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Recently I was running duty with my volunteer department in southern MD. We got dispatched to a MVA. I was the first unit on scene. Scene size-up showed a 2 vehicle rear-end collision. Collision took place on the highway with the struck vehicle going appx. 55 mph and the at fault vehicle traveling upwards of that. Both vehicles had significant damage, 15-20 inches of damage on each. Both pt's were out of their vehicles. The teen in the struck vehicle was not complaining of any injuries, stable vitals, and pupils were equal and reactive. Mom got on scene and signed a refusal for the son. The woman in the at fault vehicle was a different story. As soon as I got on scene she was screaming for me to help her and she hit her head on the windshield, however she had no lacs or tenderness. Examination of her vehicle showed airbag deployment and a spidered windshield with an obvious point of impact where her head hit. I couldn't be positive of ETOH, there was a slight odor but nothing major. Immediately seeing this I started a helicopter due to protocols and MOI. The woman was agitated and slightly combative but was Alert and Oriented x 3. I told the woman that due to her striking her head and the MOI that I started a helicopter for her to be transported to a trauma center. Pt immediately became even more agitated and told us to let her go and she wasn't going anywhere. Police on scene said that they "couldn't make her go, she's over 18." which means they didn't want to put her under emergency orders. Pt downright refused any examination and transport to even our local hospital and signed a complete refusal.

What do you all think? I was so frustrated because I couldn't do anything, forcing her into a collar or even an exam would have gotten me in trouble, but I felt so helpless and pissed because this lady needed to be looked and wouldn't go. any comments?

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Like my preceptor says, you've got to "document, document, document!". I assume you already wrote down exactly what happened, but I'd say maybe take it a step further and get the names of some of the police officers on scene, FFs, partners, etc... Anyone who will confirm your story that the patient flat out refused medical care. The chances of this person complaining later on is remote, but still... Best to CYA in cases like these!

As long as you cover all the bases (including informing your supervisors and possibly medical directors) it should be ok... But don't take my word for it... After all, I'm just a "FNG"! :lol:

Take 'er easy

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thats what one of my fire sergreants said, you did everything right just have her sign the form and walk away from her before something else happens, but thats hard to do when you want to help someone. My chiefs already know and the refusal was witnessed by an officer on scene who also signed the form, but it still bugs me.

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No, where we are pt's can sign a refusal as long as they are over 18 (or have a legal guardian present), alert and oriented, and understand and have been informed of the risks of not going. We ren't required to consult our Medical Director.

Like everyone else has said, 'Document'!. Read her her medical Miranda's in front of a couple of witnesses [cops are good since they don't work for the same org you do], make sure she knows she can call you [EMS] anytime if she has problems and wish her well. And even if your protocols don't require you to bring MedCom into it, I'd do it anyway so that you have that additional piece of documentation as backup [the base con radio transcript]. Besides, maybe the doc can talk her into it.

Looks like you did the best you could in a bad situation.

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No hx of LOC, orientated X 4, I would not had called for helo and she was informed of risk, have LEO witness that risks was informed ( death, CHI, unknown injuries, you highly suggest further evaluation and treatment), contact medical control if protocol (most anymore has quit this, they can't force anyone to go either) and out of there. Patient made an informed and conscious decision. We only can make strong suggestions, and recommendations.

R/r 911

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well my parents just had a car accident last weekend and the windshield was starred by the airbags. They watched the airbags deploy and they saw the windshield after the deployment and they said the airbags starred the windshield. I ended up on scene with them as a son not a medic.

So I think that the starring of the windshield might not be tantamount to assuming that the patients head starred it.

Some thing to think about. I would have never thought the airbag would star the window but now I know different.

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