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00:01Yorkshire.
00:03Breathtaking,
00:06but unforgiving.
00:09And when the landscape turns dangerous...
00:11Patients still breathing but doesn't sound good on the phone, mate.
00:14...and lives hang in the balance...
00:18The crews of the air ambulance are often the first and only lifeline.
00:23Hello. We're coming to help. You OK, buddy?
00:25Delays in getting your patient to hospital
00:27can literally be the difference between life and death.
00:30It was injured in his brain.
00:31Just try and get a little drip in your arm, Ian, all right?
00:34Can you remember anything about us putting your leg into us then?
00:37No. No?
00:40The jobs that we're going through can be quite catastrophic.
00:42If we weren't there, then the situation could be much worse.
00:45Bringing critical care by air.
00:48That's it. Good lad. Good lad.
00:50You're not allergic to anything.
00:52Hey!
00:53This is Yorkshire Air 999.
01:01At the air ambulance headquarters near Wakefield,
01:04paramedic Matty is on the air desk,
01:06listening in to a 999 call.
01:08I've turned my tractor over and I'm underneath it.
01:12And have you lost any blood?
01:14I can't see because my arm is under the wheel.
01:19A tractor is overturned and the patient's underneath it.
01:22Very good, my friend.
01:23Laying burnt.
01:24He's trapped by his shoulder, apparently really short of breath.
01:27I've been here for an hour.
01:30I've only got my arm out of my pocket.
01:34We're getting the help of Wayne for you, okay?
01:38Paramedic Wayne and Dr Steve are being scrambled to the man
01:42who is trapped in a remote valley 50 miles away in the middle of the Yorkshire Dales.
01:479-8 receiving.
01:48Yeah, so it's a 59-year-old male who's reported to be trapped underneath an overturned tractor.
01:55He's reported to be short of breath, but he's definitely trapped by his shoulder.
01:59And arm.
02:00Over.
02:019-8, roger that.
02:02Do we have fire on him to this?
02:04Yes, we'll get fire and rescue to go.
02:06But the reason for allocating merit is if this turns out to be a prolonged entrapment,
02:11they'll have blood and FFP if things change towards anything more serious like an amputation.
02:16Over.
02:17When we have patients that are trapped or pinned,
02:20a heavy weight on the tissue can cause parts of the tissue to die,
02:23which releases toxins into the bloodstream.
02:25So the longer someone's pinned, the more worried we are.
02:30I'll just try it.
02:31Yeah.
02:32Clear down your side here, yeah?
02:33Good on my side, yeah.
02:34Yeah.
02:35Stephen Wayne will be the first on scene to reach the man,
02:38who's at the top of an isolated valley over half a mile down a rough track.
02:43He's been alone and pinned beneath the tractor by his arm for over 90 minutes.
02:48We've landed about 50 yards away, Matty,
02:51and I'm just making my way to scene now.
02:53Yeah, roger, Steve.
02:54The patient's still breathing but doesn't sound good on the phone, mate.
02:57Yeah, it's getting carbon monoxide poisoning.
03:00The tractor's engine is still running
03:02and its fumes may be poisoning the patient with carbon monoxide.
03:05Hello.
03:06Hello.
03:07We're coming to help you, okay, buddy?
03:09Hello.
03:10How do we turn this off?
03:12Dead man's switch.
03:14Dead man's switch.
03:15Okay, no.
03:16Yeah.
03:17Yeah, that's it.
03:18Pull it.
03:19Don't go up to that.
03:20What's your name, mate?
03:21Stephen.
03:22Hi, I'm Wayne.
03:23I made a super mistake.
03:24What happened?
03:25I had to change the gear.
03:26Okay.
03:27And it caused the tractor to roll back.
03:28Okay.
03:29That's it.
03:3059-year-old Steve Rathbone was reversing his vintage tractor down a slope when the brake failed.
03:36It struck a stone and flipped over, pinning him underneath.
03:39My whole arm is underneath it.
03:41Yeah, I can see that here, mate.
03:42Have you got any pain anywhere else?
03:44I imagine my shoulder blades bugged up.
03:46Okay.
03:47I'm going to try and get in, mate, give you an assessment.
03:48Is that all right?
03:49Yeah.
03:50Yeah, we've got the fire brigade coming, mate, all right?
03:53Yes, arm, shoulder and hand, mate, on this leather.
03:56It's trapped under the wheel.
03:58Yeah.
03:59And it hurts.
04:00I bet it does, buddy.
04:02There's lots of folk coming to help.
04:03You okay, Steve?
04:05So, lots of combustible stuff around.
04:07Petrol and whatever.
04:08Diesel, sorry.
04:09Diesel.
04:10There's everything out.
04:11There's oil and all sorts.
04:12So, just think about oxygen use.
04:14Just something to be aware of.
04:15There is a fire risk.
04:17Alex, would you be able to get a fire extinguisher from the aircraft?
04:20Have it nearby.
04:21Can you feel me touching your hand?
04:23No, I can't feel you touching it, but I have a sense of it.
04:26I mean, he's trapped significantly under this wheel and this wheel arch here.
04:30Injuries top to toe.
04:31Looks like an isolated, obviously pinned shoulder, left arm, hand.
04:35Possible neurovascular compromise on the hand here.
04:38We're going to get a drip in and give you some painkillers.
04:41Okay.
04:42Steve's hand is trapped under the wheel and is losing blood flow and nerve function.
04:47Thank the Lord, Junior.
04:49So, this is going to be a bit tight.
04:50We'll have a look to get a load.
04:51Yeah.
04:52You know what?
04:53What's that?
04:54My phone.
04:55I borrowed that.
04:56Was in the pocket under the wheel.
04:57Oh, crikey.
04:58And I thought, this is it.
04:59I'm done for.
05:00A fire and rescue crew member has come ahead to assess how they can free Steve.
05:05Yeah.
