EMS Treatment of a Minor (1/2)

Mart asks: My MC is 16 yrs old. She gets hit by a truck. She has road rash. Right leg turned black and blue. Shin welled up. But other than feeling like she literally was hit by a truck, she is okay….she thinks. What would most likely occur after an incident like this? In short, how can I make it so a 16 yr old girl who has been hit by a car, stalls at home before her Mom takes her to the ER?

I hope there is a way.

Dianna says:

A 16-year-old can accept EMS treatment and transport to a hospital. However, a 16-year-old cannot refuse treatment and/or transport – EMS has a refusal form that requires a signature from the patient, a minimum of age 18, or from a parent or legal guardian of a minor aged patient, 17-years-old or younger. EMS will not leave a patient at the scene until we obtain a signed refusal form (we wait for as long as it takes to obtain that signature).

It’s not uncommon for patients to refuse an ambulance transport to avoid additional medical bills and then have someone drive them to the ED.

From your scene description, it sounds like the patient was a pedestrian stuck from a truck at low speed, propelling her body in the air slightly; her leg skidded on the road, stopping her.

A pedestrian struck by a moving vehicle is a serious mechanism of injury thus a high priority trauma. EMS will encourage both treatment and transport by explaining to your patient she may have internal injuries.

I actually say to patients, “I don’t have x-ray vision or CT scan capabilities inside my ambulance, so I’m unable to verify if you’ve sustained internal injuries or not.” If transport is still declined, I obtain a signature of refusal from a parent or legal guardian (the uncle wouldn’t be enough). The way around this legal issue is for the MC to call her mom and EMS waits for her to arrive on scene.

Was the truck driver at fault for hitting the MC? If the driver is legally at fault, then most patients tend to accept EMS treatment and transport (think law suit). Regardless of any pending law suit, I think the uncle would insist the main character be transported.

Once the mom arrives on scene, I find it unbelievable (and not likeable or smart of the mom) that a mom would refuse transport to a hospital for their injured teenager struck by a moving truck as a pedestrian. That’s a serious mechanism of injury (most car accidents are minor, but being hit by a car as a pedestrian is serious). However, if you prefer to avoid an ambulance ride in your story, then write in the following: 1) Keep the injuries extremely minor – EMS finds no abnormalities beyond right lower extremity minor swelling and abrasions with slight oozing blood.  2) All her vital signs are within normal limits. 3) The patient assessment from EMS cleared C-spine immobilization (backboard and neck collar).

However, since the mechanism of injury is significant, in order for those three above points to be believable, you’ll need to write in the following: 1) The truck was moving at extreme low speed (like 5 miles per hour); it’s amazing how much damage just 10 miles per hour causes. 2) The truck is small or it’s a small car. 3) She wasn’t thrown far in the air (height or distance) and didn’t hit anything else. 3) Her behavior and signs and symptoms indicate she suffered no injuries beyond minor contusions and abrasions. 4) She’s adamant against a trip to the ED.