Happened to me last weekend. Curious as to what everyone thinks.
Call came in for motor vehicle accident involving a motorcycle, possible loss of consciousness reported. Upon arrival found motorcyclist alert, oriented on side of road, C-collar and manual head stabilization in place by first responders. Biker states he was coming back up to speed after stopping for traffic and at 40-50 mph his Goldwing went out from under him and he laid the bike down hitting the pavement on his left side. He complained of L shoulder pain, and had obvious road rash. He denied loss of consciousness, and witness said "I thought he did for maybe a second or two". All other phys find. unremark. After splinting his shoulder, patient stood up and walked to stretcher against advice. At this point I cancelled ALS, medevac, and transp. patient to local hosp. 5 min vs. 35min+ to trauma center. Haven't been able to find out his ultimate discharge condition from hospital. I suspect broken clavicle.

Here is the rub. This call hasn't been QA/QI yet and I doubt it will be. But most of the 1st responders were very unhappy with my decision. Yes, by NYS trauma protocol this guy met the criteria for a medevac but in no way did I find it necessary or appropriate. So I made a judgment call like we all do. But whaddyathink? CYA and go with protocol or treat the patient in front of you, not the book?
Sorry for the long post. Thanks for your insight.

PS: For those interested, lets keep the FD/EMS board alive. After all, we are 911 too