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00:00En el mundo de emergencia médica
00:03¿Se está calmando?
00:04No, no, no
00:06Ni nada más extrema
00:08Los ojos son blu
00:10Que un gran peligro de vida
00:12Un gran riesgo, gran duro
00:14Respiras a los más tremendos 999
00:18Esa señora está en la cabeza
00:21Y es menos Johnson
00:23Versos avnaciones vehículos
00:24de la vecina de la Valle Air Ambulance
00:26La mujer está ataca en la inseguridad
00:27La mujer está en Covid
00:29...are at the front line delivering life-saving medical treatments.
00:32The big decision is for us whether we need to put a tube in again to protect us that way or not.
00:36Working day.
00:37We're going to give you some strong medication.
00:40And night.
00:41It should not hurt. It's a very good painkiller.
00:44Reacting to emergencies.
00:45You've been super brave, Dallin.
00:47The critical care teams.
00:48You'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.
00:54That will mean that you don't know what we're doing whilst we straighten your ankle out.
00:57Whenever.
00:58Do you think it's fast?
00:59Potentially, yeah.
01:01And wherever.
01:02Oh, my leg!
01:02It's needed.
01:04You are doing a fantastic job.
01:06Filmed over three months.
01:08Let's have your arm, my dad. Let's give you some of this morphine.
01:11Just be aware he might stop spontaneously ventilating.
01:14I have the tube.
01:15We captured every vital second.
01:18That's okay. You're safe.
01:20As 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.
01:32Let's go, go, go.
01:34Tonight.
01:35He looks a bit pale, doesn't he?
01:36A crash on the motorway leaves the passenger critically injured.
01:41So priority is to just get him in and out of the cold, yeah?
01:44A man in cardiac arrest is fighting for his life.
01:47Right, everyone clear then, please. Clear.
01:49Wait.
01:50A child suffers multiple seizures and is unresponsive.
01:55Elena.
01:55I'm one of the doctors.
01:57And...
01:58He doesn't record the events at all.
02:00A pensioner out for a cycle ride is seriously injured after colliding with a car.
02:05Do you remember what's happened?
02:06No.
02:07No.
02:07Okay.
02:22Is he breathing?
02:26Yes, he is breathing.
02:28He's just collapsed.
02:29Is he awake at the moment?
02:31No.
02:31Does his breathing sound noisy?
02:33Yes.
02:34No, he's not breathing out.
02:38No, he's not breathing.
02:41He's not breathing.
02:43Okay, you need to listen to what I'm about to say to you.
02:46If he's not breathing...
02:48Ok, tú...
02:53You have a defibrillator there right now.
02:57Continue doing the compression,
02:58and then you need to turn on the defib and listen to it,
03:01but get the person to carry on doing the compression.
03:03La persona que está haciendo las compresiones
03:05¿Can they say push out loud
03:07So I know how fast they're going please
03:09Push, push, push, push
03:12Perfect, keep going at that rate
03:13Follow what the D-Fib is telling you to do, ok
03:15So we've got crews already on the way
03:18With the man collapsed and unresponsive
03:24But vitally being given CPR on scene
03:26The specialist life-saving skills
03:28Of Dr. Laura Douglas Beveridge
03:30And critical care paramedic Hannah Hurst
03:33Are urgently required as every second counts
03:36We've been tasked to a patient
03:37Who unfortunately has gone into cardiac arrest
03:39They've had immediate bystander CPR
03:41And the crew have now arrived on scene
03:44We have had to travel some distance
03:48So at the time that we arrived
03:49There will have been potentially in cardiac arrest
03:51For quite a prolonged period of time
03:54So in the time frame
03:56If we haven't got rust
03:57Then we're probably not going to have a huge amount of margin
04:01In terms of what's salvageable
04:03Yeah
04:03Every year there are over 30,000 cardiac arrests
04:07Outside of hospital
04:08Early CPR and defibrillation
04:11Can double a patient's chance of survival
04:13Although time is critical
04:15As less than one in ten survives
04:17Oh, they've actually now just had one shock for VF
04:20Interesting
04:21So TL said initially asystolic
04:24Now VF
04:25One shock given
04:27An ambulance crew are on scene
04:29Okay, so that's a bit more of a favourable possibility
04:32They'd shock the patient to encourage his heart to restart
04:36As yet, it hasn't
04:39But there is some faint electrical activity known as VF
04:43I'll call in here
04:44The critical care team are needed for their expertise in cardiac arrest emergencies
04:49Hello
05:01Hello there guys
05:04Hello
05:0472 year old retired college lecturer Steve
05:08Was travelling with his wife Liz
05:10When they stopped to stretch their legs in Reading services on the M4
05:14After stepping out of the car
05:16He collapsed and went into cardiac arrest
05:19A Lucas machine is now giving vital chest compressions
05:22One hour and wide we were asystolic
05:24Shortly halfway to VF
05:26And he was shocked once with us
05:27So we are back into an asystolic rhythm
05:29Yeah
05:30Asystolic rhythm means Steve's heart still isn't beating
05:33So we'll need further shocks
05:35In the hope it restarts itself
05:37Okay, everyone stand clear please
05:39Everyone clear
05:40Shocking
05:41It's early morning at Thamesburg
05:52Valley Air Ambulance HQ
05:54And critical care paramedic Barry Walsh
05:56And Dr. Henry Knott
05:57That's a minute, 20 miles
05:59Are collecting vital equipment and drugs
06:02Only they carry out on the road
06:03When the first emergency of the day comes in
06:11Another, but very different motorway incident
06:16This emergency call is between two control centres in neighbouring counties
06:35I've just taken a call for an Arthur you see on the M40
06:40Just order him with ourselves and you
06:42Not a problem
06:43What details have you got?
