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From the Issue: Pre-existing Condition

The last issue of The Blue and White for the semester will be out in print soon.  In the meantime, the entire magazine will be published on Bwog. Today Chief Ambulance Chaser Mark Hay Reports on CAVA’s ongoing battle for University support.

Illustration by Hannah Ford

Pre-existing Condition

Early in the fall of 2009, then-director of Columbia University Emergency Medical Services (better known as CAVA – Columbia Area Volunteer Ambulance) Krishn Khanna, SEAS ’10, quietly informed prospective members of the student-run EMS crew that the organization’s standard certification course would no longer be offered. Because of financial difficulties, St. Vincent’s EMS Education Program, which CAVA used to train its staff, closed its doors. In turn, students who wished to join CAVA were left stranded. “We assure you that our organization suffers the most when such a course does not take place,” laments Khanna in his communiqué, “as it reduces the quantity and quality of applicants for membership.”

Any student interested in joining CAVA must attain certification in basic life support, a collection of fundamental EMS skills that the St. Vincent’s program used to teach. From an applicant pool of approximately 30 certified students, 8 to 10 would be selected for probationary CAVA membership and a further semester of on-the-job training. This tiered application process generally kept CAVA staffed in recent years with 50 to 65 active members to respond to around 700 calls per year.

Few students receive EMS training during summer breaks and even fewer have been trained before arriving at Columbia, so without an EMS education program, CAVA may soon struggle to find enough qualified personnel for membership consideration. Robbed of the ability to train consistently in-house, this leaves CAVA at the mercy of third-party training facilities.

Precisely this scenario has been playing out for CAVA since last fall. According to CAVA’s online registry, currently 41 active members respond to 1,000 calls a year, representing a staffing drop of more than 33 percent over a period of just a few years while calls have increased more than 40 percent. Anmol Gupta, SEAS ’12, applied for membership with CAVA just as the organization began to feel the aftershocks of

losing its training program. To his understanding, the lower membership reflects an intentional choice by CAVA officials to ensure that serious and dedicated members can take regular shifts and gain vital experience.

CU EMS Director Chris Kyriakakos, SEAS ’10, corroborates Gupta’s account, adding that, although membership has dropped, “the decrease in numbers has been from people who never took shifts anyway.” But Gupta also cites the organization’s efforts recently to decrease barriers in to application, removing the requirement that students commit to four-semester of service. The number of applicants and acceptances, however, has remained flat.

Numbers aside, Gupta’s experience on staff demonstrates the dangers of losing the training program. Whereas the standard course offered through St. Vincent takes three months to complete, Gupta underwent a two-week crash course which he says felt rushed and–despite receiving full certification like everyone else–he feels that his speedy education “may have affected my confidence.” Gupta was dismissed from CAVA recently, admitting that this lack of confidence and focus were cited in CAVA’s decision.

CAVA now teams with Emergency Care Programs, another third-party training program, to offer a new, free course for those interested in joining in the future. But the memories of the last year have led some students to speculate that perhaps a more centralized training program, less susceptible to unexpected collapse than using a third-party, would benefit the team’s cohesion, confidence, and services. Creating this program might be a pipe dream, though; CAVA has historically had trouble securing funding for even its most basic needs – a woe best exemplified in its perennial struggle for a working, modern ambulance.

Active since 1962 as an informal and untrained coalition of SEAS staff and faculty, CAVA operated until the early ’70s with no vehicle and little funding. In 1974, the university finally bestowed a retrofitted Ford van upon the volunteers, and funding spiked in 1980 when CAVA gained official recognition as a student group. Although the Columbia Public Safety department had already planned on buying an ambulance to participate in the rise of EMS programs nationwide, they decided to donate the vehicle to the newly recognized student service group instead. After these early marriages of convenience, though, funding was never so easy to come by.

Not all CAVA patients go to St. Luke's Hospital. Depending on the patients' conditions, they may be transported to any of several facilities around New York.

