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Ambulance Code Red Season 4 Episode 7
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FunTranscript
00:00In the intense world of medical emergencies, there's nothing more extreme than an immediate threat to life.
00:15Responding to the most severe 999 calls, the rapid response vehicles of the Thames Valley Air Ambulance,
00:28are at the front line delivering life-saving medical treatments.
00:32The big decision is for us whether we need to put a tube in again to protect us that way or not.
00:36Working day. We're going to give you some strong medication.
00:40And night. It should not hurt. It's a very good painkiller.
00:44Reacting to emergencies. You've been super brave, Dallin.
00:47The critical care teams. You've had a pretty big blow to the head.
00:50Are 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 you straighten your ankle out.
00:57Whenever. Do you think it's fast? Potentially, yeah.
01:01And wherever. Oh, my leg. It's needed.
01:04You are doing a fantastic job. Filmed over three months.
01:08Let's have your arm, my God. Let's give you some of this morphine.
01:11Just be aware you might stop spontaneously ventilating. I have the tube.
01:15We captured every vital second. That's okay. You're safe.
01:20As these highly trained critical care teams. Can you take a deep breath in for me?
01:24Fight to save lives. Your birthday present is surviving a cardiac arrest.
01:29When every second counts. Let's go, go, go.
01:33Tonight, a broken and dislocated ankle. The biggest risk here is that I won't be able to get this ankle back in.
01:39Leaves an elderly man facing life-changing consequences.
01:43It's very unstable and spontaneously re-dislocated.
01:48A seizure puts a young boy in serious danger.
01:52The decision is whether we need to put a tube in to protect us that way or not.
01:55Multiple injuries and amnesia. I literally woke up and I'm not aware for this.
01:59For a motocross rider after a crash at speed.
02:02I can't tell you, like, right now, everything is going to be fine.
02:05And... I feel I'm going to conk out.
02:07A climber's arm is crushed after a fall.
02:10You see yourself... Oh, shit!
02:25Um, it's an emergency. Patient breathing?
02:30Yes, I'm breathing.
02:32To your patient?
02:33Yes.
02:35Can I ask no reason for the call?
02:37I think I've broken my ankle. My foot is sticking out at 90 degrees from over there.
02:41But have you fallen? What's happened?
02:43I don't know. I just woke up on the floor by the bottom. My foot is sticking out at 90 degrees.
02:50And I take it you're still on the floor?
02:52I'm on the floor.
02:54Okay, do you know how long we've been on the floor, sir? Do you know how long?
02:58I do. No idea.
03:00Yeah? Okay, okay. Any other multiple major injuries that you've got at the moment?
03:07Okay, what walk is it? That's okay.
03:11Hello, can you hear me?
03:15Hello, can you hear me?
03:17A loss of consciousness and a badly broken ankle is an emergency that requires the advanced skills of the critical care team.
03:28So in addition to an ambulance, Dr. John Bailey and critical care paramedic Andy Ludlow are dispatched.
03:34So we're on our way to a court. It's for a man who's woken up on the floor, not sure how long he's been there, with his ankle facing in the wrong direction.
03:45Fractures can be serious injuries. However, the loss of consciousness could be a bigger concern.
03:51Clearly breaking your ankle is reasonably stimulating as experiences go, so it's unusual to do that whilst unconscious and not realised.
03:57So he must have been genuinely unconscious, which probably means he's had some kind of dysrhythmia or maybe a seizure.
04:04There's a bit more to consider in terms of what's happened to him medically around what's caused him to get the fracture.
04:13An ambulance crew is already on scene and updates John and Andy.
04:19The last thing he remembers is getting up, going to the bathroom, and then he woke up on the floor, has bumped his head, doesn't know what on, can't remember the fall at all.
04:29Semi-retired CEO Dave was looked after by his wife Sally and their housekeeper Helen until help arrived.
04:36BP is high.
04:38I'm not surprised your BP is high. Hello.
04:43I am. My name's John Bailey. Hi.
04:45John.
04:46How you doing?
04:48Pretty uncomfortable.
04:50You don't remember anything about what happened?
04:52No, I asked help. Is it dislocated?
04:55Probably fractured and dislocated.
04:56But we need to straighten that out.
04:59First, John needs to consider Dave's loss of consciousness.
05:03And you've been having a few episodes where you've been passing out.
05:06One at the beginning of May.
05:07Yeah.
05:08And one on Monday.
05:10Yeah. Have you seen anybody about that yet?
05:12I was meant to have an ECG at my doctor's next Friday.
05:17Well, you're definitely going to get one today.
05:18If the ECG reveals a problem with Dave's heart, it could have serious complications for how they treat his ankle.
05:25Get an ECG to make sure he's not got some drastic abnormality.
05:29The Thames Valley Air Ambulance Charity has a team of 34 doctors all trained in pre-hospital emergency medicine.
05:40When Dr. Manjit Riyat isn't with the critical care team, he works in intensive care at Oxford University Hospital.
05:46So I do two weeks, basically two weeks in the hospital and then two weeks here.
05:52The jobs that we have here probably are more challenging.
05:55Like managing a cardiac arrest sort of on the floor propped up against a radiator in a narrow corridor where you barely got access to some of the patients.
06:03Torso and airway is much more difficult. There's things that you just take right after the hospital.
06:07Today, Manjit is on shift with critical care paramedic Hannah Hurst, responding to code red calls over a patch of more than 2,000 square miles.
06:17An ambulance emergency, is the patient breathing?
06:34Yes, in the middle of having a spit.
06:36Right, okay, how old is the patient?
06:38Twelve.
06:39Okay, how long has he been sitting for?
06:41I don't know, I've just come in and I've heard some funny noises, he's been asleep.
