- 6 settimane fa
Categoria
📚
ApprendimentoTrascrizione
00:00:00C'è qualcosa di tutto questo?
00:00:02Questo?
00:00:03Sì.
00:00:04Quando la ladda slipped, la sore riuscita sull'abdomen.
00:00:07Ok.
00:00:09È un po' agitato, non?
00:00:10È un po' agitato.
00:00:12Sì.
00:00:13Sì.
00:00:14Sì.
00:00:15Sì.
00:00:16Sì.
00:00:17Sì.
00:00:18Sì.
00:00:19Sì.
00:00:20Sì.
00:00:21Sì.
00:00:22Sì.
00:00:23Sì.
00:00:24Sì.
00:00:25Sì.
00:00:26Sì.
00:00:27Sì.
00:00:28Sì.
00:00:29Sì.
00:00:30Sì.
00:00:31Sì.
00:00:32Sì.
00:00:33Sì.
00:00:34Sì.
00:00:35Sì.
00:00:36Sì.
00:00:37Sì.
00:00:38Sì.
00:00:39Sì.
00:00:40Sì.
00:00:41Sì.
00:00:42Sì.
00:00:43Sì.
00:00:44Sì.
00:00:45Sì.
00:00:46Sì.
00:00:47Sì.
00:00:48Sì.
00:00:49Sì.
00:00:50Sì.
00:00:51Sì.
00:00:52..had it all stable and reached underneath it.
00:00:54But it's still been going, it's dropped and gone through his arm.
00:00:57We've just got quite a deep laceration to the right forearm there.
00:01:00My turn.
00:01:02The blade has sliced open a deep three-inch wide wound.
00:01:07I have a clean bandage as well.
00:01:09Clean cut, went quite grey.
00:01:11Was quite shocked from everything that happened originally.
00:01:13Had his legs raised on our arrival.
00:01:16Rich was working alone when the mechanical saw caught in his coat
00:01:19and sliced through his arm.
00:01:22He ran outside to get help before collapsing unconscious in the street.
00:01:26We've got the first set of rocks done now. Just got him inside, too cold really.
00:01:30Quite deep.
00:01:31I think we have gone through some tendons, ligaments there, haven't we?
00:01:34But not much in the way of blood loss.
00:01:36We're unsure. The towel that we've wrapped around him disappeared once we were getting there.
00:01:41There was some blood in his left glove, so we're not sure exactly...
00:01:44No blood loss through the fluoride.
00:01:46Well done.
00:01:47If the blade has cut through muscles and tendons, there's a chance Rich could lose the use of his arm.
00:01:53Do you think there is tendon damage?
00:01:55It looks like it.
00:01:56Have you got a good sensation in all your fingers?
00:01:58Yeah, completely.
00:01:59Do you feel like your grip is weak?
00:02:04Last year, there were 54,000 injuries on building sites.
00:02:09Do you feel sick at all?
00:02:11Yeah, a little bit.
00:02:12A little bit.
00:02:12This is a 26-year-old chap who is working on a construction site with what he calls a prone saw.
00:02:21Will phones control to update them on Rich's condition and discuss which hospital he should be sent to.
00:02:27This saw has come down onto the inside of his right forearm and sustains an isolated, open laceration.
00:02:37It's quite deep.
00:02:39There's a lot of adipose tissue and it looks like there's possible tendon and pigment damage there as well.
00:02:45As he was sort of moving, you could see stuff moving in the forearm, if you know what I mean.
00:02:50We'll go with QE as his destination.
00:02:54Rich's arm urgently needs to be assessed by a plastic surgeon, which means he will be blue-lighted to the Queen Elizabeth Hospital Major Trauma Centre in Birmingham.
00:03:03There's no sort of foreign bodies, debris or anything. It wasn't dirty, is it? It did look clean, didn't it?
00:03:09Yeah.
00:03:11Rich's blood pressure and heart rate are returning to normal, so the ambulance crew can give him some pain relief with less risk of him passing out.
00:03:19What we might do then is pop a little cannula in your arm, give you some paracetam all that way.
00:03:26How much pain are you in?
00:03:27Well, it's getting worse as it's got, look, as I'm calming down a bit.
00:03:33Yeah.
00:03:34If you had to give the pain you were in a score, a mark out of ten, ten being the worst pain.
00:03:39I'd say I might be about a six or seven.
00:03:4222 minutes after they arrived on scene, Rich is ready to start the five-mile journey to hospital.
00:03:49Yes, guys, thank you for your help.
00:03:52Thank you.
00:03:53Take care.
00:03:54Well, see you.
00:03:54Satisfied with his progress, Will and Colin are happy to leave him in the care of the ambulance crew.
00:04:02A man is lying crushed beneath a quarter of a tonne of cast iron.
00:04:06The range of potential injuries are so severe, the critical care team have been scrambled.
00:04:11Helimed is above the house within minutes.
00:04:13Matt and Karen are concerned the longer the man is trapped under the machinery, the more damage is being done.
00:04:19If they've managed to get it off quite quickly, then we'll be looking at some soft tissue damage and fractures.
00:04:25If it's stayed on his legs, how long it's crushed his legs for, because then you'll get problems with circulation.
00:04:30How are we doing?
00:04:32How are we doing?
00:04:32You all right?
00:04:33It says you can feel it.
00:04:34Obviously, it hurts.
00:04:35Yeah.
00:04:36Arriving on scene, Matt and Karen are quickly briefed by the fire service and a local ambulance crew before they can take control of the rescue.
00:04:44He has got a colis fracture on his left wrist as well.
00:04:48Okay.
00:04:48So, we're just in the process of getting the engine off.
00:04:52Okay.
00:04:54What's your name, fella?
00:04:55Dave.
00:04:55Dave?
00:04:56My name is Matt.
00:04:57One of the docks off there.
00:04:57I'm blood.
00:04:58Sorry.
00:04:59Scrapyard manager and Land Rover enthusiast Dave Evans was renovating one of his old vehicles when the heaviest part, the engine block, fell off the workbench.
00:05:11Can we get you back on this gas and air?
00:05:13Dave tried to stop the fall, but the huge weight was too much, breaking the bones in his wrist.
00:05:19And it's just toppled over onto him from there, has it?
00:05:21Yeah.
00:05:21Presumably.
00:05:23The ambulance crew have splinted Dave's broken wrist and given him gas and air and intravenous morphine to help him deal with the pain.
00:05:31How's he doing with the morphine?
00:05:32Yeah, 50.
00:05:33I'm sorry.
00:05:35Although Dave appears calm, Karen is worried about the potential injuries to his leg that they can't see.
00:05:40Is it from the lower leg?
00:05:43Well, I can only see just around the neoparty below.
00:05:46Has he got a distal sensation?
00:05:48Karen is worried the engine could be restricting the blood supply down his leg.
00:05:52This could lead to Dave losing his foot.
00:05:55All right.
00:05:56We're all.
00:05:56We're all.
00:05:57It's essential they get the weight off before it's too late.
00:06:00Oh.
00:06:01Hang on, mate.
00:06:02Every second counts, because without proper circulation, there's a real risk that the leg won't recover and it will have to be amputated.
00:06:11The leg can just go ischemic.
00:06:13You cut off the oxygen supply and then that builds up toxins.
00:06:16And then, of course, when it's released, those toxins can then go into the main circulation.
00:06:21The fire brigade are trying to free Dave using hydraulic lifting equipment, but without a clear view of his trapped leg, it's hard to get the machinery into the correct position without risking even more traumatic injuries.
00:06:35Right.
00:06:35That's it.
00:06:36Really slow, deep breaths now.
00:06:38He's had 15 milligrams of morphine and continues to take gas and air to deal with the intense pain.
00:06:45All right.
00:06:45Let me hold it.
00:06:46Good man.
00:06:46That's it.
00:06:46And again.
00:06:47Deep breaths.
00:06:47With the lift now in position, the firefighters and medics work together.
00:06:54Good stuff in here, boy.
00:06:56We're legs loose now.
00:06:58Just report.
00:06:58Good.
00:06:59Deep breaths, Chris.
00:06:59What's the force they do this?
00:07:00How you got?
00:07:00Right.
00:07:01Come here.
00:07:01Deep breaths.
00:07:02All right, I'll say, well done.
00:07:02Oh.
00:07:05Stand down.
00:07:06Stand down, Chris.
00:07:07Just hold it there.
00:07:08You're going to help yourself, though, would you?
00:07:09Right?
00:07:10Go on.
00:07:10Fall away.
00:07:11Go on.
00:07:12Fall away.
00:07:12It's with you.
00:07:13Come on.
00:07:13Smash it.
00:07:14Go on.
00:07:15Well done.
00:07:17There we go.
00:07:17All right.
