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Ambulance- Code Red
Ambulance- Code Red (2020) S04E03
Ambulance- Code Red (2020) Season 4 Episode 3
Ambulance- Code Red (2020) S04E03
Ambulance- Code Red (2020) Season 4 Episode 3
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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 Response Vehicles are at the front line delivering life-saving medical treatment.
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 treatment.
00:53So we'll give you some ketamine, that will mean that you don't know what we're doing whilst we straighten your ankle out.
00:57Whenever, and wherever, it's needed, filmed over three months.
01:07Put this up your arm, let's give you some of this morphine.
01:10Just be aware you might stop spontaneously ventilating.
01:13I have the tube.
01:15We captured every vital second.
01:17That's okay, you're safe.
01:19As these highly trained critical care teams.
01:22Can you take a deep breath in for me?
01:24Fight to save lives.
01:26Your birthday present is surviving a cardiac arrest.
01:29When every second counts.
01:31Let's go, go, go.
01:33Tonight.
01:35Pulse is starting to drop off a little bit.
01:37A 48-year-old man's life is in the balance after a cardiac arrest.
01:41I can't feel a pulse.
01:42Most of the legs are involved, aren't they?
01:44An exploding gas canister leaves a father with extensive burns.
01:48If you start to notice it's getting a bit harder to kind of talk or breathe, then this whole situation is going to change quite rapidly.
01:53I'm going to give you some really strong pain relief, okay?
01:56Multiple injuries for a young lad after falling off his bike.
02:00You're okay?
02:01Why's my arm hurt so much?
02:03You've broken your wrist.
02:04And an eight-foot fall onto tarmac could result in a life-changing injury for a 70-year-old pensioner.
02:10Looking from here, I suspect that's broken.
02:29Emergency, is the patient breathing?
02:32It doesn't feel like it.
02:34Sean?
02:35Sean?
02:36Sir, if he's not breathing, we need to get him on his back to start basic life support.
02:42He looks like he's dead.
02:46Sean?
02:47His lips are blue, his eyes are gone, he's not breathing.
02:50I can't feel the heartbeat, I can't feel the pulse.
02:52Yes, sir, and that's why we need to start basic life support, then.
02:56Make sure he's on his back.
02:58Yep.
02:59One hand in the centre of his chest.
03:00Put your other hand on top and lock your fingers together.
03:03Keeping your arms straight, you need to push down hard and fast.
03:07And don't be afraid to push too hard.
03:09What am I supposed to do?
03:10How many times do I press?
03:12You push about two times a second.
03:14You need to keep pushing until the ambulance gets there.
03:17Push, push, push.
03:19Sean?
03:21Come on, Sean.
03:24Come on, mate.
03:26Come on.
03:28Wake up.
03:30With reports of a cardiac arrest and the patient not breathing, the specialist life-saving skills of the Thames Valley Air Ambulance are urgently required.
03:39OK, left.
03:40In their critical care response vehicle, Dr Laura Douglas Beveridge and critical care paramedic Neil Plan to scramble to the scene.
03:48OK, so this is a 48-year-old, alcohol-dependent, was having withdrawal, possibly seizures, and then has been found after a maximum of 10 to 15 minutes unresponsive and presumed in cardiac arrest.
04:03The main story tends to be suspected seizure and is now arrested, so possibly hypoxic seizure.
04:12Only around 8% of people who experience a cardiac arrest outside of hospital live to tell the tale.
04:19And for every minute they go without treatment, their chances of survival decrease by 10%.
04:24So the patient has been active, mobile, went for a walk earlier today.
04:30OK, there is now a para and ECA team on scene, and they have now confirmed cardiac arrest and a PEA rhythm.
04:39Gosh, that was very quick.
04:43The ambulance crew arrived on scene in five minutes.
04:47Here we are.
04:48And began administering CPR.
04:50Hello there.
04:51Hi, I'm Laura.
04:52Nice to meet you, Laura.
04:53This is a 48-year-old man.
04:54Yeah.
04:55I'm not sure if this is a witness collapse.
04:56OK.
04:57He is someone who's withdrawing from alcohol.
04:59Yeah.
05:0048-year-old Sean had been out on a walk, but was in his garden when he collapsed and went into cardiac arrest.
05:07I'm hoping when that bag is in place a few more times, we should have a good airway going as well.
05:10OK.
05:11Fine.
05:12During CPR, the ambulance crew then attached a Lucas machine to give continuous external chest compressions to give the heart the best chance of restarting.
05:21Now it's the turn of the Code Red team.
05:23So let's get a BM in temperature.
05:24Let's get better access in this, if that's OK.
05:26Yeah.
05:27Has someone had a go at IV?
05:28We've had a go.
05:29Fail.
05:30Do you want us to have a go at it?
05:31Sure.
05:33With little blood flowing around his body, Sean's veins have collapsed, so inserting a cannula for intravenous drugs is difficult.
05:40OK.
05:41So let's sit tight.
05:42If you notice any change, could you let us know?
05:43That would be great.
05:47We're coming to a rhythm check now.
05:51I can feel a pulse, yes.
05:52He's got a femoral pulse present.
05:54Let's start that BP, please.
05:56Yeah.
05:57So time of ROSC, 14.28.
05:59Yep, that's recorded.
06:00All right.
06:01Lovely stuff.
06:02The team have ROSC, or return of spontaneous circulation.
06:06This means Sean's heart has restarted.
06:09OK.
06:10Have we got adrenaline syringe?
06:11Can I have two mils through that IO, please, just as a push?
06:14Adrenaline improves blood flow to the heart, increasing the chances of it regaining a normal rhythm.
06:20Right, that's two mils.
06:21OK.
06:22Lovely stuff.
06:23And can we flush that through with some saline?
06:24The post-ROSC adrenaline down.