In October of 1993, despite consensus across the CAVA staff that their ambulance had become unsafe, the University denied funding for a new vehicle. That November, CAVA resorted to a ten-day strike and student ire forced a University concession. Again in 2000, the University resisted calls for a new ambulance, but the CAVA staff decided to negotiate. Three-and-a-half years later, the staff managed to raise the $110,000 needed for a fully stocked vehicle from a wide range of donors. CAVA opted to purchase a larger model partially to accommodate what was at the time a robust staff – numbered above 50 for the first time in its history.

The university’s resistance to funding CAVA does not receive much attention. Neither time nor breath was wasted on financial issues in meetings, says Gupta, though he recalls observing equipment shortages. Staff say, for example, they have needed a new pulse oximeter–a device used to measure how well a person is breathing–for several months.

Yet CAVA remains prepared and functional, as their 108-page Standard Operating Procedure, containing drill instructions for every conceivable situation a medic might face, will attest to. Each CAVA crew ensures that they have all the regulation materials to handle any situation, and, Kyriakakos assures students, none of their machines are outdated.

However, while Health Services at Columbia springs for new technologies, the ambulance is a good example of how a modern machine can still require replacement — as early as the winter of 2000, the ambulance CAVA crusaded until 2003 to replace started to break down almost weekly. And, Kyriakakos mentions, “there have been no leaps and bounds in the EMS technologies we utilize in the recent past.” While functional and perfectly efficient, then, there remains room for improvement.

On less vital matters, the University stonewalls CAVA more blatantly. Indicative of this tendency, the University has denied funding for CAVA’s annual EMS conference, an event which promotes CAVA’s professionalism and knowledge. Kyriakakos also fears that the University will clip the budget for their end-of-the-year banquet, one of the few signs of gratitude towards an overworked, underfunded, and unpaid staff.

Kyriakakos acknowledges that the staff has been, for at least the last year, negotiating for a fifth vehicle with administrators. Given that the average life span of a functional ambulance ranges from six to seven years, the time has come for CAVA’s current ambulance, but Kyriakakos says “there is much debate and discussion that needs to take place at many university levels before a new ambulance can be purchased … I do not know at the moment how they will pan out.” And whether they will have any support from students remains uncertain. Gupta admits that the closest thing they have to public relations are their interactions with students when pulling their inebriated peers out of a party.

This reputation plays into the common misconception that CAVA is, as WikiCU purports, “the preferred mode of transportation for inebriated freshmen.” This misconception unfortunately is aggravated by the fact that, as students report, despite exhibiting and explaining clear signs of fever or appendicitis, CPS, which fields all of CAVA’s calls before passing them along to the ambulance, or CAVA volunteers only asked, “Are you drunk?”

In truth, Gupta recalls, only 20 to 25 percent of his calls, even those on the most busy nights (Thursday and Saturday, in his experience), were related to alcohol. Kyriakakos claimed that the true volume is around 15 percent alcohol calls, with the bulk at the start of the year. “The vast majority,” says Kyriakakos, “are calls that one would find anywhere in the city: fainting, diabetic emergencies, seizures, chest pain, vomiting, etc.”

And the cases in which CAVA cannot respond to a call are minimal, with the dispatchers recommending that the student call 911 in the interim. Student hesitation to call 911 or walk to St. Luke’s, they argue, is the main reason so many have stories of long, uncomfortable waits. But many students fear the presence and punitive actions, especially in public situations, of CPS, which often arrives with or before CAVA. And, though CPS is required to provide callers with all alternate sources of care if CAVA is unavailable, Chaitanya Medicherla, CC’12, recalls hearing no such options. As he lay bleeding profusely from his finger, fearing he had sliced it down to the bone, his friends had to call CAVA three times before getting a crew to respond.