05:06Legs are free.
05:07Pelvis is free.
05:08Chest is free.
05:09Just the arm.
05:10You just see the knuckles out that side.
05:11Best form of attack I think we need to do is lift it all up from this side.
05:15It's going to be the leg getting the gear up here though.
05:17Yeah.
05:18So, we're going to give you some medication, Steve.
05:20One of them is going to keep some clots formed in your body in case you're bleeding anywhere.
05:24And we'll just start you on some paracetamol.
05:27And then we can top you up with a bit of morphine.
05:30Steve's accident has happened at the top of a steep and remote valley.
05:34A local farmer is helping to carry the rescue equipment up to them.
05:38I think the bucket is currently supporting it where it is.
05:40If we take the bucket off, it's going to drop onto it further.
05:43If we get something under here, lift the bucket, chop the wheel as it comes up,
05:47we might just create enough wiggle to get out.
05:50Fire and rescue will be using high pressure airbags,
05:53which when filled with air, can lift up to 60 tonnes.
05:57Steve, we're all around you, planning now to get you out.
05:59OK, buddy?
06:00OK, knock.
06:01Just put it in the centre.
06:02Yep, seat foot.
06:03Cheers, Mark.
06:04Cheers, Al.
06:05How are you feeling, Steve?
06:06I'm feeling very tired.
06:07Yeah.
06:08Probably the adrenaline dropping off, because you know help's coming.
06:10Yeah, exactly.
06:11Steve did start to say he felt quite tired.
06:22We see this sometimes.
06:23It's a phenomenon that's been described as peri-rescue collapse.
06:26When it seems that they're safe, they can take a turn for the worse.
06:29So I was worried in my mind that actually Stephen had been holding his own for some significant time,
06:35but with us there on scene, he'd start to relax a little bit
06:38and we'd be more at risk of deterioration.
06:42Steve has now been under the tractor for over two hours.
06:46OK, Steve, we're going to start moving now, OK, buddy?
06:53Rest, rest, rest, rest, rest, rest, rest.
06:55Right, knock all that off. Knock it all off.
06:57As the tractor is tilting, its mudguard is pushing into Steve's chest, so they need to stop.
07:03All it did was slip it that way.
07:05It was shifting, yeah, I did spot it.
07:07It's relieving me that it's pushing...
07:09On your chest.
07:11However, they can now access Steve more easily to provide him with additional medication.
07:16Er, Wayne, I think we might trickle some calcium in now, you know.
07:20It's a big area of crush.
07:22When your tissues are crushed, they can start breaking down
07:25and they release something called potassium.
07:28And potassium can actually be toxic to the heart.
07:30As we release the weight off of Stephen, there was a risk that that potassium
07:34could go flooding into his circulation and cause his heart to stop.
07:38Calcium is a medicine that we can administer to offset the effects of potassium.
07:43We've changed that plan now, so we're not going to push it towards you now.
07:46We're going to try and lift it off you.
07:47Yeah.
07:48All right.
07:49I'm suddenly feeling very hot, is that the morphine?
07:52That's the medicine, we've just given you the calcium.
07:55Fire and Rescue have repositioned the airbags and are making their second attempt at lifting Steve free.
08:01Ah!
08:02Ah!
08:03Yeah.
08:04It's not shocking.
08:05Really pushing his chest there.
08:06Are you ready, Steve?
08:08It's anywhere, guys.
08:09Fill those voids.
08:11It's coming up as well.
08:13Ah!
08:14You all right?
08:15Steve, is that new pain?
08:16I don't know.
08:17He's pressing into red chest.
08:18He's pressing into red chest.
08:19He's pressing into red chest.
08:20OK, I'll do that.
08:21Ah!
08:22Ah!
08:23Ah!
08:24The airbags are moving the body of the tractor, but the wheel is still stuck on Steve's hand.
08:29Ah!
08:30Press!
08:31Press!
08:32Pressing into red.
08:33Can we get an airbag under that wheel?
08:35Ah!
08:36It's moving down and tilting a little bit that way.
08:38I'm getting a bit more feet.
08:39Yeah.
08:40Because it's not going anywhere quicker than that.
08:42We kind of need to speed it up, yeah.
08:44Close to build up.
08:46We're nearly there.
08:47I think we just need another inch.
08:49Yeah.
08:50And we'll get enough space to move, Steve.
08:52Go!
08:53That's good.
08:54Keep going.
08:55Keep chocking again.
08:56That's good.
08:57Keep going.
08:58Keep chocking, guys.
08:59That's it.
09:00OK, we might have enough.
09:01Try moving that arm now.
09:03Yeah.
09:04Nearly.
09:05Nearly.
09:06Keep going, guys.
09:07Keep lifting.
09:08Steve, put your right arm down, mate.
09:09Chock where we are and snatch grab out that side.
09:13Let me know when I can get in.
09:14Right, Steve.
09:15Steve.
09:16Look at me.
09:17Look at me.
09:18Yeah.
09:19Right, nice and slowly.
09:20Don't rush this.
09:21Nice and slowly.
09:22Let's go.
09:23Give me your arm.
09:24Put your legs.
09:25Push.
09:26Steve.
09:27Look at me.
09:28That's it, Steve.
09:29Good lad.
09:30That's it.
09:31Good lad.
09:32That's it.
09:33Good lad.
09:34That's it.
09:35That's it.
09:36That's it.
09:37That's it.
09:38That's it.
09:39Just watch those wires.
09:40Are they free?
09:41It's me coming out first.
09:42Right, you out first, mate.
09:43Nice and steady.
09:44With only a few inches of space, Wayne and the team are pulling Steve out from under the tractor's
09:50mudguard.
09:51Right.
09:52On the head then.
09:53Ready to move on slide?
09:54Ready, sir.
09:55Slide.
09:56Well done, Steve.
09:57Right.
09:58Monitoring.
