Great question!
We all know that the creation of EMS is what's in the name. EMERGENCY. But what constitutes an emergency? Who's emergency is it? Why exactly was I called here?
No matter where you work, majority of your transports are going to be for CYA (cover ya asses) purposes. Especially from another medical facility. If a family doc see's a chest pain patient at their clinic, documents it as chest pain, takes basic vitals, and then tells them to drive them self to the ER, that doc is at a HUGE risk for law suit. Even if everyone in a five block radius knows this person is stable, anything that happens to that patient from the clinic to the hospital will come back to that doc. The patient falls in the parking lot, finally has an MI, or even smashed by a meteor, some sleazy lawyer will come after that doc and their family. We transport 70% of our patient population for the possible 5% of terrible or nearly impossible situations that COULD happen. A lot of our job is dictated by legal and political crap. I work for a hospital based system currently (I have worked for just about any type of service) and we are up to our eye balls in this type of stuff. Especially when you reach to leadership level. It begins to haunt your dreams... *clutches pillow* I'm drowning... drowning... drowning is bull shit!
To help create some peace of mind, just remember that transport is the game we play. It's how some of us get paid. It's how we all get new equipment and facilities. In order to keep working, the CYA covers YOU and YOUR family. Just keep in mind that everyone deserves a ride no matter how much BS the call is swimming in. Again, if you get that refusal, call a cab, and that patient comes into contact with any harm (no matter how small), it's going to fall back on you. Yes, you got the refusal. Yes, they understood the risks of going against medical advice. But lawyers know how to get around these things. They will pull up refusal frequencies, vital signs, destroy the grammar of your narrative, and will have what was once an agreeable patient with you scream bloody murder in the court room. *side note: jurors have to be able to read at a sixth level. Write all of your narratives at that level. It's a legal document, not a medical document.*
It's a dangerous game we play for the little amount of money or volunteering hours we receive. But we keep with it for the small population that we really get to use our skills and help.
Now, I am not saying this legal situation is ok. It's crap. But our society is greedy and they expect their emergency services to be faster than burger king, stronger than an athlete, the attitude of a saint, and that the bill to be free. So, keep yourself safe in a legal aspect. If it wasn't documented, it didn't happen. The patient has a legal right to transport. When the day becomes the crappy transport bus, just keep in mind why you got into this in the first place! Even on the BS calls, you can impact someone's life!
Hope this dissertation helped! Longer than I expected!