00:07:19With Dave's leg finally free, Matt and Karen can assess how badly it's been damaged.
00:07:25Come on, let's have a little look at you.
00:07:28How's your pain now that you've come out?
00:07:32Just because of my foot's being pushed, but I don't have to look at this growl.
00:07:35My wrist is definitely...
00:07:36Good.
00:07:37Are you tolerating the pain at the moment?
00:07:40That's a lot better.
00:07:41My leg feels for you.
00:07:42Good.
00:07:43All right.
00:07:44Give your toes a wiggle.
00:07:46Good man.
00:07:46Well done.
00:07:47Good man.
00:07:47All right, then.
00:07:48Good man.
00:07:49Good man.
00:07:49Good man.
00:07:49Good man.
00:07:49Good man.
00:07:50Good man.
00:07:50Good man.
00:07:51Good man.
00:07:51Good man.
00:07:52Good man.
00:07:53Good man.
00:07:53Good man.
00:07:54Miraculously, despite being trapped under a quarter of a tonne of cast iron, Dave appears
00:07:59to have escaped with just some painful bruising.
00:08:01in the hospital.
00:08:02Should we get your chair, do you think?
00:08:03Yeah.
00:08:04Pop him in a chair and go over the back.
00:08:06She gets to shout at you, now you're all right.
00:08:10You'll just have to do it in the house next time, won't you?
00:08:12It's dry.
00:08:12It'll be all right.
00:08:13He's been very lucky.
00:08:16It's just sort of pinned his leg to the floor.
00:08:18He's got no serious injuries.
00:08:20People would come off much worse if he'd fallen on his femur, his pelvis, his abdomen, his chest.
00:08:25You know, his injuries could have been far more significant.
00:08:27Dave is being taken to hospital by the ambulance crew, leaving Matt and Karen clear to respond
00:08:33to the next emergency.
00:08:36It looks like a 43-year-old male has sustained an abdominal injury from a chainsaw and his
00:08:43intestines are out on the floor.
00:08:45An ambulance is already on scene, but the man's injuries are so severe that they've requested
00:08:51critical care backup.
00:08:53Tom has been dispatched.
00:08:57It's easy to paint a picture, but you really don't know until you get there.
00:09:0311 minutes after receiving the call, Tom arrives at the address.
00:09:08His body cam records every detail of the horrific scene.
00:09:12Hi, you all right?
00:09:13Hello, sir.
00:09:15My name's Tom from the Air Ambulance.
00:09:16What's your name?
00:09:18The injured man, 43-year-old forklift driver Rafa, is being given oxygen by the ambulance crew
00:09:24to try and keep him conscious as his body reacts to the shock of the five-inch wound to his
00:09:29lower abdomen.
00:09:31Right, so with this, if you just want to cover that with that.
00:09:35I'm just taking a photo of it.
00:09:36No, that's fine.
00:09:37Just in case you want.
00:09:38Yeah, right then.
00:09:39It doesn't look too good.
00:09:40It looks like it's adipose tissue or anything, doesn't it?
00:09:43The blade has sliced down through skin and flesh, exposing his intestines.
00:09:48Oh.
00:09:49Tom needs to try and keep the wound clean, prevent his intestines coming out and stop the bleeding.
00:09:55Hopefully, if we can just hold it around, it will stick to it a little bit.
00:09:58And then, if I can get you guys to put some tape around that, is that all right?
00:10:02Just going to stick the dressing down, Rafa, okay?
00:10:05Just to keep it clean.
00:10:08Okay, so this gentleman, age I believe you already know, he's a GCS of 15 at the moment
00:10:13with an isolated abdominal injury with partly eviscerated bowel.
00:10:18With such a deep wound, Tom knows Rafa could have catastrophic internal bleeding.
00:10:22He needs to get him to hospital fast for emergency surgery.
00:10:27I think my initial plan would be to get some IV access, wound management, and then convey him to the QE.
00:10:33The danger is that moving him may put too much strain on him and send him into cardiac arrest.
00:10:39How are you feeling?
00:10:40All right.
00:10:41Sam, can you get some IV access?
00:10:44Is that population here?
00:10:45Yes, he will need to.
00:10:46All right, we're going to cut this off.
00:10:48It isn't safe to move, Rafa, until Tom knows the full extent of his injuries.
00:10:55I just want to check his back while we're here.
00:10:58Yeah.
00:10:58It's very sweaty, isn't it?
00:11:01Okay, so no other injuries.
00:11:03Was this done on the chainsaw?
00:11:04Yes.
00:11:05Can you find out exactly what's happened?
00:11:08The gentleman there speaks English.
00:11:10How are you feeling?
00:11:12He went on a ladder.
00:11:14He was doing something around this thing.
00:11:16Yeah.
00:11:16And, yeah.
00:11:17It turns out, Rafa was fixing the guttering with an electric saw.
00:11:22This one?
00:11:23Yeah.
00:11:23When the ladder slipped, the saw ripped through his abdomen.
00:11:27Yeah, 6'2", just an update.
00:11:29So, heart rate's around 50 at the moment.
00:11:31Rafa's blood pressure is low, which could be a sign that the blade has damaged some large blood vessels internally or even perforated the bowel.
00:11:40He's quite clammy and sweaty at the moment.
00:11:42I see no immediate signs of him hemorrhaging, however, don't know how deep it is.
00:11:46They have to get him to hospital.
00:11:48I'm going to get him in the back of the ambulance and convey QE.
00:11:50I'll put some details as well as we go.
00:11:55Okay, then, Rafa.
00:11:56We're going to put our chair here.
00:11:57We're going to get you to move you and take you into the back of the ambulance, okay?
00:12:01My only concern is he's a bit hypotensive, so he might go a bit funny if we stand out.
00:12:06So, we're trying to, obviously, avoid as little movement as possible.
00:12:10Hold on to my hand.
00:12:11Okay.
00:12:14Do you feel like you can walk?
00:12:15No.
00:12:16Okay, that's great.
00:12:17Are you sure?
00:12:18Okay.
00:12:18Despite Rafa's horrific injuries, Tom has no choice but to move him onto the ambulance.
00:12:23Yeah.
00:12:25Keeping the pressure on the wound to stop his intestines spilling out.
00:12:29I'm just a bit worried he's a bit hypotensive, so we'll just take our time.
00:12:33Well done.
00:12:33Thank you.
00:12:36Thank you.
00:12:39Okay.
00:12:40Up you come.
00:12:44So, at the moment, this gentleman's got a circular sore accident to his stomach, part of his bowel,
00:12:50and a lot of his stomach is out at the moment, so we've addressed it.
00:12:53I'm going to give him some drugs to stop him bleeding and pain relief and take him to the major trauma hospital in Birmingham.
00:12:59I'm just going to give you some pain relief, some paracetamol, okay,
00:13:03to help with your pain, Rafa.
00:13:05How are you feeling?
00:13:07Yeah.
00:13:08They head to the major trauma centre at the Queen Elizabeth Hospital,
00:13:12where Rafa will need immediate surgery to repair the wound and stop any internal bleeding.
00:13:19Rafa, are you all right holding that?
00:13:22On the journey, Tom needs to keep his patient under close observation.
00:13:26There's a real danger his low blood pressure could suddenly drop, putting him into cardiac arrest.
00:13:32Rafa, how are you feeling?
00:13:33Are you all right?
00:13:33Good.
00:13:34Good. Well done.
00:13:35You're doing a great job.
00:13:38We're nearly there.
00:13:42Arriving at hospital 23 minutes later, Tom can hand over his critically injured,
00:13:47but now stable patient to the waiting specialists.
00:13:51Thank you.
00:13:516-2 at scene.
00:14:00Once on scene, Pete is briefed by the ambulance crew.
00:14:04Hi, guys.
00:14:04Hi.
00:14:05Hi.
00:14:05How are we doing?
00:14:07Ah!
00:14:08Helmet came off in the crash.
00:14:10Has he been speaking to us?
00:14:11Not at all.
00:14:12He's been like, since we've got him.
00:14:1321-year-old Curtis has been thrown from his motorbike after colliding with a car.
00:14:20In the impact, his helmet came off before his head hit the road.
00:14:25He's a bit agitated, isn't he?
00:14:29He's agitated.
00:14:32Curtis has a severe head wound.
00:14:35It's quite common when we get this sort of patient, big head injury, start getting agitated.
00:14:39He doesn't, it's not intentional.
00:14:40He doesn't know what he's doing.
00:14:41He's got a really reduced level of consciousness.
00:14:44Has he got a radial pulse?
00:14:45Yeah.
00:14:45OK.
00:14:46Let's see if he'll tolerate an oxygen mask, all right?
00:14:49Let's pull his stuff out.
00:14:50Hang on.
00:14:51Yeah.
00:14:52That's it.