06:45I just want to track his rate of breathing together to make sure it's alright.
06:48When I say go, you can watch him closely and say now, every time you take the breath in until I tell you to stop?
06:55Yeah.
06:56Go.
06:58One.
07:00Going for me?
07:01Two.
07:02Keep going for me?
07:03Three.
07:04Thank you, you can stop now. That helps to arrange this beginning with the call.
07:09Caused by sudden and abnormal changes to electrical activity in the brain,
07:13seizures can be life-threatening.
07:16Manjit and Hannah are dispatched.
07:19Just two minutes away, they arrive ahead of the ambulance.
07:22Hello.
07:27I'm Hannah, this is Manjit. Who's this?
07:28This is Lewis.
07:29Hello Lewis.
07:30Hello Lewis.
07:31Twelve-year-old Lewis was found unresponsive in his bed by his younger sister,
07:36who alerted their mum Georgie.
07:38Okay.
07:39Tell us the story then, Mum.
07:40So, he had a TBI in September 23.
07:42Yeah.
07:43He was gone over by a car.
07:44Yeah.
07:45He was in a coma for eight days.
07:47Yeah.
07:48Then he was fine.
07:49And then October last year, he had the first ever seizure that he's had at school.
07:54Yeah.
07:55He was fitting for, well, they think it was over 30 minutes.
07:58They put him to sleep at school, took him back to hospital.
08:00Yeah.
08:01And this is the first time it's happened since October.
08:03The TBI, or traumatic brain injury, left Lewis with the most extreme form of epilepsy.
08:10This causes prolonged non-convulsive seizures and fitting, which can be life-threatening.
08:15I don't know how long he's been fitting for, because me and my daughter just up, and she
08:18said she could hear some funny noises.
08:19Yeah.
08:20So, I came in and found him.
08:21Okay.
08:22Found him fitting.
08:23I don't know when it started.
08:24It's over 11 minutes since Lewis's mum realised something was seriously wrong and
08:29raised the alarm.
08:30First, Manjit and Hannah need to carry out a quick assessment.
08:34Yeah.
08:35So, I think he's still fitting.
08:36Yeah, should we get...
08:37Yeah.
08:38Sats are reading at 57.
08:40Lewis, I'm just going to pop a little bit of oxygen on for you, my darling.
08:44It's just going to be a little mask over your nose and mouth, okay?
08:48Ooh, you can probably hear my colleagues arriving as well.
08:53Hmm.
08:54He's moving a little bit.
08:56How's the chest down?
08:57It's clear on the left-hand side.
08:59It's got a little bit wheezy on the right-hand side.
09:02I would say his refs are quite irregular, though.
09:04Okay.
09:05Quite slow.
09:06Yeah, thank you.
09:07I'll get you some medals.
09:08Lewis's brain functions, including those that control his breathing, are being
09:13disrupted, resulting in his low oxygen levels.
09:16Muscle spasms in his chest and throat are making it hard for him to breathe.
09:21It was one of those things where my daughter goes,
09:23Can you just check with him, Mum?
09:24He's not standing right.
09:25Oh, bless him.
09:26You might be in a bit of a sharp scratch.
09:28All right, mate?
09:29Just try and hold nice and still.
09:30You're doing really well.
09:31Well done.
09:32The team needs to act fast.
09:35A portable ultrasound scanner allows Manjit to quickly find and insert a cannula into
09:40Lewis's tiny veins.
09:41There's five.
09:457.9 BM.
09:46So that's around 98.
09:48Excellent.
09:49Excellent.
09:50Manjit is giving Lewis midazolam, a powerful, fast-acting anticonvulsant, to help bring his
09:55seizures under control.
09:57Just going to get you feeling a bit better.
09:59All right.
10:00And if you're quite sleepy, stop these seizures.
10:04Okay.
10:05That's five in and flushed.
10:06With his breathing already compromised and his brain at risk of damage, as long as
10:11he's seizing, Lewis's life is in danger.
10:14Just going to have a look at your eyes.
10:17time.
10:18Chirin.
10:19Definitely working there.
10:20Yeah.
10:21It's 7 a.m. on Sunday morning.
10:23Dr. Martin Weller and critical care paramedic, Joe Jeffries, are preparing for their shift.
10:44On duty for the next 10 hours, Jo is predicting a busy day ahead.
10:53We've had two weeks of warm weather, so we tend to think that that brings people out
10:58doing sort of leisure activities and out and about walking, cycling, doing what they do.
11:06So sometimes I think these Sundays are a little bit busier, but I might add that today is
11:11the sort of end of the hot forecast, so maybe people are more inclined to get out today ahead
11:17of the rain.
11:32Ambulance emergency, is the patient breathing?
11:35Yeah, the patient's breathing.
11:36I just had a crash, a motorbike crash out of here.
11:38It's a trap.
11:39He's got quite serious bumps to the head though, the front of the head.
11:43Oh, the head.
11:44All right, thank you.
11:45I think there was a short spout of where he went unconscious.
11:47And his helmet is cracked, or his helmet was cracked up.
11:51Yeah, thank you.
11:52Okay, so your call has been categorised as a high priority.
11:54We are on our way on blue lights and sirens.
11:58A motocross rider has crashed at speed and knocked unconscious.
12:02Martin and Joe are dispatched and updated via messaging.
12:05Motocross rider went over to jump, about 40 miles per hour, knocked out and are complaining
12:11of chest and leg injuries.
12:12Uh-huh.
12:12How's what is described as a large deformity on his head?
12:15Oh.
12:16All right, he's stopping.
12:18Yeah, you're good.
12:21With speeds up to 60 miles an hour on off-road terrain, motocross is a high-risk sport.
12:27Injuries are common and often serious, varying from broken bones to life-threatening trauma
12:33to the head and spine.
