We do have discretion to leave people where they are, and often do, but the smart ones know exactly what buttons to push to ensure we really have no choice but to take them in. A spurious bump to the head or a twinge in the chest will inevitably having us loading them up, to discharge themselves immediately on arrival. Sometimes some glorious higher power intervenes though. We were carrying a patient with a "head" injury who was well tanked up with an address 100 yards from the hospital. En route he emptied the contents of his stomach into one of our disposable kidney bowls, and moments later we went down a pothole. The entire contents of the very full kidney bowl emptied itself ALL OVER THE PATIENTS VERY EXPENSIVE SUIT. By some miracle, not a drop went on the cot or the ambulance, though I did suffer some pain from biting the inside of my cheeks so hard they bled to stop me laughing out loud.