00:14:56We'll see if we can get him onto the scoop as best we can.
00:14:59For his GCS, his eyes are open.
00:15:01To try and evaluate him, Pete uses the GCS, or Glasgow Coma Scale.
00:15:07Mate, can you hear us?
00:15:09You shall have this one, Steve.
00:15:11OK.
00:15:11A scoring system that helps describe the level of consciousness.
00:15:16A normal score for speech is five.
00:15:19Verbally, it's probably a two, isn't he?
00:15:22Further indication that Curtis may have a traumatic brain injury.
00:15:27We want to protect his brain, and by taking over his ventilation, and us doing it instead of him,
00:15:32we can protect his brain and stop it swelling, hopefully.
00:15:36That means putting him into an induced coma.
00:15:38Breathing automatically with a ventilator will allow Curtis's brain time to rest, calming the swelling.
00:15:46But an induced coma is a risky procedure, usually only carried out in hospital.
00:15:53Are we treating it as life-threatening this time?
00:15:55I would say it's got the potential for that, yeah.
00:15:59Let's just try and keep him as still as we can, all right?
00:16:01The impact dislodged his helmet, and he now has a suspected brain injury.
00:16:09Pop his legs onto there.
00:16:11We'll get him on the stretcher.
00:16:13You'll think he's a bit hyper-tentic because I can't feel a radial pose.
00:16:18Curtis's condition is so serious that he needs a trauma doctor to put him into a coma to protect his brain.
00:16:25But the air ambulance carrying one is still eight minutes away.
00:16:30I think the priority, right, if we can get him on the back of the vehicle, and we can do a proper assessment on him, we'll get some access.
00:16:37Curtis is losing blood from his head, but his weak pulse indicates internal bleeding too.
00:16:43We'll get full monitoring on him, we'll see what his BP is.
00:16:45I suspect his BP might be low, so it may be that he needs some TXA, all right.
00:16:50Well, if we could get some head blocks on just to keep his head still, all right.
00:16:53So you've got IV access, Doctor.
00:16:55Nice one, all right.
00:16:57Is that the TXA, is it?
00:16:58Yeah.
00:17:01Pete needs to give Curtis tranexamic acid, or TXA, which helps prevent excessive blood loss.
00:17:08Let's get full monitoring on him, if we can, and let's see what his observations are.
00:17:13Let's cut his trousers off and get that skin to skin.
00:17:17All right.
00:17:18The doctor on board the air ambulance is now just moments away, but Curtis is deteriorating by the second.
00:17:28Is he breathing?
00:17:29Yeah.
00:17:30His respite is very shallow.
00:17:32It's obviously quite poorly.
00:17:34Let's get an airway in him, if we can.
00:17:36What we might need is a BVM, as well, once we've got that.
00:17:38So let's get that eye gel in first.
00:17:4029 minutes after the 999 call, the Midlands Air Ambulance arrives with critical care paramedic Ryan James and trauma doctor Ben Taylor.
00:17:52He's collided with that car, or the car's collided with him.
00:17:56It's thrown him off.
00:17:56His helmet's come off in the impact.
00:17:58He's got a big head injury.
00:18:00He's been spontaneously breathing, although he's very shallow.
00:18:03I'm setting up for RSI.
00:18:04Oh, no, have you set up carrying all the systems?
00:18:06Yeah, yeah.
00:18:06All right.
00:18:06Yes, please.
00:18:07Is that all right?
00:18:08Sort of drugs out.
00:18:09He's had some takes out due to mechanism.
00:18:11Yeah.
00:18:11Yeah, I've drawn some ketamine off.
00:18:13There's 160 left there, Ben, because he's had 40.
00:18:16Yeah, my 200.
00:18:17The critical care team use a range of powerful anaesthetics, like ketamine, not carried by ambulance crews.
00:18:26They can also perform procedures normally only done in hospital.
00:18:31I'm going to give an anaesthetic just to protect his brain and give him the best possible chance of recovering from his inmate.
00:18:38Putting Curtis into an induced coma might give his brain precious time to recuperate and encourage any dangerous swelling inside his skull to subside.
00:18:51So we're planning to be RSI in the next five minutes.
00:18:55To place Curtis into a coma, he first requires RSI, rapid sequence induction, an advanced critical care respiration procedure that Pete decides is safest to do outside the ambulance.
00:19:08Because the process is quite risky, we need to have 360 degree access.
00:19:13So if the patient starts to deteriorate for any reason or we're having difficulty with the airway, we've got good access and we're not sort of fighting over each other.
00:19:23Dr. Ben then prepares to put Curtis into a coma with two injections, a sedative and a paralysing agent.
00:19:31BVM.
00:19:32Yeah, on.
00:19:33Entire.
00:19:34Entire's on.
00:19:35Reading at 3.0.
00:19:37BP to start.
00:19:37The last systolic was 1, 2, 7.
00:19:40And cycle set.
00:19:41Cycle set.
00:19:42And 3 million total matters.
00:19:43Saturations.
00:19:45OK, dog's going in now.
00:19:47OK, fentanyl's in.
00:19:48Petylene is in.
00:19:50OK, everybody ready?
00:19:51OK, so oxygen mask is coming off.
00:19:55OK, there's no loose teeth that we've seen.
00:19:57So I've got the blade and I'm going to open his mouth as wide as I can.
00:20:00I'm going to go for the video.
00:20:01So we've got a videoscope first with a size 4 blade.
00:20:05OK, we've got a backup of a max 4.
00:20:07Yep.
00:20:08Back to his check, charging.
00:20:09OK.
00:20:12A laryngoscope, a camera with a screen, allows Pete to look into Curtis's airway for obstructions.
00:20:18I'm going down the right-hand side of his mouth, sweeping the tongue to the left, and I'm going
00:20:25to walk down as I go and looking for landmarks.
00:20:30I've got the epiglottis, but...
00:20:34OK, a bit of suction, please.
00:20:36Suction.
00:20:36There's quite a lot of phlegm at the back of his throat.
00:20:45OK.
00:20:46I've got a grade one view there.
00:20:47I can see the cords.
00:20:50With a clear path, the breathing tube can be inserted into the trachea.
00:20:55OK, I think through the cords and the black line, we are 22 at the teeth, Ben.
00:21:00OK, we've got misting of the tube.
00:21:02OK, I'm coming out with the blade.
00:21:07Cheers, thanks.
00:21:12Curtis is now in an induced coma and breathing with the aid of a ventilator.
00:21:17Dr. Ben and the ambulance crew have done all they can.
00:21:21Just nice and steady, would it?
00:21:23OK.
00:21:24The importance of our services, we're bringing some of the emergency department to the patient,
00:21:30rather than the patient having to wait to get to the emergency department.
00:21:34He's been anaesthetised a lot faster by us getting a doctor quickly to see him.
00:21:39So we've saved him some time and hopefully improved his outcome that way.
00:21:43OK, are you injured?
00:21:53OK, all right.
00:21:56Listen, what's the address?
00:21:57Where are you?
00:21:59Ask somebody to help you.
00:22:03OK, are you out of the car?
00:22:06Yeah, the car's in the tree.
00:22:08The car's in the tree?
00:22:09Yeah, but my friends are trapped.
00:22:11How many people are in the car?
00:22:13Three.
00:22:14We're fine, Jim and I love her case.
00:22:16Stay on the drive.
00:22:17I think I'm right in my car.
00:22:19Help!
00:22:21Help!
00:22:22Help!
00:22:23Help!
00:22:24Help!
00:22:29Four ambulances, multiple police units and two fire engines have been called to the site of the crash.
00:22:37Mike.298 on channel, leaving QE now.
00:22:39Critical care backup is also urgently required, so Richard and Ian need to get there fast.
00:22:46But one male, two big males, still trapped in the vehicle.
00:22:51One's possibly got an injury fire on a tree.
00:22:56My dear son, I know that was all copied.
00:22:58Our ETA is approximately three to four minutes over.
00:23:00With multiple casualties, this is a major incident, requiring all the emergency services to work together to save lives.
00:23:13On arrival, they are briefed by West Midlands Ambulance Tactical Incident Commander, Tim, who is coordinating the whole emergency effort.
00:23:23So, we've got one patient who's been ejected on this ambulance here.
00:23:27We've got three more in there.
00:23:28One has just been tracked down, a male patient.
00:23:31We've got some concerns over his airway.
00:23:32We've got two more patients in the back.
00:23:34They're lying on top of each other at the moment, so we're just trying to get a plan to get them out.
00:23:36Okay.
00:23:36The four friends were returning from a restaurant when the car lost control, before hitting trees and landing on its roof.
00:23:45One female passenger in her 20s was ejected from the vehicle and has just been moved onto the ambulance.
00:23:53If one of you can have a quick look, because they're pretty much packaged and they can get going.
