The crash crushed the front side of the red Honda Accord like an aluminum can. A gray-haired man sat stunned behind the wheel as sirens wailed to the scene in Taylorsville.
On the other side of town, a diabetic man's mother dialed 911 as she saw her son in the throws of a seizure.
While Unified Fire Authority paramedics rushed to aid both men, neither ended up strapped to a stretcher. One went home with the paramedic's approval -- the other stayed back even though the emergency workers warned that he could possibly die if not treated at a hospital.
Each year, thousands of people in the Salt Lake area refuse to go to the hospital in an ambulance against medical advice. While agencies don't keep official records about their reasons, paramedics say many refuse because they can't afford the trip -- something that could become more common as the economy nosedives. No matter how serious an injury, if a patient is awake, aware, and refuses to get in an ambulance, paramedics have no choice but to leave.
"We don't force anyone to go to the hospital unless they are unconscious and we assume they want us to provide that kind of care, or they are a minor," said Salt Lake City Fire Department spokesman Scott Freitag. "Even if someone has some traumatic injuries, if they say, 'I don't want to go with you,' we don't take them."
One of those refusals was the diabetic man. He had never seized before, UFA paramedic Rod Sellers said, and an unexplained seizure could signal more serious health problems, from an infection to a brain tumor.
"We can only do so much at the scene," paramedic Rob Morley, who was with Sellers, said.
But despite the paramedics' efforts to convince him, he decided not to go. They asked him to sign forms confirming that he had refused against medical advice. Then they left.
Sometimes paramedics try to convince a patient to go by calling a hospital and putting the person on the phone with a nurse. They explain that the patient could die.
But more than 2,000 times in Salt Lake City, and more than 600 times in other Salt Lake Valley cities last year, none of that worked. Most of the time, the patient decides to drive himself or herself to the hospital, or to get a ride from someone else, said Freitag.
Sellers said many refusals are car crash victims, and often someone else has called 911. People often refuse because they can't afford the trip, he said. A typical ambulance trip costs about $800 in Salt Lake City, and an average of $1,200 at UFA, which covers most of the rest of Salt Lake County. For those who have coverage, insurance usually cover about 80 percent of that cost.
Advocates for the uninsured say it's one more way that low-income patients are forced to delay or decline treatment
"For people who can't afford it, I can see how it would be real challenge," said Lincoln Nehring, Medicaid policy director with the Utah Health Policy Project. "There's a whole list of ways where the system fails … to get care to patients in a timely manner,"
There is no indication why in September, Jodi Martinez, 40, of Santaquin, refused a helicopter transport after she was thrown from her car on Interstate 15. But the decision could have been fatal. Although she was taken by ambulance to Mountain View Hospital, her condition went downhill fast and she died of her injuries, according to the Utah Highway Patrol.
At the car crash, a paramedic probed a man's neck for spinal injuries. But he found only a few bumps and bruises, and agreed with the victim that he didn't need to go to the hospital. This is often how an ambulance call ends.
It's unclear what happens to those who refuse care.
"The only way we find out anything that happens is if they to call 911 again," said UFA spokesman Wade Russell. "We don't know."
