A 14-year-old female is distressed after a breakup; her friend calls 911 after a text stating 'I'm so hurt I could die.' Her mother wants you to leave the scene. What should you do?

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Assess safety and the patient’s capacity, then document any refusal carefully. When a teen in crisis indicates potential self-harm and a guardian wants you to leave, you must determine if the patient can make an informed decision. If, after explaining risks, benefits, and alternatives (including crisis resources and safety planning), the patient or guardian still refuses transport, you thoroughly document that informed refusal. The record should note the assessment of mental status, the information provided, the patient’s or guardian’s understanding, any alternatives offered, and the plan for ongoing safety or follow-up. This documentation protects everyone and reflects that you addressed risk and attempted to secure care, even if transport was declined. If danger is imminent, you may escalate with additional resources, but the emphasis here is on proper documentation of an informed refusal.