Imagine being called to the third pub of the shift, like the other calls the patient is 'collapsed'. You arrive and the person is stinking drunk.
He's able to answer questions, an examination shows nothing serious. You tell him that you'll take him to hospital.
He becomes aggressive, swearing at you, flailing around to push you away.
You can't 'kidnap' him, even if you could there is no way to safely force him into your ambulance.
So you leave him with his friends, or the police arrest him. Then you spend the rest of the night worrying that there was something wrong with him and that you'll end up standing in a coroner's court.
I have a problem with the sub-headline 'Paramedic refused to treat him'. It looks to me that they tried to treat him but that he refused.
99.99% of these jobs would turn out fine, the patient would sober up in the police cells, or back at home – unfortunately there is always the slight chance that alcohol is masking something more serious.
Obviously the report can't tell us everything that happened that night, and I wasn't there and anything I write about this situation is supposition. However I do have experience with calls very much like this one – a lot of experience.
I can see how the crew made the decisions that they did. I've made similar decisions myself.
Take for instance the report of being unconscious for ten minutes. Daily I come across people who don't know what 'unconscious' means, for some people sitting on the floor means 'unconscious'. For others groaning in pain is 'unconsciousness' and for some being dizzy means that they are 'unconscious'.
If the witnesses to an event have all been drinking and aren't medically trained, then you often take what they say with a pinch of salt.
If you are unconscious for ten minutes there is a good chance of you occluding your airway and dying, someone sitting there chatting to you is unlikely to have been unconscious. I'm not saying it never happens, it's just unlikely.
So I can't blame the crew for taking the history with a pinch of salt.
But in any case, they tried to take the patient to hospital (where he would probably be sat out in the waiting room to sober up where the headline would then be 'Nurses sat patient in waiting room to die'). It was only when the patient because abusive and aggressive that they stopped trying to get him into the ambulance.
So at what level of aggressiveness do you stop trying to force someone into your ambulance? When they tell you to 'fuck off'? When they threaten to hit you? When they take a swing at you? When they push you away? When they connect with a punch? When they connect with a second punch?
At what point do our bosses, and the courts, or the press, want us to ignore being abused?
When can we kidnap people? What powers should we have to force people to submit to treatment and transport? If someone doesn't want to go to hospital and they seem to understand what is happening then we have no power to drag them to hospital.
So it's not as if the crew didn't try to take him to hospital.
The question comes down to asking if the head injury this person suffered is what caused the aggression. Unfortunately we don't have portable CT scanners and the skill to read recent onset cerebral bleeds.
Also injuries of this sort after a fall of this type are very rare – I can't count the number of 'drunk – head injuries' that I've gone to (and yes, I try to take them all to hospital), but I can't remember any that went on to die.
So, it's not incompetence, it's not a lack of care, it's not a “oh, he's just another drunk, lets leave him”. It's a combination of it being illegal to take someone to hospital who doesn't want to go, of not wanting to have a fight in the back of an ambulance, and of the unlikely odds of this being something serious.
So, based on the reporting, I look at what this crew did and I think that I probably wouldn't have done anything different.
Honestly, what would I do? Take him to hospital in police cuffs for apparently only a graze to the head?
What would you do, without the benefit of 20/20 hindsight?
I have sympathy for the patient, his friends and his relatives. I also have sympathy for the ambulance crew, no-one wants their patients to die.
But that is the risk we take whenever we don't take someone to hospital.