00:23:56Okay.
00:23:56Can we have a quick eye on this one?
00:23:57Yeah.
00:23:57Yeah.
00:23:58If you could also look at the chat that they dragged out, they've potentially got airway.
00:24:02Yeah.
00:24:03Hey guys, you all right?
00:24:04How you doing?
00:24:04How you doing?
00:24:05Hello.
00:24:06What have we got?
00:24:06Very quickly.
00:24:09The patient on the ambulance is the woman who called 999.
00:24:13She is complaining of severe back pain.
00:24:16She is also bleeding from a head injury.
00:24:20Jack, very quickly.
00:24:21Patient 1 is the ejected female.
00:24:24He's a GCS 14 stroke 15, good bilateral radials, moving all four limbs.
00:24:29We'll get the crew to ring you when they're ready to go with an apnea for Worcester.
00:24:32Okay.
00:24:32With her spine immobilized, Ian and Richard decide that she is stable enough to be taken to hospital.
00:24:40Right, that's patient 1.
00:24:42An ambulance crew prepare to take her, leaving the critical care team to assess the rest of the crash victims.
00:24:48Someone's going to go to Worcester.
00:24:50Do you want to just have a look at the woman who's been dragged out?
00:24:53Yeah.
00:24:54Do you have a voice?
00:24:54Where are they?
00:24:55Just point us.
00:24:56It's just person with a green shirt on the floor.
00:24:58Can't have a look over here, okay.
00:25:00What have we got?
00:25:02The driver, a man in his 40s, is in a much more serious condition.
00:25:07Is he speaking to you at all?
00:25:08Just about.
00:25:09Just about, yeah, yeah.
00:25:10He was pulled from his seat by the ambulance crew and is now on a stretcher and only semi-conscious.
00:25:16This chap dragged out.
00:25:18He was not able to be laid flat at all.
00:25:21Okay.
00:25:21He started to come back.
00:25:22He rolled to his side.
00:25:24Quite a lot of noise coming back in his airway.
00:25:26Okay.
00:25:26So I'll just get around that way.
00:25:27We'll just scoop him on his side if that's where he'll be.
00:25:30Can you open your eyes, my friend?
00:25:31Oh, thank God.
00:25:32Where is your worst pain?
00:25:35In your chest?
00:25:37Are you happy on your side or lying on your back?
00:25:39As Ian and Richard try to assess his injuries, screams are heard from the wreckage of the car,
00:25:52where the other two passengers are still trapped.
00:26:00Can you lift this leg for me?
00:26:02The driver is on the ground, semi-conscious.
00:26:05The full extent of his injuries is still unknown.
00:26:08At the minute he's talking, he's able to speak.
00:26:10He said he's got pain in his chest and he wants to go onto his back.
00:26:14He's quite cold, but we'll just get him on his back and get him off.
00:26:17Have a look from there.
00:26:18There you go.
00:26:19Just roll onto your back, my friend.
00:26:22Don't get back.
00:26:23There you go.
00:26:24With the help of the fire brigade, the man is rolled over.
00:26:27Guys, are you okay just to give hands and we'll lift him straight on the stretcher?
00:26:30He's bleeding from a wound to his head.
00:26:33Use that lift.
00:26:36Find the...
00:26:38You stay there, friend.
00:26:39We're going to get you on the ambulance.
00:26:40It's okay.
00:26:42Well done.
00:26:44One female passenger in her 20s has already left the scene in an ambulance.
00:26:50The remaining two passengers are still trapped in the back of the car.
00:26:56How are you doing?
00:26:57You okay?
00:26:57Given the high number of casualties, extra resources have arrived.
00:27:02Ian and Richard will focus on the driver, leaving the West Midlands care team to take over the
00:27:14trapped passengers when they are freed.
00:27:15This chap, they've also got a house.
00:27:18They weren't concerned about his airway, but he's talking.
00:27:20So they're doing another assessment now that he's on the trolley.
00:27:23And there's two people still in there that are trying to get out.
00:27:25So we've not had any eyes on them, but the heart team are in there trying to get them out.
00:27:29The hazardous area response team, a specialist, trained to extricate and treat patients in dangerous situations.
00:27:41The fire brigade and ambulance crew are working against the clock to free the two remaining female passengers.
00:27:47One woman is bleeding from her head.
00:27:58An hour and eight minutes after the 999 call, the last two patients are brought out of the wreckage
00:28:04and are on their way to receiving emergency treatment.
00:28:13On board one of the ambulances, Ian has had the chance to examine the driver,
00:28:17and his condition is deteriorating.
00:28:21He needs to get to hospital fast.
00:28:24If you get to a board and we want to intervene, then we'll just give a shout, pull over.
00:28:27Jump around the back and we'll go from there.
00:28:29Is that all right?
00:28:30OK.
00:28:31Happy?
00:28:32Yeah.
00:28:32Yeah.
00:28:35Ian and Richard will travel with him to provide continual care throughout the 20-minute journey.
00:28:42So it's a male, we think in his late 40s.
00:28:45Injuries-wise, he looks like he's definitely got a max of the facial fractures and possible head injury as well.
00:28:51He's got a black eye on the right with a very swollen, deformed right cheek.
00:28:55His GCS was 13 and he's a bit agitated.
00:28:59So query head injury.
00:29:01He's been cannulated and he's had some ketamine sedation, a total of 40 milligrams so far.
00:29:05Arriving at hospital, Ian and Richard deliver their critically ill patient to the waiting emergency doctors.
00:29:16So it's quite a different job, that, from what you're probably used to dealing with.
00:29:21So a significant ITC with quite a few patients.
00:29:24After a complex multi-service job, everyone can take stock and learn valuable lessons for the future.
00:29:32It's very important, so particularly that job where there's lots of people there working and lots of things going on.
00:29:38It's quite useful to, at the end, go through, you know, what happened at the job, what we did, what could have been done better.
00:29:44And it's quite useful for the crews, for their learning, because most of the irregular ambulance crews don't go to jobs like that very often at all.
00:29:50Probably once a year, if that.
00:29:56Ambulance services, the patient breathing?
00:29:59Yes, he's breathing.
00:30:00He's fell off from the scaffolding.
00:30:02OK, how old is the patient?
00:30:04He's 74.
00:30:06He's gone very pale.
00:30:08OK.
00:30:09The emergency ambulance has been arranged.
00:30:11Back injuries are among the most common major traumas and can be life-changing.
00:30:20It's estimated that every four hours, someone in the UK is paralysed from damage to their spine.
00:30:27With a chance he could be seriously injured, critical care paramedic Stephen Mitch Mitchell and clinical team mentor Ben Rean are dispatched.
00:30:36We are going to a 74-year-old who has fallen off some scaffolding boards approximately 12 foot height and apparently landed flat on his back.
00:30:48He's complaining of back pain and arm pain.
00:30:52So the risk is that he's got a spinal injury, really.
00:30:55His age brings something into that as well.
00:30:57Any pre-existing medical conditions like osteoporosis, brittle bones, they make a big difference.
00:31:06Ben and Mitch are first on scene and find the man in his front garden.
00:31:11Hi there.
00:31:12What's your name, sir?
00:31:13Paul.
00:31:13Paul.
00:31:14I'm Steve and this is Ben.
00:31:16How old are you, if you don't mind me asking?
00:31:1874.
00:31:1974?
00:31:19Paul had been trying to repair some rotten wood on his house when the scaffold tower he was standing on gave way.
00:31:30You look like you're in a bit of pain there.
00:31:34I've got a nasty gash on the thing there.
00:31:36Yep.
00:31:38And where's the majority of your pain?
00:31:40Across my back and in my hip.
00:31:42And with regards to the pain in your hip, is it on the same side as your back?
00:31:47Or is it the other side?
00:31:48Left hip, okay.
00:31:50I'll just go a quick look at your back and left, okay?
00:31:53Whilst we're doing that, can you tell us what happened?
00:31:56Yeah.
00:31:56I was on the platform up there.
00:31:58Stood up?
00:31:59Yeah.
00:32:00Stabilised it all out.
00:32:01And for some unknown reason, it just started to go that way.
00:32:05Yeah.
00:32:05Yeah.
00:32:05Twisted around.
00:32:07And I fell onto that wall on the rock.
00:32:10Were you knocked out at all?
00:32:11No, look at him.
00:32:13Good.
00:32:13Saved that.
00:32:15No, Neil.
00:32:16All right, pop your blood pressure cuff on there.
00:32:18Where possible, the advice after a fall like Paul's is to stay still, because moving can
00:32:25cause injuries to worsen.
00:32:27The reason I got up was because the body, these plants might fall off on me.
00:32:31Okay, I gotcha.
00:32:33Fearful of the scaffold boards falling, Paul's wife and some nearby workmen moved him to safety.