06:45So it's come through as a car flipped over into a verge
06:48So a car roll over into a verge?
06:50It's saying junction 11 down to 10
06:53And obviously may need some quick care
06:56Both fire and police have confirmed that they're on route
06:59Is that correct?
07:00Yeah, that's correct
07:01And it's unknown if patients breathe in a wake
07:03Good morning
07:07Good morning
07:08It's literally just before junction 11 northbound
07:13A report of the car roll over into a verge
07:18If we get an update, we'll do it shall
07:20A serious crash with patients in potentially critical condition
07:25Means the specialist's life-saving skills and drugs
07:28Carried by the Code Red team
07:29Are instantly requested
07:31It's a road traffic collision
07:34RTC or the M40
07:37It sounds like one car's come off the road
07:39And rolled and overturned
07:41Down the sort of embankment
07:43And there seems to be two patients who are injured
07:46One who's still in the car
07:48Maybe with pelvis or abdomen injury
07:50And the other one
07:51Who's actually got themselves out of the car
07:53But we don't know the extent of their injuries at the moment
07:57On average, someone is killed or critically injured
08:00Every 17 minutes on UK roads
08:03With their advanced training
08:05Thames Valley Air Ambulance critical care teams
08:07Can deliver hospital-level care at the roadside
08:10Hi, just to update you
08:12I've just spoken to the cruise-on scene again
08:14So they tell me that one patient is in the vehicle
08:19They're about to extricate them
08:20And they've got concerns around pelvis and fever injuries
08:22The second patient is out of the vehicle
08:25Henry and Barry arrive on scene
08:28Had a good job of getting stuck in there
08:31Where multiple emergency vehicles are in attendance
08:34I'm in the hovers
08:35Yeah
08:36Hiya
08:43That's the car
08:44Can you see the roof?
08:45Yeah
08:45Operations commander Steph White
08:49Has been coordinating the ambulance service's immediate response to the incident
08:53And briefs Dr Henry
08:55So he's travelling 17 miles an hour
08:58He's flipped over
08:59Bystanders' car
09:00He's flipped car back over
09:02This gentleman was initially the P1
09:05However, I think they're probably both P1s
09:07Given his blood pressure now as well
09:09Okay
09:09A P1 designation means the casualty is of the highest priority
09:14This team have a line-in
09:17Access
09:17They have given one gram of TXA
09:21And they are just popping a pelvic binder on
09:23Because the position that we were in was quite tricky
09:25The driver of the car is already being treated in an ambulance on the hard shoulder
09:30Fortunately, the passenger has now also been extracted from the vehicle
09:35And you're both worried about their blood pressures
09:37And yeah
09:37The one's more tachycardic than the other one
09:39Tachycardic means their heart rate is fast
09:43Hello
09:43Causing blood pressure to drop
09:45Can you open your eyes for me?
09:47Good man
09:48Preventing vital organs like the brain and heart
09:51From getting enough oxygen to function normally
09:53What's your name?
09:55Okay
09:55Gonna borrow your arm, Tom
09:57Thank you, sir
09:5728-year-old Tom was the passenger in the car
10:01When it crashed, rolling down an embankment
10:03At the time, he was asleep
10:05With his legs resting on the dashboard
10:07I'm Henry, I'm one of the doctors
10:09Just come to have a look at you
10:10This position could cause serious injuries
10:12To the lower half of Tom's body
10:14Do not let me delay you
10:16Get the pelvic binder on
10:17Potentially, he's broken his pelvis
10:20And that risks life-threatening internal bleeding
10:23But there could be further undiscovered problems
10:27He looks a bit pale, doesn't he?
10:28Oh, I think he is
10:29Ambulance emergency is the patient breathing
10:57She's having a seizure
10:59She's having a seizure
11:01And how old is she?
11:02She's seven
11:03Should I get this help arranged now?
11:05Stay on the line with me
11:06I'm going to ask a couple of questions
11:07Has she been diagnosed with epilepsy?
11:10Yes, she has got epilepsy
11:11She does move any objects out of the way
11:13To protect her head
11:14To hurt herself
11:15Lose any tight clothing at her neck
11:17Don't try to move her
11:18While she's having a seizure
11:19We have emergency treatment to use
11:22If the seizure doesn't stop
11:23Yeah, but this is her fourth seizure
11:26You say fourth seizure?
11:28Back to back?
11:30Yeah
11:30And now this is the longest one
11:32You've got a high-priority ambulance range for her
11:35Are you staying with her until we get there?
11:38I am with her
11:38You're staying on here for six miles anyway, okay?
