Down here in London we are certain of the legal position - I would suspect it is the same in other parts of the country as well. We have a nice little flowchart that identifies people who have the capacity to refuse - and if they have the capacity to refuse, even if their leg is hanging off they can refuse treatment and lay down and die. This is why, when I leave someone at home I'll document 'Capacity +ve', then, should I be called in by the coroners office I can quote the flowchart at them. If someone doesn't have capacity, then I'll document *fully* why they don't have capacity. If someone is combative due to a head injury then they don't have the capacity to refuse treatment, in which case they get bundled into the ambulance (and I no doubt get inured for my trouble - so it goes). There is no SOP because every case is different. However the legal difficulty is that the patient may well have had capacity, it was longer than two hours before he was seen in hospital and I suspect that if he had collapsed before then he would have had an ambulance called straight away. The only solution is that we are allowed to kidnap people who are 'altered' due to alcohol and then they get some serial CT scans to make sure that everything is alright.