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Sun Nov 5 20:28:46 GMT 2006

Obviously the EMT's who responded were neither stellar clinically nor  
particularly interested or concerned to hear your part of the story. I agree  
strongly with Dr. Krin - any EMS provider, hearing that story, should be  concerned 
for EDH, and at least try to convince the patient to go to the ED via  EMS. If 
he still refuses after demonstrating an understanding of the risks of  
refusing transport (although by your description, I doubt the EMS providers did  
that), and he's competent, then he has the right to refuse - however... two  
thoughts. I think this is a case that illustrates quite well an example of a  
patient refusal that on-line medical direction could be involved in. We've even  
had the patient speak to the ED attending providing medical control, any in 
many  cases, if the physician says they should be seen, they may heed his or her  
advice. My second thought is, where were the cops? They can often talk some  
sense into people who don't want to go to the ED via ambulance, and they could 
 certainly tell this kid's boss to butt out. 

As others have said, you did what you could - in fact, it sounds like you  
did much more than I would have done unless the person involved was a friend or  
family. If it still upsets you, and the EMS providers acted the way you  
describe, perhaps you ought to discuss it with their agency, medical director,  
regional or state EMS office, etc.

Finally, as far as initial triage, if a trauma center was accessible  by 
ground EMS, and he were transported by EMS, I would absolutely expect him,  
despite his GCS of 15 and lack of physiologic derangement or major obvious  injury, 
to go to the trauma center. 

Sounds like a happening club. 

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