During the beginning of the pandemic, I had one situation with a resident in the Retirement home I was working in who had developed severe pain in their right rib area following an unwitnessed fall they had had in their shower that morning. Initially the resident had refused any pain or injury following the report of the fall and assessment by nurse, however later that evening, they were having severe pain upon inhalation and swelling on the ride side of their rib/chest area. The patient was under the care of the Retirement home’s MD, however, the MD would not be in until 4 days later and would not prescribe pain medications without in person assessment and was not able to come into the home that day. Furthermore, the MD also refused to make any telephone orders for pain medications in this situation as well. The resident was rating their pain as a 10/10, however was vehemently refusing to go to the hospital, because they feared being exposed to Covid19, and also knew that when they returned to the home, they would be placed on isolation precautions for 14 days (would need to stay in their suite) as per the infection control policies at the time. Though the resident refused wanting to go to the ER, after my assessment, I decided to call 911 and ask for the resident to be transferred to hospital due to their severe pain and signs of possible rib fracture. I remember weighing the pros and cons of the resident going/not going to the hospital that evening and the fact that the patient needed urgent assessment of their unmanageable pain in that moment superseded any cons of the situation they would face in terms of isolation precautions when they returned to the home. The resident did not want to go, but I had a feeling that once the paramedics arrived and also agreed with the urgent assessment I was advocating for, the resident would be more likely to agree and they did. I think the decision-making process would have helped in this situation, as it can help save time and give someone a systematic way of coming to a decision whilst also ensuring they don’t miss any important steps such as evaluating alternatives.