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Ambulance- Code Red
Ambulance- Code Red (2020) S04E01
Ambulance- Code Red (2020) Season 4 Episode 1
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FunTranscript
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.
03:07The number of people who are not having a bad life-saving shift is a patient.
03:19BIRDS
03:20BIRDS
03:20BIRDS
03:21BIRDS
03:22BIRDS
03:23Adidas, emergency. Is the patient breathing?
03:26Yeah. We've got a broken leg.
03:28Would he be able to speak to me directly and answer any of my questions at all?
03:32Yeah, 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.
05:31He's been here for the variant of Paracetamol Correct man.
05:35and tending to him until the ambulance arrived.
05:39He's got good pedal pulse, no other injuries,
05:41he's not in his head, he's not gone unconscious.
05:43We're just running some paracetamol.
05:45We haven't given him anything else.
05:47In addition to paracetamol,
05:50the ambulance crew are giving Adam Entonox gas,
05:52a form of pain relief that's frequently used
05:55in childbirth and trauma care.
05:57The benefit of Entonox, it works really, really well
06:00if you take it for a really long time, OK?
06:02Because what you're doing is you're sucking it in,
06:03blowing it out and having a break.
06:04Keep on taking it and load that pain relief for you
06:08and enable us to have a look at your leg
06:09a little bit better as well.
06:11Although Adam's in extreme pain,
06:13fortunately the bone hasn't pierced the skin
06:16as he first thought.
06:17Adam, can you wiggle your toes?
06:20That's good.
06:20And you can feel me touching?
06:21Good.
06:22However, the bone is misaligned
06:24and the blood supply to his foot could be compromised.
06:27Just relax.
06:28You've got to try and relax with it as best you can, Adam,
06:31because when you tense, it makes the pain worse.
06:33It's important the team straighten Adam's leg
06:36to prevent any complications.
06:39This is brilliant.
06:41You like the Entonox?
06:44Do 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,
07:01but it won't be enough
07:02when Dr. Rea starts pulling the bones back into line.
07:1025 miles away in Oxford,
07:12critical care paramedic Matt Jarman
07:14and Dr. Liesl Blom
07:16are on one of many late shifts they've done together.
07:19You sometimes don't see one of the paramedics
07:21for a very long time,
07:22but that's what I tend to every few months
07:24get 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,
07:32Liesl and Matt are one of the service's
07:34most experienced teams.
07:36We're both really chill, don't we?
07:38Yeah.
07:38You know, 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.
07:47You do.
07:52Two and a half hours into their shift,
07:55the 999 call center takes its 1,838th call of the day.
08:08Ambulance emergency.
08:14Is 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 ICC.
08:22She has cardiac issues.
08:23She's had cardiac arrest before.
08:25How old is she?
08:27She's five years old.
08:29She's never had a seizure before.
08:31She was fully seizing,
08:32ice rolling in the back of her head.
08:34Okay.
08:35She has two heart conditions.
08:37She 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,
08:47at least one breath every 10 seconds,
08:49then we do need to start the concentration.
08:52She's breathing again.
08:53She's breathing again.
08:53She's breathing again.
08:54I can't deal with you.
08:57Head weight.
08:58If she's having a fever, don't move her, okay?
09:02Is the ambulance on its way?
09:04As I said, the ambulance is on its way.
09:06Coming as quick, here's the top of the car.
09:08She's not breathing.
09:13The child has a known heart condition
09:16and is fitted with an ICD,
09:18an internal defibrillator.
09:20It's designed to activate only when the heart is about to stop.
09:24The child's life is in danger.
09:26So, 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.
09:48Mostly, we see them in adults, not in children.
09:52But it's basically, if your heart shorts out,
09:56then it's got a built-in defibrillator
09:58that, like, would we carry around it
09:59and it will give the heart a little shock internally.
10:02It's a little box built in under the skin.
10:05Now, well, this child is obviously known to cardiology.
10:08The ICD, or implantable cardioverter defibrillator,
10:13corrects dangerous heart rhythms by delivering electric shocks.
10:17ICD activated in 1836.
10:20Activated?
10:21Hmm.
10:23Well, I mean, I went off, yeah.