06:26Yeah.
06:29OK.
06:30Can I have another two mils, please?
06:31That pulse is just starting to brady down again.
06:33So you've got another two mils.
06:34Two mils.
06:35Yes, please.
06:36Another two.
06:37Your BM is five.
06:38Lovely.
06:40Sean's pulse is still sporadic.
06:42How are things?
06:43What are you feeling at the moment?
06:44It's becoming quite brady again.
06:45OK, fine.
06:46So let's do another two mils, please.
06:47Yeah.
06:48OK.
06:49So plan, guys.
06:50If this gentleman re-arrests, we'll go back into continuous CPR as we've done.
06:55OK, lovely.
06:56And I'm just going to pause and see if we're making any ventilatory effort ourselves at the
07:00moment.
07:03Not at the minute.
07:04OK, so he's currently apnea.
07:07Sean's not able to breathe un-aided.
07:11You've definitely got a femoral pulse.
07:13Yeah.
07:14I can't feel a crotch at all.
07:15Yeah, but he's bradycardic.
07:16Can we have another two of that adrenaline, please?
07:18OK.
07:19Radicardic means Sean's heartbeat is now dangerously low.
07:22Hang on one second.
07:23OK.
07:24I can't feel a pulse.
07:25Let's start.
07:26Sean's heart has stopped.
07:29He's back in cardiac arrest.
07:31Can we start to reach us again?
07:48OK.
07:49OK.
07:50OK.
07:51OK.
07:52OK.
07:53OK.
07:54Yeah, he is, but we've got major burns.
07:56Major burns.
07:57OK.
07:58Is he awake?
07:59Yeah, he's awake.
08:00I've put him in cold water in the shower.
08:02OK.
08:03Major burns.
08:04Yeah.
08:05Gas bottle explosion.
08:08Cold water as well.
08:09Get me a bucket of cold water.
08:10Yeah.
08:11Has he got any blood at all?
08:12No blood.
08:13No blood.
08:14Just massive, massive burns.
08:15I can see them blistering.
08:16The skin's peeling.
08:17They're on his legs and his face is burnt as well.
08:21His lips are blue.
08:23Yeah.
08:24Yeah.
08:25All clear.
08:26The report of a man with extensive burns means the life-saving skills of critical care paramedic
08:36Barry Walsh and Dr. Asher Lewinson are required.
08:40Gas bottle explosion.
08:42Burns legs and face, potentially.
08:45This is not just a straightforward burn.
08:47This has also involved an explosion of a pressurized canister as well.
08:51So there is every potential here for quite significant levels of trauma.
08:55Every year in the UK, around a quarter of a million people suffer burns, with 175,000
09:01of those having to seek hospital treatment.
09:04But the other thing as well is whatever was in that canister that's ignited and gone up,
09:08that can cause quite a sudden kind of forceful flash of burn and hot gases that can essentially
09:14be across somebody's face and breathed in quite easily.
09:17If that's the case, then you can get quite significant extensive airway burns as well.
09:21With that, we can start to lose an airway, which will be a big problem.
09:26Critically, if the patient airway swells up from the burn, Dr. Asher would have to take
09:31drastic steps to keep him alive.
09:34All right, guys, you all right?
09:37They arrive on scene to find the burns victim.
09:4036-year-old highway's electrician and father of seven, Tom, is already in the ambulance.
09:46It was propane put on the fire.
09:49He's removed it.
09:50It's then exploded.
09:51OK.
09:52He's been in the shower for 20 minutes.
09:55OK.
09:56Minutes before we arrived, 10 minutes after.
09:58OK.
09:59We've got one from his legs.
10:00It's in G's, sort of, to his face area.
10:02Yeah.
10:03But the worst bit looks up his legs at the moment.
10:05One of Tom's teenage sons had lit a garden bonfire.
10:09A small gas canister was thrown on.
10:11Tom quickly removed it.
10:13But as he did, it exploded.
10:15Hello, mate.
10:16You OK?
10:17My name's Ash.
10:18I'm one of the doctors with the air ambulance.
10:19OK, mate.
10:20How are we doing?
10:21Good, thank you.
10:22Yeah?
10:23Where's your pain at the moment?
10:24My leg, really.
10:25OK.
10:26Anywhere else?
10:27My lips a little bit.
10:28Your lips a bit, yeah.
10:29I can see that you've got a bit there, basically, from that point.
10:30OK.
10:31Following his cold shower, Tom's shaking.
10:34Mate, if it's OK, what I'm going to do, I'm just going to have a quick look at you
10:36from top to toe and see what we're up to.
10:38Yep.
10:39You can see a lot of singeing of your facial hair over there, mate.
10:41Yeah.
10:42Has this thing gone up in your face, it looks like?
10:43OK.
10:44They've mainly got my legs.
10:45Such serious-looking burns mean the critical care team need to stabilize Tom fast before
10:51getting him to a specialist burns unit.
11:09OK.
11:10OK.
11:11Let's get fingers on his pulses before we stop.
11:16OK.
11:17In Berkshire, critical care paramedic Neil and Dr. Laura are attending to 48-year-old Sean,
11:23who suffered a cardiac arrest in his garden, and after resuscitating him once...
11:28Ten seconds until rhythm check.
11:30...he's now in cardiac arrest for the second time.
11:32Ready for the rhythm check?
11:33Yeah.
11:34Yeah.
11:35That's on pulses.
11:36That looks like an organized rhythm.
11:37Any pulse felt.
11:38I can feel a pulse.
11:39You can feel a weak pulse still.
11:40I can feel a pulse.
11:41Has he got a rod?
11:42We have.
11:43We have.
11:44The team have done it.
11:47Sean's heart is beating once more.
11:50So we know that he ventilates well on the eye gel.
