UHS Works To Change Ambulance Policies

When Monique S. Bell ’03 called the Harvard University Police Department (HUPD)—sick with gastroenteritis, like many others in Cabot House—to bring her to University Health Services (UHS), little did she know that an ambulance would arrive. And the ambulance could only take her Mount Auburn Hospital, even thought she wanted to go to UHS.

“I asked to go to UHS because my doctors know me there, but they could only take me to Mount Auburn,” Bell says. “When I was discharged in the middle of the night, I couldn’t get home because the hospital didn’t have any cab vouchers. I eventually had to call the Harvard shuttle, and they came even though Mount Auburn is outside their usual route.”

Bell’s case is not uncommon.

Besides the cost of an ambulance ride to Mount Auburn, students rarely have a way to get back to Harvard. Where insurance may cover the cost of an ambulance, the inconvenience and inefficiency of the system has UHS officials lobbying for change.

UHS Director David S. Rosenthal ’59 is working in conjunction with the Massachusetts Department of Public Health, MIT and Professional Ambulance to allow Harvard students that are not acutely ill to be transported to UHS by ambulance.

Under current Massachusetts state law, ambulances are required to transport patients to emergency care facilities. So if a student calls an ambulance, they automatically will get taken to Mount Auburn Hospital. HUPD often transports students to UHS, but if they are unable to respond to the call, a student will be taken via ambulance to Mount Auburn. HUPD will transport minor injuries, such as sprained ankles, to UHS as a courtesy, saving students hundreds of dollars in ambulance bills.

Under the proposed waiver, critically ill students would still be transported to local emergency rooms; all other cases would be at the discretion of the responding Emergency Medical Technicians (EMT).

“The waiver would be a win/win situation,” Rosenthal says, “Because emergency rooms would get 700 fewer patients a year, and students wouldn’t have to go to an emergency room where they’re exposed to waiting and sometimes no care. Ambulances don’t want to take relatively minor injuries to busy emergency rooms when they could be treated at UHS or MIT.”

The push for a state law waiver is well timed, as area emergency rooms are increasingly overcrowded, due in large part to the 30 area hospitals that have closed in recent years.

“The biggest problem is that area emergency rooms are almost constantly busy and overloaded, and we’re confronted with this every day,” says Bill Mergendahl, executive director of Professional Ambulance. “Students are often forced to cool their heels for six or seven hours before even getting seen.”

Waiting times are particularly long for non-emergencies, where the same patient would likely get seen immediately at UHS.

“The challenge is to match up hospital capability and EMT capability with patient needs,” says Brad Prenney, deputy director of the Bureau of Health Quality Management. “The current law is in place because EMTs are trained to assess, not diagnose patients. There’s considerable variation in emergency situations, and a seemingly benign situation could have serious underlying causes.”

Last year, Professional Ambulance responded to 367 calls from Harvard students and 268 from MIT students.

“Both institutions are in the same boat,” Mergendahl says.

The situation is currently under review by the Department of Public Health, and the office is still gathering data on the case.

Mergendahl is developing a profile of the type of transports Professional Ambulance makes, and Rosenthal is in the process of submitting information to the states about UHS facilities.

“We have the ability to provide a waiver, but at this point it’s only a discussion of ideas,” Prenney says. “It is important to have a clear profile of the Harvard student population, as well as of UHS care capabilities, including equipment, staff and hours of operation.”

Last year, 134 students were taken to UHS in patrol cars. “The first officer on the scene is trained to determine the severity of the injury, and whether an ambulance should be notified,” says HUPD spokesperson Peggy McNamara.

“We did transport at least a dozen Cabot students to UHS in March, though one or two officers might have felt the need for emergency medical treatment and notified an ambulance,” McNamara says.

Many Harvard students agree that non-acutely ill students should be able to get to UHS via ambulance. “Any student who wants to be transported to UHS and does not need the services of a hospital emergency room should be transported to UHS,” says Victor Huang of the Student Health Advisory Council. “If ambulances cannot transport students to UHS, and HUPD is unwilling to transport certain urgent cases, then UHS needs to identify another source of transportation.”

The Department of Public Health has raised the possibility of providing students with more information about when it is appropriate to call for an ambulance. “People access 911 for many different reasons,” Prenney says. “Students are often referred back to UHS.”

“If I’m massively bleeding, I know I’m supposed to go to Mount Auburn,” Susan Brunka ’03 says. “But if I broke a limb, I’m not sure where I’d go.”

—Staff writer Arianne R. Cohen can be reached at cohen7@fas.harvard.edu.