10:25Rarely used in infants,
10:27the ICD was fitted
10:28as the child had previously suffered a cardiac arrest.
10:32All are stating the patient's unresponsive,
10:34the chest is not rising and falling.
10:37It's gone floppy.
10:38Mother's trying to keep him awake.
10:41The fact that his device is firing
10:43means his heart's gone into a funny rhythm,
10:46which also means, you know,
10:47there's a rest that he's going to stop.
11:05In Oxfordshire...
11:06Dr. Leesel and critical care paramedic Matt
11:17are en route to a five-year-old
11:19who suffered multiple seizures and stopped breathing.
11:23There's that ambulance.
11:25Let's move it in for a moment.
11:26We'll see what's going on.
11:27Yeah, fair enough.
11:28We can get the boxes.
11:28A local ambulance crew were quickly on scene
11:32and have managed to stabilise the child.
11:34I know, folks.
11:34Let me just step on.
11:35Hi, you guys.
11:36Hi.
11:37Leesel and Matt from the air ambulance.
11:38Hello.
11:39How are we doing?
11:40Hello.
11:41Hi.
11:41This is Rummy.
11:43Rummy.
11:44That's gorgeous.
11:44I bought that.
11:45I know.
11:46They brief Leesel and Matt on their findings so far.
11:49So, Rummy, five-year-old,
11:51who has an ICD fitted
11:54due to long QT, type 3, and SVT.
11:57Okay.
11:57Has had two seizures,
12:00and then after each seizure,
12:01her ICD has gone off.
12:03As Rummy has two serious heart conditions
12:06and an implanted defibrillator,
12:08they 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 that's a febrile seizure.
12:15Okay.
12:16A febrile seizure is a convulsion
12:18triggered by a high temperature.
12:20To help in their treatment of Rummy,
12:22Dr. Leesel needs more information from Mom Kelly.
12:25How long were the seizures each?
12:27They were less than a minute.
12:28Okay.
12:29And then stopped by themselves?
12:30The first one, I can't actually say whether it was.
12:32It's all right.
12:32Because she was actually sat behind me.
12:34Oh.
12:35And I heard her, like, hoaxing on her tongue.
12:37Okay.
12:38But the second one was definitely less than a minute.
12:41Okay.
12:41The fact that Rummy's internal defibrillator
12:44shocked her twice
12:45suggests that her heart had stopped beating.
12:48They were quite close together.
12:50She was stretched right out, back arched,
12:51her eyes were wide open, bulging,
12:53with a tear falling down.
12:54Yeah.
12:56She has had history of,
12:58so she's had cardiac arrest.
13:00What age was she then?
13:01She was one and a half.
13:03She had arrhythmia.
13:04Arrhythmia, that's when we found out
13:06that she had arrhythmia.
13:07Okay.
13:07So she has her ICD.
13:09She has had a few episodes of, like,
13:11sudden collapse that 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,
13:19she's never...
13:20No.
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.
13:27Well done.
13:27Not really.
13:28It's all done.
13:28How many kids have you got?
13:30I've got nine.
13:30She's well prepared.
13:31Six.
13:32Six of my own,
13:33and then I'm looking after an extra three.
13:35Yes.
13:36With Rumi in a potentially life-threatening condition,
13:39they want to get her to hospital as soon as they can.
13:42Have you got all her meds?
13:43Yeah.
13:43She's doing her medicine here.
13:45Which one is it?
13:45What's that?
13:46This is fleckonide.
13:47Oh, yeah.
13:48It looks probably like we're going to need it, yeah.
13:51So what we're going to do,
13:52if you guys are happy,
13:53we'll jump on board,
13:54and we'll get to the John Rathcliffe.
13:57Perfect.
13:57We'll get all our kids on board as well,
13:59just in case.
14:01Why 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, they're all in it.
14:09I love it.
14:10Let me just go and help Matt get the kit.
14:13These bags.
14:15If Rumi suffers another arrest,
14:17the critical care team's unrivaled life-saving skills
14:20will be crucial.
14:21Medical, please.
14:23It's the air ambulance coming by road
14:25on November Alpha 442.
14:27Due to the seriousness of Rumi's condition,
14:29Dr. Liesel calls the dispatch desk
14:32to alert the hospital in advance.
