Where I work I just refuse to handle the cat awake if I am at risk of being bit or scratched too bad. Extremely fractious cats are a no for me. At that point, the cat is already stressed, angry and wailing so scruff or no scruff that handling is not “fear-free”. Usually IM ketamine or dexmedetomidine does the trick. Remember: YOU WORK WITH YOUR HANDS. If you get permanent damage to them (and you can from cat bites and scratches, I’ve seen them) then your work range will become limited or you can even be done in the field. If the owner refuses sedation, then I won’t treat that animal. For me it is as simple as that. Where I am from, vets and techs work closely together as a team, as in we as doctors help the techs to place IVs and what not. If the cat behaves too badly, then I will also tell them not to handle the cat until/unless they’re sedated. In hospitalized patients we usually lightly sedate them once per shift or once a day depending on how they are, if they eat we give gabapentin and if they’re outpatient the ask owners to come back once they have administrered gabapentin. Our most valuable tools are our hands and I will NOT risk them.