11:45With the patient just seven years old
11:48And suffering prolonged and potentially dangerous seizures
11:50Dr. Tom Porter and critical care paramedic Lisa Brown
11:54Are instantly dispatched
11:56So we are going to a seven-year-old girl
12:00Who's having seizures
12:01The information suggests that it's a fourth seizure in a row
12:04It sounds like this girl is known to have seizures or to have epilepsy
12:10Because they have some medications at home
12:13Beyond that, we don't have much more information
12:15In the UK, epilepsy is one of the most significant long-term neurological conditions
12:22Affecting over 110,000 children in the country
12:25Seizures are extremely serious
12:28And can prove fatal unless quickly dealt with
12:31There's certainly significant harm that can be caused
12:33If a child is having a prolonged seizure
12:36If that's the case, we call it status epilepticus
12:38And the priority is to stop the seizure
12:40Also, when people are fitting
12:42They may have a reduced level of consciousness
12:44Which can mean that it's difficult for them to support their own airway and breathing
12:49And so sometimes we need to intervene from that point of view as well
12:52Just ten minutes later
12:56The critical care team arrive at the patient's house
12:58Where an ambulance responder is already in attendance
13:01Hiya
13:06Hello
13:06How are you?
13:07Seven-year-old diagnosed with epilepsy
13:09She's not having seizure at the moment
13:12She is reacting to pain
13:14Mom and dad give some buccal midazolam
13:17And just because the episode was longer than normally
13:22That's why they called
13:23Midazolam is a drug used to stop seizures
13:26It's already prescribed to Elena
13:29Oh, hello
13:30Hello
13:31Okay to come in
13:32Yeah, thank you
13:33Hello there, sir
13:34We're the critical care team
13:37My name's Tom
13:39My name's Lisa
13:40What's your name, sorry?
13:41My name is Camille
13:42Thanks, Camille
13:43Thanks, Camille
13:44And who is this?
13:45It's Malena, seven-year-old
13:47Seven-year-old Elena is autistic
13:50And has had epileptic fits from six months old
13:53People with autism
13:54Are significantly more likely to have epilepsy than most
13:58Due to underlying genetic and biological factors
14:01She had today four episodes of seizure activity
14:05Unusually today, Elena's had multiple seizures
14:09Mom and dad have given her the buccal midazolam
14:12What time was it?
14:145.23
14:155.23, the activity stopped
14:18So, the last seizure started 1712
14:21In 1727, it stopped
14:25Elena?
14:27Hello, darling
14:28Hello
14:29A common side effect of midazolam is drowsiness
14:33So Dr. Tom has to check
14:35She can breathe unaided
14:36Why, Tom, I'm one of the doctors
14:38Okay
14:39So at the moment she's maintaining her own airway, isn't she?
14:42She is, she is autistic
14:44She is not verbal
14:45Thank you, that's really helpful to know
14:47So her baseline is non-verbal, not me, okay
14:49Okay
14:50She looks to be breathing at an appropriate rate
14:53Yeah, okay
14:54Had she stopped fitting by the time you got here?
15:00She was not fitting
15:01She's been like this since you were here
15:02Tom begins a primary assessment to check her vital signs
15:07She's got a nice strong radio
15:09She's got a good air entry
15:10She's got sat to 97% on air
15:12One, two, three, four, five
15:16She's warm and well confused
15:18She's got a normal tone at the moment
15:22Although Elena has stopped seizing
15:24Elena, hello darling
15:26There's further shocking news
15:28That could impact how the critical care team proceed
15:31Around two weeks ago
15:32She has been involved in an RTC
15:34And the airway is good
15:35Breathing looks all right
15:48There are around 900 RTCs
15:52Or road traffic collisions
15:53Every day in the UK
15:54And on the hard shoulder of the M40 in Oxfordshire
15:57Dr. Henry and critical care paramedic Barry
16:01Attending to 28-year-old Tom
16:03Yeah, he's not breathing too quickly
16:06He's got a lot of bruising around his pelvis and no abdomen
16:09So I'm guessing abdominal
16:11Can you ask him if he's got tummy pain if I press?
16:14He doesn't... OK, OK
16:15Tom was a passenger in a car that rolled down a verge
16:18The driver is already being treated in an ambulance
16:21Although conscious, Tom's in critical condition
16:24With a potential pelvic fracture that could cause life-threatening internal bleeding
16:30Tom, I'm going to put a little cannula in your arm, sir
16:32So I can give you painkillers, OK?
16:34Barry, I know we said we'd stick together
16:36But his intra-abdominal pelvis mainly isolated there
16:40Is what am I working diagnosis
16:41Needs blood and go
16:43I'll have a quick look at him and then come and let you know the difference
16:46The team need to assess both patients
16:48To work out who needs their help the most
16:50So while Henry checks on the driver in the ambulance
16:53Barry prepares to administer morphine to Tom for rapid pain relief
16:57The pelvic bind is on, O2 is on
16:59He's got two points of IV access
17:01Problem is C, intra-abdominal pelvic
17:03Is his femur gone as well?