14:34I've got a five-year-old girl
14:36with a known cardiac history
14:38who's had two seizures today.
14:42She's got an ICD that fired at the same time.
14:46Latest odds at the moment,
14:48I've got pulse is quite irregular,
14:50ranging from 90 to 150,
14:54SATs of 98,
14:55GCS is 15.
14:59She had chest pain at 6 o'clock
15:02when just prior to the first seizure.
15:05Currently, she's calm and stable.
15:08We'll see you there.
15:08Cheers. Bye-bye.
15:16I'm going to pop a little reading thing in your ear, okay?
15:21After close monitoring throughout the journey,
15:23the team safely deliver Rumi
15:25to Oxford's John Radcliffe Hospital.
15:28I'm going to let you drive
15:29because I'm a terrible bed driver.
15:33Although 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,
15:52Thames Valley Air Ambulance Charity
15:54has been responding to code red emergencies,
15:57delivering advanced medical care
15:59to a population of around 2 million people.
16:02All right, swinge drivers all there.
16:04Thoracostomy, thoracostomy.
16:06It's early morning
16:08and Dr. Laura Douglas-Beverage
16:11and critical care paramedic Neil Plant,
16:13who's been with the service since its inception,
16:16are starting a 10-hour shift.
16:24I love working with Neil.
16:26He's very good fun,
16:27he's very experienced,
16:28and he keeps me laughing a lot.
16:29Humor is integral to us coping,
16:34you 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,
16:45very psychologically heavy,
16:48so having humor is a bit of a way
16:51to offset that.
16:53Ambulance margin 2,
17:11is the patient breathing?
17:13Yeah, the patient's breathing at the moment,
17:14he's just feeling a lot of pain.
17:16Okay, both of the pain.
17:17I'm both of the pain.
17:18My arm, help him.
17:19Has he injured his arm?
17:21Has he injured his arm?
17:22Yeah, he just came from the top of a trailer.
17:25Top of a trailer?
17:27And is there any heavy bleeding?
17:28He's bleeding a bit from his knife.
17:30How old is the patient?
17:3115.
17:32So we do have an ambulance on their way
17:33on Blue Archie's phone.
17:39Reports of the farm worker falling from a trailer
17:42means Neil and Laura's advanced medical skills
17:45could be needed,
17:46and quickly.
17:4716-year-old on a farm,
17:50I was approximately 5m full,
17:52has landed apparently in a ditch,
17:55has got head and arm injuries.
17:58There's a crew on scene
17:59doing an initially primary assessment.
18:0350% 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,
18:12including 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.
18:26We're thinking about any injury to the brain
18:28and what measures we might need to take
18:30to protect his brain.
18:32Then 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.
18:40So we still would have
18:41a fairly low threshold
18:42for being cautious
18:43about protecting someone's neck.
18:48It takes the critical care team
18:5011 minutes to arrive at the scene,
18:52where an ambulance crew
18:53are already in attendance.
18:56Hello there.
18:58Hello.
18:58You all right?
18:59Thank you, guys.
19:00Robin, he is 16.
19:02Yeah, he 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.
19:1116-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.
19:20The left arm is the main concern.
19:22Obviously, it brought me to the top.
19:24Pain at the elbow.
19:25The pressure was a 90 to 97 systolic,
19:27and it's why we wanted some better pain relief
19:29because we weren't getting on too well
19:30at the end stops.
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,
19:41often 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,
19:49the 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.
19:59Okay.
19:59Also?
19:59I didn't, I was worried about my teeth.
20:02They were all right.
20:02Okay.
20:03And when you fell, so you,
20:05when did you kind of injure around your face?
20:08You're not sure.
20:08Do you, do 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, in my skin.
20:15Sure.
20:16Okay.
20:16It's like moving all the power.
20:17Okay.
20:18I know it's not a very nice feeling.
20:19The ambulance crew have already checked there's no spinal damage.
20:23So Laura ensures no other serious injuries are being masked by the pain in Robin's arm.
20:29Any pain when you're moving your neck at all?
20:31No.
20:31Lovely.
20:32Let me just have a gentle feel.
20:33Any pain over the top there?
20:35No, it just feels like fat though.
20:37Okay.