11:53So should we now go back to airways?
11:55Now the team focus on his breathing.
11:58He already has an eye gel airway device in his throat to open up his airway,
12:02but Dr. Laura wants to intubate.
12:04All right.
12:05Yeah, lovely.
12:06Yeah, absolutely.
12:07A tube must be inserted into his airway.
12:10It will allow the team to fully control his breathing using a mechanical ventilator.
12:15Right.
12:16So whenever you're ready.
12:17Okay.
12:18That's fine.
12:19It's a delicate procedure that the critical care team is specially trained for out in the field.
12:23Okay.
12:24So eye gel is coming out.
12:25Okay.
12:26So I've got a grade one view of the cords.
12:29Okay.
12:30I'm through the cords.
12:31Dr. Laura uses a laryngoscope to give her a view down Sean's throat.
12:36One second, guys.
12:37Let's just keep it quiet for a moment.
12:39Oh, there we go.
12:44Lovely.
12:45So I'm going to come out with the l.
12:47I'll take the bag.
12:48Thanks, guys.
12:50The breathing tube is in place, but Sean's not quite ready for the mechanical ventilator.
12:55Do you want to give him anything to paralyse him or at least?
12:58Yes.
12:59Good thought.
13:00Yeah.
13:01Can we give him a hundred of rock and then go with some clestine?
13:03Yeah.
13:04Lovely stuff.
13:05Before the machine is activated, ketamine and rocuronium, a muscle relaxant, will temporarily
13:10paralyse him in case he tries to breathe against it.
13:13Okay.
13:14So, yes.
13:15The pressure of the rock, 8253.
13:17Okay, fine.
13:18Can we have another two of adrenaline?
13:20And then what we'll do once we get access-wise, we'll start him on an adrenaline infusion,
13:24because I think he is quite driven by the adrenaline at the minute.
13:27What's it palpating at the femoral?
13:30What's the heart rate?
13:31Just roughly.
13:32Does it feel normal?
13:33Does it feel fast?
13:34Does it feel slow?
13:35It's slow.
13:36The adrenaline is crucial in keeping Sean's heart pumping, but also increasing his blood
13:40pressure.
13:41Lovely.
13:42We've had another two of adrenaline.
13:44Excellent.
13:45That blood pressure's cycling.
13:46The next things I think are going to be ECG we've just got.
13:49Can I have a look at that?
13:50Is that all right?
13:51Yeah, four, five and six.
13:53So, we do potentially have some ischemia in the heart, whether that's primary or secondary
13:57to the arrest, we're not quite sure at the moment.
14:00Ischemia means Sean's heart isn't receiving enough blood and oxygen through his coronary
14:05arteries.
14:06What are you using for this?
14:07Are you happy if I give 100 a rock and then 20 you've kept?
14:09I think 20 will be more than fine.
14:11It's more just for his...
14:12What are we using the IO?
14:13Yeah.
14:14All right, so we're just giving you medicines that will just help you rest off to sleep there.
14:18You're very, very safe, darling.
14:20Yeah, so I definitely can feel a pulse.
14:22It is very tacky though.
14:24So, we're just going to put them onto the ventilator because then I can be hands off
14:28with that and then we can set up the ventilator and then I'll get that line sorted and then
14:33we'll be ready to move.
14:34That's fine.
14:35Okay, well if you're ready, you can come over on this.
14:37Keeping the CO2, yeah.
14:38Lovely, ready.
14:40Okay, so that's connected.
14:43Lovely stuff.
14:45So, airway we're happy with, breathing we're happy with.
14:49We are supporting his blood pressure but he's responsive to the adrenaline that he's on.
14:53Fluid we've given.
14:54After nearly an hour, the team have Sean stabilised so he can be moved to the ambulance.
14:59Is everything ready on the truck?
15:01Wonderful.
15:02Steady.
15:03Lift.
15:04Yep.
15:05Slowly.
15:06Lovely.
15:07That's good.
15:08Excellent.
15:09Thanks guys.
15:10So can I suggest we give some arminol through his foot just for now while we...
15:15Let's just see.
15:16His last blood pressure is 150.
15:18If we just do a quick one.
15:20But he's still in danger, so the critical care team will travel with Sean to closely
15:25monitor him in case he goes back into cardiac arrest.
15:2848 year old man, alcohol dependent, who has had a witness seizure, then an apnea appeared
15:35and then into a cardiac arrest.
15:37Dr. Laura calls the hospital to alert them that Sean is still in critical condition.
15:42He's arrested at 14.05 and has been in Rosk for approximately 45 minutes.
15:49He is extremely hemodynamically unstable so I'd like your consultant and an anaesthetist at the resource please.
15:58Seven minutes later...
15:59Yeah, happy?
16:00Sean is handed over to the emergency team at Wexham Park Hospital.
16:07This gentleman was incredibly unwell.
16:12His body will begin to show over the coming hours whether it's going to be able to make a recovery.
16:18But he is in a very much critical condition.
16:22The patient's breathing.
16:23He's breathing, yes.
16:24You awake?
16:25He's awake, yes.
16:26Read for the call.
16:27He's fallen off his bike and he looks like he snapped his arm.
16:28I'm about to say anything.
16:29The patient's breathing.
16:30He's breathing, yes.
16:31He's breathing, yes.
16:32You awake?
16:33He's awake, yes.
16:34Read for the call.
16:35He's fallen off his bike and he looks like he snapped his arm.
16:39I'm about to say anything.
16:40The patient's breathing.
16:41He's breathing, yes.
16:42He's breathing, yes.
16:43You awake?
16:44He's awake, yes.
16:45Read for the call.
16:46He's fallen off his bike and he looks like he's snapped his arm and about to say anything.
16:52I'm excited.
16:53Has he got some blood?
