It’s been a busy day at the station and you’re finally sitting down to dinner when the doorbell rings.
At the door a woman tells you her friend is having chest pains and points to a rather large fellow sitting on the bench out front, smoking a cigarette.

After cleverly hiding a sigh, you welcome him inside after he tells you it is too cold to be examined outside.  He presents in no visible distress, and all your measurable variables are within his normal range, or so he says.

He later amends his chief complaint from chest pain to chest pressure, then again to “just kind of sore.”

A 12 lead is unremarkable, blood sugar normal, then when questioning about his medical history he produces a prescription bottle of heart burn medication filled yesterday.

“I had this chest pain on Monday too, I called 911 and they took me in.  Idiots thought I was having a heart attack.  I just want you to make sure everything is OK.”

As you advise the boss to slow the ambulance to code 2, the patient shifts in his seat and glares at you over his reading glasses.

“Son, maybe you’re not sure how this works, if I wanted an ambulance I would have called one this morning when the pain started.  Instead I waited until now to come by to make sure this isn’t something new.”

He goes on at great lengths advising you that he will not be boarding any ambulance, no matter what words he has said or risk factors, or chance of a continuing issue from 2 days ago, he refuses to even consider boarding an ambulance.

“If an ambulance even pulls into this lot I’m gone.” he says to you.

Wondering what his motivations are you consider other options and discover his hospital of choice is only 10 blocks away and the person he is with is driving for him.

He agrees to goto the ER only after you describe it as a “Do not pass go” moment and he agrees.  He then refuses to sign your form, or speak to your Medical Control via telephone, as required by protocol for a refusal of this kind (considering his buzz words).

The ambulance pulls into the lot just as he is leaving and he gives you the 1 finger salute, then turns away from the hospital in the opposite direction.

Do you have a duty to follow up, have the ambulance track him down, or can you simply sigh and cover this with a solid chart?  Every system is different.

You make the call.

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