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Ambulance Code Red Season 4 Episode 1
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00:00In the intense world of medical emergencies, there's nothing more extreme than an immediate threat to life, responding to the most severe 999 calls.
00:18This lady is reporting pain in her head and is becoming less talkative.
00:23The Thames Valley Air Ambulance Fast Response Vehicles are at the front line delivering life-saving medical treatments.
00:32The big decision is for us whether we need to put a tube in again to protect us that way or not.
00:36Working day, and night, reacting to emergencies, the critical care teams are equipped to provide hospital-level treatments.
00:53So we'll give you some ketamine, that will mean that you don't know what we're doing whilst you straighten your ankle out.
00:57Whenever, and wherever it's needed, filmed over three months.
01:08Let's have your arm, let's give you some of this morphine.
01:11Just be aware you might stop spontaneously ventilating.
01:14I have a tube.
01:15We captured every vital second.
01:17That's okay, you're safe.
01:19As these highly trained critical care teams...
01:22Will you take a deep breath in for me?
01:24...fight to save lives.
01:26Your birthday present is surviving a cardiac arrest.
01:29...when every second counts.
01:32Let's go, go, go.
01:34Tonight, a five-year-old...
01:36She's leaving again, she's leaving again.
01:38...suffers multiple seizures with life-threatening implications.
01:41All are staining, the patient's unresponsive, and the chest is not rising and falling.
01:46A farm worker is injured after plummeting ten feet from a trailer.
01:51A young man who's had quite a significant fall.
01:54The left arm is the baby, sir.
01:57We're going to get a full heart-tracing, Luke.
01:59There should be loads of stickies on your chest.
02:01The critical care team respond to a potentially life-threatening heart condition.
02:05He's happy with a defibrillator and he's happy back into a normal rhythm, essentially.
02:09And...
02:11Adam, look at me, darling.
02:13...a postman is treated after a serious fall in the sorting office.
02:17It's all right. It's all right. It's all right. It's all right.
02:26Thames Valley Air Ambulance Charity rely on a fleet of fast-response cars
02:30to get them and their specialised equipment to the scenes of emergencies as quickly as possible.
02:36You've got asthma, COPD, a heart murmur.
02:40Thanks to the enhanced medical expertise of 34 doctors and 25 critical care paramedics...
02:46Where's all your pain?
02:48Which one?
02:50This one.
02:51...countless lives have been saved across the Thames Valley region.
02:54He's now got repetitive itics. I think he's still seizing.
02:57And today, Dr. Jazz Rayatt and critical care paramedic Lisa Brown
03:02are preparing for another potentially life-saving shift.
03:05I've got to find a 100% mask.
03:07And...
03:22...a public emergency.
03:24Is the patient breathing?
03:26Yes.
03:27We've got a broken leg.
03:28Would he be able to speak to me directly and answer any of my questions at all?
03:32Yes. I can pass the phone over.
03:34Hello?
03:35Are you the patient?
03:36Yeah.
03:37I understand that you've injured your leg.
03:40Yeah.
03:41And are you able to get up from the floor right now, or are you stuck on the floor?
03:45Stuck on the floor, the bone's showing.
03:48Oh, okay, so bone's sticking out through the skin.
03:51Yeah, the bone's popping out.
03:53Okay, so based on the information you've given me, your call has categorised as a high priority,
03:58just to confirm you've got somebody remaining with you until the ambulance arrives.
04:02Yeah.
04:06A broken bone that's pierced the skin is a code-red emergency.
04:12So in addition to an ambulance, the enhanced skills of the critical care team are also required.
04:18It's a 42-year-old male, he's got a broken leg, and the bone you can kind of see outside,
04:25and in a lot of pain.
04:26There's a crew that's just arriving on teams that should update you shortly,
04:29but the concern is supposedly the leg is pointing at the right angle.
04:34It sounds like this man's got an open fracture of his leg.
04:40That's when the bone is protruding from the skin.
04:43So things that we're thinking about is most likely he'll need good pain relief,
04:48probably sedation to manage his injury, so he can reduce the fracture.
04:53With a high risk of infection, if they're not treated quickly, open fractures can lead to complications,
05:00including internal bleeding, nerve damage, and even loss of limbs.
05:05Is that him?
05:06Yes, he is.
05:07Yes, he is.
05:13The accident has taken place at a Royal Mail sorting office, where an ambulance crew is already with the patient.
05:19Hello.
05:20Hello.
05:21Hello.
05:22Hiya.
05:23Hello.
05:24Hiya.
05:25Hello.
05:26Hello.
05:27Hello.
05:28Hello.
05:29Hiya.
05:30Hiya.
05:31Hiya.
05:32Hiya.
05:33Hiya.
05:34Hiya.
05:35Hiya, hiya.
05:38He's got good pedal pulse, no other injuries, he's not in his head, he's not gone unconscious.
05:43We're just running some paracetamol, we haven't given him anything else.
05:47In addition to paracetamol, the ambulance crew are giving Adam Entonox gas,
05:52a form of pain relief that's frequently used in childbirth and trauma care.