16:55Yes, there's blood coming but from where I don't know.
16:58We're in a woods.
16:59He's 12.
17:00Okay, we have a crew assigned to you.
17:01We will endeavor to arrive with you as soon as possible.
17:03With reports of a child with serious injuries deep in the woods, Dr Matt McGurran and critical
17:17care paramedic Hannah Hurst are dispatched to support the ambulance crew already in attendance.
17:22You're going to a 12-year-old lad who's had a bike accident in the woods.
17:27He is conscious of breathing.
17:29He's got an isolated radial ulnar fracture which is closed.
17:33The concern from the paramedic is that she's got quite a weak radial pulse in that wrist.
17:39In terms of the scene, is it fairly obvious when we get there where we need to go or you say it's in the middle of the woods?
17:46They are in the woods.
17:48Perfect.
17:49Thank you very much.
17:50Around 15,000 people are injured on bicycles every year.
17:54One in ten under the age of 16.
17:57Serious accidents can result in head trauma, spinal injuries and fractured bones.
18:02We're on our way to a 12-year-old boy who has come off his mountain bike and he's injured his forearm.
18:08It's visibly deformed so we carry medications that aren't carried on typical ambulances.
18:15And in addition, we have been trained in further skills such as procedural sedation where we give patients medications to make them drowsing less aware so that we're able to perform procedures such as manipulation of a fracture.
18:29Realigning bones is extremely painful and patients require strong drugs so it's a task usually reserved for the critical care teams.
18:38Additional challenges, we know that this boy has fallen off his mountain bike in the woods.
18:42We don't know exactly how far into the woods or whether or not he's in a position that we're able to deliver safe care to him.
18:50Fifteen minutes later, Matt and Hannah arrive on the edge of the woods.
18:56Ah, there's an ambulance.
18:58Where Oscar's friends are waiting to show them the way.
19:02I think we need to be mindful here as well of how much we do here.
19:07Absolutely, because he's going to have to walk all the way up there.
19:11Hello, hello.
19:12This is Oscar.
19:13Hi Oscar.
19:14Hi Oscar.
19:15Hi Oscar.
19:1612-year-old Oscar was riding in the woods after school.
19:20Although he was wearing a helmet, he tried a jump but flew head first over the handlebars, landing hard on the ground.
19:27His mum and dad were quick to the scene.
19:29The only injury we found is the wrist.
19:32No c-spine concerns, no head injury concerns.
19:35The ambulance paramedic briefs Matt and Hannah on their findings so far.
19:39The blood on his face is from a scratch on his nose and he did bite his teeth into his lip.
19:45We've just given Entonox and we've done IVP.
19:48He's responded really well to the Entonox.
19:51Entonox, or gas and air, is carried by ambulance crews.
19:55It makes the patient feel lightheaded and drowsy.
19:58Despite his injuries, Oscar's certainly feeling its effects.
20:02How are you doing?
20:03I just want to examine you if that's okay.
20:05The ambulance crew have supported Oscar's arm and inserted a cannula for intravenous painkillers.
20:10Now Matt needs to check for any internal injuries that could be life-threatening.
20:15Breathing out for me.
20:16Bum bum.
20:17And again.
20:18Well done.
20:19I'm just going to feel your tummy.
20:21Is there any pain more impressing?
20:23No.
20:24Very good.
20:25Puff puff.
20:26Any pain more impressing here?
20:29And any pain more impressing here?
20:32Just want to have a look at this.
20:34I just need to lift this arm up ever so slightly.
20:36Just have a look at the rest of your tummy.
20:37A hard, rigid abdomen could mean internal bleeding or severe organ damage.
20:42No bruising.
20:43Good.
20:44Nice and soft.
20:45Any pain here in your leg?
20:47No, that's fine.
20:48My legs feel fine.
20:49Can you wiggle your feet for me?
20:52Very good.
20:53Okay.
20:54All right.
20:55Good.
20:56Strong radial pulse there.
20:57Now.
20:58I'm not going to move this arm.
20:59But I just want you.
21:00Can you feel when I touch your hand here?
21:02Yep.
21:03Dr. Matt is checking that Oscar has normal sensation.
21:07His blood flow is good.
21:09And his nerves are functioning properly.
21:11Can you feel when I touch your hand here?
21:12Can you?
21:13Wiggle your thumb and your little finger.
21:14Thank you, Edward.
21:15Just be careful.
21:16Very good.
21:17Well done.
21:18Okay.
21:19It just feels a bit sunny.
21:20Yeah.
21:21You can feel this here.
21:22That hurts.
21:23Why does my arm hurt so much?
21:24You've broken your wrist.
21:26Oh!
21:27Oscar has good sensation, meaning the blood flow to his hand hasn't been compromised by his
21:32broken wrist.
21:33Now, can I have a quick look at your teeth?
21:35Can you bite down?
21:36Bite down, Oscar.
21:37Does your bite feel normal or different?
21:40A little bit different.
21:42Yeah.
21:43It might be a little bit angulated, but that's okay.
21:46We can be dealt with at the later stage.
21:48Fine.
21:49All right.
21:50Good.
21:51Oscar has potentially damaged his teeth and gums on impact with the ground.
21:54From a primary surgery point of view, it's sort of isolated wrist plus a few sort
21:58of abrasions to his sort of face.
22:01A laceration on the inside of his lower lip.
22:04Okay.
22:05And that extends quite inferiorly.
22:07Okay.
22:08But happy otherwise.
22:09Yeah.
22:10Okay.
22:11So an extracation plan will be carriage hair.
22:12Yeah.
22:13Cool.
22:14So shall we?
22:15I've got it here, so I can set that up.
22:16Great.
22:17Amazing.
22:18And then shall we get the morphine up?
22:19Yeah.
