DECISION-MAKING

“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.

Josie Steuer Ingall was making a turn on her bike at the intersection of State and Bradley when she was hit by a car. Josie went flying and dislocated her hip. Some people eating nearby at September in Bangkok witnessed what happened and called an ambulance. Josie had heard stories before, and was not keen to pay any ambulance bills. She put her own hip back in place. “Do not put me in your white van. I am not going to the hospital,” Josie remembers thinking. But she was scared; she’d just been hit by a car after all. So when the paramedics from American Medical Response arrived on scene, they managed to persuade her to get into the ambulance for a quick assessment, so long as the vehicle didn’t move an inch. “I told them ten thousand times I don’t want to go to the hospital,” Josie said. The paramedics asked her a few questions, diagnosed her with hip contusions, and allowed her to hobble to her boyfriend’s house. Josie thought she’d managed to avoid the charge. Later, she got a bill for $500.

Frocos

“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.”