One other item, which may or may not influence your view of how this incident unfolded. I live in an area where both urban and rural environments may be encountered. In general our Fire/rescue personnel deal with many situations requiring us to think outside the box. Individuals, who for the most part respond in strictly urban settings may not have the training or access to methods either by protocol, equipment or cultural (within the fire/rescue service) norms to deal with patients who cannot be directly transported from their inside their homes into the back of the ambulance.

Again, this may be a case of pure laziness, but it could also be the case where local protocol is so engrained into their thought processes, that using anything other that the ambulance cot may not be an option. For example, one of the main injuries EMS responders are subject to is back injuries from picking up patients. Many jurisdictions, utilize power devices on their cots or stair chairs to assist in raising the patient and loading them into the ambulance. Faced with the prospect of having to carry the patient through the snow without the benefit of the cot/power assist device, may have violated their local protocols, presented the possibility of self-injury and/or potentially ran the risk of dropping the patient. It is clear they misjudged/under-judged the significance of abdominal pain in this case, but having dealt with many patients whose chief complaint was abdominal pain, they may have decided not to risk injury. With all of that said, whether or not they were in the position to transport the patient back to the ambulance, in my humble opinion they should have at least made a reasonable attempt to access the patient.

Pete