20:38It's a little bit swollen perhaps.
20:39Any pain when I'm pressing down under the jaw there?
20:41No.
20:42Okay.
20:42What about over the side?
20:45No.
20:46And across that front section.
20:49Anything 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.
20:56And you mentioned that your teeth felt a bit strange.
20:59I 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, let us 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.
21:16Good stuff.
21:17Laura has to check for tingling sensations or numbness
21:20that could indicate potential nerve damage alongside the fracture.
21:24Can you give my hands a good squeeze?
21:26Before any further treatment can be done.
21:32At the Royal Mail Sorting Office in Aylesbury...
21:35Your blood pressure moment's a little bit sky high.
21:37Is that normal for you?
21:38Dr. Jazz Rayatt and critical care paramedic Lisa Brown are treating posty Adam,
21:43whose leg is badly broken after a fall.
21:46Can you just lift my leg a little bit more?
21:48With a risk of internal bleeding and nerve damage,
21:50Adam's bone needs straightening before they can move him.
21:54Is that a little bit more support or is that worse?
21:57That's better.
21:57It's an agonising procedure, so the first stage is to control his pain.
22:03Adam, you keep doing what you're doing, but 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, OK?
22:08It's our Green Whistle.
22:10It's an anaesthetic type drug.
22:12It works a lot more effectively than the Entonox.
22:14OK, and I just confirmed you've got no allergies and the problem is with your kidneys that you're aware of.
22:21Brilliant.
22:22Now, what you need to do is hold this, OK?
22:24You take it exactly the same to do with the Entonox, but what I want you to do, keep this in your mouth,
22:30breathe it in and breathe it back out through the chamber.
22:32OK.
22:33It will make you feel very light-headed and a little bit sleepy and it's going to work a lot better than the Entonox.
22:44It has got a horrible taste, so give it a go, Adam.
22:47Adam, so what you need to do, six really big breaths in and out, so fill up your lungs fully and then breathe out and then breathe normally after that.
22:55OK.
22:57I know the taste isn't nice, Adam, but it's the effect of the drug that's going to help you.
23:03OK.
23:05Good man, Adam.
23:06Yeah, yeah, keep going.
23:07Well done, well done.
23:08Do your leg, yeah, you're going to need this, yeah?
23:11You're going to want this.
23:12Is it the taste?
23:13Office first aider Tracy is among colleagues rallying around Adam to offer their support.
23:19Keep going.
23:20Don't tell us what it's down there.
23:22Keep going.
23:22Just, yeah, keep breathing.
23:23Just really breathe it in.
23:25Yeah, yeah.
23:26It's all for your own benefit.
23:28Yeah.
23:28Keep going, keep 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.
23:35Adam, carry on using it, because every time you come off, it's going to wear off very quickly.
23:41The critical care team is concerned that Adam isn't inhaling enough of the gas to control his pain.
23:46Have you got any morphine?
23:49Yeah, give them some morphine.
23:50Yeah, give them a little bit.
23:51Don't you have the game?
23:52How much do you want into half?
23:54Just give them five, start with.
23:56Adam, Adam, look at me, darling.
23:57Did you prefer the other one?
23:59Yeah.
23:59Let me give you the other one.
24:01Right, pick your head.
24:02They're just going to give you some medication into your arm, yeah?
24:05You're fine.
24:07They just need to get the drugs in your system to stop the pain.
24:09If it isn't straight and soon, Adam's leg is at risk of permanent damage.
24:19But until his pain is under control, the critical care team can't safely move him.
24:25In Aylesbury, critical care paramedic Lisa Brown and Dr. Jazz Rayett are trying to get
24:47posty Adam's pain relief under control with a cocktail of morphine and Entonox gas.
24:52Keep that in your mouth, and breathe in, and breathe out.
24:55So they can straighten his badly broken ankle.
24:58What are you worried about, Adam?
25:00Nothing.
25:01And what exactly are we waiting for at the moment?
25:04So we're just waiting to get you to a good place before we can strap your leg into a splint,
25:08okay?
25:08So that's all we're waiting for.
25:10We need you to relax.
25:11Because it's going to hurt.
25:12Yeah.
25:12Adam, I need you to keep using the pain relief, and then I can reduce your ankle.
