Background: Refusal by the patient to travel after calling an emergency ambulance may lead to a preventable waste of scarce resources if it can be shown that an alternative more appropriate response could be employed. A greater understanding is required of the reasons behind 'refusal to travel' (RTT) in order to find appropriate solutions to address this issue. We sought to investigate the reasons why patients refuse to travel following emergency call-out in a rural county.

Black or gallows humour has long been recognised as having therapeutic value, particularly when used by individuals dealing with traumatic incidents. With this in mind, it is no surprise that this type of humour is commonly used by emergency services personnel. It is a bona fide coping mechanism which can contribute to the resilience, health and wellbeing of emergency services personnel but one which, to the uninitiated, may appear callous and uncaring. With student paramedics now taking the higher educational route into paramedicine, they will have had less exposure to ambulance service culture before qualifying than would have been the case with the old 'in service' pathway. This often results in the type of humour employed by their new colleagues coming as something of a culture shock. This article hopes to go some way to explain why this type of humour is employed, what purposes it serves, and prepare students so that it may appear less shocking when they first encounter it.

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