17:06Okay, cool
17:07So we'll do a sort that out in the truck
17:09Alongside the pelvic injury
17:11The ambulance paramedic also suspects a fractured femur
17:14The strongest and longest bone in the body
17:17That connects the hip to the knee
17:19So let's get him out of the cold
17:20Because that's not going to help his coagulation
17:22We need another gram of TXA
17:24TXA is a drug to help Tom's blood clot
17:27I'm going to start blood in the truck, okay?
17:29So priority is to just get him in out of the cold, yeah?
17:33I think just go
17:34Just go with this truck
17:35With the driver sent straight to hospital
17:38Henry's priority is now with Tom
17:41Okay, how are we getting on here
17:44With that sort of plan of pelvic spin, OBS
17:47A suspected broken pelvis and pain in his abdomen
17:50Indicates Tom does have internal bleeding
17:53This can lead to organ failure
17:55Even death
17:56I just want to confirm what we think
17:59Is our blood pressure is our problem here
18:00Just pelvic and abdate
18:01He'll need a vital blood transfusion
18:04Before he can be taken to hospital
18:06I think volume and go is what it looks like
18:09That's his third truck in total
18:23In the car park of Reading Services on the M4
18:28Critical care paramedic Hannah and Dr. Laura
18:31Are attending to 72-year-old Steve
18:33Who's had a cardiac arrest
18:35Currently he has no heartbeat or pulse
18:37And with every minute passing
18:39His chance of survival is decreasing
18:41So just to confirm
18:43We've still got oxygen in the cylinder?
18:45Okay, so we'll need the next cylinder ready
18:47If we can get a new cylinder of oxygen, please
18:50The team are using a Lucas machine for chest compressions
18:53And shocking his heart
18:54Using the ambulance crew's defibrillator
18:57Get this pad behind
18:58Once we've got that adrenaline on
19:00Adrenaline is vital during a cardiac arrest
19:03It increases blood flow to the heart
19:05Improving its chances of regaining a rhythm
19:08Okay, so my suggestion would be then
19:12Hannah, if you're happy to do the defib
19:14From our machine now on the new pads
19:16And then subsequently, Hannah will do dual sequential
19:20On both machines
19:21If the single shock from Hannah's doesn't work
19:24Everyone clear? Shocking?
19:26Lovely
19:26She'll try giving dual shocks using both machines
19:29Okay, okay, and do we have any next of kin
19:32Who are here with him?
19:34Somewhere
19:34Fine
19:35The increased energy of dual shocks
19:38Could encourage Steve's heart to restart
19:40Bringing ROSC
19:41Or return of spontaneous circulation
19:43Can we get fingers on a pulse
19:45Just in case that rhythm has changed
19:46Before we stop, please
19:48The Lucas machine is switched off
19:50So the team can gather precise readings
19:52From the monitor
19:52Hopefully the single shock and adrenaline
19:55Have been successful
19:56Okay, that is via
19:57The monitor is showing some faint
19:59Electrical activity in Steve's heart
20:02Are we going dual?
20:03But it's not enough to sustain life
20:05Okay, so chaps
20:07We're going to do two shocks back to back
20:09We don't go back onto the chest or touching
20:11Until Hannah's delivered the second one
20:12And given the instruction, okay
20:13And both will be delivered by Hannah
20:15Right, everyone clear then, please
20:19Clear
20:19Wait
20:20Thank you
20:22Okay, lovely stuff
20:24Rhythm check
20:25Fingers on pulses, please, first
20:28Thank you
20:29Okay, we are asystolic
20:31Back on
20:32Even with the double shock
20:34Steve is still asystolic
20:36His heart is yet to restart itself
20:38Okay, I've got fingers on a pulse
20:40Dr. Laura searches for any sign of life
20:43Okay, we have the odds complex
20:47I can't feel any pulse
20:48Okay, back on with the Lucas then, please
20:50Lucas battery
20:54After giving continuous chest compressions for 40 minutes
20:58The Lucas machine's battery is running low
21:00And needs changing
21:02Let's have a little bit of warning
21:03Into the rhythm checks
21:04So, ace is solid on the monitor
21:06Steve's chances of survival are diminishing
21:10And whilst the Lucas battery has changed
21:12Okay, I'm just going to do some CPR
21:14Yeah
21:14Hannah takes over
21:16ND25 message to the HEMS desk over
21:41On the busy M40 motorway in Oxfordshire
21:44Critical care paramedic Barry and Dr. Henry
21:47Are attending to Tom
21:49A passenger in a car that's crashed down the embankment
21:52At the time he was asleep
21:53With his legs on the dashboard
21:55Just an update here
21:59Patient 2, the patient we are going to travel with
22:02We're just getting into the DMA
22:05Probably going to start some volume
22:06And going to the JR
22:08But that's the update
22:09Over
22:10Tom's potentially broken his pelvis
22:13Fractured his leg
22:14And has internal bleeding
22:15So the team need to give him a vital blood transfusion
22:19I want to get him on my monitor guys please
22:21So he needs a blood pressure
22:22The critical care teams are the only people on the road
22:25Allowed to do this
22:26Do you want to start
22:27Do you want to get some ketamine
22:29Henry and I start doing some blood, yeah?
22:31Yeah
22:31If Tom has internal bleeding
22:34Blood is seeping into body cavities instead of organs
22:37A transfusion restores red blood cells
22:40And the plasma that carries them
22:41Vitally improving oxygen delivery
22:44What is his blood pressure?