05:57The benefit of Entonox, it works really, really well if you take it for a really long time,
06:02because what you're doing is you're sucking it in, blowing it out and having a break.
06:05Keep on taking it and load that pain relief for you, and enable us to have a look at your leg a little bit better as well.
06:11Although Adam's in extreme pain, fortunately the bone hasn't pierced the skin as he first thought.
06:17Adam, can you wiggle your toes? That's good. And you can feel me touching?
06:21Good. Thank you.
06:22However, the bone is misaligned, and the blood supply to his foot could be compromised.
06:27Just relax. You've got to try and relax with it as best you can, Adam, because when you tense, it makes the pain worse.
06:33It's important the team straighten Adam's leg to prevent any complications.
06:39This is brilliant.
06:42You like the Entonox? Do you know what they call it?
06:47Anybody know?
06:47No, I don't know.
06:48Laughing gas.
06:49Oh, laughing gas.
06:50I was going to say something else.
06:52You can turn the meter cup now.
06:54The Entonox gas might be masking Adam's pain now, but it won't be enough when Dr. Rea starts pulling the bones back into line.
07:0525 miles away in Oxford, critical care paramedic Matt Jarman and Dr. Liesel Blom are on one of many late shifts they've done together.
07:19You sometimes don't see one of the paramedics for a very long time, but that's what I tend to every few months get a shift together.
07:26Probably more regular than that, right?
07:27Yeah.
07:27Probably at least once a month.
07:29With over 25 years of critical care medicine between them, Liesel and Matt are one of the service's most experienced teams.
07:36We're both really chill, don't we?
07:38Yeah.
07:38You know, there's no, I don't really feel that much pressure.
07:41No.
07:42I'm pretty relaxed.
07:42We're not a special team.
07:44No, no, exactly.
07:46And we're both on the same wavelength, I think.
07:47We do.
07:52Two and a half hours into their shift, the 999 call center takes its 1,838th call of the day.
08:01Ambulance emergency, is the patient breathing?
08:15She wasn't, but she is now.
08:17Is that her up in here?
08:19Yeah, she's just had a seizure.
08:21She's got an ICD, she has cardiac issues, she's had cardiac arrest before.
08:25How old is she?
08:27She's five years old.
08:29She's never had a seizure before.
08:30She was fully seizing, rolling in the back of her head.
08:34Okay.
08:35She has two heart conditions, she has long QT syndrome and she has STP.
08:39Is she breathing in and out in a regular pattern?
08:42No.
08:43What we would advise is that if she's not breathing in and out in a regular pattern, at least one breath every 10 seconds, then we do need to start the concentration.
08:52She's seizing again, she's seizing again, she's okay.
08:54And her body's...
08:55I can't deal with you, her body's feet off.
08:58If she's having a seizure, don't move her, okay?
09:02Is the ambulance on its way?
09:04As I said, the ambulance is on its way, coming as quick as it possibly can.
09:08She's not breathing.
09:10The child has a known heart condition and is fitted with an ICD, an internal defibrillator.
09:20It's designed to activate only when the heart is about to stop.
09:24The child's life is in danger.
09:27So as well as an ambulance, the critical care team are urgently needed.
09:31Five-year-old fatigue following chest pain.
09:33Liesel and Matt are updated through phone messaging en route to the emergency.
09:40Yeah, multiple seizures, extensive cardiac history.
09:44Oh, seriously?
09:45Built-in ICD.
09:47Five-year-old with an ICD.
09:49Mostly we see them in adults, not in children.
09:51But it's basically, if your heart shorts out, then it's got a built-in defibrillator that, like, what we carry around and it will give the heart a little shock internally.
10:02It's a little box built in under the skin.
10:05And well, this child is obviously known to cardiology.
10:09The ICD, or implantable cardioverter defibrillator, corrects dangerous heart rhythms by delivering electric shocks.
10:17ICD activated in 1836.
10:19Activated?
10:21Hmm.
10:23Well, I mean I went off, yeah.
10:25Rarely used in infants, the ICD was fitted as the child had previously suffered a cardiac arrest.
10:32All the state information is unresponsive.
10:34The chest is not rising and falling.
10:37It's gone f***ing.
10:38Mother trying to keep him awake.
10:41The fact that his device is firing means his heart's gone into a funny rhythm, which also means, you know, there's a risk that he's going to stop.
10:49In Oxfordshire...
11:01In Oxfordshire
11:06Dr. Liesel and critical care paramedic Matt
11:18are en route to a five-year-old
11:19who suffered multiple seizures and stopped breathing
11:22There's that ambulance
11:24Let's move it in for a moment, we'll see what's going on
11:27Yeah, fair enough, we'll get the balance as you want
11:29A local ambulance crew were quickly on scene
11:32and have managed to stabilise the child
11:34Hi there folks, let me just step on
11:35Hi you guys, Liesel and Matt from the air ambulance
11:38Hello
11:39How are we doing?
