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00:00After dark, while the nation sleeps, the A&E night shift begins.
00:11You never know what's going to come through the door.
00:15At night, you always have to be prepared for the unexpected.
00:19Multiple kicks to the face.
00:21They said if anyone approaches them, they're going to attack us all.
00:24Across the UK, with extraordinary access to three of the most challenged emergency departments.
00:29in the country.
00:31Guys, I need help in here.
00:33He could have died.
00:34We follow the work of emergency medics who battle every night to save lives.
00:38Chuck in now.
00:40It's a stab wound.
00:42With drugs and alcohol rife.
00:44I've had five or six pints.
00:46Step back, big man.
00:48The department's just on fire.
00:50I've got a kick!
00:51Yeah, yeah, yeah, yeah!
00:53The risk of violence and abuse looms large every night.
00:56And you, you're messing your ****.
00:58Stop.
00:59Try me, boys.
01:01They can be verbally aggressive, physically aggressive.
01:05I've been punched.
01:06I've been spat at.
01:07You've got nothing on me, bro.
01:09Fire!
01:10There have been days when there have been more police officers than patients.
01:13I'll punch your head in, mate.
01:15What's going on?
01:16All hell's broken loose.
01:17Patients running around.
01:18Security everywhere.
01:19Shut up!
01:20I don't care!
01:21This is the sort of thing that we have to put up this.
01:23Get security to remove it.
01:25This chaos.
01:26Glorious chaos.
01:38What's that in the box, you ****?
01:41Got some animal tears here on board.
01:42They won't explore.
01:43Last year, violent offences, robberies, knife and gun crime...
01:47It's a stab wound.
01:48...were on the rise across the country.
01:50Move away from this area.
01:53There are some guys outside with masks.
02:00He's been stabbed multiple times to the chest.
02:02It is a complete situation.
02:04They've got it on the ice.
02:05Recently, Birmingham overtook London as the gun crime capital of Britain.
02:09Yeah, the kid in AGP's been shot.
02:11With firearm offences rising 86% in a year.
02:15Just the carnage.
02:16Very silly.
02:17It's right.
02:18And his sats on there, 86, which fits with his ABG.
02:22Registrar Dr Jake is running the resource department overnight.
02:27Hello, it's Jake.
02:28The department's just on fire a bit.
02:31We've just had a few big sick traumas in.
02:34I've got ICU down with one, anaesthetics down with the other,
02:38because he's tubed and not doing well.
02:40I've got tons of people who've been here more than a day.
02:42Full corridor, fully OU.
02:44I've just got nowhere to do anything.
02:46While Dr Jake is struggling to manage the cases already in,
02:49another patient has rushed himself in who needs immediate help.
02:53I'm Jake. I'm the ED Regist.
02:56What happened tonight?
02:57Because I know what it looks like happened.
02:59I've got a bullet in my back.
03:02We definitely don't go more than a couple of days
03:04without having a sick patient who's been stabbed.
03:07Shootings are rarer.
03:09Although some of that is because patients only come to us
03:12if they're still alive.
03:17Yeah, that does indeed look like it.
03:20Bullet wounds never look like they do on films.
03:22They're always tiny.
03:24So that is about right for a bullet wound.
03:26About 22 mil, that's what I've risen.
03:29Uh, yeah.
03:30Gunshot wounds tend to come in one of three sorts,
03:33which is military-style high-velocity rifles,
03:36shotgun-style,
03:38and then there's low-velocity penetrating trauma.
03:41So pistols and things like that,
03:44which we see a lot more of.
03:46Relax back. Let's have another look.
03:48But often the difference between them and the patients who die
03:52or who end up on intensive care with massive surgery
03:55is a matter of a couple of centimetres.
03:59Any pains in your chest at all?
04:01I can feel but not when you squeeze them.
04:03Fine.
04:05Has anyone put a needle in you or took any blood from you?
04:08No.
04:09Fine. We're going to do that.
04:10Give you some meds,
04:11and then I'm going to take you through for a scan.
04:13Because the problem with bullets is they bounce and they move around.
04:17Low-velocity bounces off bones and whizzes around,
04:19so even though we can see where it is now
04:22and I can see where it's probably went in,
04:24it doesn't mean that that's the only place it's gone.
04:27I've had someone who's been shot up here before,
04:30and it bounced around and ended up coming out of their bum.
04:32The bullet could be dangerously close to his spine.
04:35Partly because the wounds are usually tiny,
04:37so they can be really difficult to assess.
04:39You know, you've got this one dot where something went into them,
04:44and who knows where the problems are.
04:46Can't tell you what's going on inside until I scan them.