12:35Hello.
12:36Hello.
12:36Hi.
12:37You all right?
12:38This was initially unconscious, quite a large mechanism.
12:41Do have a cruise side, but they're coming from quite a distance.
12:44They're 30 minutes away at the moment, 3-0.
12:47Yeah, cool.
12:48That's all right.
12:48Cheers, mate.
12:49Thank you, guys.
12:49Thanks.
12:50Bye-bye.
12:50In the UK, there is a hospital admission for a head injury every four minutes.
12:55Unconsciousness after a blow to the head is dangerous, as it can signal swelling or trauma
13:00to the brain.
13:01Looks like somebody's expecting us, which is good.
13:03First to arrive at the scene, Martin and Joe are greeted by one of the other riders.
13:09He's down on the bottom.
13:11I'll see you guys down there.
13:12Far left behind, okay?
13:13Okay, thank you.
13:14I assume you'll be somewhere in there.
13:15I'm probably in the line.
13:17Yeah.
13:19Let's take these two and then we'll decide everything else once we've seen him.
13:24With the help of his friends, the injured rider has made it back to his van.
13:29Hello there.
13:30Martin and Joe.
13:31You're the one who's done the jumping and the falling.
13:33What's your name, buddy?
13:34Hello.
13:35Charlie.
13:36Hello, Charlie.
13:37Where are you most sore?
13:39My head, my hips.
13:41Yeah.
13:42Oh, my arm, that's a little bit.
13:44Yeah.
13:45Okay, fine.
13:46Obviously, where did you fall at, just right on the track?
13:47Did you jump at the back?
13:48At the back.
13:49And you walked all the way back here?
13:51Yeah.
13:52Or did you walk in back?
13:54Did you?
13:55Okay, gotcha.
13:56Do you remember doing the jump?
13:57No.
13:58Or not?
13:59I remember hitting there.
14:00Yeah.
14:01Yeah.
14:02I couldn't get anything.
14:03And then I must just, like, nose dive, crack.
14:05Do you mind if I check you over?
14:06Is that all right?
14:07And we'll take some observations.
14:08Short-term memory loss after an impact to the head is a sign of a concussion, but could indicate a more serious brain injury.
14:15Any pain in the middle of your neck yet?
14:17No, that's fine.
14:18And then, can you pull this up for me?
14:19Is that okay?
14:20I'll just have a good look at your chest.
14:22Just a little bit feel around that.
14:25Is that sore when I'm pressing anywhere?
14:27A little bit sore, yeah.
14:28Both sides?
14:29Not really, not really.
14:30Yeah, that hurts.
14:31Which side?
14:32The front.
14:33The front.
14:34Okay.
14:35Charlie's body has hit the ground at high speed with little protection, so Martin must carry out a head-to-toe assessment.
14:42Any pain in the middle of your spine?
14:44Uh, nah.
14:45No, that's okay?
14:46How about your tummy?
14:47Is that okay?
14:48Yeah, that's fine.
14:49Okay, so that's sore when I pressed on there, but you were able to walk on it, were you?
14:52Yeah.
14:53Okay.
14:54I'm going to just squeeze your arms.
14:55There we go.
14:56That's a...
14:57Whereabouts?
14:58Down there.
14:59The crash has left Charlie with injuries to his head, chest, leg and arm.
15:03But it's the risk of brain trauma that is the biggest concern.
15:07It's more just like, oh, fuck, I'm just in a different world, to be honest.
15:21We're getting to move your position slightly in a minute.
15:24In Reading, critical care paramedic Andy Ludlow and Dr. John Bailey are with Dave, who has a badly broken ankle after a fall.
15:32Here we are.
15:33So, have we got some fentanyl?
15:35The last thing Dave remembers is going to the bathroom and then waking up on the floor, with his ankle facing the wrong way.
15:43I'll start feeling a bit better in a couple of minutes' time.
15:46What's that?
15:47That's fentanyl, which is sort of a faster action version of Morphe.
15:51Do you mind grabbing some hands on?
15:53We'll just come a little further away from the top here.
15:55Yes.
15:56Okay.
15:57You're shuffling.
15:58Oh, well done.
15:59That's it.
16:00I think this is how he got here, isn't it?
16:02Yeah, he shuffled on his bum up to the bed.
16:04There we go.
16:06Lie yourself down again.
16:07The pillows are behind you.
16:08It could be several hours since the injury happened.
16:11If the blood flow in Dave's foot is compromised, then it's at risk of permanent damage or amputation.
16:17He has actually got a pulse on that, and it is quite warm.
16:21But it clearly can't stay that way because of the skin.
16:23Yep.
16:24So, we'll sedate him, pull it straight.
16:27The blood supply appears to be healthy, but it's a particularly bad break.
16:31This will be quite difficult to reduce because I think his entire tailor joints there.
16:35John suspects that Dave's ankle is broken and dislocated, making realignment difficult and painful.
16:41To complicate matters further, there's an additional concern.
16:45Of course, there's a lot of pressure on the skin.
16:48We need to be able to reduce the ankle to take the pressure away from the skin, otherwise the skin itself will start to break down.
16:53And that then can cause a problem with an open fracture later on.
16:56So, we'll sedate him here, reduce it, and then once that's done, package him up, let him recover from his sedation and go to the local hospital.
17:04Right.
17:05The team must act quickly.
17:07But Dave can't be sedated until they're confident his collapse wasn't caused by a problem with his heart.
17:13We're just looking at your heart rhythm.
17:15ECG's coming, that's it.
17:16It's fine.
17:17It's QRS, it's fine.
17:18That'll do.
17:19An ECG of Dave's heart is all clear.
17:22Right, Dave, I've got to put this mask on you, okay?