25:18Put your head down.
25:19If you keep coming up, I can't.
25:20Right.
25:21So Tracy's going to tell you to keep on breathing, okay?
25:25And a good five minutes of deep breaths of that.
25:29Keep that in your mouth.
25:31Breathe in and out.
25:32Just in and out all the time.
25:35Yeah?
25:35We're using this.
25:36In and out.
25:37That is brilliant.
25:38That was good.
25:39Yeah.
25:39Right, Adam, keep going.
25:40We're going to make your leg straight now to keep taking the gas.
25:44Big, deep breaths.
25:45Deep breaths.
25:45Wow, done.
25:46The increased pain relief has taken effect, and Dr. Rayet can attempt to realign the bones
25:51in Adam's leg.
25:53And just try and relax yourself down.
25:55Wow, done.
25:56That's it.
25:57That's it, Adam.
25:58Fantastic.
25:58Fantastic.
25:59Brilliant.
25:59Big, big breath.
26:02That's it.
26:02Don't breathe.
26:03Breathe.
26:04Breathe.
26:04It's all right?
26:04It's all right?
26:05Breathe.
26:05Breathe.
26:05It's all right?
26:06It's all right?
26:06It's all right?
26:07It's all right?
26:08It's all right?
26:08Okay, we've got you, yeah?
26:10We've got you.
26:11Okay.
26:12It's okay.
26:12That's it.
26:13Just relax.
26:13Relax.
26:14Relax.
26:14Be on air.
26:14Relax.
26:15Okay?
26:15Yeah, it's good.
26:16Wow, damn.
26:17Yeah, yeah.
26:18That's the work of Adam.
26:19Your leg's nice and straight, okay?
26:21All right, well done.
26:22Before he can be moved, Adam's leg will need to be immobilized.
26:26All right, Adam, open your eyes.
26:27Well done.
26:28How are you doing?
26:28Well done.
26:29I'm good.
26:29All right?
26:31Talk to me.
26:33Are you all right?
26:34Adam?
26:36Hang on.
26:36There's about four people, no, one to seven people talking to me now.
26:40Twenty-five people talking to me now.
26:42Oh, just me and just Tracy, yeah?
26:45Adam, just pop your leg down for me.
26:47Yeah.
26:47Relax.
26:48Let's go, let's go.
26:49I don't think I've seen anybody experience Entenox's great news you.
26:53This is absolutely brilliant.
26:56Okay.
26:57So my leg's nice.
26:58Adam, if you need to take it, take it, okay?
27:01But don't take it if you don't need to.
27:02It's a bit like a debate.
27:03It's like a comfort debate.
27:05Yeah, yeah, okay.
27:06I'll give you that.
27:07I'll give you that.
27:09With his leg secured in a vacuum splint, Adam can be loaded onto a stretcher.
27:14So, Adam, what we need you to do, we're going to help you to stand, put all your weight into
27:18this good leg here.
27:19We're going to hold that leg.
27:20We're going to go on three.
27:21Might be a little bit uncomfortable.
27:22Luckily, the combination of morphine and Entenox has Adam in high spirits.
27:28Okay, we'll do one, two, three if you want to.
27:30Go, man.
27:31One, two, three.
27:31What would you like?
27:32One, two, three.
27:33One, two, three.
27:33One, two, three.
27:35One, two, three.
27:36Okay, right.
27:37On.
27:37Dos.
27:38Dos.
27:39Tres.
27:40Up.
27:42Brilliant.
27:43Well done.
27:44Okay, good leg up.
27:45As Adam's condition is stable, he can be left in the hands of the ambulance crew.
27:55So, we're going to pop you up to State Mandeville Hospital, and they'll see you over there, AK.
28:00Freeing up the critical care team to respond to the next emergency call.
28:05He was certainly interacting with his colleagues.
28:06He was certainly interacting with his colleagues and with us, and I think that his demeanor made
28:11it a little bit easier for us to communicate with him, explain what we're going to do, and
28:15it also helped with his pain and management of his injury at the same time as well.
28:18Okay.
28:19So, job's well done, and he's no longer required any pain relief, and the plan is to go to State
28:24Mandeville Hospital for X-ray.