00:32:38When they assisted you off, did you move anything by his own means, or...?
00:32:43None of that, no.
00:32:44No, okay.
00:32:45Mitch and Ben decide to leave him sitting.
00:32:48You're fine as you are.
00:32:50We'll work around you.
00:32:51Okay.
00:32:52All right.
00:32:53Are you short of breath at all?
00:32:55No, it's painful to breathe.
00:32:57Just painful?
00:32:58Okay.
00:32:59You might have done something with your ribs at the back.
00:33:02Can you try and push down on your legs if you're going to get up?
00:33:05But I don't want you to get up like that.
00:33:07Okay.
00:33:09Right, we'll get you a little bit of oxygen, and I'll just go and get some painkillers out
00:33:13of the car, okay?
00:33:14Thank you.
00:33:14All right.
00:33:15The pain in Paul's chest points to a fractured rib.
00:33:19Pop this on.
00:33:21Is he normally quite a pile complexion?
00:33:24Yeah, he's a pile, but he's gone.
00:33:25Yeah.
00:33:27Mitch calls the control room to request an ambulance.
00:33:30Could do with an ambulance, perhaps he's got shortness of breath from pain along ribs.
00:33:34A spinal injury also can't be ruled out.
00:33:38Would you like that as a red or an amber back?
00:33:41I'd probably put it as a red.
00:33:44What were you trying to do, then?
00:33:46All the wood's rotten.
00:33:48I'm going to replace that.
00:33:49Yeah.
00:33:50And then paint the house.
00:33:53Paul is in a lot of pain.
00:33:55He needs a scan to determine whether he's broken any ribs and to make sure he hasn't damaged
00:34:01his spine.
00:34:01Did you want to do cannula and stuff like that?
00:34:05Yeah.
00:34:05Yeah, it's sad.
00:34:06While they wait for an ambulance, Ben and Mitch are doing everything they can to make
00:34:10him more comfortable.
00:34:12This arm's not sore, is it?
00:34:13No.
00:34:13All right.
00:34:14Only below the elbow.
00:34:15I'm going to pop a needle in one of these veins and we'll get some pain relief in, all
00:34:18right?
00:34:18Okay.
00:34:19All right, a little scratch coming up, okay?
00:34:20Yeah.
00:34:21Ben inserts a cannula into Paul's arm so that painkillers can be administered straight into
00:34:26the blood.
00:34:28Are you allergic to anything at all?
00:34:30No.
00:34:30Have you had any paracetamol at all?
00:34:32No.
00:34:32Okay.
00:34:33It's paracetamol.
00:34:34Lovely.
00:34:35Thank you.
00:34:37Feel that going.
00:34:41Although it's just paracetamol.
00:34:42It works really well, actually, through the vein.
00:34:44Yeah.
00:34:45It should be a bit quicker for you.
00:34:46Out of ten, how bad would you say the pain is?
00:34:49Ten being really bad.
00:34:50I don't know.
00:34:52Pardon?
00:34:53I've had seven.
00:34:55Although Paul's putting a brave face on it, he's still in agony.
00:34:59Have we had morphine before?
00:35:01No.
00:35:02No.
00:35:03Morphine sulphate, 10mg, one mil, 223.
00:35:11Is that easy enough a little bit there?
00:35:14Yeah.
00:35:14No, it's only when I get the time.
00:35:18Okay.
00:35:19Finally, the pain is beginning to subside.
00:35:22We're just waiting on the ambulance now, all right?
00:35:24Yeah.
00:35:25Paul will be taken to the nearest hospital, where he'll be x-rayed, to find out exactly what
00:35:31damage he's done.
00:35:33Hiya.
00:35:36I don't think he's going to be able to move too far, so I think if we bring the stretcher
00:35:41light right up next to him.
00:35:42Start there a sec.
00:35:43I think, come back a bit.
00:35:44That's it.
00:35:44Are you all right, Matt?
00:35:45Yeah, perfect.
00:35:47As they are confident his injury doesn't involve the spinal cord, Ben and Mitch help
00:35:51Paul to get himself onto the stretcher.
00:35:55Brilliant work.
00:35:56Well done, Paul.
00:35:57So your head goes that end.
00:35:59I'll bring your feet up.
00:36:02I'll pull you back if you've got the legs.
00:36:04Okay.
00:36:05Keep your feet together.
00:36:06Keep your feet together.
00:36:06That's it.
00:36:09Will he have to stay?
00:36:10We don't know.
00:36:11It's completely up to the doctors and what they see and what they find.
00:36:14He was clearly in a lot of pain and he may have some rib fractures.
00:36:22Hopefully he hasn't done anything to his lung or anything underneath.
00:36:29Ambulance service, patient breathing.
00:36:40He's come off his bus, right?
00:36:42He's unconscious.
00:36:43He's breathing.
00:36:44All his teeth have gone and everything.
00:36:46He's in a bad way.
00:36:47His face is in the road.
00:36:48And he doesn't seem to be taking regular breaths.
00:36:52He's breathing very fast.
00:36:54Is the patient in the road?
00:36:57He's in the road, yeah.
00:36:58How old do you think he is?
00:37:00I'd say he's in his 60s.
00:37:02Not tall, it's the 30s.
00:37:04We've got an ambulance on route, okay, so just keep your eye out for the ambulance.
00:37:08I will do, yeah.
00:37:18A local ambulance has already been dispatched to the scene of the accident, but there's
00:37:22a high chance the man has suffered paralysis or brain damage, and his life may be at risk,
00:37:28so critical care backup is needed.
00:37:33It's 73 with a little conscious of the male in the 60s that's come off the motorbike.
00:37:4160, that's obviously, thanks very much.
00:37:43I think it'll be about eight minutes or something.
00:37:46Critical care paramedics Will Meadows and Colin Aps deal with life-threatening emergencies
00:37:53on a daily basis.
00:37:55Their advanced trauma training gives the most gravely ill the best chance of survival.
00:38:01The information's come through that he's unconscious.
00:38:05That suggests that he may well have serious injuries, including injuries to his head.
00:38:13Ten minutes after receiving the emergency call,
00:38:16they are on scene.
00:38:17The local paramedics have taken the injured man into their ambulance.
00:38:23Sorry, guys.
00:38:23My name's Will.
00:38:24I'm one of the critical care paramedics.
00:38:26I'm Joe.
00:38:30Paramedic Joe quickly briefs Will on the details of the accident so he can begin his assessment.
00:38:35He's been travelling on his motorbike, no helmet, pushbikes, all right.
00:38:40Pushbikes, all right.
00:38:41Yeah, apparently the front wheel has locked up.
00:38:43Yeah.
00:38:43He's gone over the handlebars and full impact on the front of his face.
00:38:47OK.
00:38:4873-year-old Fred, a retired crane driver, was riding back home after visiting his 99-year-old mother
00:38:54when the accident happened.
00:38:57Bystanders state that he didn't move to start with, so we're querying a period of unconsciousness
00:39:02with him.
00:39:03On our arrival, he's sat up, he's talking, he's fully orientated, he knew where he was,
00:39:07but he couldn't recall the incident of what had happened.
00:39:10OK.
00:39:11Fred's injuries are so extensive, he needs urgent hospital treatment and a brain scan.
00:39:17We've got a good two-inch laceration above his right eyebrow.
00:39:21Initially, they said that he wasn't moving.
00:39:24At the very least, he has concussion, but the memory loss and blackout could be the sign
00:39:29of a much more serious brain injury.
00:39:33Have we found the teeth?
00:39:35Yeah, we've got three of them there.
00:39:36OK, so there's three missing and you've found them all.
00:39:38Yeah, the ones at the back look quite broken as well.
00:39:41There's nothing there I can see that's gone through the panache at the top.
00:39:44How are you breathing?
00:39:45Is it OK?
00:39:46Yes.
00:39:47Yeah?
00:39:48Yeah.
00:39:48OK.
00:39:49Are you in much pain at all?
00:39:51No, no pain.
00:39:52Just a little bit of a nose there, yeah?
00:39:54Yeah, try not to touch your face there, sir, OK, because we don't want to contaminate that.
00:39:58Yeah.
00:39:59Yeah, you've taken a bit of a beating, haven't you?
00:40:00I think the road's won this time.
00:40:02Yeah.
00:40:03Yeah.
00:40:04OK.
00:40:04Will is most worried about Fred's unseen injuries.
00:40:08His head took the full force of the impact.
00:40:11Head traumas are very unpredictable, and there is a risk he may have damaged blood vessels
00:40:15that could turn into a more serious bleed on the brain.
00:40:20I don't know what happened, actually.
00:40:22No.
00:40:23I don't think you're going to have the answers either, Fred.
00:40:25Accidents happen really quick, don't they?
