What's so unusual?

You're probably asking yourself, "What's so different about this case?" The patient was on the side of the road, explained what she was doing there, denied any injuries and refused treatment and transport. Sounds like a routine call--what's the big deal? But this case did not end after the patient signed a treatment refusal form and was asked by law enforcement to get back in her car and drive on. The EMS providers returned to their station, only to get called back 30 minutes later to the same spot they had just responded to, again for a "woman down." Upon this arrival, they found the same car on the side of the road, and a parked semi tractor trailer in a traffic [figure: see text] lane approximately 25 yards ahead of the vehicle. There was no damage to either vehicle, and providers noticed a familiar dog inside the woman's car. A police officer informed the providers that the woman, the driver of the vehicle, had jumped in front of the semi, as described by the truck's driver, and was hit at a very high rate of speed. The victim was deceased on the scene. Upon assessing the scene, providers confirmed that the victim was the same woman they'd responded to earlier. Several days after the incident, more information about the patient's medical history was released. She had been released on the morning of the accident from a mental health institution, where she'd been diagnosed as a manic depressive. Manic depression is a condition characterized by mood swings. For example, a patient might rapidly go from a state of euphoria to experiencing debilitating depression. Although this patient appeared fine on the exterior, she had been diagnosed with a severe psychological disorder. She presented as being alert, oriented and non-threatening moments before taking actions that led to her death. This case posed a significant challenge for the EMS providers because there was no clinical evidence that there was anything wrong with the patient. Moreover, the patient denied any past medical history. It was a lesson to all involved with this case: There is no such thing as a routine call.