28:25Every year, the Thames Valley Air Ambulance responds to over 1,200 cardiac arrest calls.
28:37When the food got here, it was lay on the floor.
28:39Okay.
28:40They account for more than a third of its emergencies.
28:43Graham, have you got any chest pain at the moment?
28:45Out of hospital, the chances of surviving a cardiac arrest are just one in ten.
28:51I can't feel a pulse.
28:51All right, let's get back to it.
28:52But with early access to a defibrillator, those odds are greatly increased.
29:11Good morning, and it's just 111.
29:13What's the reason for your call today?
29:15I found myself at work with an irregular heartbeat, shortness of breath, and pain from my chest
29:22on my neck.
29:23Are you alone, or do you have another adult with you?
29:25I have one of my colleagues nearby.
29:27Have you lost any blood?
29:29No, I haven't.
29:30You mentioned chest pain, shortness of breath, irregular heartbeat.
29:33Which one is giving you the most concern?
29:36Probably the shortness of breath.
29:39And do you have any pain in the chest or upper back?
29:42I have a very slight pain in sort of the center of my chest.
29:45And have you got palpitations right now?
29:47Yes.
29:47I mean, it's going fairly quickly, and the left side is going sort of a beat or two just
29:52before the right side.
29:55Okay.
29:56The information will be passed on to the ambulance service, who will attempt to dispatch an ambulance
29:59to your location.
30:01All right.
30:02Heart palpitations can occur when the heart's electrical signals malfunction.
30:11Thames Valley Air Ambulance crews carry medications and cutting-edge kit to treat these problems.
30:16So Dr. Tim Waite and critical care paramedic Emma Gray are dispatched.
30:21It's a 22-year-old male, pulse VT, pulse rate 200-odd.
30:25He's very shut down.
30:26The crew are quite worried.
30:28They're just trying to get a line in.
30:29They know you're coming.
30:30Okay, cool.
30:32So we're going to a 22-year-old man who's reported to be in an abnormal, fast heart rhythm.
30:41And there's been some concerns passed from the ambulance crew that he looks quite unwell,
30:46potentially 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.
31:01The kind of obvious consideration is whether he needs electrical or cardioversion,
31:05whether he needs some sedation and an electrical shock from a defibrillator to get him back
31:10into a normal heart rhythm.
31:12And it sounds like he's shut down and they're worried about him.
31:16So I feel like our default should be sedation, cardiovert.
31:22Sedation is going to be moderately high risk.
31:24The patient was on his way to work at a garden centre when he began to feel unwell.
31:30Presumably the DMA is there somewhere.
31:33After calling 111, a local ambulance crew was dispatched and he's already on scene.
31:38Oh, have they? Brilliant.
31:43Hello.
31:44Hello.
31:46This is Luke.
31:48Howdy.
31:49Hey, how are you doing?
31:50Around kind of 10 to 9, he was cycling into work,
31:53had started to have palpitations on the left side of his chest with 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,
32:04which will 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,
32:14the team are carrying out a tracing to record the electrical activity.
32:17Do you have any medical problems normally?
32:19Yes.
32:20Excellent.
32:20Any medicines you take regularly?
32:21I take Lortype for my haykeeper, that's it.
32:24Okay, nothing else.
32:25And you were just cycling into work?
32:26Yep, literally woke up fine, showered, everything like that.
32:29Started cycling, got to the roundabout just down the road from here,
32:32and chest felt weird.
32:34And you've never experienced that before?
32:36Nothing else before, so first time.
32:38Uncommon in someone of Luke's age,
32:40chest pain and unusual sensations
32:42can indicate a serious heart problem,
32:45which without urgent treatment could lead to cardiac arrest.
32:49I think there's, broadly speaking,
32:50two directions that we might go with this,
32:53and 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.
33:09Who's here next to Kim, by the way?
33:10Mum and Dad are just outside.
33:13Cheers.
33:15I think we have to presume that's a VT, don't we?
33:19I don't...
33:20I think you'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.
33:34OK.
33:35Shall we get the ultrasound,
33:37put a big line into a big vein, hopefully,
33:40and then load with amiodo in over 20 minutes?
33:43No problem.
33:44Instead 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.
33:55Would you be able to hold the screen about there?
