at other schools, it appears this does a lot to encourage students to seek medical attention. “We see a lot of times, we’ll get on scene and a student does not want to go to the hospital that really needs to go,” said Maribeth Novsak, Chief of Rowan University EMS. “So us being able to walk in and say, ‘hey, you’re not going to get a bill for this’…it usually can get them to get into the ambulance and go to the hospital.”
Michelle Kight, Chief of Montclair State EMS, told a similar story. “I have recently heard of a case where a student didn’t want to go to the hospital, and that was the rationale that they gave, is that they thought we billed,” she told me. “And we’re like, ‘No, we don’t bill, we’ll take you for no fee.’ And then they went.”
If Yale wanted to set up an ambulance system on campus, they would probably start with Yale Emergency Medical Services (YEMS). YEMS is a Yale organization made up of volunteer student EMTs––most commonly seen at sports games or other large events. Though they’re qualified to administer basic life support––same as any professional EMT––they currently only provide stand-by coverage. In other words, they don’t respond to calls.
I talked to Judi Reynolds, New Haven’s Regional EMS Coordinator, about what it would take for YEMS to expand into an ambulance agency. Together we went through each of the state requirements. Given the necessary funding and patience, there were really only two that posed a considerable challenge.
The first––personnel acquisition––is theoretically achievable, say members of the YEMS Executive Board and university EMS captains. In order to earn Primary Service Area Responder (PSAR) status for Yale campus––the designation that allows an organization to run an ambulance program ––YEMS would need to provide 24/7 coverage, 365 days a year. That would likely require hiring licensed EMTs outside the student body to fill in during the times of year when students are on break. The only Connecticut college to do this is the University of Connecticut, by way of their in-house fire department. William Perez, Chief of UConn Fire, told me the effort wouldn’t be worth the requisite time and money for Yale, so long as back-end reimbursement options exist.
The second challenge I discussed with Judi Reynolds is more herculean. According to CT law, only one agency can serve as the designated PSAR in a given municipality at a time. Currently, for Yale campus, that agency is AMR. “If you want to have an ambulance, then that’s an agreement [with AMR] or a relinquishing by them,” Reynolds said.
So Yale would have to get AMR to voluntarily give up the service rights to Yale campus, no doubt a sizable portion of their New Haven income. Though Yale could conceivably exert enormous pressure on AMR, the chances of them succeeding appear small. To hear Chief Perez talk about it, Yale would have the same luck asking AMR to write them a check. “If me or you work at AMR we’d be like, ‘What? Absolutely not.’ That’s our business. That’s our bread and butter,” he said.
AMR earned 860 million dollars in revenue in 2021. The North American ambulance services market as a whole was valued at 18.85 billion U.S. dollars in 2022, according to a 2022 report by Grand View Research, and is expected to reach $40.64 billion by 2030. “Ambulances…it’s a business. [They make it so complicated] to keep things in check.” Chief Perez said. “It keeps the chess board stable. So when you move that chess piece, a lot of people gotta agree and a lot of people gotta know.”
I asked Dr. McCarthy if Yale Health had ever discussed acquiring their own ambulances: “We have not…There are lots of requirements.”
I asked Shaun Heffernon if YEMS had ever reached out to AMR: “To the best of my knowledge, they have not formally requested to expand their services.”
“There’s no reason why it shouldn’t be free. [Yale has] the money. Even if it hurts their budget a little bit, they have the money.” — Kyle H. ’25
Chief Perez had his own idea for how to maintain student safety, for a much lower price tag.
“Is there any way [Yale] could set aside a little pot of money with some administrator that examines it case by case? How much can it be?” he said. “How is that a bad thing?”
The problem of ambulance bills raises a fundamental question about the University’s responsibility to its students. To be clear, ambulances are not the only medical expense students struggle with, nor the only reason they might delay medical care. However, according to student accounts, they present a disproportionately large obstacle to seeking emergency medical attention and an unreasonable financial burden.
Madeline O’Brien believes something needs to change. “Any situation where somebody is not taking [an ambulance] because they’re worried about cost, that could be life or death,” she said. “So even if I don’t have the data on all the people who are doing that, if you know one person at Yale, or a handful of people at Yale, who didn’t get service and it could have made a difference in their safety, then that’s an issue that needs to be solved,” she said.
Chief Perez seemed to agree. “I don’t need…something bad happening to you guys because you don’t want to call 911 because you don’t want to pay,” he told me. “I’d pay for it out of my damn pocket before I let you get hurt.”
“It’s not right,” he added after a pause. “We’re supposed to take care of each other.”
**One source who opted to waive anonymity has requested to remove their last name from the online version of this article, which The New Journal has granted.
– Jesse Goodman is a senior in Berkeley College and Executive Editor of The New Journal