17:25So the team can proceed with the sedation.
17:28You won't feel strange straight away.
17:31Give it a minute or two and it'll start feeling a bit weird.
17:34When you wake up, your pain will have gone away.
17:38Okay?
17:39My ankle's straight, right?
17:40Yeah, well, as long as we've been able to reduce it, which I'm reasonably sure we will be able to, then your ankle will be straight.
17:47Is it propane or is it just this?
17:49It's both of those things.
17:51Andy's administered ketamine, a strong sedative that will allow John to try and straighten Dave's ankle without causing him distress.
17:59Dave, you're still with us?
18:01Open your eyes, Dave.
18:03A bit nystagmus now.
18:05Still aware.
18:07You're very safe.
18:09Can you squeeze my hand?
18:11You're still with us, sir?
18:13I think you can...
18:15So the biggest risk here realistically is that I won't be able to get this ankle back in, which means I'm going to have to pull it really, really hard.
18:23So when we do that, if I have to, I'm going to stand up and then I'm going to pull him with me standing and him still on the floor.
18:29If we get to that point, you need to hold his pelvis.
18:32So basically whoever's going to support him, just keep his pelvis on the floor and I'll pull against that.
18:36The harder John has to pull Dave's ankle, the greater the risk of the skin rupturing, which could lead to infection and even loss of his foot.
18:44Well done.
18:48You're very safe.
18:50No, I don't think I can reduce it.
18:54No, I don't think I can reduce it.
19:08I'm just going to pop this on your arm.
19:10It's going to go a bit tight.
19:12In Stoke and Church, Dr. Manjit and critical care paramedic Hannah are treating 12-year-old Lewis, who has had a seizure and is struggling to breathe.
19:22The numbers are heart rate is 111, SATs of 99 on the 15 litres.
19:27We've got a respirator of 8, end tidal 4, BP 12664.
19:32Two years ago, Lewis suffered a traumatic brain injury that left him with a rare and severe form of epilepsy.
19:38OK, so I've got three grams of Keppra in 100ml. Happy?
19:42Happy.
19:43An ambulance crew is now on scene.
19:45The intravenous infusion of Keppra, an anti-epileptic drug, will also help to stop Lewis's seizure,
19:51while they transport him to hospital.
19:57OK, nice and easy.
19:59Just keep coming.
20:00OK, one, roll, ready, steady.
20:02Roll.
20:07OK, OK, OK, OK, OK.
20:09Coughing and gagging.
20:11OK.
20:12Should we get suction?
20:13Yeah.
20:14One of the biggest dangers of the seizure is that Lewis can't control his body's gag and cough reflexes.
20:19So, just because he's had this vomit, the main thing we need to think about is his airway and making sure things aren't going down the wrong way.
20:26And the big decision is for us whether we need to put a tube in again to protect his airway or not.
20:30OK.
20:31With his vomiting posing a threat to his breathing, maintaining Lewis's airway is the critical care team's first priority.
20:38All right, mate.
20:46So, we're going to move.
20:47What I'm going to do is I'm just going to support the airway.
20:49Yeah, great.
20:50And that's what we'll do all the way down.
20:51We'll do the rest, OK?
20:52Now Lewis has stopped being sick, the team can begin moving him to the ambulance.
20:58Ready, steady, slide.
21:00Great job.
21:01But that involves navigating a narrow, steep staircase, whilst Manjit holds open Lewis's airway.
21:07All right, if you rest up there, I'll go down there and get the feet.
21:10Is one helping for that?
21:11Yeah, I'll go in.
21:12OK.
21:13Ready, steady, slide.
21:15OK.
21:16Tell me if you need me to stop.
21:17No, you're OK.
21:18All Lewis's mum Georgie can do is watch on.
21:21Well done, Lewis.
21:23We're downstairs now, OK.
21:26Safely down, Lewis's breathing needs to be reassessed before they can move him any further.
21:31OK.
21:32Sats are good.
21:33Restoration is good.
21:34Restoration is good.
21:35You're still needing to support the airway, yeah?
21:38Yeah, periodically, yes.
21:40OK.
21:41I think the main concern is airway en route.
21:45Yeah.
21:46Hello, can you put me through to soccer, please?
21:49Concerned that Lewis can't breathe properly without his airway being supported, Manjit
21:53puts in a call for advice.
21:55So, 12-year-old, he was found by sister this morning and mum to be not right, not breathing
22:02properly.
22:03So he has some respiratory depression, but we're correcting that with a jaw thrust and we're
22:05supporting him.
22:06The concern is just airway protection.
22:09Just looking at him now, so he's having some intermittent twitching of his arms, which,
22:14again, is a bit concerning, yeah.
22:17But we're just going to give him another two milligrams of midaz now.
22:20His risks are quite irregular as well.
22:22Yeah, because now he's fitted again.
22:24As Lewis is still showing signs of fitting, another dose of the anticonvulsant midazolam is
22:29administered.
22:30Yeah, so if it's airway protection, we might be able to support the airway en route.
22:34But if we think there is some residual ongoing seizure activity, just for airway protection,
22:38we're just going to intubate, so, yeah.
22:41Intubating would mean anesthetizing Lewis to take control of his breathing.
22:46It's a high-risk procedure, but without it his condition is critical.
23:11Dave has been sedated, while critical care paramedic Andy and Dr. John attempt to realign
23:20his badly fractured and dislocated ankle.
23:23No, I don't think I can reduce it because his bones are in his joint.
23:29It's a brutal yet delicate procedure, as the protruding bone could rupture the skin, turning
23:35it into an open fracture and compromising the blood supply to Dave's foot.
23:40It's a bit up here.
23:53Okay, so, he is closed all round.
23:56Okay.
23:57The skin on this side is probably ulcerating.