11:40Hello
11:40Hi
11:41This is Rummy
11:43Rummy, that's gorgeous
11:44I bought that
11:45I know
11:46They brief Liesel and Matt on their findings so far
11:49So Rummy, five-year-old who has an ICD fitted
11:54due to long QT, type 3 and SVT
11:57Okay
11:57has had two seizures
11:59and then after each seizure
12:01her ICD has gone off
12:03As Rummy has two serious heart conditions
12:06and an implanted defibrillator
12:07they need to be sure she remains stable
12:10and doesn't deteriorate
12:11She's got a fever of 38.5
12:13So we don't know whether they're febrile seizures
12:15Okay
12:15A febrile seizure is a convulsion triggered by a high temperature
12:19To help in their treatment of Rummy
12:21Dr. Liesel needs more information from mum Kelly
12:25How long were the seizures each?
12:27They were less than a minute
12:28Okay
12:28And then stopped by themselves?
12:30The first one I can't actually say whether it was
12:32It's alright
12:32Because she was actually sat behind me
12:34Oh
12:34And I heard her like coating on her tongue
12:37Okay
12:37But the second one was definitely less than a minute
12:40Okay
12:41The fact that Rummy's internal defibrillator shocked her twice
12:45suggests that her heart had stopped beating
12:47They were quite close together
12:49She was stretched right out
12:51Back arched
12:51Her eyes were wide open bulging
12:53With a tear falling down
12:54Yeah
12:55She has had history of
12:58So she's had cardiac arrest
12:59What age was she then?
13:01She was one and a half
13:03So she had arrhythmia
13:04Arrhythmia
13:05That's when we found out
13:06Okay
13:06So she has her ICD
13:09She has had a few episodes of like sudden collapse
13:12That they thought was low blood sugars
13:13Okay
13:14She has had like sickness and diarrhoea for 24 hours
13:18But even with the temperature she's never
13:20Never had a seizure before
13:21And how much has she been drinking?
13:23She's been sipping water
13:24And I have put diarrhoea in it
13:26Fabulous
13:26Well done
13:27Not really
13:28Well done
13:28How many kids have you got?
13:30I've got nine
13:30She's well prepared
13:31So I've got six
13:32Six of my own
13:33And then I'm looking after an extra three
13:35Yes
13:35With Rummy in a potentially life-threatening condition
13:38They want to get her to hospital as soon as they can
13:41Have you got all her meds?
13:43Yeah, she's doing her medicine here
13:45Which one is it?
13:45What's that?
13:46This is fleckonide
13:47Oh yeah
13:47It looks probably like we're going to need it
13:50Yeah
13:51So what we're going to do
13:52If you guys are happy
13:53We'll jump on board
13:54Yeah
13:54And we'll get to the John Rath Club
13:56Perfect
13:57And we'll get all our kits on board as well
13:59Just in case
14:00Why don't you get on board and get her fleckonide
14:03Yeah
14:03And then have you got her drugs in a bag ready to go as well
14:06Yeah, they're all in that
14:07You are so well prepared
14:09Yeah, we're all sorted
14:09I love it
14:10Yeah
14:10Let me just go and help Matt get the kit
14:12Please back
14:14If Rumi suffers another arrest
14:17The critical care team's unrivaled life-saving skills will be crucial
14:21Medical please
14:22It's the air ambulance coming by road on November Alpha 442
14:26Due to the seriousness of Rumi's condition
14:29Dr. Liesel calls the dispatch desk to alert the hospital in advance
14:34I've got a five-year-old girl with a known cardiac history
14:38Who's had two seizures today
14:41She's got an ICD that fired at the same time
14:45Latest ops at the moment
14:48I've got pulse is quite irregular ranging from 90 to 150
14:53Sats of 98
14:55GCS is 15
14:57She had chest pain at six o'clock when just prior to the first seizure
15:04Currently she's calm and stable
15:07We'll see you there
15:08Cheers
15:09Bye-bye
15:09I'm going to pop a little reading thingy in your ear, okay?
15:20After close monitoring throughout the journey
15:23The team safely deliver Rumi to Oxford's John Radcliffe Hospital
15:27I'm going to let you drive because I'm a terrible bed driver
15:30Although she's stable now
15:35Rumi will undergo a thorough investigation
15:37To find out exactly why her heart stopped beating
15:41For 26 years, Thames Valley Air Ambulance Charity
15:54Has been responding to code red emergencies
15:56Delivering advanced medical care
15:59To a population of around 2 million people
16:02All right, syringe drivers all there
16:04Thoracostomy, thoracostomy
16:06It's early morning
16:08And Dr. Laura Douglas Beveridge
16:11And critical care paramedic Neil Plant
16:13Who's been with the service since its inception
16:15Are starting a 10-hour shift
16:18I love working with Neil
16:25He's very good fun
16:26He's very experienced
16:28And he keeps me laughing a lot
16:29Humour is integral to us coping, you know
16:34And if you don't do this job
16:36Then you might not understand it
16:37But it is just a coping mechanism
16:39The reality of what we're dealing with
16:41Is it's often very intense
16:43Very emotionally challenging
16:44Very psychologically heavy
16:47So having humour is a bit of a way to offset that
16:53Ambulance margin 2, patient breathing
16:58Yeah, the patient's breathing at the moment
17:14Are they awake?
