Surely the safety of the paramedic crew should come first? Personally I think that unless there is a real and recognised danger of the patient coming to serious harm if they aren't removed to hospital then the crew should be allowed to leave at the first sign of violence. It is deemed unacceaptable for patients to show violence towards A&E nurses, why should paramedics not get the same regard? Why can't the ambulance service set up a small team of specialist paramedics who are specially trained to deal with violent patients who are at risk and who have specialist ambulances that allow the patient to be safely contained or restrained? They could be called out after an assessment by a regular paramedic. Just an idea.