24:00It's probably been out a long time.
24:02It's very unstable and spontaneously re-dislocated.
24:05Okay.
24:06Are you able to maintain circulation?
24:07Yeah.
24:08Circulation is fine.
24:09That's probably as good as it's going to get.
24:10Right.
24:11To prevent any movement that could tether skin, Dave's ankle must be immobilised.
24:23So, this needs to be really, really tight.
24:24Okay.
24:25So, it's very old fire on it.
24:30Just trying to stay out because it's so unstable.
24:36In your house and we're the ambulance people, you're very safe.
24:43Yeah.
24:44The team are using a vacuum splint to try and hold the bones in place.
24:48You just can't keep him in the joint.
24:49He basically just keeps slipping back out again.
24:52And when he slips, he slips into the skin threat position.
24:55Do you want to need a sand spin?
24:57Let's see how unstable it is.
25:00It's just...
25:03His lateral component is completely gone.
25:06So, there's nothing to hold it in.
25:08Yeah.
25:09I think, to be honest, I think if we pack this well enough, this will be just as good.
25:13It's just holding it in place while...
25:14While we do it.
25:15Yeah.
25:16So...
25:17Right.
25:18Let's try that.
25:20After several attempts, Dave's ankle is splinted and the skin is still intact.
25:25How you doing, buddy?
25:26You're in...
25:27You're in your bed...
25:28You're in your bedroom.
25:29Okay.
25:30We're the ambulance people.
25:31You're going to feel a bit strange for a little while.
25:34And that's perfectly normal.
25:35But you're safe.
25:36Okay.
25:37Dave's feeling a bit whappy.
25:38Yeah.
25:39But we're going to scoop him.
25:40All right.
25:41Ready, steady, roll.
25:42That's it.
25:43How's that?
25:45All right.
25:46Perfect.
25:47He can now be moved downstairs and into the end of the room.
25:50He can now be moved downstairs and into the end of the room.
25:54Down the stairs and into the ambulance.
25:55Ketamine facial.
25:56Ready?
25:57Are you okay?
25:58Ready.
25:59Steady.
26:00Up.
26:01Down.
26:02That's it.
26:03Okay.
26:04Ready.
26:05Steady.
26:06Heave.
26:07That's it.
26:08Well done, folks.
26:09That's it.
26:10Right.
26:11Everybody ready?
26:12Ready.
26:13Steady.
26:14Lift.
26:15John updates Dave's wife, Sally.
26:17So, he'll go to Rawlbarkshire.
26:20Now that he's awake.
26:21So, if he was still not quite conscious from the ketamine, we'd come with him.
26:22Yep.
26:23But he's waking up.
26:24He's appropriately orientated.
26:25He knows where he is.
26:26Happy that Dave's condition is now stable, John and Andy leave him in the care of the
26:27ambulance crew for the journey to hospital.
26:28We're going to get it clear if you're all right?
26:29Yeah, thank you.
26:30Thanks so much.
26:31Bye-bye.
26:32Bye-bye.
26:33We had to pull the fracture quite hard to get it back into alignment, because it was quite
26:49significantly displaced.
26:50And when we'd done that, the fracture's in lots of pieces, so it's very unstable and it
26:56He keeps slipping in and out of joints, so he will need surgery on his ankle, it's quite a nasty fracture.
27:12At a motocross track in Buckinghamshire...
27:14First ride back, mate.
27:17Critical care paramedic Joe and Dr Martin are treating Charlie,
27:21who has suffered multiple injuries after hitting a jump at 40 miles an hour.
27:26OK, so that just looks like you've got a bit of bruise.
27:28His friends were first to the scene.
27:30Were you there immediately?
27:32Well, I just tried to get some responses out of him and there was nothing.
27:35And it took two minutes to... OK.
27:38And when he did respond, how was he?
27:40Err, non-verbal.
27:41And how have you got him back here?
27:43He walked himself.
27:44And how far off from where we are?
27:46It's about 100 yards, 150 yards.
27:49A loss of consciousness for two minutes is a sign of brain trauma,
27:53and will need investigating to rule out bleeding or swelling of the brain.
27:57You're obviously a little bit sore, but that's hopefully all just bruising, OK?
28:00But I think from a head perspective, and sometimes it just takes a little bit of time for that to develop.
28:05You definitely have to go to hospital and then...
28:07To be honest, I think I'm awful, right?
28:09I think you should go to hospital.
28:10I think I might. Do you know it is? If anything, I'm a bit worried just because I've knocked out.
28:15Yeah, exactly. And I think that's why you should go.
28:18I literally woke up thinking, like, what the f...
28:20Yeah.
28:21Where the f... is this?
28:22So we may well end up scanning your head when you come to a hospital to make sure you haven't done any damage.
28:26And that's the main reason to go at the moment.
28:28We need to observe you for a bit, so I think you should go to hospital, OK?
28:31An ambulance is on its way to take Charlie to hospital.
28:34Right, this is some pain relief. It's called Penthox.
28:37If you want to start, you're new.
28:38And just... just... well, you were quite sore when I was patting you down.
28:41Try it. Pop your hand through this.
28:43And then you breathe through this.
28:45In and out through it, yeah, in and out through it.
28:47Keep your mouth nice and closed, your lips doesn't close.
28:49I don't know about that.
28:50No? OK, that's fine.
28:51You know, like, when you take a bit of medication, you know, it's just not...
28:54That's OK. That's OK. You don't have to have it.
28:56Pain relief isn't the only thing Charlie isn't keen on.
29:00What happened? Almost all.
29:01I think you should.
29:02Because you were knocked out, and we often end up scanning your head if you've done something like that, OK?
29:05And it takes us a little bit of time to make sure that nothing has happened in your head.
