Yes, that truly does suck...and whilst I have never attended a hyperglycaemic in extremis to that extent I think we would have been expected to have initiated an IV line as per the protocol (above 20mmol and lowered GCS) and resuscitated at scene...possible transporting under emergency conditions depending on the response to the CPR/IV fluids. We are lucky that most of our dwellings are single/double storey structures, not the five flights of stairs you mention. In our situation the LATER concept would have applied i.e. Load And Treat EnRoute. In yours...I don't know how I would have managed that. I presume there was no Amb Para around for IV access/fluids etc. Who knows what the outcome would have been had you stayed? Yes...living in a house probably would have helped (egress wise)...and yes had the patient better managed his medical problems the situation might have been avoidable. But lets face it, a large proportion of our work is derived from people who are unable to (or choose to) not manage their health - I'm grateful for the employment!