Thousands of injured Utahns annually refuse to be transported by ambulances to access medical care — some because they can't afford the trip.

Public safety agencies don't keep official records about the reasons for refusal, but paramedics say many patients decline because they can't pay the fees. And no matter how serious the injury, if a patient is awake, aware, and refuses to get in an ambulance, paramedics have no choice but to leave.

"We don't force anyone to go to the hospital unless they are unconscious and we assume they want us to provide that kind of care, or they are a minor," said Salt Lake City Fire Department spokesman Scott Freitag. "Even if someone has some traumatic injuries, if they say, 'I don't want to go with you,' we don't take them."

Freitag said most patients opt to drive themselves to the hospital or get a ride from someone else. Statistics show that happened more than 2,000 times in Salt Lake City and another 600-plus times in other Salt Lake valley cities last year.

The average ambulance ride in a Salt Lake City ambulance is about $800. A ride provided through the Unified Fire Authority, which provides fire and medical services across Salt Lake County, costs about $1,200.

"For people who can't afford it, I can see how it would be a real challenge," said Lincoln Nehring, Medicaid policy director with the Utah Health Policy Project. "There's a whole list of ways where the system fails to get care to patients in a timely manner."

Paramedics said they sometimes try to convince a patient to go to a hospital by getting a nurse on the phone to explain that without proper treatment, the person could die.

It's unclear what happens to patients who refuse care.

"The only way we find out anything that happens is if they call 911 again," UFA spokesman Wade Russell said. "We don't know."