00:40:26Will calls into the trauma desk to alert them that Fred is likely to need reconstructive
00:40:31surgery on his face.
00:40:34He's got split lips.
00:40:37He's had three teeth knocked out.
00:40:38They're all accounted for.
00:40:40And his tongue's been split as well, sort of in the middle, and quite aptly described as
00:40:46lizard tongue.
00:40:46The Queen Elizabeth Major Trauma Centre in Birmingham has specialist maxillofacial surgeons
00:40:52who can assess and treat Fred's head wounds.
00:40:55Do you want pain relief for you?
00:40:56No, no, no.
00:40:57Have you solved?
00:40:58No, no.
00:40:59No?
00:40:59Don't have any trouble, Roy.
00:41:01That's fair enough.
00:41:03Try not to keep that.
00:41:04Amazingly, Fred seems to be untroubled by his injuries.
00:41:08He wasn't wearing a helmet.
00:41:10If he had been, it may have deflected some of the force of the blow and given him more
00:41:14protection from serious long-term brain injury.
00:41:17If you're getting blood into your mouth, just let it dribble into there.
00:41:21Try not to force the speed, just let it dribble out.
00:41:23As it stands, he will need a brain scan to rule out any potentially fatal clots or bruising.
00:41:31How fast do you normally cycle there, Fred?
00:41:33Oh, no, no.
00:41:35It's not got a battery in it, has it, your boy?
00:41:37No, no.
00:41:38It's a normal eraser.
00:41:40Eraser?
00:41:41Yeah.
00:41:41Yeah, I'm saying.
00:41:42Yeah?
00:41:43So, yeah.
00:41:43Forty-mile now, then.
00:41:45Head down.
00:41:46Probably that's going to give them a heads up so you can be seen sooner rather than later.
00:41:50And if they can't manage Fred, then they'll get him transferred to the QE where you can go.
00:41:54All right.
00:41:54Lovely.
00:41:55We'll get out of your way.
00:41:56I've done.
00:41:56Have a nice day.
00:41:57Take care.
00:41:57Have a nice day.
00:41:58All right, Fred, you mind how you go, okay?
00:42:00Next time, wear a helmet.
00:42:02Yeah, I know what happened.
00:42:03All right, guys.
00:42:05Thanks very much.
00:42:05See you later.
00:42:05Cheers.
00:42:07Cumberland services, the patient breathing.
00:42:09Er, yeah, he's had his hand in a steel saw.
00:42:12A steel saw?
00:42:13Yeah, it's gone straight through.
00:42:15Yeah, I don't want to describe it too much.
00:42:17How far through his hand has the saw gone?
00:42:19Dan, you need to move your hand, please, because I need to describe it to a gentleman.
00:42:22I need to put your hand over your face.
00:42:25Hold on.
00:42:27Oh, very, very, very, very, very bad.
00:42:30You can get someone to him as soon as you can.
00:42:32Just keep the pressure on the wound, directly on the wound.
00:42:34An accident with a power tool can inflict life-altering injuries.
00:42:47An ambulance has been called, but they've requested specialist trauma backup, and critical care paramedic Tom Waters is now en route.
00:42:54It looks like I'm going to be first on the scene, and it's someone, they just said, who's cut through his hand with an angle grinder.
00:43:02DIY gone wrong.
00:43:04The benefit that I think my team and myself can go to is we can hopefully make that assessment to really identify what hospital is best for that patient.
00:43:17Ten minutes later, Tom is on scene.
00:43:20The local ambulance crew are already there.
00:43:23Hello?
00:43:23Hi, are you all right?
00:43:26So what's happened?
00:43:27He was cutting the door frame there and went straight through his hand.
00:43:3330-year-old bricklayer Daniel was cutting the timber on a workbench using an angle grinder with a four-and-a-half-inch circular blade when he lost control and it sliced through his right hand.
00:43:44His wife, Stacey, found him and has been trying to stop the bleeding.
00:43:48Okay, and how bad is it before we have a look at it?
00:43:52Is it pretty bad?
00:43:53He hasn't seen it.
00:43:55Okay, what's your name, sir?
00:43:57Daniel.
00:43:57Daniel.
00:43:58Do you live here, do you?
00:43:59Right, okay.
00:44:00The paramedics have been on scene for five minutes.
00:44:03Daniel is in a severe state of shock and close to passing out.
00:44:07They've got him to raise his arm above his heart to try and stop the bleeding.
00:44:12It's fine.
00:44:13Have you got your trauma pack with you at all?
00:44:14No, no.
00:44:15Yeah, I think maybe if you're saying it's quite bad, we'll get our bandages just in case.
00:44:20Have you hurt yourself anywhere else?
00:44:21No.
00:44:22No, so it's just your hand?
00:44:23Yeah.
00:44:23Do you mind if I...
00:44:24No.
00:44:25It's an impressive towel you've got on here.
00:44:27It's the second one.
00:44:28Okay.
00:44:30Okay, so what we do, before we open it up, we'll get our bandages just in case.
00:44:35Daniel's in excruciating pain and can't bear to look at the damage he's done.
00:44:40Let's have a look.
00:44:42All right.
00:44:42Are you all right to come around here and cut his sleeve off?
00:44:45Yeah, yeah, yeah.
00:44:45I've got some scissors on me if you want.
00:44:47Yeah.
00:44:49So quick.
00:44:49I know.
00:44:50I'll set you really tight.
00:44:51Okay.
00:44:52I know, I know.
00:44:53Sorry, buddy.
00:44:53We'll give you some pain relief.
00:44:54But what I want to do is have a real quick look at it first.
00:44:57Until he can actually see the wound, Tom doesn't know if Daniel has cut an artery or is in danger of losing any fingers.
00:45:04Both require immediate surgery.
00:45:08Okay.
00:45:08All right, bud.
00:45:09All right, bud.
00:45:10Feel me touching you here?
00:45:12Okay.
00:45:13Daniel has a three-inch wound an inch and a half deep between his thumb and forefinger.
00:45:19Once the towel is removed, it starts bleeding freely again.
00:45:22Wiggle that thumb for me.
00:45:23I can't.
00:45:24Okay.
00:45:25All right.
00:45:26What we're going to do, buddy, is we're going to clean it up.
00:45:29It's in the corner bit of your thumb.
00:45:30That makes you obviously know where it is.
00:45:32Lucky for Daniel, the blade stops short of the bone.
00:45:36Straighten that arm out for me.
00:45:37I'm sorry.
00:45:37I'm sorry.
00:45:38I'm sorry.
00:45:38I'm sorry.
00:45:38Well done.
00:45:40I just want to straighten this hand for me.
00:45:42Daniel is fortunate.
00:45:43All his fingers are still there and there's no obvious nerve damage.
00:45:47The wound will now be cleaned with saline solution and dressed to immobilize the fingers and help stop the bleeding.
00:45:55It's just obviously in the crease of his thumb.
00:45:56He's got good circulation here.
00:45:58Yeah.
00:45:58And he can feel me touching his hands.
00:46:00Yeah.
00:46:00And it's, yeah, so I think it's just more soft tissue.
00:46:05Yeah.
00:46:05And we're going to cover it.
00:46:06Yeah.
00:46:07And then I think we'll...
00:46:08Yeah, if we'll just take a picture.
00:46:10Yeah, yeah, yeah, that's fine.
00:46:11One of the paramedics takes photographs of the wound to show to the hospital doctors in A&E
00:46:16so they can assess whether he needs immediate surgery.
00:46:20Nice and still.
00:46:21It's all right.
00:46:22Keep still, close, buddy.
00:46:23See if you've done this, we'll get you some family.
00:46:25Last year, almost 5,000 people were admitted to hospital following accidents with power tools.
00:46:32We're going to bandage that up.
00:46:34It's going to be a little bit painful for a little while.
00:46:36I'm sorry, mate.
00:46:42When you're working next, don't say Monday.
00:46:45Yeah.
00:46:46It won't be.
00:46:47I think it probably feels and looks worse than what it is.
00:46:50Yeah.
00:46:51I think it needs to be cleaned, it needs to be x-rayed.
00:46:53Yeah.
00:46:53And it needs to be stitched back together.
00:46:55Cheers for that, Tommy.
00:46:56I don't know how you could look at it, to be fair.
00:46:59It's all right, mate.
00:47:00There you go.
00:47:01Just take your time, nice and slow.
00:47:03With no rush.
00:47:05Feel all right?
00:47:06Let me just walk behind you.
00:47:10With Daniel now recovered enough to walk out to the ambulance,
00:47:13Tommy's happy to leave him in the care of the local crew for the journey to hospital.
00:47:19He'll go to the local A&E where he'll get it cleaned.
00:47:21He most likely will have some formal antibiotics and an x-ray,
00:47:23and then it'll be decided on today if he needs specialist care to treat that part of his hand.