Although CAVA is one of the oldest and most effective nationally recognized EMS organizations, responds three to four times faster than any other city EMS service to campus calls, and is absolutely free, the organization has little means of interacting with the student body off of a stretcher. Their attempts at separating themselves from their identity in the minds of many students–changing their name from the now-verb CAVA to CU EMS in 2002–have failed to stick. Save for reporting on their Oct. 23, 2009, ambulance-traffic collision, they have garnered no University-wide attention. Kyriakakos mentions that he wants to have more contact with the University, and claims that CAVA “will be starting a CPR training program … [that] will be a cheap way for the University and students to become certified in this life-saving skill” and become more familiar with the CAVA program in the process.

All griping aside, even those who had a somewhat negative or mixed experience with CAVA ultimately appreciate the service. Medicherla mentioned that, despite the wait, CAVA fixed him up and saved his finger, “so all in all, it was a positive experience with CAVA. Humorous, too,” at least in hindsight. Lives are saved and the organization is functional and worthy of praise, although many students are not aware of that fact, having never appreciated CAVA’s services themselves, or done so sober and privately. And the stories of those who do appreciate their services often hint that there is room for improvement, highly contingent on fast and cooperative funding.

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  • Anonymous says:

    @Anonymous Do none of you realize that while you guys are hanging out with your friends, these guys sit around waiting to try and make you feel better? Also, if you were to call a non volunteer ambulance you would end up paying over 600 dollars in medical bills apart from your already steep medical bill- do everyone a favor and just appreciate when youve got a good thing coming to you. As for funding for conferences etc, just like any organization, to motivate people they need to have a forum for being awarded for their service- it is at the conference they get awards like best collegiate ambulance service. In addition, sure some of them may not be as suave as you want them to be, but they are still the only ones willing to come running when you dont feel well…

  • Anonymous says:

    @Anonymous You work in NYC and work in type IIs. Ok. Check out what FDNY just ordered for their new ambulance fleet – even larger type Is, with the reason of providing their crews more space to operate. And having worked more codes than I can count, the handful of times I’ve had to work them in the back of a type II are not particularly pleasant memories.

    Type IIs are more maneuverabe. But there is not space for 4 people (CAVAs routine staffing) let alone friends, family or PD/ALS.

    1. yeah says:

      @yeah No question it’s a better vehicle, and you can’t have a large crew in a Type II. But if call volume is a big issue, it’s better to have two smaller crews, and if cost is an issue you might have to settle for a cheaper vehicle. Of course, it’s a shittier experience and you might get even fewer volunteers.

      Really not a lot of disagreement here. Best thing is to get them well funded and get the best stuff.

      1. Anonymous says:

        @Anonymous They run 4 person crews in order to allow for ongoing on-the-job training of a relatively inexperienced workforce that is regularly turning over with a maximum of 3 or 4 years of experience as CAVA is mostly staffed by undergrads.

  • Anonymous says:

    @Anonymous Columbia’s students and staff are very lucky to have such an awesome resource available. Most universities don’t have an ambulance service as a safety net for students. Not even regarding the lack of supplies, to think that the university can’t even pony up a couple thousand in thanks of the tremendous amounts of time these people have put in is stupefying and shameful. I’d rather them getting some thanks from the university instead of the lawns on the side of Low being redone for what seems like the 50th year (or those fancy looking gates). If CU actually puts as much effort and money into substance as it does into looks, it’d be a much better place for all of us. As of now, it’s more a school for alumni and prospective students than actual students. As long as cava exists as something for the brochure, the university can’t care less. Sad.

    TL:DR = Give cava some fing money.

  • ummm says:

    @ummm as a past member of cava, i can attest to the fact that a lot of the people in this thread are incorrect about these people being “intelligent” and “remarkable.” of course you have your perfect harvard-bound premed-er in the ranks of the corps, but there are definitely a lot of douchebags mixed in with the rest.

    1. Anonymous says:

      @Anonymous I’m friends with a bunch of cava guys/gals. Seems like most of cava is decent and awesome, just a couple douches bags/nozzles and perhaps a few boring premeds who joined cava to do the bare minimum to stay active in order to pad his/her resume.

  • Anonymous says:

    @Anonymous CAVA is amazing. Enough said.

