Last October, just before Halloween, a “mass-casualty event” befell the emergency department at Lansing’s Sparrow Hospital. Staff put incoming patients in every bed, gurney and wheelchair that could be found. A hallway was turned into a ward, patients lined head-to-toe against the walls, a nurse assigned to move up and down the line, checking airways to ensure none were in imminent danger.
Over 200 patients bombarded the ER in a three-hour period, pushing it into Code Yellow status, meaning only heart attack and stroke patients could add to the caseload.
It wasn’t a plane crash or mile-long pileup on I-96 that fueled this emergency, but the annual football rivalry between the University of Michigan Wolverines and the Michigan State University Spartans. The patients, to a man and woman, were drunk; so drunk they needed medical attention to ensure they didn’t die.
The overserved can overwhelm hospitals during football season in Michigan’s legendary college football towns, taking staff attention away from broken limbs and tender appendixes.
For the Michigan home opener Sept. 12, 22 patients with alcohol-related health conditions were seen in the department at the University of Michigan Health System.
Dr. Jeffrey Desmond, interim chief medical officer at U-M’s hospital, likes to say that, unlike most football fans, he yearns for unpleasant conditions on days when the Big House is roaring: “I hope for not-very-exciting games, held early, and in bad weather. It makes a huge difference for the emergency department.”
In Ann Arbor, as on other campuses in the state, extra medical staff are added for home games. At U-M, that means at least one doctor and two or three nurses. There’s a first-response area at the stadium. Ambulances transport the worst cases to the ER. As with East Lansing last fall, the workload for U-M doctors rises or falls with the game conditions.
A wing filled with alcohol patients
Desmond analyzed alcohol-related ER arrivals over four years of Wolverine football seasons, 2009-13. The lowest number of visits during a home game was Oct. 17, 2009, against Delaware State; the Wolverines won in a 63-6 blowout, temperatures hovered in the mid-40s and only eight patients were seen.
The highest was Sept. 7, 2013, a night game against longtime rival Notre Dame, when it was in the low 70s at kickoff. Michigan won 41-30, and 57 people were transported to the ER, drunk.
And, Desmond notes, that’s only the people whose primary complaint was drunkenness.
“If you came in with a broken ankle because you fell off a curb drunk, it was recorded as a broken ankle,” he said, “not alcohol.”
The level of dangerous campus drinking can surprise even those who live in college towns.
Mark Maynard, an Ypsilanti resident, found himself in the U-M emergency department on a November Saturday last fall, suffering from chest pains. His condition wasn’t life-threatening, so he was ushered into an area usually reserved for the observation of cardiac patients. But, as he explained in a blog he wrote later, the nurse attributed the crush of patients to football Saturday, “I was told that the mix of patients might be ‘a little different’ from what a person in my condition might normally expect. And thus began my day in the drunk tank.”
All day, plastered patients, most apparently students, were wheeled past and treated near Maynard’s bed. One young woman, who was said to have been found covered with vomit somewhere in Ann Arbor, was particularly concerning:
“The EMTs brought her down the corridor, strapped to a board, telling the hospital staff where she’d been found,” he wrote. “Her head was hanging to one side, like her neck couldn’t support the weight of it. ...When she first came in, before I realized that her admission was alcohol related, I honestly thought that she had an advanced neuromuscular disease of some kind.”
“It was a revelation,” Maynard said in an interview recently. “It wasn’t one or two beds, it was like a whole wing. They had to move me to make room for them.”
None of this surprises Dr. John Dery, an emergency specialist at Sparrow in Lansing, the hospital that receives the majority of alcohol cases as MSU. Fifty to 60 visits are usually that hospital’s minimum load on a football game day.
“We’ll have ambulance traffic before and after, and after the bars close. It’ll be somebody found passed out on someone else’s lawn,” Dery said. “Our difficulty becomes, how long do we have to hold on to this individual? How can we find them a sober ride home? Half the time they don’t have a cell phone or are too drunk to remember anyone’s phone number. We can’t medically clear them until they are safe to discharge.”
A hospital’s role
To some extent, the medicalization of drunkenness is a recent phenomenon. In the past, many of these people, particularly students, would have been led to their bed or a couch, a bucket placed next to them, and left to sober up on their own.
