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First off, I didn't realize I was going to start such a shit storm by asking that question! Here's my take on the whole deal: We know that there's certain criteria established to be able to make an informed decision to refuse medical attention. One of the first items of that list is that they be COMPETENT enough to be able to make that decision in the first place. ETOH, drugs, and certain medical conditions and trauma will negate that condition (diabetic emergency, stroke, head trauma to name a few). With these conditions present, we are free to treat them based on the concept of 'implied consent'. This means that we have to establish that they're in a predicament/situation that if an average unimpaired person of normal intelligence would ask for help and want to be treated. We know that drugs, ETOH and other chemicals taken into the body (either by inhalation, ingestion, injection or transdermally) WILL alter mental status/capactiy. What is the difference between the patient who is 'drunk off their ass' and the patient who is 'gorked out of their minds' by some other chemical? Why is it acceptable to take one in and not the other? I'm intentionally excluding the trauma and medical patients simply because of possible underlying life threatening conditions. How is it that the person at home who has a BAC of 0.18 should be treated differently than the 'urban outdoorsman' who has a similar BAC? Is it because the patient found at home HAS a 'home', and the other patient does not? If both are 'falling down drunk', do they both not present a clear danger to themselves and possibly others? Sure, the 'urban outdoorsman' could stumble into traffic, get hit by a car and be killed; but by the same token, the patient at home could stumble in to the bathroom to puke their guts up, slip on that cute little bathmat...fall, striking their head on the tile wall and die in a heap in the bathtub... We don't have the equipment to determine the level of intoxication; we can't definatively state that one is legally drunk, while the other is one of the 'walking embalmed'. If both people mentioned above are refusing treatment/transport, would you leave the both of them where you found them and simply state "they don't want to be seen; so no harm no foul"? We can throw in a list of 'what ifs' from now until next Christmas, but the point still remains that both individuals have an altered mental status, and by definition cannot make a clear and informed decision to refuse treatment based upon their similar condition. We also know that based, on the intoxicant involved; they are at least at risk of further injury.

No one should go straight from emt to medic. You need time in the back of a bus (ambulance) by yourself with a patient in need to have the clinical experience to make you ready to be a decent medic.