Many prehospital docs are now going with the idea of permissive hypotension in trauma- i.e don't aim for a normal BP, aim for a blood pressure adequate to perfuse brain/kidneys/myocardium- in your example of a young trauma victim (e.g 19 year old male, fit and well), this may be very low e.g 60mmHg systolic. This comes from the idea that a normal BP may actually increase bleeding, and the bleeding may be from somewhere you can't stop without a surgeon. Given this, why do you want to hang around getting IV access when you can have a go on route? I can understand not wanting to transport a patient long distances without adequate access, but logically; if you're that rural, you probably took a long time to get there, so if they're really very sick, they self-triage and die. In the urban environments familiar to many ambulance crews, surrounded by excellent hospital facilities, I can see practically no justification for faffing on scene with seriously ill patients (except if e.g trapped). Even in STEMIs- why thrombolyse pre-hospital when you're 20 mins from primary angioplasty? I am quite certain I know which one I'd like if that was my myocardium. And, for my interest, do you really have to measure CO2 as part of your obs? How are you doing this? Is this in the JRCALC guidelines?