04:49Until the scan has been done,
04:51Dr Jake can't tell if there's been serious internal damage
04:54to the man's back.
04:56I'm going to get your scan sorted so we can see what we're dealing with.
05:09Hello, Norfolk and Norwich, Jamie.
05:14I don't think you've been playing football for Bristol this week.
05:16No. No.
05:17Do you? No.
05:20What a night.
05:21Well, no.
05:22Where else would you want to be?
05:24Pludgeon.
05:25Really?
05:26Can we do buscats?
05:27In Norwich, Kerry has been admitted with a dangerously high heart rate
05:30and is being treated by Nurse Chloe.
05:33Her heart rate is going very, very quick,
05:35so it's like she's sprinting a marathon, really.
05:38We need to try and sort her heart rate out
05:40so that she starts feeling better.
05:42I do need to try and pop another channel in,
05:45because we're going to give you a couple of different things
05:47out of her heart rate.
05:49Kerry's heart rate has been beating
05:51at more than double the speed it should be for hours.
05:55Medics have tried to treat it with medicine with no luck.
05:58If they can't slow it down, she could have a cardiac arrest.
06:02Oh, still up there, aren't they?
06:07Yeah.
06:09Dr Lucia has joined them with a plan B.
06:13Right, so what we're going to do
06:14is we're going to get your heart rate down to a normal level.
06:17We're going to give you a wee bit of an electric shock.
06:21That's...
06:22Do you think it's right?
06:23No.
06:24You want me?
06:25Basically, you will be sedated.
06:27Oh, right.
06:28OK.
06:29Does that make sense?
06:30Yes, it does.
06:31Shocking the heart back into a safe rhythm is painful,
06:34so Kerry needs to be sedated.
06:36So the plan is to try to get you sort of sleepy,
06:39a little bit knocked out, but not too knocked out.
06:42Yeah.
06:43To the point that you're still conversing.
06:45Yeah.
06:46You won't remember.
06:47Fair enough.
06:48Well, the point is, is that ketamine
06:51gives you sort of like that forgetfulness.
06:53Yeah.
06:54And that's all a bonus.
06:55Can we drop some ketamine?
06:57Yeah.
06:58Kerry has persistently low blood pressure,
07:00so ketamine is being used for sedation
07:02to prevent this becoming dangerously low.
07:05OK.
07:06Have you been feeling pretty naughty?
07:09Uh, when it happens, yes.
07:12Emergency department consultant Dr. Sean
07:15is overseeing the procedure.
07:17It's not efficient.
07:19Yeah.
07:20Sorry.
07:21Do you know what I mean?
07:22The only one who gave it back is using L twist.
07:23Basically, I've got to turn it up and on.
07:25As long as you turn me back all again, that's the idea.
07:28Atrial fibrillation is a very common condition,
07:32and it's when your heart rate is way too fast.
07:36You either want to control the rate or control the rhythm.
07:41So for rate control is medication.
07:44And if that's not working, delivering a shock
07:46is one of our treatment options.
07:48It's a risk of it not working.
07:50Yeah.
07:51In which case, we'll wake you up,
07:52and we'll have to try other methods.
07:55Rest your head back and just breathe in and out.
08:01Wear 200 beats per minute.
08:04Kerry's heart rate is still climbing,
08:06and so the team needs to act quickly.
08:08No deep breaths at me.
08:10Probably not.
08:13How are you doing?
08:15A little bit away.
08:17Mushy.
08:18Mushy.
08:19Mushy.
08:20Mushy.
08:21Flasher.
08:23Oh.
08:24Sorry.
08:25Are you all right, darling?
08:26How are you feeling?
08:27Are you okay?
08:28You're all right, sweetheart?
08:33Nice deep breaths in the neck.
08:35Okay.
08:36We're going to be doing a synchronized DC cardioversion
08:38carried on the ketamine sedation.
08:41We're going to be starting at 150 joules.
08:45If we need to, we'll escalate joules.
08:48With Kerry's heart rate still climbing after racing for hours,
08:51the shock needs to work, as she can't sustain this much longer.
08:55Please step away, everybody.
08:57Everybody clear.
08:58So I'm going to shock.
08:59Shocking now.
09:06In the UK, over a third of accidents and emergencies that happen at night
09:17are brought in by ambulance, including violent attacks.
09:22Is our blood pressure cycling now?
09:24Yes.
09:25Falls and cardiac events.
09:27She's GCS 11.
09:28No speed started with a headache.
09:37We're 200 beats per minute.
09:40In Norwich, Kerry's heart rate is over double its normal beats per minute
09:45and won't slow down.
09:46Nice deep breaths in the neck.
