We’ve all heard, "We can't force people to go to the hospital" and while that's mostly true, it's weak as a stand-alone statement.
Just as consent must be "informed" so, too, must a refusal be "informed," and in this context "informed" entails education because the patient may not understand the seriousness of the situation.
As the medical professional on the scene, it's imperative that our actions are reasonable: That means performing a mental status exam to make sure the patient possesses decisional capacity, explaining to the patient the risk of refusing care, ensuring that the patient can articulate that risk in his or her own words, and taking other steps to help mitigate the patient's risk. For a full listing of the criteria that must be met for a Refusal, please see the Aid to Capacity Assessment of the Ambulance Call Report Completion manual.
These include encouraging the patient to go to the hospital, waiting on scene, making sure the patient is not left alone, encouraging the patient to contact 911 again if he changes his mind, and so on.
By doing something other than saying "sign here," you can save lives.
The bottom line from both a patient care perspective, as well as risk management perspective, is that the patient needs to be well-informed of their situation and is able to make a clear and concise decision for their health and well-being. Documentation of these events on the ACR help provide crucial information, that validate the findings and the patient decision regardless of outcome.