I agree Tom those jobs can be really difficult. Still acting within common law to prevent the patient coming to any harm more or less empowers you to treat them. On our BAA course, we were told that it's more or less a case of if the patient doesn't say no then they have consented! The biggest problem with ambulance work is that until you actually get into the front line, you can't make any hard and fast rules. Every job and situation is different and that's why EMTs, Paras and ECPs are some of the most resourceful people i know. They think on their feet, using common sense and often the complete lack of scant resources around them!