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<xTITLE>Ambulance Usage Pursuant to an MVA as Determinative of Severity of Sustained Injuries</xTITLE>

Ambulance Usage Pursuant to an MVA as Determinative of Severity of Sustained Injuries

by Bruce Ally
February 2021 Bruce Ally

Those who have been involved in an accident and chose to pursue their options to recovery through the legal system, often end up at mediation. In the mediation they will find that the absence of an ambulance or refusal to use one at the time of the accident colours some parties’ perspectives on how severe the accident was. This can be corroborated by many personal injury lawyers. It is common knowledge to many mediators (neutrals who impartially preside over the proceedings at this level) that the severity of a lot of injury claims seem to be weighted on the use of an ambulance at the scene of the accident. It is difficult to determine if this stance with respect to the choice made is appropriate or not. Prior to agreeing or disagreeing with this position it is important to remember that most often the minutes after an accident are a blur.

In 2019, in Toronto, 400,000 people called 911, and 234,610 people were transported to the hospital via ambulance. This would mean that 165,390 people, or 41.35%, reject the services of ambulatory transport opting for other means of personal transportation or refusing to go to the hospital at all. This article seeks to examine some of the reasons why people may choose not to utilize an ambulance. It must be understood that these reasons may vary from physical and psychological to practical, as each of these constituent factors impact each of us on a different level.  

On a practical level, many feel they cannot afford the use of an ambulance. Maham Abedia, a Global News journalist, wrote an article entitled “’I can’t afford that’: A US woman left bleeding after subway accident begs for no ambulance,” where she shares the story of an American tourist who was involved in an accident while visiting Canada, and begged not to be taken to the hospital by ambulance because she did not have enough money. The costs to call an ambulance in Toronto is $240 if the hospital services were non-necessary upon assessment on arrival, or $45 for transport if the hospital services were required.  To some people this amount can be prohibitive and thus may influence their decision.

A lack of understanding of the emergency protocols in North America may also influence the likelihood of choosing an ambulance. In North America, the use of emergency services is common. We have designated a specific protocol for the initiation of services, and there are constant television advertisements on how and when we can and should initiate calls. The 911 emergency system was consistently used throughout North America to ensure its familiarity for most seasoned inhabitants of continental North America. In contrast, new Canadian may not be familiar with the procedure. Even persons from the United Kingdom including England, Ireland, Scotland and Wales, may be more familiar with the use of 999 and thus in a crisis may be unaware of the North American process, and thus not access the services of an ambulance. 

Similarly, an even more impactful reason for the lack of utility may stem from cultural conditioning. In some cultures where access to health care facilities is limited, using these resources may be restricted to only the occasions when the need for service is critical. The injured party may not fully appreciate that the use of an ambulance after an accident constitutes part of the standard of acceptable protocols in North America that may influence the perceived level of injury. Alternatively, they may choose to err on the side of caution or due to culturally patterns of conditioning and thus they may choose not to call an ambulance even if it would be beneficial.

Another significant and often overlooked consideration that may impact the decision is the effect of adrenaline. The release of adrenaline is a response from the endocrine system triggered as part of the Fight or Flight system originating in the limbic system to protect the body when it is subject to an immediate danger or a stressful event. The effect of its secretion is to mask the intensity of the real pain and thus the intensity is not apparent, as it was masked by adrenaline (Crook, 1998). The release of this hormone occurs unconsciously in your body once the situational threat is perceived and dramatically reduces the level of pain that a person is experiencing. This affect, needless to say, can lead to the individual minimizing the magnitude of the trauma experienced. Examined by itself, this can be one of the significant determining factors used by the afflicted to decide whether or not they need to call an ambulance. 

Injuries may also be experienced by different people in different ways. For some people involved in an accident the pains felt from the impact may be immediate. They may notice a headache, or neck and or back pain as well as a variety of other aches and pains throughout their body. Other people are more insensitive to pain, (Crook, 1998). Even if they were involved in the same accident, different people may experience less pain, and may be able to continue with the rest of the day as previously planned. This sensitivity or insensitivity can be determinative in influencing the decision as to calling or not calling an ambulance. For the more susceptible person the potential to use the ambulance may be greater while the converse may apply for the more insensitive person. 