17:15Reports of the farm worker falling from a trailer means Neil and Laura's advanced medical skills could be
17:45Needed and quickly
17:47Sixteen-year-old on a farm
17:49It was approximately five metre full
17:51Has landed apparently in a ditch
17:55Has got head and arm injuries
17:57There's a crew on scene
17:59Doing an initially primary assessment
18:0250% of all fatalities in the workplace
18:06Are due to falls from height
18:08And life-threatening injuries
18:09Can include damage to vital organs
18:11Including the brain
18:13So this patient's a young man
18:16Who's had quite a significant fall
18:18Is what we've been given so far
18:20We have to make sure we're being cautious
18:22Of any injury to the spine potentially
18:25We're thinking about any injury to the brain
18:28And what measures we might need to take to protect his brain
18:31Then we have to just make sure
18:33That we're not being falsely reassured
18:35By an injury that they're just less aware of
18:38Because of the pain elsewhere
18:39So we still would have a fairly low threshold
18:42For being cautious about protecting someone's neck
18:45It takes the critical care team
18:5011 minutes to arrive at the scene
18:52Where an ambulance crew are already in attendance
18:55Hello there
18:57Hello
18:58You alright?
18:59Hi, how are you guys?
19:00Robin, he is 16
19:01Yep
19:02He was on a trailer
19:03It was moving in that direction
19:05The connection between the forklift
19:08And the trailer has gone loose
19:09It's gone into the ground
19:1016-year-old Robin works on his family's farm
19:14And was on the trailer when the hitch broke
19:16Plunging him over 10 feet to the ground
19:19The left arm is the main concern
19:22Obviously it will be to the top
19:23Pain at the elbow
19:24The pressure was a 90-97 systolic
19:27And that's why we wanted some better pain relief
19:29Because we weren't getting on too well with the entonox
19:31The ambulance crew have administered
19:33An intravenous infusion of paracetamol
19:35And given Robin entonox gas
19:37A 50-50 mix of nitrous oxide and oxygen
19:40Often used as an initial pain reliever at a scene
19:44I understand you've got this injury to your arm
19:46But with Robin not responding well to the gas and air
19:48The ambulance crew asked for the critical care team
19:51To help with their advanced medical skills
19:53And stronger pain relief
19:55Any pain anywhere else at all?
19:57My mouth hurts, but it's fine
19:59I didn't, I was worried about my teeth
20:01They were all right
20:02Okay, and when you fell
20:04So when did you kind of injure around your face?
20:08You're not sure
20:08Do you remember falling the first time?
20:11Yeah
20:11You hurt your arm then?
20:12My arm was broken
20:13I felt it, it's moving in my skin
20:15Sure, okay
20:16It's like moving all the power
20:17Okay, and that's not a very nice feeling
20:19The ambulance crew have already checked
20:22There's no spinal damage
20:23So Laura ensures no other serious injuries
20:26Are being masked by the pain in Robin's arm
20:29Any pain when you're moving your neck at all?
20:31No
20:31Lovely
20:31Let me just have a gentle feel
20:33Any pain over the top there?
20:35No, it does feel like fat though
20:37Okay, it's a little bit swollen perhaps
20:39Any pain when I'm pressing down under the jaw there?
20:41No
20:42Okay, and what about over the side?
20:45No
20:45And across that front section
20:48Any pain coming down over the top?
20:51No
20:51Can you open your jaw nice and wide for me?
20:54Look, I'm just going to have a quick look inside
20:55And you mentioned that your teeth felt a bit strange
20:58I just saw
21:00Fortunately, Robin seems to have avoided serious injury to his head and face
21:05But his arm needs attention
21:07Do you mind if I just have a little look at this arm?
21:09You can look, babe
21:10I'm not going to prod up there where it's sore
21:12Feel me touch on this side?
21:14Lovely stuff on this side
21:15Yeah, yeah
21:15Good stuff
21:16Laura has to check for tingling sensations or numbness
21:20That could indicate potential nerve damage alongside the fracture
21:23Can you give my hands a good squeeze?
21:26Before any further treatment
21:28Can be done
21:29At the Royal Mail Sorting Office in Aylesbury
21:34Your blood pressure moment is a little bit sky high
21:37Is that normal for you?
21:38Dr. Jazz Rayatt and critical care paramedic Lisa Brown
21:41Are treating posty Adam
21:43Whose leg is badly broken after a fall
21:46With a risk of internal bleeding and nerve damage
21:50Adam's bone needs straightening before they can move him
21:53Is that a little bit more support or is that worse?