00:47:29It's very much in the forefront of our minds that we want him to get the best care for his hand.
00:47:32So he's a young chap, he's a labourer.
00:47:34We obviously need to get him back to work as soon as possible.
00:47:37It could have been a lot worse.
00:47:38It's still going to be a really painful injury, but hopefully I'll have a really quick recovery.
00:47:46Ambulance service, is the patient breathing?
00:47:48Yeah, yeah, he's conscious.
00:47:49He's been knocked off the motor scooter, he's lying in the road.
00:47:52What's he been knocked off with?
00:47:53A kite.
00:47:54He's still got his helmet on.
00:47:55OK, don't remove the helmet.
00:47:57Any pain anywhere in particular?
00:47:59In his leg and in his arm.
00:48:00Health is all arranged for the gentleman.
00:48:02Somebody could kind of remain with the gentleman until he'll come on.
00:48:05Yeah, yeah, we'll stay with him now until he gets here, yeah.
00:48:07OK.
00:48:11In a collision, motor bikers are in danger of a direct bodily impact.
00:48:17They're 50 times more likely to suffer a fatal injury than car drivers.
00:48:22Faye and Tom are dispatched.
00:48:24I've got a report to the 28-year-old male.
00:48:28He's come off his motorbike.
00:48:30He's got what they're assuming is a couple of fractures.
00:48:35With Faye and Tom still a few minutes away,
00:48:37an ambulance is first to the scene of the accident.
00:48:49That's all understood.
00:48:50Thank you, mate.
00:48:51Thank you.
00:48:51Thank you.
00:49:00What's his name again?
00:49:02Jack.
00:49:02Jack.
00:49:03Hey, mate.
00:49:04How are you?
00:49:06Mechanism-wise, just came off...
00:49:07Came off the bike.
00:49:08He was doing 30 and hit with this one.
00:49:13Came straight off.
00:49:14OK, right.
00:49:14Reminded everything.
00:49:15Had helmet, had jacket.
00:49:1828-year-old Jack crashed into the side of a car,
00:49:21which pulled out in front of him, throwing him off his bike.
00:49:24Doing quite well.
00:49:25Despite being given Entonox, he's still in severe pain.
00:49:29So, chest, abdomen, pelvis-wise, you're all happy?
00:49:31Yeah, actually, fine.
00:49:32No, he's fine.
00:49:32Come on, let's have a quick feel.
00:49:33Any pain around here?
00:49:34OK.
00:49:36Tom first assesses Jack for internal injuries.
00:49:40No pain in the tummy, buddy?
00:49:41No?
00:49:41No pain in the tummy?
00:49:44Arm-wise, it looks obviously fractured.
00:49:46I would take it.
00:49:47About there, I think.
00:49:48OK.
00:49:48He does have a suspected fracture in his forearm.
00:49:54Let's just have a quick look at your legs.
00:49:56Oh.
00:49:57All right, buddy.
00:49:58So, we are quite swollen.
00:50:00Yeah.
00:50:00It's all right.
00:50:03And his femur, or thigh bone, is also broken.
00:50:07I'm just going to take your shoe off, your right foot.
00:50:09Is that all right?
00:50:11Good, good, good.
00:50:12I just don't want to do stuff without your permission.
00:50:14When you have been, like, manipulated,
00:50:18so was it more significantly, anatomically not,
00:50:21in the right way?
00:50:21It was swollen quite a lot.
00:50:23We also had some residual spasms as well.
00:50:27In his femur, is it?
00:50:28OK.
00:50:29Yeah, in his thigh.
00:50:30All right.
00:50:30OK, good, good.
00:50:31So, you're happy no other real,
00:50:32other obvious injuries in here?
00:50:35The femur is the longest and strongest bone in the body,
00:50:38and fractures can lead to life-threatening complications,
00:50:41including blood clots.
00:50:44OK, you've had 20 of morphine.
00:50:4620 of morphine.
00:50:48Cylinder of N-Snot.
00:50:49OK.
00:50:50And it's a gram of IV, paracetamol.
00:50:52OK.
00:50:52In regards to the pain, it's just too much, is it?
00:50:55Yeah.
00:50:55Have you tried to put the Kendrick on?
00:50:57No.
00:50:57OK.
00:50:58Tom and Faye urgently need to get Jack to hospital for surgery,
00:51:02but to prevent his condition from worsening,
00:51:05they must first realign the bone using a Kendrick traction device.
00:51:09Jack, we're going to sort your leg out.
00:51:11Is that OK?
00:51:12I'm just putting something on your foot.
00:51:13but it's a painful process.
00:51:18Does it work well on N-Snot?
00:51:19It's been working quite well.
00:51:21Good.
00:51:21So Tom administers more pain relief.
00:51:25So what I want you to do is just take some nice deep breaths on that.
00:51:28Gas on that.
00:51:28Big, deep breaths for us.
00:51:30OK.
00:51:30If you happily just hold the femur where it's unstable,
00:51:33I'll do a little bit of traction.
00:51:35When you're ready?
00:51:37Yeah, he's aware of it.
00:51:38So let's get you.
00:51:39Go on, Jack.
00:51:39Be brave.
00:51:40Good man.
00:51:40While the traction device stretches out the leg,
00:51:43Tom manipulates the bones back into place.
00:51:48It is going to be a little bit sore for just a second.
00:51:53Good deep breaths, mate.
00:51:55Doing well, buddy.
00:51:56Jack's broken his femur or thigh bone
00:52:00and the team need to manipulate it back into place.
00:52:03Go on, take a nice deep breath of that good stuff, mate.
00:52:06It's painful to do,
00:52:08but necessary to prevent blood loss
00:52:10and reduce the risk of complications.
00:52:13So he's probably got a bit of spasm in his leg.
00:52:16Yeah.
00:52:16Well done.
00:52:18A bit more, Faye, if you can.
00:52:19Nice deep breaths, mate.
00:52:21Jack's taking deep breaths of entonox or nitrous oxide
00:52:24to manage the pain.
00:52:26That's it.
00:52:27One more.
00:52:28That's nice.
00:52:29That's looking good, actually, Faye.
00:52:30Nice deep breaths.
00:52:31Pretty tight, isn't it, yeah?
00:52:33Looks matching, doesn't it?
00:52:34He's got a bit of a bend in his leg.
00:52:37Good man.
00:52:38There we go.
00:52:39Well done.
00:52:40OK.
00:52:41Now that his thigh bone's realigned,
00:52:43Jack's condition should start to improve.
00:52:45Is he a little less in discomfort?
00:52:48Jack's asking.
00:52:48Yeah.
00:52:50Is that a little bit better?
00:52:51Jack, you're listening.
00:52:53Instead, he's stopped responding.
00:52:56Open your eyes to us, buddy.
00:52:57I just want to have a quick chat with you.
00:52:59Hello.
00:52:59Jack, come on.
00:53:02Jack, are you all right?
00:53:03Jack, you all right, mate?
00:53:04Jack.
00:53:05You all right?
00:53:06You all right, mate?
00:53:08It's because he's taken a lot of entonox,
00:53:09so he's just coming around.
00:53:11He's already done a part.
00:53:12The pain relief has left him momentarily dazed.
00:53:17Jack, which foot am I touching?
00:53:19Your left or your right?
00:53:21Good.
00:53:22Well done.
00:53:22OK.
00:53:23Brilliant.
00:53:23How are you feeling?
00:53:24I'm all good.
00:53:26Pardon?
00:53:27My leg goes in love.
00:53:28Good.
00:53:28Good.
00:53:28Good.
00:53:28That's what it's meant to do.
00:53:31I told you to feel much better once we've done it.
00:53:33You ready?
00:53:33Yeah.
00:53:34OK.
00:53:34On three.
00:53:35One, two, three.
00:53:37Jack now needs to have surgery as soon as possible.
00:53:44Looks a bit pale, doesn't he?
00:53:45Yeah.
00:53:46Let's just get him in the back then.
00:53:47Yeah.
00:53:47See how we are.
00:53:49You all right, mate?
00:53:51See you soon, bud.
00:53:52Yeah, mate.
00:53:56There we go.
00:53:58It's a little bump, buddy.
00:53:59Just nice and slow.
00:54:00So, he seems in quite a good spirit, doesn't he?
00:54:03Yeah, yeah, yeah.
00:54:03He's definitely got a bit of a bow, but, yeah, I think, no, compared to what it was.
00:54:09Once at Birmingham's Queen Elizabeth Hospital, it'll also be confirmed whether he has any other internal injuries.
00:54:15You can feel me touching your feet?
00:54:17Brilliant.
00:54:18And just finally, what am I doing just up here?
00:54:21Yeah.
00:54:22Good.
00:54:23OK.