09:59Monitoring.
10:00Less than two hours after making the 999 call, Steve is finally free from beneath the
10:04one and a half tonne tractor.
10:05Thank you very much, everybody.
10:07Anything around here?
10:08Yeah?
10:09Yeah.
10:10No.
10:11Ah!
10:12Yeah, I know, mate.
10:13Ah!
10:14Nice and steady, mate, for monitoring.
10:16Steve, take a deep breath in, mate, if you can.
10:21We've got that oxygen back on, guys.
10:23Obvious left side and rib fractures, mate.
10:25Yeah.
10:26Ah, glad to be away from that.
10:27You got your step hands, mate.
10:28You're out now, Steve.
10:31I am.
10:32Thank you so much.
10:33Any pain up here, mate?
10:35Well, ah, ah, ah, ah, ah, ah.
10:39Yeah, possible humerus there.
10:41How's that pain now we've got you released, mate?
10:43It's a lot better.
10:44It's a lot better.
10:45It's better than having a tractor on you.
10:46So at the minute, we've got left shoulder fracture, left mid-shaft humeral fracture.
10:51Yeah.
10:52Possible radial fracture.
10:53Yeah.
10:54And multiple anterior rib fractures on the left side.
10:56Yeah, we'll go with that.
10:57What we'll do is get you wrapped up nice and warm, Steve, and then we'll get you up to
11:01the ground.
11:02Oh, James Cook, OK.
11:03Three, two, one.
11:04There we go.
11:05All right.
11:06You think I've broken some ribs?
11:07If you've not, I'll be surprised.
11:09But you've probably made a tough stuff if you made it this far, my friend.
11:13The local mountain rescue team have arrived to help carry Steve to the helicopter,
11:18whilst Dr Steve calls ahead to the hospital.
11:21Hello, I've got a trauma pre-alert for you.
11:24We're bringing you a 59-year-old male who's been trapped underneath a tractor for two hours.
11:30He looks reasonably well oxygenated.
11:32He's moving both sides of his chest, but we're suspecting some chest injuries.
11:38He's remained relatively stable throughout the period he's been with us,
11:41and we'll probably be about 25 minutes from now to yourselves.
11:46Keep coming via air.
11:47Coming via air, yep.
11:53He's been, in some respects, very lucky that it didn't impact right in the middle of his chest,
11:56just to the side of him.
11:57He's been able to get his phone off for an hour, which, you know,
11:59you can't imagine how uncomfortable he must have been for that time.
12:02Managed to give him some pain relief, some drugs to stabilise him.
12:05Fire service worked incredibly hard to get him out.
12:07Partners in mountain rescue have brought him up to the aircraft.
12:10So, yeah, we're in a good position to be able to take him to hospital now.
12:16Steve will be flown across the Dales to the major trauma centre
12:19at the James Cook Hospital in Middlesbrough.
12:24Where Stephen was trapped, no-one was going to walk past and find him.
12:28He wasn't on a public footpath, and he was up on top of the moors.
12:33Had he not been able to get his mobile phone out of his pocket
12:36and call for help, he would have been there for hours and hours
12:39and possibly even succumb to his injuries.
12:44Steve?
12:46Yeah.
12:47You all right there, dude?
12:48Hello there.
12:49Right, we'll get you on to the A&E trolley
12:51and take you down to the emergency department and get you sorted out.
12:55I feel like royalty.
12:58Ready, steady, lift.
13:01Two and a half hours after making the 999 call that may have saved his life,
13:05Steve is stable and safely delivered to a waiting critical care team.
13:15Every year the air ambulance paramedics have to undergo a physical competency assessment.
13:31And today Danny is giving Sam a refresher on the on-site gym equipment.
13:36Welcome to the health and wellbeing suite.
13:38I don't go to the gym that much, as you can probably tell.
13:41This is me going to the gym.
13:46But the session will have to be cut short as a job has come in.
13:49Did I actually fall on my horse?
13:50Yeah.
13:51Broken ankle.
13:52Clear left, please.
13:53Clear left.
13:54Clear left.
13:55Clear right.
13:56Lifting.
13:5799.
13:58Lifting.
13:59They're being scrambled to a farm 13 miles away near North Allerton,
14:05where their patient has a suspected broken ankle.
14:08Hey, this is from 99.
14:09We are airborne with a five-minute ATA.
14:12I believe the patient is down a track from the location.
14:18Roger.
14:20We're going to an 18-year-old who's fallen off a horse,
14:23reported to be conscious but has a broken ankle with the bone sticking out.
14:27The crew just got there and she's down a track, I believe,
14:29so they are requesting our help.
14:31Sometimes, with fractures, you can get impingement of the nerves
14:35and the blood vessels that supply the sort of the extremity.
14:38If you cut off the blood flow significantly or completely
14:42and if it's left long enough like that,
14:44ultimately, you can lose that limb if it's bad enough.
14:47That's the farm there.
14:48Yeah.
14:49But we'll see where they are.
14:50We'll have loads of horses around us.
14:52Pilot Owen is mindful that there could be loose horses near
14:55where he wants to land.
14:56There's the DCA, mate.
14:57It's in that field at the far back of that stable that's going east.
15:00OK, go on.
15:01That's going east to west, mate.
15:02Right, the wind's pressed, but it's not too pressed,
15:04so this is a closer there.
15:05Go.
15:06And we're down.
15:08Can you clear about 12 o'clock, please?
15:0910 o'clock.
15:1010 o'clock.
15:1110 o'clock.
15:1210 o'clock.
15:1310 o'clock.
15:1410 o'clock.
15:15Local paramedics have arrived ahead of them
15:16and are waiting to hand over.
15:17How are we doing?
15:18All right.
15:19Yeah.
15:20This is a 19-year-old maddie.
15:21Hi, buddy.
15:2245 minutes ago and the horse has kind of been
15:24fallen off until about five.