33:57That's really helpful, thanks.
33:58Just say to me,
33:59sort of piling yet more stuff on top of Luke.
34:02Just kind of look around for a good vein, Luke,
34:05and then when we find one,
34:06we'll hopefully put a cannula in it for you.
34:12Well, these guys have got a bit more gadgets than we do.
34:14Yeah.
34:15We'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.
34:24Bring that arm a little straight there, if that's all right.
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.
34:34Very can you around there?
34:36Come on, I'm going to press really hard
34:38to try and stop it bleeding.
34:40I've got the end of it.
34:45In a matter of seconds,
34:47the cannula is successfully in.
34:49Good.
34:50Now she'll be dressing in there.
34:51Outside, Emma updates Luke's mum.
34:56His heart's still gone way too fast,
34:58but his blood pressure's good and all that kind of stuff.
35:01So we are just going to give him a medication
35:03to help, hopefully, to bring his heart back to a normal rate.
35:07We've got several different things we can do to help him here.
35:10So we're starting at the least invasive
35:13and see if we can do it.
35:15But there's many other options.
35:16All right, so you're starting the things
35:17that you would maybe 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.
35:22All right.
35:22But if you've got any questions,
35:23in the meantime, just shout.
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.
35:34We'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,
36:00critical care paramedic Neil and Dr Laura
36:02are assessing 16-year-old farm worker Robin
36:05who's fallen 10 feet from a trailer.
36:08He'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.
36:30I wonder if a sling might be a bit more comfortable for him.
36:32I wonder if the fact that when we got here,
36:33we were like this.
36:34Sure.
36:35Yeah, to kind of get some...
36:36Normally, the humorous fracture,
36:38the weight of the arm's quite good,
36:39so just a...
36:40Yeah, yeah, absolutely.
36:40...crangler bandage?
36:41Yeah.
36:42It's just doing his blood pressure,
36:44so just wait two seconds just because he won't go in.
36:46Fine.
36:47Although it's well-supported now,
36:49Robin's arm will need to be properly immobilized
36:51in a sling for the trip to hospital.
36:54What 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
36:58in 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, yeah.
37:05Slew, yeah.
37:05Slew, yeah.
37:06We'll just budge this out the way,
37:08and I can take the weight of that arm.
37:09It will feel a little bit strange
37:11as we're starting to get you moving, okay?
37:13But I'll support your arm as much as possible,
37:14and we'll very much take our time.
37:16No rush, okay?
37:18Grant, 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?
37:23Laura and Neil are satisfied
37:26that Robin can be safely moved.
37:28Oh, dear.
37:29Shall we just stand up first?
37:32That's it.
37:33There we go.
37:34Then you'll be here.
37:35If you just turn yourself around
37:36and come out this way...
37:37You got that arm?
37:39I've got you,
37:40so don't worry about, like...
37:41And then, yeah,
37:42just sit your bottom on there.
37:45That's it.
37:45Put your bum right back
37:46into the back of the trolley.
37:47Okay?
37:48Whenever you're comfortable,
37:49just pop your other leg up.
37:51Whilst Neil moves Robin to the ambulance,
37:53Laura talks to his mum,
37:55who's arrived at the scene.
37:56...of the injuries,
37:57but he has got what looks like
37:58a break to the top part of his arm.
38:00From our side of things,
38:02otherwise, in terms of his heart rate,
38:03his blood pressure,
38:04everything else is looking lovely and settled.
38:07Yeah, absolutely.
38:08Obviously, he has still had
38:09a significant bump to the head,
38:11so he'll need to be observed
38:12for a period of time.
38:13And the wound,
38:14you'll need to have x-rays of his arm.
38:16On the stretcher,
38:18Neil can get a better look at Robin's arm.
38:20So we've got the sling ready.
38:22We're just going to remove that.
38:23That's what?
38:25There you go.
38:26That's, you've just got some abrasions on there.
38:29So is it broken?
38:30So we think you might have broke this bone,
38:32your humerus bone,
38:34this top bone here,
38:35which is fine,
38:36because they heal quite easily.
38:37Really?
38:38All right, darling.
38:42You all right there, buddy?
38:43Yeah.
38:44Yeah.
38:44Confident that Robin is stable.