00:54:23In the meantime, the critical care paramedics have done all they can to put him on the road to recovery.
00:54:29Jack, take care, buddy.
00:54:31We're fairly confident he's got a fractured forearm and a broken, fractured femur.
00:54:36He'll probably need an operation, which he'll get either tomorrow or tonight.
00:54:39And then I think he'll have quite a good recovery.
00:54:45Ambulance, sir.
00:54:46This is a patient brief, then.
00:54:48Yes, he is.
00:54:48What's happened is he's a tree surgeon.
00:54:51He's fallen from the tree.
00:54:52Yeah.
00:54:53And impaled himself on a steel spike that was below it.
00:54:57OK.
00:54:57Is he conscious of the weight?
00:54:58Yes, he's conscious and awake, but the spike has gone through towards his kidney area.
00:55:04They've got him over.
00:55:04They're trying to put some toes on to stem the bleeding.
00:55:07Did he look extremely pale?
00:55:09He does look extremely pale, yes.
00:55:11Yeah, OK.
00:55:12He's now going paler every minute.
00:55:14Of course.
00:55:14So we do have an emergency ambulance arranged for him, OK?
00:55:17As this is a potentially life-threatening accident, Tom and Ben are immediately dispatched.
00:55:25So we are going to a report of a 60-year-old male who has fallen out of a tree and impaled himself on some sort of spike or some metal.
00:55:37We are looking at some quite significant potential injuries from both the fall and the impaling of the spike.
00:55:46So we've also got 03, which is one of the helicopters coming as well, just in case he's really, really quite poorly.
00:56:09Tree surgeon. I'm going for the tree surgeon.
00:56:17Do you reckon?
00:56:18I think that's a sensible option, isn't it?
00:56:23Tom and Ben's colleagues, the Air Ambulance Critical Care Team, are already on scene.
00:56:28Hello.
00:56:28Dr Ali Hussain gives Tom a quick update on the patient's condition.
00:56:33Hi, guys.
00:56:34You all right?
00:56:34Hey.
00:56:35So, three holes.
00:56:36Take it up.
00:56:36Hi, mate.
00:56:37Two planks.
00:56:37OK.
00:56:38One midline.
00:56:39What's your name, sir?
00:56:40Alan.
00:56:41Alan.
00:56:4164-year-old tree surgeon Alan was cutting back branches in a client's back garden when he lost his footing.
00:56:48It feels difficult to take a breath in.
00:56:49It's OK.
00:56:50It's OK.
00:56:51Alan fell 12 feet onto metal railings, which embedded themselves in his lower back.
00:56:56The homeowner called 999.
00:56:59Take a big breath in for us.
00:57:01Do you find it's catching you?
00:57:02Here we are.
00:57:03Dr Ali is worried that one of the spikes may have punctured a lung.
00:57:07In terms of chest, the air entry is good.
00:57:09Ali is tender.
00:57:10Yeah.
00:57:10Thank you.
00:57:11It's a bit difficult to know if our father's gone in.
00:57:13It looks like he could have gone in a bit further.
00:57:15But at the minute, the breathing's OK and everything.
00:57:17I'll do it.
00:57:17So, but we don't know how far it's gone into your chest.
00:57:20OK.
00:57:21So, we're going to get her dripping.
00:57:22OK.
00:57:23Just reduces the chance of any bleeding.
00:57:24OK.
00:57:25How is your pain at the minute?
00:57:29Roughly out of 10, would you say?
00:57:31Yeah.
00:57:31I think probably if we could be in strength.
00:57:32If 10 is the worst possible pain you could have, and one's very, very little.
00:57:36Out of six.
00:57:37We'll get some TXA in.
00:57:38Yeah.
00:57:39The team are concerned about the level of damage.
00:57:42The four-inch spikes may have caused Alan's internal organs.
00:57:45Yeah.
00:57:46What actually happened?
00:57:46I was in the middle, and I just stepped over and just landed on the spikes.
00:57:51Ben fits a cannula so drugs can be given intravenously, while Tom updates the trauma desk.
00:57:58So, this male is probably in his late 50s, 60s.
00:58:03He's fallen and impaired himself on a metal-spiked fence.
00:58:07From visual inspection, he's got three punch wounds, central back, lumbar region.
00:58:11So, currently, he's getting some IV access.
00:58:13I'm giving him some TXA and doing some clinical observations.
00:58:17Currently, the aircraft has landed probably about 200 metres away.
00:58:22Alan is given a drug called tranexamic acid, or TXA.
00:58:26If he has internal bleeding, this will help the blood to clot.
00:58:30You know when you're sort of like squeezing your butt up together?
00:58:32Can you do that for us?
00:58:34Squeeze together.
00:58:35Good lad, that's fine.
00:58:37And you feel everything down below where you sat on?
00:58:40Dr Ali checks if the spikes have damaged any nerves in the spinal cord, which could lead to paralysis.
00:58:46You can feel everything there, and to that area.
00:58:51I can move everything down.
00:58:52It's really kind of...
00:58:53Now, are you sure we can't give you some pain relief?
00:58:56No.
00:58:56No?
00:58:57Right, OK.
00:58:59They're pretty nasty things at all, aren't they?
00:59:01They are.
00:59:01Can we give this antibiotic sometimes a bit stingy?
00:59:03Yeah, I think that.
00:59:04Is that the Coamoxicab thing?
00:59:05Yeah.
00:59:08Coamoxicab is a penicillin antibiotic.
00:59:11This will fight any bacteria that was on the metal spikes and help stop infection.
00:59:16The ambulance has just pulled up.
00:59:17We're going to bring their stretcher to the patio.
00:59:20Gentle walk, take a seat, and then we'll pop you over to the QE.
00:59:23Is that all right?
00:59:24It's because of the nature of...
00:59:25Well, first of all, if you look, then the spikes have gone in quite a few inches.
00:59:30So we'll take you to a trauma centre.
00:59:32OK.
00:59:33All right.
00:59:34Tom, Ben, and the air ambulance medics are happy that Alan travels to hospital by road.
00:59:39I'll have a copy of the Ops for you as well.
00:59:42Swing your legs.
00:59:42Tom will travel with Alan to the Queen Elizabeth Hospital to provide advanced critical care
00:59:48if required.
00:59:50So, we've got the pain relief wipes.
00:59:53I'm going to give you a bit of morphine en route if you're happy, or would you like
00:59:56some pain relief?
00:59:57Are you sure?
00:59:59OK.
01:00:00If that change is en route, then just let us know and we'll go from there.
01:00:04It's just a dangerous job you guys do, isn't it?
01:00:06It's natural.
01:00:08Very often anything, huh?
01:00:09No!
01:00:10Very rare, but that was just...
01:00:14I just tumbled out of the tree.
01:00:16Yeah, yeah.
01:00:17And if that fence was there, you'd have been fine.
01:00:20Yeah, but I'd land in a few yards.
01:00:21Absolutely.
01:00:22Yeah, yeah.
01:00:23You'd have just got up and carried on cutting.
01:00:25How did you get yourself off?
01:00:27Alan may be putting on a brave face, but his injuries are profound.
01:00:39Tom will be keeping a close eye on his condition in case he deteriorates.
01:00:43I'm just going to take your blood pressure again, if that's all right.
01:00:46That's going to go a bit tight on your right arm, that blood pressure.
01:00:49Just taking your blood pressure, OK?
01:00:51Right then.
01:00:51Only a scan in hospital will confirm whether Alan has damaged his spine
01:00:57or any internal organs.
01:01:00Two on the side don't look too bad.
01:01:02I think the main one's been in the middle of your back.
01:01:04One.
01:01:04Yeah.
01:01:06But the fact that you've walked and you've moved
01:01:08and you've got no pins and needles in your arms and your legs
01:01:12or anything like that...
01:01:12I don't really know.
01:01:13No? Does it feel OK?
01:01:15No.
01:01:15Good.
01:01:16So that's the only thing they need to be quite...
01:01:18You know, we need to be quite careful about.
01:01:20But you're normally fit and well.
01:01:22You don't suffer any medical problems or...
01:01:24It's a bit of a middle.
01:01:26You're looking too fair.
01:01:30Arriving at the Queen Elizabeth Hospital...
01:01:32Perfect.
01:01:34Alan is handed over to the waiting emergency team.
01:01:36To know what exactly the next guest is,
01:01:39you're safe to see if you're able to get legal stones.
01:01:41You're coming as a first guest
01:01:50when you're in a minute together.
01:01:53After that, make a mistake.
01:01:55Grazie a tutti.
01:02:25Grazie a tutti.
Consigliato
1:48:49
|
Prossimi video
1:34:24
1:27:59
10:16
15:46
1:10
1:55
4:08
4:17
5:39
7:09
8:42
3:47
9:55
Commenta prima di tutti