29:09I can't tell you, like, right now, everything is going to be fine.
29:12It was clearly at a significant impact if you were knocked out, right?
29:15And I think our colleague was saying you were going, what, sort of, 40 miles an hour?
29:18I've never been knocked out.
29:19Yeah.
29:20And I, like, literally...
29:22When I woke up and I had all these people around me, I thought, what?
29:25Like, how have I ended up here?
29:26Exactly.
29:27It's 45 minutes since Charlie's accident, and more injuries are coming to light.
29:32Yeah.
29:33Jesus, why is that like that?
29:36Well, you've got a big bruise, but underneath.
29:39Big bruise? That's a big bruise?
29:40Yeah. Yes, it will be.
29:42The lump is a hematoma, a pocket of blood that carries a risk of infection, nerve and tissue damage.
29:48So I ain't internal bleeding, is that?
29:50Well, it's...
29:51I mean, any bruise is technically internal bleeding, but not... probably not what you mean.
29:55Oh, don't spoil it, Harry.
29:56So, well, again, that might get... that might swell up again a bit more over the next few hours,
30:01so that's another reason why we need to just keep an eye on you.
30:03An ambulance crew has now arrived and will take Charlie to Wexham Park Hospital.
30:08Hello.
30:09Charlie here.
30:10He was going up one of the jump over there, about 40 miles an hour.
30:13He remembers coming down and then, basically, the guys picked him up, he'd knocked himself out.
30:17But then he's walked from there to here.
30:19His ups are all right at the moment, and, yeah, just the abrasions.
30:22It's like, on the side here, on the side here, no C-spine or any spinal tenderness, really,
30:26and no obvious immediate neurology.
30:28You guys are happy, I'm assuming?
30:29Yeah? Yeah, yeah, yeah.
30:30Sweet.
30:32I'll let these guys look after you.
30:33OK, we'll get you properly checked over.
30:35Satisfied that Charlie doesn't need any specialist treatment from the critical care team.
30:39These guys want to look after you, all right?
30:41If you do want that pain relief, then they do have it, OK?
30:43Thanks, mate.
30:44All right, you take care.
30:45He's left in the hands of the paramedics, who will take him to hospital, where he'll undergo
30:50x-rays, a CT scan, and further examination.
30:54There's an ambulance emergency, is the patient breathing?
30:59Yeah, they are.
31:00Do you want to feel cool to go to?
31:01Ambulance emergency, is the patient breathing?
31:12Yeah, they are.
31:13Do you really feel cool to go, please?
31:15So, we are at a climbing centre, and we've just had someone come off the wall and land badly,
31:20and their elbow has to be dislocated.
31:22How old is the patient?
31:23Uh, mid-thirties. Male.
31:25Yes!
31:26We're wondering if it's also maybe fractured, but definitely dislocated.
31:29Okay.
31:30We're getting some help range.
31:33UK hospitals treat over 2 million sports-related injuries each year.
31:39Climbing carries a particularly high risk of serious trauma.
31:42So, the specialist skills of Dr Jasperit Rayat and critical care paramedic Tracy Olden are required.
31:49This is a 28-year-old by the name of Matthew, who is at a rock climbing wall.
31:55He's fallen off 33 metres.
31:56I think he's landed on his left hand.
31:59And it looks like a supracondular fracture dislocation.
32:03He's in a lot of pain, and it looks like something which needs to be pulled sooner rather than later.
32:09But, uh, you can obviously be the judge of that.
32:12Okay.
32:12Super.
32:13A supracondular fracture dislocation means the upper arm has broken and the elbow joint is dislocated.
32:20Without urgent treatment, it can lead to loss of mobility, nerve damage and deformity.
32:25So, you haven't got an ambulance at the moment?
32:27Okay.
32:28No problem.
32:29Okay?
32:30Yeah, cool.
32:33The accident happened at a climbing centre in Oxford.
32:36Just 30 minutes after receiving the call, the critical care team arrive on scene.
32:41Hello.
32:42Hello.
32:43What have you been doing?
32:44I fell off there, but if anyone asks, I actually did it.
32:47You did do it.
32:49Okay.
32:49It was just, you came down then.
32:51Yeah.
32:51Any other injuries?
32:52No.
32:53What's your name?
32:53Sorry.
32:54Matthew.
32:54Matthew.
32:55I'm Jals.
32:55This is Tracy.
32:56Hello, Matthew.
32:57Nice to meet you guys.
32:57Nice to meet you too.
32:58Nice to meet you.
32:5828-year-old robotics engineer Matthew fell over three metres onto his left arm.
33:04Centre staff put an ice pack on the injury.
33:07Are you left or right-handed?
33:08I'm left-handed.
33:09Left-handed.
33:09Are you able to make a fist?
33:11I can.
33:13Good.
33:13Can you squeeze my hand?
33:14Yeah.
33:15Good.
33:15Yeah.
33:16And just open your hand for me.
33:18Yeah.
33:18Can you feel me touching?
33:19I can feel you, yeah.
33:20There?
33:20Yeah.
33:21There?
33:22Yeah.
33:22And there?
33:23There's a risk that the nerves in Matthew's arm have been crushed from the fall,
33:26so Dr. Jaspreet must assess whether he has any loss of sensation or movement.
33:31Feels normal?
33:32It feels like it hurts, but it is numb.
33:34Okay.
33:35No numbness, tingling?
33:37I mean, it's a bit numb because I've had the ice.
33:39It's tingling.
33:39I think it's all just within the normalities of it looking messed up.
33:43But no numbness, tingling in the hand?
33:45No.
33:46Okay.
33:46I feel everything in the hand.
33:47Okay.
33:48And you've got a nice strong pulse.
33:49Fine.
33:49Good.
