I got a call from a paramedic at 1 in the a.m. this morning. She works for an ambulance service that responds as a second tier to the fire department, and transports any patients that the firemedic deems is not serious enough for them to handle. The call went like this:
"I need your help. My supervisor won't answer the phone, and I don't know how to handle this. I am on scene of a single vehicle rollover that shattered a telephone pole, and the driver is a 26 year old female who woke up in the grass and didn't remember the crash, or how she got out of the vehicle. She states that she had a single glass of wine, is otherwise appropriate, and is refusing medical care and transport. She states that she doesn't want to be on a backboard or have a C collar. Her vitals are: HR 162, BP 126/78, RR 16. The fire department allowed her to sign a refusal, but I don't think that's right. The other medics here from the fire department are telling me that I'm being too much like a "rookie." What should I do? She is in SVT, and had an accident."
The first thing that you need to know is that this particular medic only got her license 4 months ago. She is a very bright woman, but has no experience. I advised her to talk the lady into going, and if there was no other way, agree to not immobilize her if she agrees to go, and just document that she refused being immobilized. I also told her that she was not likely dealing with SVT, the patient was likely bleeding internally, was in compensated shock, and getting her to the trauma center was a high priority.
Enroute to the hospital, the woman began complaining of abdominal pain, and her abdomen became rigid and distended. It turns out that she had some significant bleeding.
Medics: This is one of the dumbest refusals I've heard of a medic taking. Lazy medics make me angry. Make fun of the new medic for confusing shock and SVT all you want, but at least she was smart enough to know what a sick patient looks like.