21:57That's better
21:57It's an agonising procedure
21:59So the first stage is to control his pain
22:02Adam, you keep doing what you're doing
22:04But what I'm going to give you is I'm going to hold it in front of your face
22:07I'm going to give you this, okay
22:08It's our green whistle
22:10It's an anaesthetic type drug
22:12It works a lot more effectively than the Entonox
22:14Okay, and I just confirmed you've got no allergies
22:17And the problem with your kidneys that you're aware of
22:21Brilliant
22:21Now what you need to do is hold this
22:24Okay, you take it exactly the same to do with the Entonox
22:26But what I want you to do
22:27Keep this in your mouth
22:29Breathe it in and breathe it back out through the chamber
22:32Okay
22:33Penthox, omethoxyflurane
22:36Is an extremely potent and fast-acting form of pain relief
22:39It will make you feel very light-headed
22:41And a little bit sleepy
22:42And it's going to work a lot better than the Entonox
22:43It has got a horrible taste
22:45So give it a go, Adam
22:47Adam
22:47So what you need to do
22:49Six really big breaths in and out
22:51So fill up your lungs fully
22:52And then breathe out
22:53And then breathe normally after that
22:55Okay
22:56I know the taste isn't nice, Adam
22:59But it's the effect of the jug that's going to help you
23:02Okay
23:04Good man, Adam
23:05Yeah, yeah, keep going
23:07Well done, well done
23:08Do your leg, yeah
23:10You're going to need this, yeah
23:12You're going to want this
23:12Is it the taste?
23:13Office first aider, Tracy
23:15Is among colleagues rallying around Adam
23:17To offer their support
23:18Keep going
23:19Keep using it
23:21Keep going
23:22So really breathe it in
23:25Yeah
23:25Keep going
23:28Keep going
23:29Don't worry about what everyone else is doing
23:31Just listen to us
23:32And let them do what they're going to do
23:34Adam, carry on using it
23:37Because every time you come off
23:38It's going to wear off very quickly
23:39The critical care team is concerned
23:43That Adam isn't inhaling enough of the gas
23:45To control his pain
23:46Have you got any morphine?
23:49Yeah, give him some morphine
23:50Yeah, give him a little bit
23:51How much do you want him to have?
23:54Um, just give him five
23:55Start with
23:55Adam, Adam
23:56Look at me, darling
23:57Did you prefer the other one?
23:59Yeah
23:59Let me give you the other one
24:00Right, pick your head
24:02They're just going to give you some medication into your arm
24:05Yeah
24:05You're fine
24:06They just need to get the drugs in your system
24:08To stop the pain
24:09Yes
24:10Have some laughing gas
24:13And suck away on that
24:14If it isn't straightened soon
24:16Adam's leg is at risk of permanent damage
24:19But until his pain is under control
24:22The critical care team can't safely move him
24:25In Aylesbury
24:39So can you take four really big breaths in and out?
24:42Critical care paramedic Lisa Brown and Dr. Jazz Rayatt
24:46Are trying to get posty Adam's pain relief under control
24:49With a cocktail of morphine and Entonox gas
24:52Keep that in your mouth yet
24:53And breathe in
24:54And breathe out
24:54So they can straighten his badly broken ankle
24:58What are you worried about, Adam?
25:00Nothing
25:00And more
25:01What exactly are we waiting for at the moment?
25:04So we're just waiting to get you to a good place
25:06Before we can strap your leg into a splint
25:08Okay, so that's all we're waiting for
25:10We need you to relax
25:11Because it's going to hurt
25:11Yeah
25:12Adam
25:13I need you to keep using the pain relief
25:15And then I can reduce your ankle
25:18Head down
25:19If you keep coming up, I can't
25:20Right
25:21So Tracy's going to tell you to keep on breathing
25:24Okay, and a good five minutes of deep breaths of that
25:28Keep that in your mouth
25:30Breathe in and out
25:32Just in and out all the time
25:33Yeah, just keep breathing in and out
25:36That is brilliant
25:38Right, Adam, keep going
25:40We're going to make your leg straight now
25:42So keep taking the gas
25:43Big, big breath
25:45Wow, done
25:46The increased pain relief has taken effect
25:48And Dr. Rayet can attempt to realign the bones in Adam's leg
25:52And just try and relax yourself down
25:55Wow, done
25:55That's it
25:57That's it, Adam
25:57Fantastic
25:58Brilliant
25:59Before he can be moved, Adam's leg will need to be immobilized
26:13Okay, well done. Yeah, yeah, that's the work of Adam your legs nice and straight. Okay
26:22Before he can be moved Adam's leg will need to be immobilized. Adam up your eyes. Well done. How are you doing?
26:28I'm good. All right
26:31Talk to me
26:33All right, Adam
26:36I'm gonna about four people. No one seven people talking about 25 people talking to me now
26:43Just me and just Tracy. Yeah, I don't just pop your leg down for me. Relax
26:49I don't think I've seen anybody experience and synopsis great news
26:57If you need to take it take it, okay, but don't take it if you don't need to
27:05Yeah, yeah
27:07With his legs secured in a vacuum splint Adam can be loaded onto a stretcher
27:14So Adam what we need you to do. We're gonna have you to stand for all your weight to this good leg here
27:18We're gonna hold that leg. We're gonna go on three might be a little bit uncomfortable
27:22Luckily the combination of morphine and entonox has Adam in high spirits
27:26Said it for not to stress. Okay, we do on the doctor if you want to go man. That's why would you like what I'm trying to die?