33:50With Matthew's hand responding normally, Dr. Jaspreet turns his attention to the injury
33:55itself.
33:55I'm just going to pop these on your finger, okay, and do your blood pressure in bits.
33:58Is that okay?
33:59Yeah, that's true.
33:59Yeah.
34:00I'm just going to have a look at your elbow.
34:01Yeah, yeah, have a look.
34:02Whilst we're doing your observations.
34:03And how high do you think you were when you fell?
34:05I was on that hold there.
34:07The green one?
34:07And I was joking.
34:08I was actually at the top.
34:09Okay, so reasonably...
34:10Should we be surprised?
34:11Do you not normally climb?
34:13It's the first time I've climbed in a while.
34:14Oh, no.
34:15The team need to check if Matthew's high spirits are masking potentially serious internal injuries.
34:21It looks a bit messed up, doesn't it?
34:23Yeah.
34:24Any pain here?
34:25No, not anymore.
34:27Is that good?
34:27It's not hit the nerve there?
34:28Stuff you've got to say at the moment.
34:29Okay.
34:30And here?
34:32A tiny bit.
34:33Okay.
34:34Unsure if it's safe to straighten Matthew's arm, the critical care team will have to proceed
34:39with caution.
34:40What you need is an x-ray to determine whether that's just a dislocation, whether that's
34:44fractured.
34:45All right.
34:45Or it could be both.
34:46There you've got lots of important nerves and vessels that run through there.
34:50And I think pulling it here is probably not the best thing to do.
34:54So we're going to put the tube in.
34:58So we're going to put the tube in.
35:14Just a bit.
35:15Just a bit.
35:15In Stoke and Church, Dr. Manjit and critical care paramedic Hannah are treating 12-year-old
35:21Lewis, who has had a seizure.
35:22We're going to get a second line in.
35:24Okay.
35:25He is also struggling to breathe, so the team are preparing to insert a tube into his wind
35:32pipe.
35:32Okay.
35:33Just going to get another line in.
35:34You're doing really, really well, mate.
35:36To do this, they need to perform a pre-hospital emergency anaesthesia, which will allow them
35:41to secure Lewis's airway and take control of his breathing.
35:45All right.
35:46All right.
35:47Oh, that's it.
35:48Sorry.
35:49Sorry.
35:50Sorry.
35:51Just relax.
35:52Just relax.
35:53Okay.
35:54Okay.
35:55Okay.
35:56Stay still.
35:57Nice and easy.
35:58You're doing really well.
35:59So Manjit inserts a second cannula to administer the drugs for the procedure.
36:04That's okay.
36:05All right.
36:06Okay.
36:07All right.
36:08Okay.
36:09Waking up a bit.
36:10I think you might be a strong one.
36:12Just close to the door now.
36:13Okay.
36:14Lewis's increased movement and awareness as the team insert a second cannula is a positive
36:20sign.
36:21Oh, he's been sick.
36:24Oh.
36:25Rolling over.
36:26Well done.
36:27Sorry.
36:28I know it's not comfortable.
36:31I'm sorry.
36:32Well done.
36:33Just having a look at him.
36:34He had some much more purposeful movements was trying to sit up a little bit ago.
36:40So he actually looks like he's I think much better from a transfer point of view and not
36:46seizing anymore.
36:47I would agree.
36:48I think our risk benefit has possibly.
36:50Has possibly just shifted.
36:51Yeah.
36:52Yeah.
36:53An hour after he was found by his sister.
36:56Lewis's seizing has stopped and his level of consciousness is improving.
37:00I think actually at the moment we don't need to intubate and I think you're absolutely right in terms
37:05of risk benefit.
37:06I think it's safer not to at the moment and observe.
37:09Yeah.
37:10And I think it would hopefully make his journey a bit smoother as well.
37:12I'd agree with that.
37:13Cool.
37:14Okay.
37:15Great.
37:16Everyone happy?
37:17Yeah.
37:18Good.
37:19Okay.
37:20Having decided it's more suitable to get Lewis straight to hospital without intubating.
37:22Manchit updates Lewis's mum Georgie.
37:24You heard what we were talking about.
37:26So I think we're, yeah I think so.
37:29We've got all our things ready.
37:31So if anything changes when we're going out or if anything changes on route then we can
37:37do whatever interventions we need to do.
37:40It's fine.
37:41Yeah.
37:42As you know we're going to take really good care of him and they're fantastic.
37:44I've had your experience twice and I trust all of you.
37:49Okay.
37:50We're going to lift on lift.
37:51Hands on.
37:52Ready.
37:53Steady.
37:54Lift.
37:55Happy?
37:56Due to the seriousness of Lewis's condition, Manchit and Hannah will travel with him
38:00in case he deteriorates on the journey.
38:02Alright Lewis.
38:03I'm just going to get you in the ambulance.
38:05Mum's right here.
38:07See there she is.
38:08Hey baby.
38:09Just going to get you in the ambulance mate.
38:10Okay.
38:11How are we doing?
38:12Yeah we're good.
38:13Oh I know it's a bit tickling your nose isn't it?
38:14Lewis is being taken to the John Radcliffe Hospital in Oxford as it has a dedicated paediatric
38:28care unit.
38:29The latest blood pressure reading is 76 over 47.
38:33He's got a good tempo pulse yeah.
38:35Blood pressure, heart rate and other vital signs can be unstable after a seizure.
38:40So Lewis is closely observed.
38:43See you again with an apology.
38:45Need a little drop of blood.
38:47No.
38:48Thanks to the rapid response of the critical care team, Lewis is no longer seizing and handed
38:53over to the emergency paediatric team for urgent assessment.
38:56It was a real team effort between everyone wasn't it?