22:20A strong painkiller, morphine, will help Oscar with the difficult extraction through the woods.
22:24Alphabet.
22:25A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P.
22:34You've had your bike three weeks.
22:36So it's a new bike?
22:37New bike.
22:38Shall we get your stabilisers back on?
22:40How's your pain at the minute, Oscar, out of ten?
22:43Five.
22:44Five.
22:45Five.
22:46Okay.
22:47We'll give you some really strong pain relief, okay?
22:49It might make you feel a little bit woozy, okay?
22:51That's perfectly normal.
22:52So you're doing really well, darling.
22:55This will make all the pain go away.
22:57We can't stay here all night, okay?
23:00So we want to start thinking about moving you towards the ambulance.
23:04In order to see that, we want to pop you in this chair that's got some wheels on.
23:09Transferring Oscar to the ambulance will be difficult.
23:12Pain aside, any wrong movement could damage tissues and nerves around the bone,
23:16or potentially displace his fractured wrist.
23:19Slough!
23:20I'm sorry.
23:38I'm going to have a quick listen to your chest, all right?
23:40In Slough.
23:41Just keep taking some nice deep breaths in half of me.
23:43Good, just like that.
23:44Dr. Asher and critical care paramedic Barry, attending to 36-year-old father of seven,
23:50Tom.
23:51Okay.
23:52I think it's cold while I've been under the water.
23:53He suffered extensive major burns to his legs and face when a gas canister exploded
23:57after being thrown on a garden bonfire.
24:00Did anything hit you, mate?
24:01Did any of the canisters explode at you?
24:03No.
24:04No pain here?
24:05No.
24:06Your chest sounds relatively clear.
24:07There's a tender way I'm touching.
24:09I can feel it.
24:10No, it's fine.
24:11I'm going to pop a little cannula in you and eat in one of your veins, okay?
24:14Yeah.
24:15It's my face bad.
24:16It's about the same as what your legs look like, basically, from this point of view.
24:19So, but it's not, it hasn't a solid to peel off yet at the moment.
24:22So most, most of the legs are involved, aren't they?
24:24There's some going up the back here.
24:26It doesn't look like there's anything towards buttocks, so it looks all right, yeah.
24:29Burns are not only extremely painful, but over time they can get worse as they begin to blister and swell.
24:35Nerves can also be permanently damaged.
24:38Right, um, some analgesic, guys.
24:39Can we start thinking about some paracetamol, endotron, some morphine, is that all right?
24:43Can we get some warm blankets, some dry blankets?
24:46Does it feel like at the back of your throat anything's burnt at all?
24:48Does it feel, your breathing feels okay?
24:50Yeah.
24:51Dr. Asher is also concerned the explosion might have burnt Tom's airways.
24:55If his throat was to swell, it could obstruct his breathing.
24:58With that extent of burns, he is definitely going to need to go to a burn center of some description.
25:02Do you start with fibromorphine?
25:03Yeah, yeah, start with some morphine, give some IVP.
25:06What percentage do we make it out to?
25:08The ambulance crew have visually assessed Tom's injuries, gauging that around a third of his body has second degree burns.
25:15If we start some fluids and we'll just start them running at 750 mils per hour.
25:19I'm going to put a warming blanket on you as well, okay?
25:23How's your airway feel?
25:25Yeah, fine.
25:26Any pain in your throat?
25:27No.
25:28No?
25:29This is going to warm up over time.
25:31Ideally, I don't want it touching your skin, so let's get your arm underneath this blanket, okay?
25:36And, I'm going to start giving you some morphine, okay?
25:39Good, decent painkiller for burns.
25:41Morphine, an opioid, blocks pain signals in the nervous system and should dramatically reduce Tom's pain.
25:48Just give me three milligrams of sulphur.
25:50The plan is to give you five and see how you tolerate it, okay?
25:53Yeah.
25:54Yeah, hello.
25:55Could you put me through to...
25:56This is Stoke, isn't it?
25:57Stoke Mandeville.
25:58I'm going to start fluid resuscitating him.
26:00I'm going to start bringing him down.
26:01But if you're happy to take him directly, then I'll bring him directly to you guys.
26:04With such serious injuries, the burns units at Stoke Mandeville have agreed to accept Tom as a direct admission.
26:11How's pain?
26:12Yes, fine.
26:13Is it better than four?
26:14Same or worse?
26:15No, it's better.
26:16Better?
26:17Better.
26:18Okay, cool.
26:19Are you still feeling cold?
26:20A little bit.
26:21Yeah.
26:22At least slowly we'll get warm as time goes on, okay?
26:27Yeah.
26:28Do we have another blanket?
26:30Tom's burns could disrupt his body's thermostat, making it harder to maintain a stable temperature, potentially causing damage to his organs.
26:39All right, fella, you okay?
26:40Yes.
26:41Here's what we're going to do, all right?
26:42I've just had a chat to the burn specialist down in Stoke, okay?
26:44They're one of our specialist centres in the area.
26:46Yeah.
26:47They're prepared to take you directly.
26:48Yeah.
26:49Okay?
26:50So what we've got, I think we're going to get it, I think this is going to, if it doesn't progress anymore, we should be okay in terms of what we're looking at.
26:57My concerns will be if this progresses.
26:59The big one I'm just a bit worried about is obviously I know your lips are involved and your upper mouth is in the airway at the moment.
27:03Yeah.
27:04Burns tend to change.
27:05The way I tell people, the way I say to patients is what it looks like now is not what it's going to look like tomorrow, okay?
27:10Yeah.
27:11So if you start to notice your mouth is swelling or the back of your throat is a little bit tighter or it's getting a bit harder to kind of talk or breathe, then this whole situation is going to change quite rapidly, okay?
27:19But I will do what I need to do to keep you safe.
27:21Yeah.