15:26It's got an obvious open fracture here.
15:28Mm-hmm.
15:29We're just on Entenox at the moment.
15:30We're just trying to get a little line and just see what we can do.
15:32Yeah.
15:33Student Maddie landed badly on her ankle after the horse she was riding reared up,
15:37throwing her off.
15:38Is it Maddie?
15:39Hello.
15:40Hey, I'm Sam.
15:41There's Dan over there as well.
15:42Can I just pop a little needle in this hand as well?
15:44Just so we've got two in there.
15:45Is that all right?
15:47Maddie was still laying on the floor.
15:48She was taking Entenox given by the crew just to try and help that pain.
15:51Although we couldn't quite see because the boot was still on.
15:54It was just too painful to take off at that point.
15:56We knew that Maddie was injured.
15:58Maddie works at the stables and rides these horses every day.
16:01This is Mum on the phone.
16:02Yeah.
16:03Hi, Mum on the phone.
16:04Mum's the doctor, which is why she's trying to go.
16:07All right, OK.
16:08Do you want me to speak to your Mum, Maddie?
16:10No, no.
16:11We're just going to get her some pain relief.
16:12So her ankle is an open fracture essentially.
16:15So we're just going to give her some ketamine to be able to relocate it and pop it in a splint
16:19and go to James Cook.
16:20So with an open fracture it creates more risk.
16:23You increase the infection risk because you've now got open tissue exposed to the environment.
16:28Not only that though, you've got nerves which are impinged and blood vessels which, you know,
16:31normally if it's a closed fracture you can bleed into a solid compartment and the blood can't escape
16:37particularly.
16:38With it being an open fracture then the blood can just continue to bleed essentially.
16:42So stopping the bleeding and making sure you relocate the fracture is really important.
16:48Maddie, my name is Danny, one of the parameters for the air ambulance.
16:51Do you remember exactly what happened then?
16:53You talked all the way through it, yeah?
16:54Yeah, the horse.
16:55He was jumping about and I stacked quite a bit of it to be fair and then he just reared
16:59up and I tried to pump that.
17:01He just went round and then just came back on top of me.
17:04Did you, consciousness do you think at all that you remember?
17:06No, no, no.
17:07Okay.
17:08Have you got any pains anywhere else other than your ankle at the moment?
17:10My knee but that's it.
17:11Your knee?
17:12On the same leg?
17:13Yeah.
17:14Okay.
17:15We need to have a really good look at that ankle and see what we're dealing with but
17:16we'll make sure that you've got adequate pain relief before we do all that.
17:19Do you want to keep on going with that gas and air for the time being?
17:23Big breaths in and out for me.
17:25And out.
17:26That's it, breathe in and out.
17:28You will feel a little bit light headed.
17:31Gas and air works fast but it doesn't last long.
17:34It'll keep Maddy's pain under control until the team can give her something stronger.
17:40So Maddy, the plan is we're going to give you some strong pain relief.
17:44You might feel a little bit funny with it.
17:46What tends to happen when we give this sort of pain relief is it you don't tend to remember
17:49anything that's happened but it'll keep you nice and relaxed.
17:52If you see unicorns then that's good.
17:54Right, just pop that arm nice and straight for you Maddy.
17:57Sam's giving Maddy ketten, the strongest drug they carry.
18:01How are we feeling Maddy?
18:02I feel like this really hurts.
18:04Yeah.
18:05You won't remember much about it shortly Maddy and you'll be completely pain free.
18:09If you imagine a bone normally it would be in natural alignment and everything's connected.
18:14If you've got a fracture then the bone isn't connected and it can sometimes be out of alignment
18:19at a funny angle which was the case with Maddy.
18:21So being able to relocate it or reduce it as we call it is essentially pulling the limb straight
18:26or moving it back into neutral alignment so you're getting that bone as straight as possible
18:30to how it normally would be without a fracture there.
18:33With the ketamine taking effect, Danny can now attempt to straighten Maddy's leg.
18:38She might scream and things like that but she won't remember anything about it.
18:41It's just an aspect of the drug.
18:45All right Maddy?
18:47Yeah?
18:49It sucks like stuck in the back.
18:52Her broken bone is pierced through the skin of her ankle.
18:55Hold on Maddy.
18:57And there's the bone.
18:58I'm willing.
19:03I'm just going to pull it straight.
19:04All right Maddy.
19:07I'm giving it some traction but it doesn't seem to be putting it back in.
19:10I think it's caught on the bottom of the skin.
19:11So what we need to do is we need to bend a leg at the knee and then you need to put it back in there
19:17because that will ease it with the muscle a little bit to be able to get it back into place.
19:20Bend it at the knee.
19:21Back into place.
19:22Sometimes reducing a fracture can be nice and easy and if the patient's nice and relaxed and there isn't too much muscle tension it can go back to where it needs to be quite quickly.
19:30With this case obviously we've given Maddy some analgesia in the form of ketamine.
19:35That can make everything a little bit tense and often when the legs straight the muscles are quite tense and they're stretched.
19:40So when you're trying to reduce an injury or relocate that fracture there's not much stretch.
19:46One thing you can do is you can just bend the knee and that just helps relieve the muscles a little bit.
19:50Loosen them, shorten them, giving you a little bit more room for movement to put the bone back where it needs to be.
19:55That's right Maddy.
19:56See if we can get it back in.
19:57You're going to lift this leg up a little bit, okay.
19:58Just bend your knee Maddy.
19:59The aim now is to manipulate the two pieces of broken bone back into place.
20:04into place. The bones in Maddy's ankle are now back in alignment but it's crucial they stay in
20:24place until she reaches hospital. Okay if you keep pulling traction on that then we can get this tight
20:29so it doesn't pop back. All done Maddy it's back into where it needs to be okay. Maddy slow your breathing down.
