There's a nuance here that you may be forgetting. There is a difference between being a violent jerk because the patient is still altered (can't refuse) and the patient being a violent jerk because they're just a jerk (can refuse). Most of us can tell the difference pretty quickly and we weren't sitting in front of the patient described in the OP.Safety is everyones responsibility. Think about the original scenario ("EMS arrives on scene patient is still not very responsive. Loaded onto gurney and halfway through the first set of vitals she wakes up. She presents irate and inconsolable, starts removing all vitals equipment") this is a suspected narcotic OD but initially the patient had not yet responded to the Narcan and was altered upon EMS arrival so other medical causes for the patients presentation MUST be considered at this point. This patient should be initially assessed, searched for weapons/needles, loaded onto the stretcher, secured AND restrained. Restrained not because they are in custody or in "trouble" but because they are "not very responsive" and needed to have their limbs controlled. Once the pt wakes up "irate and inconsolable" and is actively trying to "remove all vitals equipment" (or fight against restraints) and is not able to reasonably communicate or allow a complete and thorough assessment than they should be sedated.
We have all determined this is in fact a "patient" and I have shared why I believe this patient does not have capacity to refuse care. So now I have a patient, that I am responsible for, on my stretcher who does not have the decision making capacity to refuse care. I am not going to allow someone to scream and fight in the back of the ambulance, they are going to be sedated.
It sucks waking up a narcotic OD patient and having to re-sedate them, I've done it and I am always bummed the call went that way but safety is paramount. Like I said earlier, its a lot easier when the pt doesn't receive Narcan prior to EMS arrival and can be treated with small doses of Narcan JUST enough to improve their respiratory effort but not enough to remove all of the effects of the opioid.
Also can anyone share a case study or article written about when an EMT/Paramedic has successfully been prosecuted for treating/transporting a patient against their will when the patients decision making capacity was in question? It seems like most litigation against EMS personnel is when the DO NOT treat/transport the pt appropriately (think about that case in N.C earlier this year).
Here is an article written by a co-worker regarding assessing a patients decision making capacity.
Honestly, it's this nuance that's critical to the entire conversation.
Frankly - it's been my experience that the overwhelming majority of patients who receive narcan wake up completely and are subsequently completely lucid and oriented.