I'm a big fan of Nitrous too. Unfortunately, very few EMS providers carry it.
Anyone that is bad enough to NEED an IV in the short period of time between the scene and the hospital that fights against it is not in their right mind. And in such a case, you find a way to do it through the fighting. Anyone else can wait until the hospital. And trust me, the hospitals around here wont give them anything for needle pain either. Mostly because the anxiety of getting a shot/IV is often not due to the pain at all.
But even beyond that, why won't I numb someone up for an IV? Besides time, that is? Because we don't carry anything that can.
Unfortunately, even many people who "need" an IV will not just sit there and allow you to start it, as I've said before. And no, doing it "through the fighting" isn't always the best choice; if the issue is due to anxiety, nitrous is great, if it is due to pain (when they rip their arm away from you as soon as you penetrate the skin) you use a numbing agent. (many people we pick up are also not in their right mind...go figure) Sometimes "doping up your patients" is the best course of action, the only course sometimes. Physically restraining someone to start an IV if you have other more appropriate options...not a good idea. Remember, this job is not about what is easiest for you, but what is best for you patient.
As well, forget time...although there are exceptions to this, if the appropriate course of treatement means that you have to sit on scene for another minute, or your call lasts just a bit longer...do it. Again, what is best for the patient is what we should be concerned with.
Good patient care includes not starting an IV just-because, telling the patient that you want to give them and IV and why, giving them an opportunity to refuse, and letting someone else try if you can't get it the first time.
You do know that none of that matters, right? If the patient loses it when you try and start a line, why would it be any different when the next person does? And explaining a procedure, while damned important, won't fix that problem either.
At the next level, I believe explaining why they need an IV, giving them the option to refuse, not attempting more than once, and not starting one if not absolutely necessary provides the best patient care to my patients.
Again, explanations are great, but don't expect them to always work; you need to have a plan for when, either because of anxiety/needle phobia, pain, or some other reason, the patient will not allow you to start an IV.
Saying that you don't do this because it's not an option is a lot different than saying that it's innapropriate.