20:50Danny is removing air from inside the vacuum splint to create a mould around her leg.
20:55All right Maddy how's that pain doing now?
21:08It's all normal.
21:13So you need to let us know if you start to feel any different for all of the stuff that we've done
21:17that's that's the bad stuff out of the way. All right can you remember anything about us
21:20putting your leg into a splint? Do we have any help here? No. No? There we go.
21:26So if you want to press your stuff back on and I'll just put it in.
21:29You were here before you put it into a splint? Yeah. Really? And you can't remember? No.
21:35Right pop this back in your nose there a second. Have you been in a helicopter before?
21:40Yes. Have you actually? Oh when? My rich friend took me on holiday with her. Your rich friend took you on holiday with her? Yeah.
21:48Italy to um... I can't remember where we went. Why do you have to go spoil our fun like that?
21:53Because it's not the same in Yorkshire is it? Italy's more exciting. I've never been in a
21:58air ambulance though. Okay well there we go. There we go. Best for everything. Pop you in this. I promise it's not a body bag.
22:08Right then we'll go and lift then. Lift. Oh. Going by helicopter to the nearest major trauma centre in
22:14Middlesborough will take less than 10 minutes. All right Maddy pop these on for you. Don't pop your head down. You all right? There we go.
22:22There we go. Okay lifting slowly because of the crosswind. 9-9 lifting. Rooting to James Cook.
22:339-9 Roger thanks. Did Maddy say 64 kilos? Yeah I think about 64. Oh okay. She might have had a big breakfast then because of struggling to the climb here.
22:42But you're not. Cool. We're managing though. We're managing. Yep. I bet your Italian pilot wasn't that cheeky was he?
22:50All right official James Cook. I think I've got visual security mate. 9-9 finals for James Cook.
22:58Right now Maddy. Yeah? The aircraft vibrates a little bit as we come to the hover. It's just what helicopters do. It's not my fault I promise.
23:06Okay. Yeah. It's not me being a rubbish pilot. Do we clap when you land? Well the guy in the back normally do.
23:11Don't give too much of an ego. And then we all get the ick.
23:13You clap we normally just take a sigh of relief.
23:16That's better there. Behind the trees a bit smoother.
23:21Right. That wasn't bad. That was a good landing. I'll take that.
23:27Right. Lovely jumping.
23:29Right Maddy. We're going to move. Okay. On slide. Ready. Steady. Slide.
23:37Oops. Sorry.
23:38Whilst Maddy will be taken for surgery, paramedic Sam will be enjoying a little light refreshment.
23:43Could I have a oat milk latte please? With vanilla syrup?
23:46I'm asking if I can open it. Thanks.
23:48At the headquarters in West Yorkshire, paramedics Mattie and Tom are preparing for the shift ahead.
24:04Is the blood off please?
24:07It's a hot summer's day. And the pace is picking up on the air desk.
24:12Hello Yorkshire.
24:14A call's come in about a motorbike accident on a remote track in the Yorkshire Walt.
24:19If it is as inaccessible as it sounds anyway, I'm hoping that we might be able to land rather closely and then get him in anyway.
24:27Cool. I will allocate them now. No worries. I'll see you later.
24:40All clear there. Clear right. Lifting.
24:42Pilot Owen is flying them 34 miles towards Driftfield in the east of the county.
24:49It's over 200 feet. All clear. I'll turn right as I go.
24:54If we do think about ketamine, say he's a 100 kilo patient, I'll just throw up 10 mils of ket.
25:03I don't even know what injuries he's got. Just that he's in pain and he's big.
25:10On the way to this job we had limited clinical information about what the presenting complaint was with this patient.
25:16We knew that they were a motorcyclist that they'd been riding on green lanes and they'd had an accident.
25:20That's as much as we knew.
25:22Location wise, it was quite remote as well.
25:24So it's a really good asset to have a helicopter to be able to help you manage these patients.
25:28It gets them quickly.
25:29It just feels like that main road isn't it? From the left and the road right? Somewhere?
25:35Yeah, just beyond there, more sort of the left.
25:37Is that what I mean?
25:38There it is. No, I don't head.
25:40Okay, well it looks it's a bit further down.
25:42So where did you see people down there?
25:44Yeah, so at the end of the tree line.
25:46Feels like this feels flattered and it won't be.
25:49Yeah, is it?
25:50There's fire as well.
25:51Fire service on scene.
25:52Okay.
25:53Alright, I'm going to go tail left in a second then go with the valley.
25:57Yeah, you're all clear left.
25:59It does drop away quite well.
26:01Doesn't it?
26:02We're going to quite a few motorcycle accidents.
26:05They tend to be on the road but people are off-roading as well.
26:08So the injuries you get can be from minor injuries, minor notural bruises to something that's really life-threatening as well.
26:14Yeah, I've got a lot of grass all the way for the intake.
26:16So I'm going to land on.
26:27Hiya mate.
26:28Yeah, initially just a difficult extrication really.
26:31So we asked for fire to come and assist but he's got a bone of crepitus on his right ribs.
26:35We think he's busted a few ribs on his right side.
26:37Okay.
26:38We think he's busted his clavicle.
26:39He's complaining of clavicle pain.
26:40We give him 20 morphine, a gram of IV paracetamol.
26:43Every time we try and move him or do anything he's absolutely screaming in agony.
26:46Okay.
26:47No problem.
26:48What's his name?
26:49Big Mark.
26:50How are you doing?
26:51I'll just come in there just so I can get him.
26:5255-year-old Mark Hunter was out with friends greenlading or riding unsurfaced country roads when he lost control of his motorbike.
27:01Hiya Mark.
27:02Hello mate.
27:03My name's Tom.
27:04I've got Matt here as well.
27:05Sounds like you're still in quite a lot of pain when they try and move you.
27:06Yeah.
27:07Are you comfy as best you can in that position as you are there?
27:10Yeah.