27:22Does that make sense?
27:23Yep.
27:24Okay?
27:25Apart from that, let's get you down to specialists to have a look at you and see what they can do.
27:27Yes.
27:28All right.
27:29If Tom's throat was to swell up, Dr. Asher would have to insert a tube into his airway to mechanically take over his breathing.
27:36What have we given pain relief on us so far?
27:37He's got a gram of IVP, five of morphine.
27:39Yeah.
27:40You okay?
27:41Yeah.
27:42It's quite an unsettling experience, isn't it?
27:43Yeah.
27:44Yeah.
27:45The more things are going to be a wrong chance, I think we do.
27:47Dr. Asher and critical care paramedic Barry will accompany Tom to hospital in case his condition deteriorates.
27:54You said it was your little one that threw the canister, is that right?
27:59Yeah.
28:00How many kids you got?
28:01Seven.
28:02Seven kids.
28:03Wow.
28:04I've got two.
28:05That's enough of a handful, I think, for me, mate.
28:07I don't know how you do seven.
28:09I bet he's going to be the naughty step later on tonight.
28:12One of the best dressings we can put on this is cling film, so we're just going to get it now and do that.
28:19Wrapping Tom's burns in cling film will help protect the damaged nerves.
28:23It also stops air flow, helping reduce pain and infection.
28:27I'm just going to lift this one leg up, mate.
28:28Just again.
28:31That's it.
28:32Lift down.
28:33And this one as well.
28:36I was never good at making sandwiches, so let's hope I'm better at wrapping legs.
28:40You look like you're doing all right.
28:42Okay, lovely.
28:43Pop this leg down for us.
28:44Have a look at the other barriers.
28:46Is there anything there we need to do?
28:47Because this one wasn't a lot.
28:48That's the other hand as well, yeah?
28:49Yeah.
28:50The other hand as well.
28:51I don't think there was any other burns areas as well.
28:58On arrival at Stoke Mandeville, Tom is taken straight to the specialist burns unit.
29:03All right.
29:04Couple of bumps on the way, everybody.
29:06Burns can be incredibly painful.
29:08The more pain in their experiences, the higher the adrenaline levels, the higher the adrenaline levels, the more strain on the system.
29:14And actually that can have a detrimental effect for long-term outcomes as well.
29:17So we want our energies early, we want to make them comfortable, and we want to make this experience, while it's horrendous, as kind as it can possibly be for somebody to have to go through.
29:27Tom will now await surgery, and remain in the burns unit until he's stable enough to return home.
29:34As long as we can see, we need any other things.
29:50Ambulance emergency, is the patient breathing?
29:53Breathing, but with a badBCD button.
29:54but with a really badly broken leg. Listen, I'm really sorry to interrupt you. Is the patient awake?
30:00Yes, she's awake. Okay, and what's happened?
30:04She's fallen off a ladder. How high is the ladder?
30:08How tall is the ladder down? About eight foot.
30:12Her whole leg's...it's like a completely wrong angle. Badly done.
30:16Okay. Is there any obvious deformity?
30:20Yes. Okay. An ambulance will be assigned your call as soon as possible, okay?
30:30We're going to a lady in her 70s who's fallen off a ladder.
30:34And I think because we were in such close proximity to the address,
30:37there's a possibility we're going to be the first people there in terms of medical services.
30:41That's all we know.
30:44Falls from height can result in serious fractures, spinal injuries and brain trauma.
30:49So, Dr. Susie Stokes and critical care paramedic Nick Cole are dispatched.
30:55Oh, there she is.
30:57Fortunately, they're nearby and on arrival... Hello.
31:01...a first responder is already in attendance.
31:04Right, well, this is Glenis. Hello, Glenis. Hello.
31:07About 20 minutes ago now. Okay.
31:09A retired nurse, 70-year-old Glen was trimming her hedge when she lost her footing and fell around eight foot onto tarmac.
31:16I'm Susie, my colleague's Nick. We're with the air ambulance where we've come by car.
31:20So, what were you doing? Trimming the bush?
31:22Yes. Yeah.
31:23She fell onto the ladder. Yeah.
31:25Very sensitive. It is swollen. Okay.
31:27It's got a real wobble to it. You know what I mean? Yeah.
31:30Yeah.
31:31Just looking from here, I suspect that's broken. Yeah.
31:34What we can do for you is give you some strong painkillers. Yes.
31:37And get your ankle in a slightly better position with a splint to get you to hospital. Okay.
31:42Around a third of people over 65 fall at least once a year in the UK, with serious injuries often sustained.
31:49They can take longer to heal, leading to reduced mobility and quality of life.
31:54Didn't bang your head.
31:55You know, everywhere else, I think I cushioned myself. I tried to stop myself in the bush.
32:00Yeah. Okay.
32:01Unfortunately, the ladder went. Yeah.
32:03And the rest of me that came down, bit back.
32:06Took all the weight on that. And can you feel your foot okay?
32:09I can wither my toes. Good. Yeah.
32:11Numbness or tingling in the foot could signify nerve damage alongside the suspected fracture.
32:16So it's a positive sign that Glenn still has normal sensation.
32:20What I need to do is get the shoe off. Let's get some painkillers in first.
32:23Shall we pop some Penthrox? Yeah.
32:25So we've got, you know, have you heard of gas and air? Old style gas and air.
32:29So we have a newer version of that that comes in a little green whistle and you breathe it in and out and it's absolutely excellent for pain relief.
32:36Fast acting Penthrox is often the critical care team's first port of call when it comes to pain relief, before stronger intravenous drugs can be given.
32:45Now we'll go around the wrist, just like a bracelet, and you can self-administer this.
32:49Any objections to me popping a drip in your arm? No.
32:52So on a scale of zero to ten, if zero is no pain at all and ten is the worst pain you've ever experienced, what number would you put it at at the moment?