27:36Right on
27:38Just today
27:42Brilliant
27:44Good leg up
27:46As Adam's condition is stable he can be left in the hands of the ambulance crew
27:55So they're gonna pop you up to state manderville hospital. They'll see you over there, okay?
28:00Freeing up the critical care team to respond to the next emergency call
28:05He was certainly interacting with his colleagues and with us and I think that his
28:10Demeanor made it a little bit easier for us to communicate with him
28:13Explain what we're going to do and it also help with his pain and management of his injury at the same time as well
28:19So job well done and he's no longer quite any pain relief and the plan is to go to state manderville hospital for x-ray
28:31Every year the Thames Valley air ambulance responds to over
28:351200 cardiac arrest calls and food by here was lay on the floor, okay
28:39They account for more than a third of its emergencies
28:43Brain have you got any chest pain at the moment out of hospital the chances of surviving a cardiac arrest are just one in ten
28:50I can't feel a pulse all right, but with early access to a defibrillator those odds are greatly increased
29:05Good morning and it's just one on one and what's the reason for your call today?
29:14I found myself at work with an irregular heartbeat shortness of breath and pain from my chest and my neck
29:25I have one of my colleagues nearby
29:27Have you lost any blood?
29:29No, I haven't you mentioned chest pain shortness of breath irregular heartbeat which one is
29:34Giving you the most concern probably the shortness of breath and do you have any pain in the chest or upper back?
29:41I have a very slight pain in sort of the center of my chest and have you got palpitations right now?
29:47Yeah, I mean it's going fairly quickly and the left side is going sort of a beat or two just before the right side
29:54Okay, the information will be passed on to the ambulance service who will attempt to dispatch an ambulance to your location
30:00All right
30:02Heart palpitations can occur when the heart's electrical signals malfunction
30:10Thames Valley Air Ambulance crews carry medications and cutting-edge kit to treat these problems
30:15So Dr. Tim Waite and critical care paramedic Emma Gray are dispatched
30:20It's a 22-year-old male, Pulse VT, Pulse VT, Pulse VT 200-odd
30:24He's very shut down, the crew are quite worried
30:27They're just trying to get a line in and they know you're coming
30:29Okay, cool
30:31So we're going to a 22-year-old man
30:35Who's reported to be in an abnormal fast heart rhythm
30:40And there's been some concerns passed from the ambulance crew that he looks quite unwell
30:45Potentially with a low blood pressure and what we'd call a kind of shocked state
30:51A very fast and irregular heartbeat is a potentially life-threatening combination
30:56If left untreated, it can lead to catastrophic consequences
31:00The kind of obvious consideration is whether he needs electrical cardioversion
31:05Whether he needs some sedation and an electrical shock from a defibrillator
31:10To get him back into a normal heart rhythm
31:12And it sounds like he's shut down and they're worried about him
31:15So I feel like our default should be sedate and cardiovert
31:21Sedation is going to be moderately high risk
31:24The patient was on his way to work at a garden centre
31:28When he began to feel unwell
31:30Presumably the DMA's there somewhere
31:32After calling 111
31:34A local ambulance crew was dispatched
31:36And he's already on scene
31:38Oh, have they? Brilliant
31:42Hello
31:43This is Luke
31:47Hey, how are you doing?
31:50Around 10 to 9
31:52He was cycling into work
31:53Had started to have palpitations on the left side of his chest
31:56With tightness
31:57Shortness of breath
31:58That's persisted for the last kind of three hours
32:01Okay, wow
32:02We're going to get a full heart tracing, Luke
32:04There should be loads of stickies on your chest
32:06Yeah, that's fine
32:0622-year-old Luke works as a sales assistant at the garden centre
32:12To assess his heart
32:13The team are carrying out a tracing to record the electrical activity
32:17Do you have any medical problems normally?
32:19Seconds
32:19Excellent, any medicines you take regularly?
32:21I take Loratide for my hairkeeper, that's it
32:24Okay, nothing else
32:25And you were just cycling into work?
32:26Yep, literally woke up fine
32:28Showered, everything like that
32:29Started cycling
32:30Got to the roundabout just down the road from here
32:32And chest felt weird
32:34And you've never experienced that before?
32:36Nothing that has before
32:36First time
32:37Uncommon in someone of Luke's age
32:40Chest pain and unusual sensations
32:42Can indicate a serious heart problem
32:45Which without urgent treatment
32:47Could lead to cardiac arrest
32:49I think there's broadly speaking two directions
32:51That we might go with this
32:52And it will depend a bit on the heart tracing
32:54The first is we give you some medicines
32:56To see if they make your heart go back into a normal rhythm
32:59The second, which we might need to do
33:01Is we give you some sleepy medicine
33:03So you're sleepy and sedated
33:04And then we zap you with a defibrillator
33:06And zap you back into a normal rhythm essentially
33:08Who's here next to Kim, by the way?