27:11Okay.
27:12So I think that's probably quite a go.
27:13We can just keep him there.
27:14So if you were to tell me where this pain is and I haven't even told that colleague just remind me again where it is.
27:19Ribs and shoulder.
27:22Ribs and shoulder.
27:23All on your right hand side.
27:24Yeah.
27:25And what made you lose control of the bike?
27:29Just lost the front end.
27:31Okay.
27:32Just lost the front end.
27:33He's come round this bend and he's hit a rut.
27:37Just lost the front end and it's obviously spat him off the bike.
27:40Me and Gaz have come, found him laid on the floor, tried to make him comfortable.
27:43Now obviously we're here just trying to sort him out.
27:46In terms of conveying, I think keeping him left lateral is the right way to go.
27:51Yeah.
27:52Because you've got him on it and there's no point moving him.
27:53Yeah.
27:54He's going pretty saturating.
27:55Have a listen to his chest.
27:56Get him on nasal specs.
27:57Yeah.
27:58I'll get that.
27:59Is that alright?
28:00When we first arrived on scene, he obviously sustained quite a significant chest injury.
28:04He was quite agitated, a bit distressed, probably in quite a lot of pain as well.
28:08He was having some difficulty breathing.
28:10He's probably got a number of injuries, potentially broken ribs and there may have been some internal bleeding as well.
28:17Mark, I know you've got this pain in your shoulder and your chest.
28:20I just want to make sure that there's no other injuries that have sort of become apparent since you've had that pain relief.
28:24Alright?
28:25So we're going to try and move some of these clothes.
28:29Yeah.
28:30Alright.
28:31Our sacks have come from 99 down to 93 with a good waveform.
28:36Mark, what we're going to do, we're going to get a few pairs of hands and we're going to try and get you onto our stretcher into the back of the aircraft.
28:43Okay?
28:44It might be very uncomfortable when we try to do that.
28:47Okay?
28:48And we're going to need a few hands just to try and position you.
28:51If at any point we think it's not safe, then we'll stop and we'll get you into the ambulance.
28:56We're going to give you some stronger pain relief and that might make you feel a little bit weird, but that's perfectly normal.
29:02But I'll explain everything to you before we give you that strong medicine.
29:05Does that sound okay?
29:06Yeah.
29:07Yeah?
29:08Ketamine is a fast acting pain relief.
29:11It's only used outside of hospitals in the most serious cases.
29:14We're quite fortunate that we get to carry ketamine, which is this really strong pain relief.
29:19The land amateurs don't carry that, so there is potential that some of our colleagues won't have seen us administer ketamine before.
29:25He may start acting a bit strange and a bit weird and might start shouting out.
29:29Yeah.
29:30So things we can do to combat that is just have a nice and quiet environment.
29:33And what we'll do is we'll just have a chat before we give it to him because I'll explain to him that he's probably going to start feeling really weird.
29:38But he won't remember anything that we're doing to him.
29:40The danger of giving a little bit of ketamine is that we might start vomiting and might start having excessive saliva.
29:45So we're just going to go nice and seduce.
29:47Guys, when we start giving him this medicine, I know it's quite tempting to look after your friends and want to help them.
29:53But all I'm going to ask is that everybody's really quiet and we're just going to let Tom speak to him and nobody else.
29:58He might start shouting the stuff, but that's normal.
30:01He won't remember any of it.
30:02Okay.
30:03So I know you're probably concerned, but I just need everybody to be really quiet.
30:07Okay.
30:08Okay.
30:09Open your eyes.
30:10Hello, mate.
30:11So we're going to give you a medication and then we're going to give you this strong pain relief.
30:14Okay.
30:15So really important that you just relax.
30:17Let's do what we need to.
30:18Try and go with the flow.
30:20Think happy thoughts when we give you.
30:22All right.
30:23Might make you feel a little bit weird, a bit spaced out, but that's okay because that's actually what you want to be.
30:27Okay.
30:28That's how it's going to work.
30:29All right.
30:30Nice happy thoughts.
30:31You're doing really well.
30:32Well done, mate.
30:33You all right there?
30:34Yeah?
30:35Is that helping?
30:36Yeah?
30:37Good man.
30:38Take a breath.
30:39I feel all right?
30:40A bit better?
30:41With no adverse reaction to the Kettleman, the crew can now start to move Mark to the helicopter.
30:56Just as many hands as we can then, please, guys.
30:58Grab the A2.
30:59If somebody could do the monitor as well, that'd be really helpful.
31:00Carry that.
31:01Carry that.
31:02Carry that.
31:03Is everybody ready?
31:04Okay.
31:05You'll be on lift.
31:06Ready, set, lift.
31:07All right, Mark.
31:08Here we go.
31:09Let's get you on.
31:10That's it.
31:11You're doing really well, Mark.
31:12We're halfway there.
31:13Watch your head.
31:14All right, Mark.
31:15Here we go.
31:16Let's get you on.
31:17That's it.
31:18You're doing really well, Mark.
31:19We're halfway there.
31:20Watch your head.
31:21You're doing really well.
31:22We're halfway there.
31:23Watch your head.
31:24Watch your head, please.
31:25You all right?
31:26Mark, you all right?
31:27Open your eyes for me, fella.
31:28Good, man.
31:29So we're going to fly you to Hull, just because of the injury you've got to your chest.
31:42We're just going to get you hooked up to our machines, and then I'll give you something
31:46for that pain.
31:47Good, man.
31:48You're doing really well.
31:49Okay, good.
31:50Okay, clear this.
31:51We're all right.
31:52We're all right.
31:53We're all right.
31:54We're all right.
31:55We're all right.
31:56We're all right.
31:57We're all right.
31:58Good.
31:59Coming into the wind now, that's why I like it.
32:03I know I can't hear him, but he looks relatively comfortable compared to how he was on the scene.
