Hi Tom. I've been a lurker for quite some time & firstly would like to compliment you on your superb writing. You really have a talent & I'm delighted we can share in it. As a "colleague" (tech currently doing para training) in a neighbouring trust ,I really felt compelled to post a response to your blog entry. The 'customer' is NOT always right or know what's going on and that's what makes us the medical professionals and them the people phoning 999. It is a clinical decision to be made by the attending crew as to what the most appropriate course of treatment is and what alternative care pathway, if any, could be used. In this case, as you yourself said, hospitalisation is not indicated, nor appropriate. The patient is stable with no associated respiratory depression (as a result of sedation) or presenting with ANY symptoms causing concern, so why did he still go to hospital? We have Non conveyance forms and more importantly the knowledge to be able to decide what happens to this patient. I strongly doubt that it's only our trust that has the autonomy of practice to be able to make the decision to leave someone at home and it's exactly because of cases like this that the government is now proposing to give additional incentives to the trusts when an alternate, and specifically more appropriate alternate care pathway is used, rather than just carting everyone off to A&E. In my opinion you should have stood your ground, educated the 'nurses' in the care home that the patient was stable in every sense of the word, completed a non conveyance form (medical model style) and possible referral to GP for medication review if they were that concerned that the dose m