22:46He's unable to read blood pressure
22:48That's okay
22:48He's got a radial doesn't he?
22:50We've got radial, yeah
22:51Yeah, lovely
22:52Right, I need to keep him warm, mate
22:54I'm closing the back here, okay?
22:55You know, I think this guy's femur's gone as well
23:03What I'm going to do, Tom
23:06Is I'm starting to give you some blood
23:07The blood bags will be attached to one of the cannulas
23:10I think you're bleeding in your tummy, okay?
23:13I'm going to give you some fresh, clean blood
23:15Where did that hurt?
23:17Where is that hurt, Tom?
23:18In the belly
23:19Your tummy?
23:20Yeah
23:20Okay, mate
23:21That is flying through, mate, okay
23:24The transfusion is swiftly underway
23:27Starting with the yellow plasma
23:28Before the red blood cells are added
23:30Tom, I'm going to give you some medical, clean ketamine
23:34It's going to really help, okay?
23:35Ketamine is then administered for rapid pain relief
23:38So, blood pressure
23:40It's now cycling and connected and turned off
23:43With Tom's pain now dulled with ketamine
23:46Dr. Henry can properly assess his injuries
23:49I think he's done his left hip
23:51Has he done his ankle?
23:53Maybe his pelvis
23:54Yeah, but it's not open
23:56No
23:57So, I think we leave that
23:58It doesn't look that deformed
23:59The big bruising
24:00It's much shorter, though, isn't it?
24:01Yeah
24:01That left leg's shorter
24:02Femur
24:03Is swelling here
24:05So, he might have done
24:06There was a lot of swelling there
24:07So, he might have done his femur
24:09Should we ask him?
24:09Yeah, let's do that
24:11Tom, just need to slip this up
24:13Around the top of your leg, okay?
24:15Pull your leg a bit straight
24:17Because I think you've broken the big bone here
24:18In your leg, sir
24:19It seems Tom has broken his femur
24:22So, it's critical the team realign his leg
24:25So, the blood flow isn't compromised
24:27Be as gentle as I can
24:29Sorry, sir
24:32Give you more of that painkiller now, all right?
24:38Okay, sorry, mate
24:39Extremely painful
24:42But Barry has to pull Tom's leg down
24:44To straighten it
24:45Using a Kendrick traction device
24:47A splint designed to stabilise fractures
24:49So, when you're
24:51In a position to tighten
24:53Yeah?
24:53I'll give another ten
24:54I'm ready
24:55Tom, just gonna put a little pressure on here, mate
24:58Okay, stop
25:00Sorry
25:00Okay, sorry, Tom
25:03Sorry
25:03Just giving a bit more
25:05Tom, gonna put some more pressure on this leg
25:09Sir
25:10He might moan a bit
25:12But
25:12I'm gonna draw up some more ketamine
25:19I am at the limit there now, mate
25:23Tom's legs are now equal in length and realigned
25:26I'll re-blanket him
25:29And then we're good to go, yeah?
25:30Yeah, mate
25:30Blood pressure's good
25:31Heart rate's okay
25:32Sats has always been fine
25:34Our primary survey just thinks
25:35Pelvis, left hip
25:37Maybe femur
25:38We'll just give him ketamine on the way
25:40Um, do you want to start moving?
25:42Is that okay?
25:43Happy with that?
25:44Yeah, mate
25:44You're doing really well, sir, okay?
25:50All right, it's now one, two, nine
25:56All right, let's get the IVP on his left arm if we can, please
26:00And can we get some Ondansetron up too, please?
26:03Intravenous paracetamol will further help Tom's pain
26:06While Ondansetron is an anti-sickness drug
26:09Hello
26:11Hello
26:12You're okay, sorry
26:13You're in the ambulance going to hospital
26:16Because you hurt your hip
26:17Henry, I'm one of the doctors
26:20We've given you some ketamine
26:22Which is a good pen killer
26:23That's why you feel really weird
26:24But you're okay
26:26We're looking after you
26:27Where am I?
26:28You're in the ambulance going to the John Radcliffe Hospital Oxford
26:31We're taking you to the hospital
26:33Because you injured yourself
26:34It takes 32 minutes for the ambulance
26:37To reach the John Radcliffe Hospital
26:39You're going to be all right?
26:40Yeah, you'll be all right, yeah
26:41Where Tom's admitted for further emergency treatment
26:44Dr. Henry and critical care paramedic Barry
26:48Will shortly be ready for their next life-saving job
27:01She has been complaining of some abdominal pains
27:05In Buckinghamshire, critical care paramedic Lisa and Dr. Tom
27:09Are attending to 7-year-old Elena
27:11Who's autistic and has epilepsy
27:13She has been in a hospital
27:15Today, she suffered multiple seizures
27:17There has been no history of head injury during that episode
27:22Two weeks ago, she was hit by a car
27:25Today, before the event, she was actually holding her side
27:31Which mum and dad says that it has been normal since the event
27:35Elena ran in front of the car
27:38But fortunately, it wasn't at speed
27:40And she was left relatively unscathed
27:42However, it's possible the trauma could have sparked the seizures
27:46Right now, I think the picture we're seeing
27:48Is someone who's had the benzos, right?