38:46Yeah.
38:46He's like a rollercoaster.
38:48Rob, we are going to leave you
38:51in 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.
38:56All right, darling?
38:57All right.
38:57Thank you very much.
38:58Laura is happy that no further critical care is needed,
39:03so the ambulance crew are taking Robin
39:05to Wexham Park Hospital for x-rays and further treatment.
39:13At a garden centre in Wokingham...
39:15What's that to you?
39:16Is that all right?
39:16Save me dropping it.
39:18Dr. 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
39:26and irregular heartbeat.
39:28I think you're sort of well enough,
39:29if I could put it that way,
39:31that we shouldn't be zapping you with a defibrillator.
39:34Yeah.
39:35Let's try with the medicines.
39:37Yeah.
39:37We'll spend the time while the medicines are trickling in,
39:40transporting you up to Royal Barclays Hospital.
39:42Sounds like a good plan.
39:43If the medicines don't agree with you
39:44or 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,
39:51so to speak, and use a defibrillator.
39:53But once we've got amiodarone running,
39:55there's probably little reason to stay on scene.
39:58A powerful and potentially life-saving drug,
40:01the amiodarone should slow down
40:03the overactive electrical signals in Luke's heart.
40:05Here I am.
40:06Yeah.
40:06So we leave us in.
40:07I think we give 300 of amiodarone
40:11and we run it in a mini bag of saline.
40:13And we're about, what, 20 minutes from the Royal Barclays?
40:16And we want our amiodarone going in over about 20, 30 minutes.
40:19If successful, the drug will restore a stable rhythm
40:23to Luke's heart without shocking him with a defibrillator.
40:26Why don't we start amiodarone,
40:28pack up, gentle, slow time, steady blues up to the Royal Barclays,
40:32and then that will sort of use the interval of time
40:35while that's running to move into hospital.
40:37And then he can always have a sedation and cardioversion
40:39if he doesn't respond to pharmacological management.
40:42Lovely. We can always pull over, can't we?
40:44Yeah, exactly.
40:46Let me just go and speak to mum again and tell her.
40:48Yeah, that would be brilliant.
40:51So we are going to give him the medication
40:53whilst moving on the way to hospital.
40:55He's not going to be worse or anything.
40:57It's just that we can do it on route.
40:58So that's what we're going to do.
41:00If given too quickly,
41:02the amiodarone could dangerously lower Luke's blood pressure,
41:05so Tim's administering it slowly with saline.
41:09This one, it sometimes can cause a bit of irritation in the vein,
41:12but it doesn't normally,
41:13sort of when it's diluted and it's in the initial,
41:15initial sort of dosing.
41:18Wonderful.
41:19You're a very calm, cool customer, Luke.
41:22There's no point in having to talk about something
41:24when there's nothing I can do about it.
41:26I like you.
41:27I like your style.
41:28I'm just going to put your seatbelt on.
41:32There we go.
41:33So the intent is for this to trickle in
41:37over about 20 to 30 minutes.
41:39Just keep an eye on it.
41:42Luke appears stable,
41:44but with the possibility that his heart
41:46may still need to be shocked,
41:47Tim and Emma travel with him.
41:51We are on November Alpha 410
41:53with an ETA of approximately 10 minutes, 1-0 minutes.
41:58Tim puts in a call to the dispatch desk
42:00to alert the hospital to their imminent arrival.
42:03Bring in a 22-year-old male
42:06with onset of haemodynamically stable pulsed VT
42:10at approximately 9 a.m. this morning.
42:14He's got a heart rate currently of 167.
42:18So we've given him three bits of amiodarone,
42:20which is just finishing now.
42:21But I think the outcome of that strategy
42:24is going to be we're likely to arrive
42:25with a man who will need a procedure of sedation
42:27and a cardioversion.
42:29As serious as the situation is,
42:32Luke's maintaining his cool
42:33and looking to the future.
42:35I'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 worth double-checking the catheter
42:47and making sure you've got it as well in America.
42:50Absolutely.
42:51On arrival at hospital,
42:52with his heart rate still dangerously high,
42:55Luke's handed over to the cardiac team,
42:59leaving Dr. Tim and critical care paramedic Emma free
43:02for the next emergency call.
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