33:10Mum and Dad are just outside
33:12Thank you
33:13Cheers
33:14I think we have to presume that's a VT
33:18Don't we?
33:19I don't
33:19I think you'd be
33:21You'd be brave to call that anything else
33:24The heart trace shows ventricular tachycardia or VT
33:28Meaning a problem with the electrical signals in Luke's heart
33:31Are causing it to beat in an abnormal rhythm
33:34Okay
33:35Shall we get the ultrasound?
33:37Put a big line into a big vein hopefully
33:40And then load with amiodarone over 20 minutes
33:43No problem
33:43Instead of using a defibrillator
33:46To shock and reset the rhythm and rate of Luke's heart
33:49Tim is opting for a less invasive approach
33:52A powerful intravenous medication
33:54Would you be able to hold the screen about there?
33:57That's really helpful
33:57Thanks
33:58Just say to me
33:58Instead of piling yet more stuff on top of Luke
34:02And just kind of look around for a good vein Luke
34:04And then when we find one
34:05We'll hopefully put a cannula in it for you
34:09Well these guys have got a bit more gadgets than we do
34:14Yeah
34:14We'll use our toys
34:17Speed is of the essence
34:19So Tim is using a portable ultrasound scanner
34:21To find a vein in Luke's arm
34:23Bring that arm a little straight there if that's alright
34:26Thanks man that's perfect
34:27Yeah well done
34:28So he can quickly insert a cannula
34:31And administer the medication Luke needs
34:33It's broken here around there
34:35Come in I'm going to press really hard to try and stop it bleeding
34:39I've got the end of it
34:41In a matter of seconds the cannula is successfully in
34:49Good
34:49Now she'll be addressing in there
34:52Outside Emma updates Luke's mum
34:55His heart's still gone way too fast
34:58But his blood pressure's good and all that kind of stuff
35:00So we are just going to give him a medication
35:03To help hopefully to bring his heart back to a normal rate
35:07Yeah
35:07We've got several different things we can do to help him here
35:10So we're starting at the least invasive
35:13Yep
35:13And see if we can do it
35:15But there's many other options
35:16Alright
35:16So you're starting the things that you would
35:18Maybe would have been done in the hospital
35:19In hospital we're doing it now
35:20So yeah that's why we're not rushing off
35:22Alright
35:22But if you've got any questions in the meantime just shout
35:24Thank you
35:24Okay
35:25If Luke doesn't respond to the medication
35:28Then the critical care team will have no option
35:31Other than to shock his heart with a defibrillator
35:40We'll do one more blood pressure
35:53And then we'll give you something a bit stronger for the pain
35:55If you're not getting on with that gas in there
35:57In a farmer's field near Windsor
35:59Critical care paramedic Neil and Dr Laura
36:02Are assessing 16 year old farm worker Robin
36:05Who's fallen 10 feet from a trailer
36:07He's in pain with a fractured arm
36:10And facial cuts from the fall
36:12If you're not too keen on the end to knock
36:14We can lose that one
36:15Laura has checked for nerve damage
36:17And fortunately Robin appears to have normal sensation
36:20So now she can treat his arm
36:22Is it humorous the fracture?
36:24Yeah
36:25A humorous fracture is a break to the bone in the upper arm
36:29Okay
36:29I wonder if a sling might be a bit more comfortable for him than that
36:32Yeah, I'm sure it's the fact that when we got here we were like this
36:34Sure
36:34Yeah
36:35Normally the humoral fracture the weight of the arm is quite good
36:39So just a triangle bandage
36:41Yeah
36:42It's just doing his blood pressure
36:44So just wait two seconds just because you won't go in
36:46Although it's well supported now
36:49Robin's arm will need to be properly immobilized in a sling for the trip to hospital
36:53What we'll do is we'll do your blood pressure
36:56We'll get you on the trolley
36:57And then we can look to get your arm in a bit of a better sort of position
37:00Something a bit more comfortable
37:01Where are we going?
37:03We're going to be to Wexham
37:03Wexham Park
37:04Yeah
37:05We'll just budge this out the way
37:07And I can take the weight of that arm
37:09It will feel a little bit strange as we're starting to get you moving
37:12Okay
37:12But I'll support your arm as much as possible
37:14And we'll very much take our time
37:16No rush
37:16Okay
37:17Brand, you're doing really well
37:19I'll just take that on there now
37:21Neil, when you're ready
37:22Do you mind just moving that bag out there?
37:25Laura and Neil are satisfied that Robin can be safely moved
37:28Shall we just stand up first?
37:32That's it
37:33There we go
37:33Then you'll be here
37:35If you just turn yourself around and come out this way
37:37You got that arm?