32:11They asked speed, but I wasn't sure on the...
32:13I asked his mates and they stood about 20 miles an hour.
32:17The flight time to Hull Royal Infirmary is 15 minutes.
32:20Without the air ambulance, Mark's journey would be over an hour.
32:24Right.
32:25That's us now on finals.
32:26Cool.
32:27I'm going to go to LBP.
32:28Look at this.
32:29Now that's finals.
32:30This is a class two kind of clear area.
32:31Okay.
32:32Yeah.
32:33Yeah.
32:34Time again for the guy in the back.
32:35Thanks, mate.
32:36Tom.
32:37Yeah, Tom.
32:38Class back, Tom.
32:39Thank you, Owen.
32:40Yeah.
32:41Mark.
32:42Hello, mate.
32:43We're in the hospital now.
32:44So we're going to keep you on this stretcher and then we'll get you out the back of the
32:47helicopter.
32:48Can you bring this arm to hold on to your other one?
32:53Okay.
32:54Ready, set it, slide.
32:55Okay.
32:56Okay.
32:57Okay.
32:58Let's go.
32:59Let's go.
33:00Let's go.
33:01Let's go.
33:02Let's go.
33:03Let's go.
33:04Let's go.
33:05Let's go.
33:06Let's go.
33:07Okay.
33:08Ready, set it, slide.
33:14Just a couple of bumps as we wheel you into the hospital, Mark.
33:17Mark will be taken to a waiting trauma team who will carry out scans to get a clearer picture
33:22of his injuries.
33:24It's been a busy shift.
33:38Paramedic Chris and the team are giving the very muddy helicopter a deep clean.
33:45Leanne is on the air desk and has spotted a job.
33:49A 999 call has come in for a two-year-old who is struggling to breathe.
33:54Hello, job.
33:55Job.
33:56Okay.
33:57Not great.
33:58Yes.
33:59She's scrambling Chris and paramedic James from the Topcliffe base, which is nearer to
34:04the patient.
34:05It's in this.
34:06It's asthmatic, unconscious, no degree then.
34:09The U.K. has one of the highest emergency admission and death rates for childhood asthma
34:14in Europe.
34:15Well, if the safety part should have been every other time, it seems to be straight ahead.
34:18HeliMed 99 will make the journey to rural Thirsk in just three minutes.
34:22Tells come around your way.
34:24Oh, that's fine.
34:25Everything else is looking good inside.
34:28It's a two-year-old.
34:29I'm not really too sure what's happening.
34:31The information we got from the air desk was quite limited.
34:34The only information we had was attending a two-year-old who had a history of asthma,
34:39who was having quite significant breathing difficulties and reported to have been unconscious
34:43at some point.
34:46Asthma is the most common long-term illness in children in the U.K., affecting about 1 in
34:5211 and claiming a life every four weeks.
34:56It's one of those houses on the road that matches the grid location.
35:00Hopefully there's a gate there as well.
35:03The little girl is on her family farm and the surrounding fields are proving difficult
35:07for Pilot Harry to land in.
35:10I reckon you can go through a gap in the hedge just there opposite that grey gate.
35:13Yep.
35:14Happy with that?
35:15There's not a big ditch, but we'll soon find out.
35:17Yep.
35:18Two-year-old Enola is being looked after by her mum and auntie.
35:28Go straight onto the ambulance.
35:29Yeah.
35:30Have a look at me.
35:32A land ambulance has also arrived, providing a space to examine her properly.
35:38I'm a auntie, but I'm a nurse.
35:40I'm the mum.
35:41Yeah, she's the mum.
35:42She began struggling to breathe as she sat down to eat with her family.
35:47But when I went in, I listened to her chest.
35:49She's got bilateral wheezing.
35:50Okay.
35:51Right.
35:52Her heart rate was about 200.
35:53So you'll sit on the end there because she'll be familiar with you so she can see you.
35:56Yeah, yeah.
35:57Hi, baby.
35:58What's her name?
35:59Enola.
36:00Enola.
36:01And what's her history?
36:02About four weeks ago, she had pneumonia.
36:05Okay.
36:06They started her on a salveic mal inhaler.
36:08Yep.
36:09She was out playing all day with us.
36:10Yep.
36:11And about 20 minutes ago, she just went downhill, didn't she?
36:14The young girl's aunt, who said she was a nurse, had explained to us that she had quite
36:19a noticeable wheezing coming from both sides of her chest.
36:22That's an indication that there is an acute problem relating to the asthma and the wheezing's
36:28caused by the small air tubes in the lungs going into spasm and making it difficult to
36:33breathe.
36:34And she also said that she had a heart rate of 200, which was quite significant.
36:38A child of that age, you would expect the heart rate to range between around 90 and 110.
36:43Any signosis or?
36:44Yeah, I could see her jugular.
36:46Okay.
36:47I could see her jugular going.
36:48Okay.
36:49Can I have another listen at your chest, do you think?
36:50Is that all right?
36:51Yeah.
36:52You're all very good, aren't you?
36:53This might be a little bit cold, so I apologise.
36:57I did do her sats earlier.
36:59There were 87 at one point.
37:01Okay.
37:02But after the inhaler, we got them up to 95.
37:05So, any recession or anything like that when she was breathing?
37:08She had a lot of recession.
37:09Okay.
37:10A lot of recession and she was losing confidence.
37:12I think that's why you got here with the air ambulance.
37:15Chest recession potentially indicates, particularly children, are in some sort of respiratory distress.
37:21When the child's breathing in, it looks almost as though the chest is moving in an opposite direction to how it should be.
37:26There's an increased effort to try and get as much air in as possible.
37:30What a little girl, aren't you?
37:32Oh, you know what's going on, don't you?
37:34Good girl.
37:35And you say this colour's not normal for her.
37:37No, she looks quite...
37:38Yeah.
37:39Yeah.