But that can be dangerous; a freshman at Michigan State, Jiayi Dai, died in her bed before classes even started last school year, with a blood-alcohol level of .41, following a night of partying with friends.
At least once a year, Desmond said, a student will arrive so drunk they need to have a breathing tube inserted, which means automatic transfer to the intensive care unit. They, and others less severely affected, have to be monitored as they metabolize the alcohol they consumed. Medical and university staff have tried to send a better-safe-than-sorry message to encourage students to seek help in extreme cases, Desmond said.
“If you see someone who’s at risk, come to the ER. That’s why we’re here,” he said. “It can be hard to judge when someone’s in trouble. Novice drinkers frequently have no idea of how drunk they are.”
Doctors stress that students are not the only football Saturday visitors to the emergency department.
Desmond recalled a 50-year-old woman who was left, unable to walk or stand, outside a woman’s restroom at Michigan Stadium last season. Her husband returned to his seat; she was taken to the hospital.
“We finally got a text through to him telling him his wife was in the hospital,” Desmond said. He replied that he was watching the game, and would be there after it was over.
Which illustrates what may be a significant obstacle to selling a message of moderation to college students: Wherever they look around them on game day, they see adults behaving in much the same way.
“Walk from the student union down State Street to Hoover,” said attorney Mark Bernstein, a University of Michigan regent. “Turn right on Hoover, maybe an hour before the game, you’ll see what we’re trying to deal with.”
Both streets, and many others in Ann Arbor and elsewhere, are lined with fraternity houses, student rentals and others where front-lawn partying on game days is raucous and jubilant.
University of Michigan students walking to the stadium from central campus are a celebration in motion, with drinking all around them. Beer pong is played in tiny yards surrounded by temporary snow fencing, so that guests, who can legally drink in the yard, don’t step onto the sidewalk, where they can’t. Students on balconies hold funnels with tubing extending to the ground, and beckon passersby, “Who wants a free beer?”
Alcohol-fueled tailgates remain a lively tradition; Pioneer High School, across the street from Michigan Stadium, is a prime location, and non-student fans set up bars and open coolers for their guests. No alcohol is served inside most college stadiums, so students and elders compensate by “pre-gaming” at parking-lot parties.
“I find it ironic and inconsistent that you can’t drink in (Michigan’s) stadium, but there’s an ocean of it around it,” said Bernstein, noting that some universities are experimenting with allowing drinking in stadiums, in part to raise revenue but also in hopes it might moderate the binge drinking beforehand.
Other schools have different strategies. Students ejected from the University of Wisconsin’s Camp Randall Stadium for alcohol violations will only be readmitted to subsequent games if they submit to a Breathalyzer test at a specific gate. The University of Notre Dame shuts down tailgating at kickoff. (At Michigan and Michigan State, by contrast, the partying continues throughout the game by fans unable or unwilling to buy tickets.)
All of which makes more work for doctors. Desmond and Dery said that while hospitals treat all patients who enter (or are helped) through emergency-department doors, there’s no question the large number of drunks stretches staff resources on game days.
“It’s extremely frustrating,” said Sparrow’s Dery. “Because it decreases my ability to provide the high-level care that I want to give all my patients. My drunk patient is just as much a patient as my chest pain patient or one with a urinary tract infection. But it’s a different type of challenge. You fell at work and broke your arm, and you’re waiting in the waiting room. But what you’re not seeing are the multiple ambulances pulling up, taking up all the beds, and I literally have no place to put you.”
The hospital didn’t add staff for football games in 1993, when Desmond took the job in Ann Arbor. But with the addition of night games, and a fortified culture on social media and in music of celebrating youthful drinking, the problem has snowballed, he said.
“People have always drank, but it’s definitely worse,” he said. “Scale is part of it, part is culture. We don’t do it for basketball games. Or hockey.”
Dery would differ on that.
“I pick my vacation based on the NCAA (basketball) tournament,” he said, referring to the MSU basketball squad’s reliable presence in the event. “I know pretty far in advance (when) it’s going to be, and I ask for those days off.”
– Nancy Derringer and Ron French