Several years ago I arrived at a large Georgian revival house just off the campus of a university. A party was in full swing. Music was blaring and a crush of people spilled onto the lawn—blue and red cups ubiquitous. Unfortunately, I wasn’t there to join the party, but to serve in my capacity as an EMT. We arrived to find a young man crumpled at the bottom of a short set of stairs. His skin was clammy, and he was barely responsive. Because his fall was unwitnessed, we strapped the patient to a rigid backboard to protect his spine. Each time the patient needed to vomit, my fellow EMT and I lifted and tilted the backboard, doing our best to direct the stream away from the patient’s airway. Under the unforgiving fluorescent lights, the back of the ambulance was filled with mixed scents of vomit, sweat, alcohol and the moans of the patient’s discomfort.

My experience working as an EMT in a college town made me seriously question the acceptance and flippancy with which society treats binge drinking on college campuses. Through my work, behavior that I had previously seen as wild, foolish and raucous took on a grim tone. Like many students, the statistics regarding the ramifications of drinking felt abstract to me; however, I gained first hand experience caring for those incapacitated or injured by the practice. Now instead of numbers, I associated the negative outcomes of binge drinking with faces, names and stories. I strongly believe that a normalization of binge drinking on campus poses a significant health risk to students, one that is commonly trivialized by our peers and society.

By now, students are well into the throes of the fall semester. Undoubtedly, many have consumed alcohol, some have engaged in binge drinking, and some have possibly needed medical assistance as a result. The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as consuming enough alcohol to bring a person’s BAC to 0.08—which typically equates to five drinks in eight hours for men, and four drinks for women. However, many college students would scoff at the moderation of this technical definition, more colloquially equating binge drinking with the practice of drinking to intentionally become significantly intoxicated. In 2014, a national survey revealed that 60 percent of college students had consumed alcohol in the past month, and of those students two of three engaged in binge drinking.

There are many reasons why students engage in binge drinking. In the 2011 CORE Alcohol and Drug Use Survey college students reported that alcohol was a tool to enhance social interactions (74.4 percent), “break the ice” (74.4 percent) or facilitate a connection with peers (61.7 percent). Stress, academic pressure, the perception of being in a safe environment and social acceptance all contribute to binge drinking.

Students normalize binge drinking by reacting with nonchalance, or humor, when recounting friends or classmates who were “blackout” or “wasted.” When we joke about dangerous, belligerent or criminal behavior that occurs while intoxicated, we trivialize the practice. This level of social acceptability is jarring when juxtaposed to the fact that a staggering number of college students die annually from alcohol-related unintentional injuries.

Of course it’s not just students who are to blame for creating a culture tolerant of binge drinking. Movies and television shows send the message that drinking heavily in college is not only acceptable, but expected. This media portrayal influences cultural norms and expectations; youth with high exposure to drinking in movies were more likely to drink experimentally and more likely to binge drink.

I’m not advocating for a dry campus, or even disparaging the consumption of alcohol as a general principle. Studies suggest that moderate alcohol consumption may be beneficial for cardiovascular health, and may decrease the risk of type-2 diabetes and gallstones. Alcohol is a part of cultural and culinary life in America, and that shouldn’t change. But binge drinking must be viewed through a more critical lens that appreciates symptoms such as blacking out as a sign of serious biological dysfunction.

What does this mean from a practical perspective? Treat binge drinking and blacking out as serious medical red flags. Don’t create social situations where people are pressured to drink more than they would like. Avoid creating situations in which consuming alcohol rapidly is modeled as a norm. Create social spaces on campus where alcohol is consumed without binging.

Years later, I am still struck by the tenuousness of the patient at the bottom of the stairs. It’s hard not to think about the alternate iterations of that night. What if he hadn’t fallen at the party, but instead on a quiet street on the way home? What if his fall had not just left bruises—but fractures and a brain injury? But for some fortunate details, that student could have been irrevocably injured or could have died.

Meaningful change in behavior and culture regarding alcohol consumption will only occur if it is championed by the student body. A school administration may shape the environment dictating the logistics of alcohol consumption. Nevertheless, most students are legally adults, and many are over the age of 21. Students make the meaningful decisions about the manner in which alcohol is consumed and set the tenor regarding what behaviors are appropriate. The behaviors and traditions exhibited by returning students to new students have a major impact on binge drinking. No matter what rules an administration puts in place, students with ingenuity and perseverance will find ways to binge drink, if that is their prerogative. So long as the student body sees binge drinking as acceptable, admirable or desirable, it will persevere on campus. It is up to students to make the changes in culture needed to protect themselves and their classmates.

Lauren Groskaufmanis is a graduate student in the school of medicine. Her column, “The Picture of Health,” runs on alternate Fridays.