27:49But I think she's breathing in an appropriate way
27:51I don't think we need to intervene anyway at the moment
27:52One thing I was going to ask
27:54Because we don't have one here
27:55Can we get our nasal and tidal out and stick it on?
27:58Elena's airway is working normally
28:00But as a precaution
28:01Tom wants to fit a nasal cannula to monitor her breathing
28:04In case things take a turn for the worse
28:07When is the last time, before today
28:10That she had a seizure like this?
28:12Six weeks ago
28:13Six weeks ago
28:14Okay
28:15And can you tell me that it's normal for her
28:19Not to communicate verbally?
28:21It's imperative that Tom gathers all the information he can
28:25On Elena's autism and epilepsy
28:27Before making any decisions on how to proceed
28:30So today, how has she been in herself?
28:34Fine
28:34Then her lips went white
28:36And her face went pale
28:38And then she started going blue
28:39Okay, that must have been really scary
28:41I think it's much more likely that what we're seeing is an epileptic seizure
28:43Rather than a, you know, traumatic
28:45Something for a traumatic injury
28:46Tom's assessment is Elena has most likely had a normal epileptic seizure
28:52Not one triggered by possible brain trauma from the car accident
28:56Which hospital does she normally go to for her epilepsy care?
29:00Stoke Mandeville
29:01She definitely needs to go to the hospital
29:02And the reason she needs to go to the hospital is to be observed
29:05I don't think we need to do any sort of critical interventions to reassure you
29:08As Elena doesn't require any further treatment at the scene
29:12Tom is happy for her to be taken to Stoke Mandeville Hospital
29:16Okay, okay
29:18There we go
29:19Hello you
29:20Ready, prepare, lift
29:22And I'll just low down now
29:24Happy
29:25Hello
29:33Hello, we're in the back of an ambulance
29:35On you, yeah
29:37Well, I'll keep the blank off
29:42Because
29:42Hello
29:43We're clearly seeing a significant improvement
29:46Yeah
29:47I'm more inclined to not go with that
29:50I'm happy
29:51Because she has nicely recovered
29:54Happy to not go with
29:55Happy to not go with
29:57Yeah
29:57The very good news is that Elena seems to be recovering well
30:00All the best, Mum
30:02You take care
30:03See you later
30:04The critical care team are confident
30:06They're not needed for the onwards journey
30:08The next steps now is for her to go to Stoke Mandeville Hospital
30:11They will probably just do a period of observation
30:14But obviously if things do deteriorate
30:16Then she's going to be in the right place
30:17With the right people
30:18To obviously manage
30:18Manage her epilepsy
30:20Two six hems there
30:24Thank you, just to let you know
30:25We are now clear
30:26On scene
30:27Ground assist
30:28And then she's going to be in the right place
30:29And then she's going to be in the right place
30:30And then she's going to be in the right place
30:31And then she's going to be in the right place
30:32And then she's going to be in the right place
30:33And then she's going to be in the right place
30:34And then she's going to be in the right place
30:35And then she's going to be in the right place
30:36And then she's going to be in the right place
30:37And then she's going to be in the right place
30:38And then she's going to be in the right place
30:40And then she's going to be in the right place
30:41And then she's going to be in the right place
30:42And then she's going to be in the right place
30:42And then she's going to be in the right place
30:43¿Qué pasa?
31:13He's responding, but not fully.
31:15So he's making some noise, but not verbalising fully.
31:19Has he got any bleeding?
31:21He's bleeding from a head injury.
31:26With the report of an elderly gentleman who's semi-responsive with a head injury
31:31after being knocked off his bike and not wearing a helmet,
31:34Dr Asher Lewinson and critical care paramedic Matt Bailey are immediately dispatched.
31:43All right, we're going to a road traffic accident.
31:4880-year-old, knocked off a push bike by car, not wearing a helmet,
31:52bleeding from a head.
31:54I've got a vehicle on scene anyway at the moment.
31:56My heart goes out to this guy if he is actually seriously injured.
31:59On average, two cyclists die, and 80 are seriously injured every week on UK roads.
32:06Although wearing a helmet can significantly reduce the chance of a serious head or spinal injury.
32:13We don't know much information at the moment.
32:15We know that it looks like it might be an 80-year-old gentleman
32:18who's been on a push bike and been hit by a car.
32:2246% of bike fatalities result from collisions with cars.
32:27Sounds like he might have a head injury and possibly reduced conscious level.
32:32We're not far from seen, so we've been sent quite early, basically.
32:36Head injuries can be extremely serious.
32:38So keep your eyes peeled now for where we're heading.
32:42Potentially resulting in skull fractures and damage to the brain.
32:46There we go, there's a truck down the left.
32:49I'll pull over just onto the other side of the rear red zone.
32:58I'll come back for anything else, will you?
33:00Sounds good.
33:05Hello, guys, you all right?
33:06An ambulance crew are already in attendance
33:08and have moved the patient into their vehicle.
33:11Christian, an 84-year-old gentleman,
33:13was riding his bicycle around the roundabout this morning.
