You Make the Call - The Kid in the Street

Oh, I caught you off guard didn't I?

For you new people, this is a situation I completely made up.  This did not happen.  Today I give you a situation, on Monday we discuss what I would have done.  Now that that is out of the way, let us begin the call.


You are dispatched to a reported motor vehicle versus pedestrian incident at an intersection well known for trouble.  You and your EMT partner arrive on scene before anyone else to find a car stopped BEFORE the crosswalk and a woman and a toddler nearby on the sidewalk.

As you approach the child, later you discover he is 2, he begins to do the usual "I'm afraid of the new people" dance behind mom's legs.  He does it steadily, never off balance and if he's hurt he isn't showing it.

Mom is giving you the same impressions as you complete your primary assessment, finding nothing of note, except she does not speak English.  They're from out of town but your partner speaks their native language, but the kiddo seems uninterested in answering questions.

No trauma, no pain, no complaint.  All she wants is the police to come and cite the driver.


A BLS crew arrives as you begin to head for the driver, just to be sure, when they wave you off.  They're a strong crew and you trust their judgment.

That's why you believe them when they tell you what the driver tells them:

"I came around the corner and the lady was in the street already.  I couldn't have been doing much more than 10, when I hit her, she was carrying the kid and she flopped onto the hood.  Well, onto the kid on the hood at least.  They seemed fine, the kid didn't cry or anything, but they hit the ground and got up no problem.  I backed up just to make sure they were OK."

Per your own protocols and policies in your area, what do you do next?

You make the call.


Fakingpatience said…
I would have my partner question the woman again and repeat what the other woman stated, and ask for permission to perform a basic physical exam of her son (and her). If she refuses again I would simply have her sign a refusal of medical evaluation for herself and her son.
anon408 said…
Cancel the rest of the responders, except the police.
Ask permission to move mom and child to your ambulance.
Establish rapport.
Request permission to examine.
Explain local county treatment protocols (2 pt's c-spined, going to the trauma center).
She agrees, good.
She disagrees, call base hospital MD, make report that the mother wants nothing, refusing care for either her or the kid.
Wait for PD to show up.
Chart as 2 AMA's.
Jason Low said…
Local police would be well en route already due to it being (reported as) an injury collision. Deliver the info to them when they get there and let them deal with it (partner translating if necessary).
Dave said…
Check the kid over, C-spine him up and transport. Same with mom. Easy, peasy. No one there can give you the info you really need to clear C-spine.
John Vanatta said…
If they spoke English, would you still insist on transport?

Other than a language barrier, which is addressed by the partner knowing the language, what is the problem? The child seems to be acting age appropriate. Only Mom can really determine that, we have no idea what the child's normal behavior is. Mom believes he is fine and doesn't want the child or herself to be treated.  

Did the mother request EMS, or a bystander? By previous discussion here, a person who 1) did not initiate EMS response 2) is alert, oriented, unimpaired, and understands the situation, 3) denies having any illness/injuries, and 4) states they do not wish to be treated, does not meet the definition of "patient", and therefore does not even require a refusal form to be signed.

Personally, I'd do a refusal for both just to CYA, provided the partner is able to explain it adequately.
Neal Parkes said…
Follow my selective c-spine immobilisation guidelines, a set of obs, paperwork, another set of obs, offer hospital assessment, complete paperwork with pt signature, offer advice and if necessary contact GP or out of hours GP or if sos call 999. 
Let police sort out the rest.
CBEMT said…
Immobilize, RSI, and fly em out.  Better safe than sorry.
Charlie M. said…
I like your style, CBEMT...
the Happy Medic said…
on separate birds, of course.
the Happy Medic said…
I can communicate with mom just fine, it's the child who isn't answering our questions.  They did call for PD, but PD only rolls on injury accidents, so we get added to the call.  To address your bullets:
1)Did initiate response
2)Alert, oriented and understands: Mom, yes, kiddo unknown.
3) yup, denying any injury
4)Does not wish to be treated.

This is where our protocols fail us and sometimes require the extreme based on arbitrary numbers and events.  More on that on monday.
Certainly refusals for both at a minimum.  This needs documentation no matter what decision we make.
Rob (3dot0) said…
I ran a similar call involving the bicyclist struck. A simple scrape on the elbow & a request for PD for the report. Assessment, Vitals, Explain the refusal form & the implications, Express any concerns I have, document refusal, wait for PD to come from the other side of the district & clear
CBEMT said…
Like, duh.
Jon B. said…
First - Dave - do you have any research to back up that C-spine immobilization has any benifit, or more benifit than risk?

Given the nature of the collision, I'd attempt to assess mother and son. And obtain refusals to transport and/or refusals to assess. Possibly documenting with a call to a command doc, too.

I'd document the heck out of this call
Ossifer said…
Issue an Offence Notice for Fail to Yield to Pedestrians in Crosswalk, 575 clams and 6 points. 10-8!
[...] "You Make the Call – Kid in the Street – What Happened", "nick": "@theHappyMedic"}); This call was fabricated to see what different kinds of treatment options and requirements exist amongst my [...]
Russell Stine said…
Had a situation similar to this many moons ago. The hospital insisted on immobilization en route (which there was no indication and I got fought with when I attempted it the first time). The hospital ended up torturing that poor child with IV sticks and c collars and boards and the mother, who I had built up en route, now broke down uncontrollably. I couldn't help but laugh at the staff as they wrestled with a child that not minutes before was in a calm state and an assessment would have been much more revealing. They didn't like that too much.