1) Was the paramedic in question actually an ECP? 2) I think most clinical staff in the NHS with even a modicom of sense realise that if you have a patient who has a sudden worsening of headache, vomiting etc., then a proper assessment of pupils, blood pressure etc. is mandatory. This amounted to more than not filling in a pain score! 3) "By taking the patient to hospital we are avoiding the responsibility if they later die."I think we've established from this piece that that is simply not the case! Reading into it a little more, it appears that this clearly unwell patient was asked to walk down some stairs, and went unconscious whilst on the stairs; almost certainly leading to a fall, and possible further injury; and was then transported in an inappropriate manner to the ambulance. If this is the case, it's entirely possible that the patient's condition deteriorated as a result of this paramedic's actions, in which case he IS negligent, no matter what went on when she got to hospital.