38:59The ambulance service came in, they kind of picked up exactly immediately where we were
39:04headed, that we needed to get extrication sorted, they managed all of that.
39:07He's actually sitting up now in A&E with his mum doing really well, yep.
39:12And most importantly in that scene I think is his little sister.
39:17Big kudos to her because she absolutely saved his life by raising the alarm this morning
39:22and highlighting to mum that something was wrong.
39:24So yeah, well done her.
39:37At a climbing centre in Oxfordshire.
39:39Okay, I think probably the best thing we can do for you is some gas to breathe in and out.
39:44Critical care paramedic Tracy Olden and Dr Jaspreet Rehatt are treating 28 year old Matthew,
39:50who has had a badly broken arm and dislocated elbow after falling three metres.
39:55So what you need to do is you can use your good hand, if you hold onto that for me,
40:00just pop your mouth round it and take some nice deep breaths in but keep your mouth round it when you breathe out as well.
40:06With important nerves and blood vessels around the injury,
40:09it's too risky to straighten Matthew's arm here.
40:12So he's been giving a potent form of pain relief before they can move him.
40:16So breathing in and out through there Matthew.
40:18It might make you feel a little bit funny but that's normal, okay.
40:21And then what we'll do is we'll dose you up on that and then we'll try and get a splint round it,
40:25just to get you a bit more mobile, okay.
40:27Is it taking the edge off a bit?
40:29Maybe, I'm not feeling any like high or anything.
40:31It's okay, keep going.
40:33Take some nice deep breaths.
40:34Keep going.
40:35Keep going.
40:36Deep breaths.
40:37Deep breaths.
40:38Keep your mouth round it all the time.
40:40That's it.
40:41Good lad.
40:42Keep going.
40:43Dr. Rayet is preparing a foam covered aluminium splint that can be moulded to support Matthew's arm.
40:49Oh, I'm feeling a bit light-headed now, yeah.
40:51Yeah, that's perfectly normal.
40:52Oh, fuck.
40:53All right.
40:54Listen.
40:55Oh, fuck that hurts.
40:56You're not going to go anywhere.
40:57You keep going on the gas.
40:58Keep going.
40:59You're not going anywhere.
41:00Deep breaths.
41:01Deep breaths.
41:02The splint is in place, but it needs to be secured.
41:06Fine.
41:07We're going to set you up in just a moment.
41:09All right.
41:10I'm going to pop this.
41:11Do you want to hold that and keep using that if you need it?
41:13Oh, Phil, I'm going to conk out this.
41:15No, you're not conking anywhere.
41:16You're on the floor, okay?
41:17All right.
41:18We've got you.
41:19Okay, on through.
41:20One, two, three.
41:21Can you set yourself up?
41:22Oh, sugar muffin.
41:24Oh.
41:25That's the politest thing I've ever heard anyone say.
41:28How's that?
41:29I don't know.
41:30Those drugs are probably quite good.
41:31Yeah.
41:32Wait, are those drugs actually affecting me?
41:34Oh.
41:35Yeah.
41:36I can't believe those drugs have affected me.
41:38Are they actually supposed to do that?
41:39They can make you go funny.
41:41Now, Matthew is upright.
41:43Yeah, so if I'll pass this round to you.
41:45No, no, no.
41:46And enjoying the pain relief.
41:48Oh.
41:49Under the arm.
41:50Wee-wah.
41:51They can finish immobilising his arm.
41:53We come round the, just under the.
41:55You're funny.
41:56Underneath.
41:57Yeah.
41:58Can you go in?
41:59Amazing.
42:00All right?
42:01Good lad.
42:03With the splint now secure and holding Matthew's arm in place,
42:05he's ready for the trip to hospital.
42:08What the plan is, is we're going to see if somebody would be able to give you a ride down to the hospital.
42:13Take your time.
42:14It's okay to take it here for us.
42:16He's doing really well.
42:17He doesn't really need an ambulance to take him to a hospital.
42:20So, do you have a car here?
42:22We have his car here.
42:23Okay.
42:24He can drive.
42:25Amazing.
42:26What we'll do is we write some notes and we'll send it to the hospital.
42:29So they'll be able to see that we've been out.
42:31All right.
42:32No problem.
42:33Okay.
42:34They're happy to drive him down.
42:35Okay.
42:36Cool.
42:37Once he's settled a little bit.
42:39Matthew's lifter hospital may be organised, but he's still enjoying the benefits of penthrops.
42:45You've been so good.
42:48I'm sorry.
42:49I'm acting like an absolute dude.
42:50No, you're fine.
42:51I'm so sorry for being a good dude.
42:52Can we get you into the car?
42:54Come on then.
42:55I'm just being an idiot.
42:56Just take your time.
42:57Take it nice and steady.
42:58Watch where you're going because we don't want you to hurt anything else.
43:03Matthew is going to the John Radcliffe Hospital in Oxford, where he'll undergo further treatment.
43:08All right.
43:10Pleasure.
43:11Nice to meet you.
43:12Take care, guys.
43:13Drive safe.
43:14Bye.
43:15He'll need x-rays in hospital to determine what the injury is, really.
43:22Possibly an elbow fracture or a dislocation elbow.
43:25Slightly swollen, quite tender.
43:27I should imagine he'll make a full recovery once he's had his fracture or dislocation treated.
43:33And he should be able to use his left arm again.
43:36If you look there, still don't mind coming off.
43:37Blessing you in the morning.
43:38Take care, guys.
43:39Take care, guys.
43:40Opamente!
43:41All-ctica teeth are now⅛
43:45You are all ultimately beenupy of an orphanage.
43:46Pulling out before the injury.
43:49Don't even fold them apart.
43:50Almighty change...
43:55You are all alone.
43:58Don't be access to the infantry.
44:00Don't be anak- plays.
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