32:58Three, four, nine.
33:01Scoring her pain nine out of ten, Glenn will need strong pain relief before the critical care team can do anything else.
33:08Oh, oh, oh.
33:10So I'll just check your blood sugar as well. You're not diabetic?
33:15No.
33:16And have you had breakfast and lunch today?
33:18I had breakfast, yes.
33:19But no lunch?
33:20No lunch, I'm afraid, no. That was my next job.
33:23That's actually a good thing for us, because if we give you medicine and it makes you feel even slightly sick, we'd prefer if we don't see your lunch again.
33:28Yeah, it will.
33:298.8.
33:30After running through her checklist, Dr. Susie can proceed with stronger intravenous drugs, so a cannula is inserted.
33:37Fantastic.
33:39So keep going on that.
33:42Dr. Susie needs to remove the shoe so they can straighten Glenn's foot and splint it, keeping the ankle and bones in the correct position.
33:50This is a medication called morphine, have you ever had it before?
33:52Never in my life.
33:53You've done very well.
33:55No, no, I've had no need for such things.
33:58So what I'm going to do is go very gently, okay?
34:00This is working very well.
34:02It's good stuff, isn't it?
34:03Sounds like it.
34:04Yeah.
34:05So what we do, if we give you medication that can make you feel a bit sleepy, just as a preventative, we give you oxygen and we monitor your breathing in case you get more sleepy than we expect.
34:14It's absolutely routine. We keep a close eye on you with the monitor as well, and that allows us to safely take care of your ankle, okay?
34:21What number is your pain at the moment if it was a nine before?
34:24It's high.
34:25Okay.
34:26That's okay.
34:29With the morphine taking effect, it's time to remove the shoe.
34:34Ow, ow.
34:35Okay.
34:36I won't cut you, I promise.
34:39A delicate procedure.
34:41But the morphine isn't strong enough to stop Glenn's pain.
34:45Okay, I'll wait.
34:47I think we're probably going to need Ketnik.
34:49Ketnik.
35:10Deep in the woods near Great Missenden, Buckinghamshire.
35:13Dad, are you happy to reach over and take the Entonox as he's coming forward, is that okay?
35:17Yeah.
35:1812-year-old Oscar has fallen head first over his bike, fracturing his arm and injuring his mouth.
35:24Dr. Matt and critical care paramedic Hannah now need to get him out to the ambulance.
35:29So, Oscar, we're going to sit you up.
35:31So you're sat forwards, and then we're going to pause there, okay?
35:34And then, Mum, if you slip out once he's sat up, is that okay?
35:37Yeah.
35:38I believe, Oscar's having Entonox, and Hannah has administered morphine.
35:42One, two, three.
35:44Well done.
35:45Well done.
35:46Great job.
35:47Well done, well done.
35:48Are you okay?
35:49I'm still dizzy.
35:50Yeah, that's okay.
35:51You're okay.
35:52There's a chair coming in behind, okay?
35:54That arse bent.
35:56Yeah, it is done.
35:57We're going to lift you up underneath your armpits, and there's a seat right behind you.
36:01One, two, three.
36:02Well done.
36:03And drop your bottom down.
36:04Well done.
36:05And shuffle back.
36:06Fantastic.
36:07How do you feel at the minute?
36:08Okay, Oscar.
36:09Pop this.
36:10You're okay?
36:11You're okay.
36:12You hold it where you want it.
36:15How are you feeling at the minute?
36:18Um...
36:19Yeah.
36:21That hurts like a five right now, but when moving it's a seven.
36:25Yeah.
36:28Now the critical care team face their next obstacle.
36:31Wheeling Oscar around 500 meters over uneven muddy terrain to the safety of the ambulance.
36:38Well done, Oscar.
36:39Right.
36:40Oscar, if at any point you want us to stop, you just ask us to stop and we will, okay?
36:44That's fine.
36:45Um, I think we were going to go that way because that way is fair enough.
36:48Okay, so this way?
36:49Yeah.
36:50Yeah.
36:51It's slow going as the team delicately pick their way through the trees and over roots and rocks.
36:58Okay.
36:59You need some into knocks?
37:00Yes.
37:01No.
37:02Oscar's pain needs managing every step of the way.
37:05Okay.
37:06Should we get going again?
37:07Yeah.
37:08Good job.
37:09Oh, that's soft ground there.
37:12Another little one now.
37:13That's it.
37:14All right, buddy.
37:15Let's get you on the ambulance.
37:16It's all right.
37:17We've got you.
37:1820 minutes later and Oscar's arduous woodland journey is over.
37:29I'm dizzy.
37:30That's okay.
37:31You're okay.
37:32You can lie back now.
37:33I'm going to get your legs, all right?
37:34That's it.
37:35If you need this, you can have a couple of...
37:39That's it.
37:40Well done.
37:41Good job.
37:44Should we give a little bit of morphine to tie it over?
37:46Yeah.
37:47I think it's probably reasonable.
37:48Yeah.
37:49We gave two before.
37:50We gave two.
37:51Should we go up to five?
37:52Hannah administers more morphine to keep Oscar's pain at bay.
37:55Right.
37:56We're just going to put some straps around your legs, okay?
37:58Buckle me in.
38:02I'm going to leave you with the crew, okay, buddy?
38:04Okay.
38:05Hope you feel better soon.
38:06All right.
38:07Thank you so much.
38:08Yeah.
38:09Keep me up.
38:10The critical care team have done everything they can for Oscar.
38:12See you soon.
38:13Enjoy the rest.
38:14Safe journey.
38:15You too, mate.
38:16Now the ambulance crew can take him to Stoke Mandeville Hospital.
38:19Right here.
38:20He's a funny one, isn't he?