37:40Mottled skin, when accompanied with breathing difficulties, can be the sign of an asthma attack or chest infection.
37:46You want to sit up a little bit more because that doesn't look comfortable.
37:48You punch that.
37:49Come on, mate.
37:50Good girl.
37:51Right.
37:52We'll see what your oxygen levels are and just see if we need to do anything else with regard to giving her a bit more salbutamol.
37:56Yeah.
37:57Salbutamol is a medication that relaxes the muscles of the airways, making it easier to breathe.
38:03She's actually getting more mottled.
38:05Yeah.
38:06It is still bobbing along that heart rate.
38:08It's probably still accurate.
38:09Yeah.
38:10So, strip up to hospital.
38:12Yeah.
38:13The cause of Enola's breathing difficulties is still unclear, so she'll need to go to hospital for further assessment.
38:20Enola's dad, Brian, has rushed back to the farm from work.
38:24She's got quite a high temperature, so I think probably some infection of some sort is going on somewhere.
38:30What's the time?
38:31So, she's going to be going in the ambulance up to James Cook.
38:34You're such a clever darling there.
38:36Have you got everything you need?
38:38Yeah, Brian's packed your bag.
38:40Yeah?
38:41Okay.
38:42But they don't quite have everything they need for the trip to hospital.
38:45Dolly.
38:46She needs Dolly.
38:47Oh, look who's this.
38:49Dolly.
38:50Are you going to have a little trip up to hospital then with Mummy?
38:53Go see the doctors.
38:54Again.
38:55Again.
38:56Are they on first name terms these last few weeks?
38:58I know.
38:59Super.
39:00Edith 99.
39:03Yeah, that's just clear, patient stable, going with the DCA crew there to James Cook.
39:09Enola is being taken to the paediatric unit at James Cook Hospital in Middlesbrough.
39:14The cause of her condition is still unknown.
39:1655-year-old Mark Hunter spent 10 days in hospital after coming off his motorbike whilst greenlating.
39:27All right, Mark.
39:28Here we go.
39:29Let's get you on.
39:30He suffered seven broken ribs, a broken collar bone and punctured his lung.
39:35After several months recovery he got back on his bike and recently enjoyed a biking holiday through France.
39:41The cause of two-year-old Enola's breathing difficulties is still being investigated.
39:49But doctors believe it could be related to her previous chest infection.
39:53Can I have another listen at your chest, do you think? Is that all right?
39:56She stayed in hospital for one night, happily accompanied by her beloved Dolly.
40:02Is it Maddy?
40:05Hello.
40:06Hey, I'm Sam.
40:0719-year-old Maddy needed surgery on her broken ankle after coming off Rebel, the horse she was riding.
40:13The morning of the accident, it was just a typical kind of day.
40:17I was mucking out the horses, I'd ridden another two.
40:20Then I'd got onto Rebel, the horse that I had the accident on.
40:23So he was my third ride of the day and my last.
40:27How's that pain doing now?
40:28When it first happened, I think it was more shock.
40:31I couldn't process anything.
40:33I just remember looking at my ankle and being like, God, this doesn't look right.
40:38Maddy's been riding since she was two years old, but it will be some time before she can get back on the horse.
40:44I'm a very active person.
40:45I'm constantly out riding and seeing my sisters kind of hack out on the horses, especially my horse.
40:52It's been quite difficult, but I think once the pain got better,
40:55I felt a lot better about getting more active and getting out in the sun
40:59and trying to make the most of the situation that I'm in at the moment.
41:03Because as soon as the cage is off, I'm getting on a horse.
41:06I mean, I don't want to put myself at risk, but I'm definitely going to do it the first opportunity I get
41:11because I miss it so much.
41:13Hello. We're coming to help. You okay, buddy?
41:23Steve Rathbone was in hospital for 12 days after being trapped by his overturned tractor for two and a half hours.
41:30Suddenly I find I'm moving backwards. I'm moving faster and faster down the hill and I come bouncing to a stop.
41:37And suddenly I realise here I am with this tractor on me.
41:41I had a phone, but I couldn't get to it. And then, of course, my heart slightly sank at that point,
41:45thinking, well, I'm really quite reliant on somebody seeing me or missing me.
41:51And I knew that it was very unlikely they were going to miss me in the time that was probably going to be available to me
41:56as this weight was squashing down on my chest and my arm.
42:00So it was quite an alarming scenario to be in, obviously.
42:03Can you feel me touching your hand?
42:05The amazing thing was, after about an hour of just sitting there trying to process what I was going to do,
42:09how I was going to get out of it, I suddenly realised I had movement within the lower part of my body.
42:15But it gave me, I felt, a few centimetres of wiggle room to be able to get my hand right round and under,
42:22to pull the phone out very slowly, which I did, and I finally was able to get to 999.
42:30And that moment, of course, there's a great relief that now, actually, I don't have to contemplate dying on the hill,
42:34which is what I've been doing up until that point.
42:39Steve broke eight ribs, his shoulder and sternum, and suffered a punctured lung.
42:44There were a lot of people that came out that day to save my life.
42:52I was just so impressed that everybody had been able to get there relatively quickly to this obscure part of the Yorkshire Dales,
42:57and then to work together with military precision to get me out of that pickle that I got into with my old classic tractor.
43:04I shall always be so grateful to everybody.
43:07Since this happened, I've not been anywhere near tractors.
43:10The tractor involved, the dear old Massey Ferguson 35, is in a barn currently being repaired.
43:17As much as I'm fond of it, I think it's going to be up for sale, because it's actually in remarkable condition.
43:22It took a few dints, but actually I think it came out of it better than I did.
43:26Okay, I'll see you later on Facebook.
43:34See you later!
43:35Now, as long as we can see you nail the scale out,
43:39we'll see you too.
43:42Bye-bye.
43:43If you need me, please feel mute!
43:45Transcription by CastingWords
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