Aidey, here's my answer: I kidnap drunks
I think this is an area where the laws/regulations need to be clarified. I've yet to get a clear, straightforward answer about whether someone who is intoxicated can refuse treatment or not.
Does opinion count as an answer? No, a truly intoxicated person will never get me a refusal. (I'm not talking about the smell of booze, but someone who is slurring, incontinent, belligerent, swaying, or at least slow to respond).
Some cities I work in are wonderful, the police don't tolerate the BS and the guy goes in the cruiser. Some towns however, the police like to use ABC (ambulance before cruiser) simply because they are short staffed and don't want to PC and babysit. Apparently the one dedicated ambulance is an unlimited resource compared to the five cruisers on patrol... but that's another issue.
Anyways, back to the point Aidey. Myself and my employer can defend (probably quite well) in the court of law "kidnapping" charges for an intoxicated pt. Myself and MAYBE my employer, will find it much harder to defend me against abandonment charges should ANYTHING happen to the pt after we leave him/her with a refusal, or even worse, a "no EMS needed". Sure, that means occasionally we'll get stuck hauling off the violent drunk, but at least we are protected. Secondly, perhaps the most important part to consider, is a lot of alcohol/polysubstance abusers have a good chance of underlying medical problems, that may never have been addressed, until you hauled them "against their will" to the hospital.
Almost nobody will ever sue a cop for not arresting them. How many people will sue an ambulance for not "helping" them?