33:16He's fallen to the ground, bike's gone under him,
33:18sustained a head injury left-hand side,
33:20approximately four minutes loss of consciousness.
33:24He was assisted off the road by a parcel by,
33:28and we brought him in.
33:29He has been quite significantly hyperintensive with us.
33:32He is not known by a propensity.
33:34Hypertension means 84-year-old retired teacher Christian
33:38has high blood pressure,
33:39potentially as a result of the accident.
33:42It can elevate the risk of both a heart attack or stroke.
33:45And there's also another concerning problem.
33:48He doesn't record the events at all.
33:50He has been able to in the corner's address.
34:14In High Wycombe, 84-year-old Christian was riding his bicycle
34:18when a car knocked him off.
34:20He lost consciousness, has a large swelling on his head,
34:23unusually high blood pressure, and can't remember the event.
34:27Are you guys happy?
34:28I'll just do a quick Dr. Thomas, see what we're up to.
34:29Hello, young man.
34:31Dr. Asher and critical care paramedic Matt are on scene.
34:35How are you doing?
34:36No, I'm a bad thought, because I don't remember what led to all this.
34:41Memory loss or amnesia is extremely concerning.
34:44It could mean Christian has a traumatic brain injury.
34:48Okay, what's your name?
34:50Christian.
34:50Christian.
34:51My name's Asher, I'm one of the doctors of the air ambulance, all right.
34:53This is Matt, one of my colleagues over here.
34:55Hi, Christian.
34:55All right.
34:56Do you remember what's happened?
34:58No.
34:59No.
34:59When assessing for a brain injury,
35:02medics use the Glasgow Coma Scale, or GCS,
35:05to measure a patient's level of consciousness.
35:08You're on your bike, and you've been knocked over,
35:11you've fallen off, basically, and you've hit your head.
35:13Remember any of that?
35:14No, I don't.
35:14No, okay, all right.
35:16It evaluates three areas.
35:18Eye-opening, verbal response, and motor response.
35:22Do you know where you are at the moment?
35:25Well, I'm in and out of the room.
35:26That's right.
35:27It scored between three, the worst, and 15, the best.
35:32Do you know where you are at the moment, other than the ambulance?
35:35The area you're in?
35:37Well, I mean, I work in, but I'm not sure exactly where I am.
35:40Okay, all right.
35:41Do you know what day it is today?
35:43Uh, no, I'm not sure.
35:47Okay.
35:47I normally, I usually know what the day is.
35:50All right, mate.
35:50You all right?
35:51If I just have a quick look at you, if that's all right?
35:53Dr. Asher begins a primary assessment.
35:55If I press down here, no pain at all?
35:57No pain, no.
35:58Nothing there?
35:59No.
36:00Nothing there, and all over?
36:01Okay.
36:01So no pain in the neck at all, and you've been moving your head and neck, have you?
36:05Okay.
36:05No, that's good.
36:07Asher first wants to rule out any neck or spinal injuries.
36:11And look the other way for me, and back again, and put your head back up, look up towards
36:15the ceiling, look up towards the ceiling, and chin in your chest, and there's no pain
36:19in your way when you're doing any of that.
36:20Put your chin down to your chest, head down.
36:22Okay, no pain at all when you're doing that?
36:25No.
36:26No.
36:26Okay, let's have a quick listen to your...
36:27My head hurts.
36:29Now he needs to assess Christian's chest and look for injuries such as fractured ribs.
36:34Deep press in and out.
36:36Good.
36:37Okay.
36:38Nice bilateral air injury.
36:39Good.
36:41And any pain if I press here?
36:43No.
36:44No pain?
36:45No pain?
36:46It's no obvious chest injury, Matt, I think, from that point of view.
36:48Obviously, the head injury.
36:50A little bit dazed, okay, but not massively confused at the moment.
36:55The early signs are good.
36:57Right, young man.
36:58No pain in the hips areas at all?
37:00No.
37:01Okay.
37:01Keep this leg straight.
37:02I want you to lift this leg up off the bed for me if you can, but keep it straight.
37:04Perfect.
37:05Good.
37:05Pop that down.
37:06Better than I can do that.
37:07And this one as well?
37:09Perfect.
37:10Good.
37:10Okay.
37:11So my abdomen feels okay.
37:13Pelvis looks symmetrical.
37:14Lombus is all intact.
37:15So actually, apart from the head, there's nothing else I think I've got at this point in time.
37:20Christian's motor skills are in excellent shape, but he does have a head injury, possible amnesia, and high blood pressure.
37:28Do you know when the last time is you've had your blood pressure checked?
37:31When the last time you've seen a doctor is?
37:34No.
37:35No.
37:36Christian's high blood pressure could be a result of the accident or an underlying condition.
37:41I wonder if that might be a long-standing background kind of issue from that point of view.
37:46However, as he is in a dazed, possibly concussed state, the crew are unable to confirm.
37:53We're going to be taking you to the hospital.
37:55All right?
37:55Uh-huh.
37:56Yeah.
37:56You've had quite a nasty bump on the head.
37:59You've got quite a nasty swelling over here.
38:02We're probably going to need to do a scan of your head.
38:04And the only place we can do that is in the hospital.
38:06Thank you, MSS from 2-5.