37:39I've got you
37:39So don't worry about like
37:40And then yeah
37:42Just sit your bottom on there
37:43That's it
37:45Put your bum right back into the back of the trolley
37:47Okay
37:48Whenever you're comfortable
37:49Just pop your other leg up
37:50Whilst Neil moves Robin to the ambulance
37:53Laura talks to his mum
37:54Who's arrived at the scene
37:56Some of the injuries
37:57But he has got what looks like a break to the top part of his arm
37:59From our side of things
38:01Otherwise in terms of his heart rate, his blood pressure
38:04Everything else is looking lovely and settled
38:06Yeah, absolutely
38:08Obviously he has still had a significant bump to the head
38:11So he'll need to be observed for a period of time
38:12And the wound
38:14You'll need to have x-rays of his arm
38:15On the stretcher
38:17Neil can get a better look at Robin's arm
38:20So we've got the sling ready
38:21We're just going to remove that
38:23There you go
38:26That's you've just got some abrasions on there
38:28So is it broken?
38:30So we think you might have broke this bone
38:32Your humerus bone
38:33This top bone here
38:35Which is fine
38:36Because they heal quite easily
38:37Really?
38:39Alright darling
38:39You alright there buddy?
38:43Yeah
38:43Yeah
38:44Confident that Robin is stable
38:46Rob we are going to leave you in the team's very capable hands
38:53I think mum's going to come with you as well
38:54But wish you all the best
38:56Alright darling
38:56Alright
38:57Thank you very much
38:59Laura is happy that no further critical care is needed
39:02So the ambulance crew are taking Robin
39:05To Wexham Park Hospital for x-rays and further treatment
39:09At a garden centre in Wokingham
39:15Is that right to save me dropping
39:17Dr. Tim Waite and critical care paramedic Emma Gray
39:21Are treating 22 year old sales assistant Luke
39:24Who has a potentially life-threatening fast and irregular heartbeat
39:28I think you're sort of well enough if I could put it that way
39:30That we shouldn't be zapping you with a defibrillator
39:34Let's try with the medicines
39:36We'll spend the time while the medicines are trickling in
39:39Transporting you up to Royal Barks Hospital
39:42Sounds like a good plan
39:43If the medicines don't agree with you or if things get worse on the way
39:46We can give you some sleepy medicines
39:48Pull over and go back to sort of plan A so to speak
39:52And use the defibrillator
39:53But once we've got amiodarone running
39:55There's probably little reason to stay on scene
39:57A powerful and potentially life-saving drug
40:00The amiodarone should slow down the overactive electrical signals in Luke's heart
40:05Here I am
40:06So ladies in
40:07I think we give 300 of amiodarone and we run it in a mini bag of saline
40:13And we're about what 20 minutes from the Royal Barks
40:16And we want our amiodarone going in over about 20-30 minutes
40:19If successful the drug will restore a stable rhythm to Luke's heart
40:23Without shocking him with a defibrillator
40:26Why don't we start amiodarone, pack up, gentle, slow time, steady blues up to the Royal Barks
40:32And then that will sort of use the interval of time while that's running to move into hospital
40:37And then he can always have a sedation and cardioversion if he doesn't respond to pharmacological management
40:42Lovely, we can always pull over can't we?
40:43Yeah, exactly
40:45Let me just go and speak to mum and tell her
40:48Yeah, that would be brilliant
40:50So we are going to give him the medication whilst moving on the way to hospital
40:55He's not going to work with anything
40:56It's just that we can do it on week
40:58So that's what we're going to do
40:59If given too quickly, the amiodarone could dangerously lower Luke's blood pressure
41:05So Tim's administering it slowly with saline
41:08This one, it sometimes can cause a bit of irritation in the vein
41:12But it doesn't normally, when it's diluted and it's in the initial sort of dosing
41:18Wonderful
41:18You're a very calm, cool customer Luke
41:21There's no point in him when I talk about something when there's nothing I can do about it
41:25I like you
41:26I like your style
41:28I'm just going to put your seatbelts on
41:30There we go
41:33So the intent is for this to trickle in over about 20 to 30 minutes
41:39Just keep an eye on it
41:42Luke appears stable
41:44But with the possibility that his heart may still need to be shocked
41:48Tim and Emma travel with him
41:50We are on November Alpha 410
41:53With an ETA of approximately 10 minutes, 1-0 minutes
41:57Tim puts in a call to the dispatch desk to alert the hospital to their imminent arrival
42:03Bring in a 22-year-old male with onset of hemodynamically stable pulsed VT at approximately 9am this morning
42:13He's got a heart rate currently of 167
42:17So we've given him three people of amiodrome which is just finishing now
42:20But I think the outcome of that strategy is going to be we're likely to arrive with a man who will need a procedural sedation and a cardioversion
42:28As serious as the situation is Luke's maintaining his cool and looking to the future
42:34I'm meant to be going on a trip to Boston
42:38Would anything like this cause any sort of issues?
42:40I would say take this one thing at a time
42:42Work out what's going on first
42:44Yeah, absolutely
42:44Yeah, it's probably just the worst double checking
42:47Making sure you've got it as well in America
42:49On arrival at hospital, with his heart rate still dangerously high, Luke's handed over to the cardiac team
42:57Leaving Dr. Tim and critical care paramedic Emma free for the next emergency call
43:19Thank you
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