38:22He's a funny one, isn't he?
38:33What I need to do is get the shoe off.
38:35In Marlow, 70-year-old Glenn has fallen eight feet from a ladder breaking her leg.
38:40Critical care paramedic Nick and Dr. Susie are on scene and have administered morphine before trying to remove her shoe and align the bone.
38:48But she needs something stronger.
38:51So the other medication that we've got in our little pharmacy is called ketamine.
38:55Basically, it's an excellent, excellent painkiller.
38:58And one of the ways it also works is by making you sort of, you feel a bit like you've had a gin and tonic, a little bit away with the fairies, but still awake.
39:05Unlike morphine, ketamine, a powerful anaesthetic drug is a painkiller only carried by the critical care team.
39:12I'm going to give you some of this good stuff. It will make you think about whatever happy thing you're already thinking about.
39:18Once that's working, Nick's going to help me with your ankle, get your shoe off, get it slightly better aligned and put a splint around it to hold it.
39:25And actually, the splint itself is a really good painkiller because it keeps it still.
39:30Yeah, it's not flip-flopping around.
39:33Where's your happy place?
39:36In my garden.
39:37There you go.
39:38All right?
39:41Yep.
39:42Good.
39:43Doing well.
39:45You're super safe, all right?
39:48You starting to feel some effects of that?
39:51Yeah.
39:53Okay, imagine yourself in a big garden.
39:56How about Kew Gardens?
39:59That's okay. It's okay.
40:01You're safe.
40:02You're safe.
40:03Everything's okay.
40:05You think of those flowers in a nice cold stream.
40:09With the drugs now taking effect, Dr. Susie can straighten the ankle to realign the bones.
40:15It's crucial for healing, but also to ensure Glenn's blood supply isn't compromised.
40:20There, here.
40:21Just a little bit.
40:22Doing fine.
40:23Doing fine.
40:24You can take that at the same time as you want to.
40:27With the ankle quickly straightened, the splints can be fitted.
40:33Okay.
40:34It's nice and aligned now.
40:35There wasn't a lot of tailor shift, but it was definitely out.
40:37I felt a crunch.
40:39Everything's okay.
40:40You're doing really, really well.
40:44Well done.
40:45Good.
40:46Now, if we relax that down slowly.
40:49Well done.
40:50Then the nasty part's done, okay?
40:51Your ankle looks more like an ankle should.
40:54All right, and you've got it in a nice, comfy splint.
40:56Wait till she recovers a bit more and get some paracetamol drawn up.
40:58I think so.
41:00Ketamine only lasts between 10 to 15 minutes, so intravenous paracetamol will help for the journey onwards to hospital.
41:08Cool.
41:09You back with us, Glen?
41:10How are we feeling?
41:11Good.
41:12Okay?
41:13Good.
41:14Fantastic.
41:15You did brilliantly.
41:16You did so, so well.
41:17It's all done.
41:18Your leg's in a splint.
41:19Yeah?
41:20Yeah.
41:21Magic.
41:22I'm waiting for an ambulance that can drive you to hospital.
41:24Okay.
41:26The main thing is that you've got a really good blood supply to your foot.
41:28Yeah.
41:29Because one of the problems that can happen when it's a bit skewiff is that the blood vessels get squished,
41:32and then you don't get blood to your foot, and that's why it can be tingly and painful and everything else.
41:36But I think, looking at it, it's nice and pink, you can wiggle your toes, I can feel the pulse, and it's in a straight line again.
41:41So, all those things make me happy.
41:46I just can't believe it.
41:47I know.
41:48What number would you give your pain now?
41:49It's only about five now.
41:51Okay.
41:52It's not so bad.
41:53So it's not completely gone, but it's much better than it was.
41:55Good.
41:57Here they are.
41:58Okay.
41:59Blue light's flashing.
42:00I just have a quick chat to these guys.
42:03Hello, hello.
42:04In short, a 70-year-old lady has kind of had a fall whilst using a ladder.
42:08Okay.
42:09She's got a closed distal tibfib.
42:11Okay.
42:12But yeah, isolated injury, everything else is absolutely fine.
42:14Okay.
42:15She's in really good spirits.
42:16She had a ketamine sedation.
42:17It's in a splint.
42:19With the ambulance crew briefed, the team now need to delicately maneuver Glenn onto the trolley.
42:24This is Glenn.
42:25We've come to take your task at all.
42:27All right.
42:28Thank you so much.
42:29How you doing?
42:30All right.
42:31Yeah.
42:32So we're going to all help you.
42:33We'll use your good leg and we'll get you onto the trolley.
42:35Okay.
42:36Is that all right with you?
42:37Yeah.
42:38Yeah.
42:39By the way.
42:40Concentrate on all your pressure on that leg.
42:43Ready?
42:44Yeah.
42:45Well done.
42:46Lovely.
42:47Excellent.
42:48We've got you.
42:49That's it.
42:50Just concentrate on that leg.
42:51I'm going to put them out the way.
42:52Yep.
42:53When we're safely on board, the critical care team are happy for Glenn to be taken to Wexham
42:57Park Hospital for scans to assess the break and any necessary surgery to repair it.
43:03W-W, any questions?
43:04Happy?
43:06Great.
43:07Very happy.
43:08Nice to meet you, Glenis.
43:09I hope you made a swift recovery.
43:10Thank you for everything.
43:11Thank you guys.
43:12Take care.
43:13Thank you guys.
43:14Dr. Susie and critical care paramedic Nick now await their next emergency.
43:23Thanks for the ride.
43:24Too, good to meet you.
43:26And if we invite them to make a forward.
43:27Let me know.
43:28That's all you got.
43:29To arrive, we're亲間 to check our Kenny world.
43:30If we're talking to our calendar, they're doing the holiday weekend to
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