38:09Asher radios the Thames Valley Air Ambulance Dispatch Desk.
38:13Yeah, 2-5, go ahead.
38:16Yeah, mate, just to let you know, this gentleman's pretty much a GCS of 15 now.
38:20He's had a bit of a knock and had a period of amnesia, but he's doing okay at the moment.
38:25Asher estimates Christian's GCS at around 15, the best possible number on the scale.
38:30How are you doing?
38:34How are you doing?
38:34All right, brilliant.
38:36Thanks, guys.
38:37With Christian stable, Asher is happy for the ambulance crew to take him to the John Radcliffe Hospital around 30 minutes away.
38:46He'll probably get some scans, so a CT scan, perhaps an X-ray of any other areas of his body if he had some pain that didn't present initially.
38:53And then from there, they'll observe and go with the findings that those scans show.
38:57We're going to go eyes in on this tube for a couple of minutes, okay?
39:12So you're happy with timings and drugs?
39:14Yeah, fab, thank you.
39:16In Reading Services, 72-year-old Steve's heart has stopped after a cardiac arrest.
39:21The Lucas machine battery was also running out after 40 minutes of mechanical chest compressions.
39:27It's now been changed.
39:29When you're ready, we're following the skin.
39:31The VL is down here.
39:33Thank you.
39:33Thank you.
39:34We've still got suction.
39:36We've got everything ready to hand, Abby?
39:38Yeah.
39:38Yeah, lovely stuff.
39:39Dr. Laura wants to intubate Steve so they can take over his breathing mechanically should he regain a heartbeat.
39:46Okay.
39:46Okay, so here I'm through the tube.
39:53That feels nice.
39:54Yeah, lovely.
39:55That feels really nice there.
39:57Okay.
39:58Okay, I've got the BG.
40:00A laryngoscope is inserted so Laura can see Steve's airways as the intubation is performed.
40:05There we go.
40:06When we're through first and second lines, and that is 24 at the teeth.
40:10Okay, this is up.
40:13Lovely stuff.
40:15Let's connect up.
40:17Steve is successfully intubated.
40:19Can we just get fingers on that pulse, David, before we pause?
40:22Okay, asystole.
40:23But his heart isn't regaining rhythm.
40:27We've been in asystole now for what, about 12 minutes?
40:3016 minutes?
40:31Steve's had no heartbeat for a substantial period of time.
40:35Hannah, I feel like we're starting to reach the point of futility, but I'm just aware team-wise to bring that in.
40:41Yeah, so this monitor's been on for 40 minutes.
40:43Fine, okay.
40:44Yeah.
40:45And the AED was on for some time prior.
40:47Yeah, so I've got fingers on.
40:51Okay, that is asystole on the monitor.
40:53Okay, so just in terms of where we're at at the moment.
40:56So we're now a good, what time is it now?
41:0040 minutes in.
41:01Okay.
41:01So we're 40 plus the bystander CPR time, almost an hour in.
41:06We've gone from a VF rhythm into now an asystole, which has been sustained for approximately 14 minutes.
41:12So I think we are at the point where everything that could be potentially done is being done and hasn't then gotten rust.
41:19I think we are probably reaching that point of futility.
41:23And I think speaking with family, making sure that they're aware of that is important.
41:27With Steve's heart still asystolic or flatlining, after nearly an hour of critical intervention from the team, there's sadly little else they can do.
41:37Laura speaks to his wife, Liz.
41:39Hello there, is it Liz?
41:41Yes.
41:41I'm so sorry it's taken a little while to come to you.
41:44My name's Laura, I'm one of the doctors.
41:45Thank you.
41:45So I'm sure you've kind of been aware that unfortunately things have deteriorated quite drastically today.
41:52We very much have been trying to do everything along with the ambulance service.
41:56But I think everything that could be done has been.
42:02But I'm so sorry we haven't been able to change the situation.
42:05But at this point, if it was that we think that continuing isn't going to change anything,
42:09we would always want to give family the opportunity to be with them, if that's something that you would want, at the point that we stop.
42:16I know it's an incredibly difficult thing.
42:18No, it would be.
42:19Yeah.
42:20Give me just a moment and I'll come straight back to you, darling, okay?
42:23Okay.
42:23Okay.
42:27Okie dokie.
42:27So his wife is aware and understanding of the situation.
42:32She's in agreement that to continue on unnecessarily wouldn't be the right thing.
42:36And she does wish to be present at the point that we would stop.
42:40Okay.
42:41Ace is still here on the monitor.
42:42Okay.
42:43So I would suggest that we pause on any more adrenaline.
42:46Hannah, are you happy for a family member to be brought to you?
42:48Yeah, absolutely.
42:49Okay.
42:49Supporting the patient and their family through what then becomes the final stage of their life is actually something that we would count as a real privilege.
43:02And supporting family members through what inevitably will be the hardest day of their lives is a real privilege too.
43:10And something that I think we all would certainly not take lightly and take a great deal of care to bring as much dignity and sensitivity to as we can.
43:21So let's say,
43:31yeah.
43:34Thank you.
43:34Gracias por ver el video.
44:04Gracias por ver el video.
44:34Gracias por ver el video.
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