  • EMT says:

    @EMT Of course it is great that CU even has a volunteer service and people are willing to take shifts and work for free; all I mean is that the call volume isn’t all that much, and they have nicer equipment than they probably need. Conditions are shittier in EMS elsewhere. CAVA definitely deserves support but privates and the city slash costs whenever they get the chance so it comes with the territory.

    1. Anonymous says:

      @Anonymous From what it looks like, call volumes are increasingly with equipment and personnel staying the same. Keep in mind that CAVA people are first and foremost students. I’m always seeing them run of our class and butler. It’s amazing the job they do at this rate with everything else they have going on.

  • EMT says:

    @EMT At a busy private company, one crew will get 5 calls in a 10 hr. shift. FDNY gets more. Of course they’re paid in both cases.

    But anyway I wonder why they need a pulse ox for BLS anyway? It’s nice to have but it’s not in the protocol and there’s plenty of other signs you can use to make the call.

    On that subject, why do they need a big ol’ mod? Of course, they’re already in for the ambulance, but you could almost buy two new type 2 ambulances for that price.

    1. Anonymous says:

      @Anonymous Have you worked urban EMS? Anyone who has worked in an urban (or suburban or any system) will tell you that the type 1’s are far more comfortable for delivering patient care in. Particularly for situations where a patient needs ALS/aggressive BLS management type 2’s are simply too small.

      As for pulse ox, like many things it is not absolutely necessary. However it does provide additional information when delivering care and gives information that is useful for the ED staff on arrival.

      1. EMT says:

        @EMT I work in new york city and type IIs are not all that bad at all for BLS emergencies. A little cramped but you can do everything you need to. And they’re faster and easier and more maneuverable.

  • anonymous says:

    @anonymous you have no idea what you are talking about. you do not even work for CAVA and you are critiquing them? Students are donating their time to help you, its ridiculous that the university does not provide enough funding. Have you even seen CAVA enough to say that their care is sloppy and rushed? I was treated by CAVA and I am extremely appreciative. They were caring, considerate and I was very happy with their medical treatment. And to make it sound like they are volunteering for a banquet is ridiculous. They are working for us 24/7 for the entire academic year, the school cannot give them a dinner, or send them to a conference? CAVA needs funding, period.

  • happy endings says:

    @happy endings that picture looks like he’s giving a bj…

  • Student Run Organizations says:

    @Student Run Organizations Are great, except when their actions matter to people. Nobody cares if the hockey club self-destructs. In CAVA’s case, there’s no way a couple of Seniors on CAVA can effectively manage their organization while providing the high standard of medical care they should/need to provide. As an EMT with inside knowledge of CAVA (I do not work for them, but for another volunteer EMS organization outside of CU) their medicine is sometimes sloppy and rushed. It’s true that they generally deal with less-than-ideal circumstances, but what EMTs don’t? No excuses. Most of these overachieving Pre-meds, when not too busy trying to play politics to move up in the ranks of Cava, are probably capable of good EMS. But they don’t care and neither do their superiors.

    I certainly hope it doesn’t take an injury CAUSED by Cava, followed by lawsuits etc, in order to get this organization the dedicated professional oversight of daily operations that it so desperately needs. If it ever comes to a lawsuit, I fear that Columbia will just shut CAVA down rather than deal with malpractice.

    And cry me a river about their fucking party…If someone is volunteering in order to earn a banquet, god help us all.

  • Dave says:

    @Dave The people in CAVA who I have been fortunate enough to meet are some of the more remarkable and intelligent human beings I know. I am not the type of person that gets angry at the administration for small things, but a funding problem for what is probably the most important student organization is inexcusable.

  • CAVA says:

    @CAVA let us know when CPR training programs are! I would love to learn!

  • This is probably says:

    @This is probably because of Obama’s healthcare bill, the president probably wants state sanctioned servants to take drunk Columbia kids to the hospital, not some SEAS student
    Viva Socialism

    1. Assessment says:

      @Assessment Needs more effort. Effective trolls are subtle and plausible. Grade: 1/10. Please see me after class.

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