Given that injuries resulting from an accident can range from minor to severe which may also include injuries that are permanent. For those in the latter category, this means they may be afflicted with the pain for the rest of their life. Its impact would influence their quality of life, as well as their ability to work.  To complicate matters, the pain is not always constant but can range from mild to moderate levels of discomfort to absolutely excruciating unbearable pain. At the time of the accident, a person cannot fully appreciate the true level of their injury, or the impact it may have on their lives, and thus they may have difficulty deciding on if an ambulance should be called. 

In addition to all of the aforementioned reasons that may influence someone’s decision to call an ambulance, one of the most straight forward are the numerous questions they will likely be asking themselves after an accident. There can be a multiplicity of questions and concerns running through the mind of the parties involved. Some of these questions include, what happened? How did it happen? Can I make it into work? How late will I be getting the children? What about dinner? What about the appointment I was trying to get to? How much damage is there to the car? What about the other car? Can the cars be repaired or replaced? How will I get around? Am I hurt? what about the other people?  If I went to the hospital how long would I have to wait? Do I have the time to do so or am I better off just trying to get an appointment with my doctor? If I went how would I be able to accomplish/achieve/finish the task or tasks that I was involved in prior to the accident? Clearly even the most logical and even thinking person would be hard pressed to find answers immediately on the spur of the moment.

Considering this multiplicity of questions and concerns that arise often after a Motor Vehicle Accident combined with, the need for a decision on the spur of the moment, and potential systemic unfamiliarity, also the masking effect of adrenaline released at the accident, it is my opinion that the use of an ambulance is not a reliable indicator of the degree of injuries experienced at a Motor Vehicle Accident. Based on this conclusion, it becomes important to examine other salient factors in order that we can accurately decide on the level of injury. Some of these factors may well include finding out about the involved person’s culture, familiarity and what was their agenda on the day in question. While, obtaining this information does not necessarily give us access to fool proof decision making, it provides indicators that can assist us to make our decision. Conversely, it is important to remember that choosing to use an ambulance can be an indicator of how a sophisticated party, irrespective of how minor their injury, can use this accepted protocol to manipulate the system, especially since they are aware on the amount of reliance placed on this fact. I suggest that it is imperative that we obtain the answers to these questions which can offer even more reliable information that can be used to inform our decision making. And Further that this can be easily obtained at the examination for discovery. Therefore, it is my position that until we are in possession of these facts, we are not able to assess the degree of trauma and reason for choosing to use an ambulance after an accident. 


Abedi, M. (2018). ‘I can’t afford that’: U.S. woman left bleeding after subway accident begs for no ambulance. Global News. Retrieved on January 15, 2021 from 

Crooks, R. L. (1998). Psychology: Science, Behavior and Life. Second Edition. Holt, Rineheart and Winston Inc.

Hormone Health Network. (2021). Adrenaline., Endocrine Society. Retrieved on January 13, 2021 from

McAlpine, F. (2014). 999 vs 911: How Did Brits and Americans Get Their Emergency Numbers? Anglophenia. Retrieved on January 21, 2021 from

Meyer, S. (2016). 11 Thoughts You Have After Your First Car Accident. Odyssey. Retrieved on January 21, 2021 from 

Razzak, J.; Kellermann, A. (2002). Emergency medical care in developing countries: is it worthwhile? Bulletin of the World Health Organization, 80 (11). Retrieved on January 21, 2021 from 

Sissions, C. (2018). What happens when you get an adrenaline rush? Medical New Today. Retrieved on January 13, 2021 from

Stone, S. (2014). How Did “911” Become the Emergency Call Number in North America? Today I Found Out. Retrieved on January 21, 2021 from


Bruce Ally is the founder of A Place for Mediation. As a mediator in private practice he has conducted in excess of 4000 matters. He is an instructor in the Lawyer in Negotiation course at Osgood Hall Law School, and a facilitator in the Advanced Mediator Program and the Workplace Elective at York University. He is currently on the Attorney General Roster and a Member of the Workplace Fairness Institute.

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