09:50She needs an electric shock to the muscle in her heart to reset its rhythm.
09:54We're going to be starting at 150 joules.
09:58So the defibrillator itself, you need paddles that go on either side of the heart.
10:02And the idea is to pass an electrical current from one to the other through the heart
10:09to try and deliver that shock to the right part of the heart muscle.
10:13It looks quite violent, I suppose, if you don't know what's happening.
10:17And it is painful.
10:19If Dr. Sean and the team can't slow her heart down, Kerry could go into heart failure.
10:25So charging.
10:28Nobody touching.
10:29Everybody clear.
10:31So I'm going to shock.
10:32Shocking now.
10:35Big deep breaths in and out if you can.
10:37All right.
10:38We're going to go on.
10:39Increase to 200.
10:41Charging.
10:44Is everybody clear?
10:46I'm going to shock.
10:47Shock now.
10:49Shock delivered.
10:50All right.
10:55Kerry's heart rate is not coming down.
10:57They have one final chance to get it back into rhythm and prevent her potentially going into heart failure.
11:03I'll just increase the joules.
11:07360.
11:09I'm going to charge.
11:10We're at 360 joules.
11:12If they shock her at anything higher than 360 joules, the electricity could permanently damage her heart.
11:19Charging now.
11:20I'm going to shock, shock now.
11:21I'm going to shock, shock now.
11:22Hang fire.
11:23I do love that.
11:24You can pop some back in your face, you know.
11:25You all right?
11:26No.
11:27All right.
11:28All right, darling.
11:29Fantastic.
11:30How are we doing?
11:31Feeling a bit better?
11:32The final shock did the job.
11:33You're a bit zonked out, but you'll be okay.
11:35Kerry's heart rate is slowing.
11:36Well done.
11:37You did a really well.
11:38All right.
11:39All right, darling.
11:40You're fantastic.
11:41Yeah.
11:42How are we doing?
11:43Feeling a bit better?
11:44The final shock did the job.
11:45You're a bit zonked out, but you'll be okay.
11:48Kerry's heart rate is slowing.
11:49Well done.
11:50You did a really well.
11:51Not too bad.
11:52No.
11:53Fantastic.
11:54Yeah, we escalated our electricity.
11:55We gave about as high as we were going to go at that stage, and I'm just glad that worked.
11:58But, yeah, got her back to a nice, normal rhythm.
12:00She doesn't remember it.
12:01She quite enjoyed her trip.
12:02So I'm quite pleased with how it went for her.
12:03So I'm quite pleased with how it went for her.
12:04Yeah.
12:05All right.
12:06All right.
12:07All right.
12:08All right.
12:09All right.
12:10All right.
12:11All right.
12:12All right.
12:13All right.
12:14All right.
12:15All right.
12:16All right.
12:17All right.
12:18All right.
12:19All right.
12:20What do you want to say?
12:21What do you want to say?
12:22From the committee?
12:23I've got to feel that I'm quite enjoying her trip.
12:24So I'm quite pleased with how it went for her.
12:26Kerry can be stepped down to a less critical ward.
12:27I can't be disappeared until I was going to a normal ward somewhere.
12:28While the ketamine wears off.
12:29Enjoying the pregnancy of the NHS.
12:31Thank you very much.
12:32Hello.
12:33Hello.
12:34What are you doing?
12:35Well, in a family land.
12:37In Birmingham, Dr. Jake has a patient who needs an immediate scan after being shot in the back.
12:59At the minute, he's in recess in there.
13:01He's already there?
13:02Yeah.
13:03Is there any obelisk officers there?
13:04No.
13:05While the scan is prepared, following protocol, police officers on site are called to A&E.
13:11It does look like he's been shot.
13:13The story fits.
13:14He heard a loud bang and then felt like you're hit in the back.
13:18It is my young gentleman here.
13:21At the minute, he is stable.
13:23I'm going to get him through to scan and see what's going on.
13:27So, gunshots and stabbings, regardless of whether the patient wants to or not, we have to let the police know.
13:33But beyond that, it's up to the adult concerned whether they want to involve the police.
13:39You don't want to tell us anything?
13:48Because I'm a bit drunk.
13:50I don't think it's fair.
13:51So, you don't want to tell us what's led you to be in here or anything like that?
13:54No, I don't want it while I'm drunk.
13:56Okay.
13:57How much have you had to drink?
13:58Quite a lot, to be honest.
14:00Okay.
14:00At this point in time, I don't even actually remember nothing whatsoever.
14:06I just don't remember seeing anyone.
14:10Are we saying that the x-ray is showing he's got the bullet wound to his back?
14:15So, he needs a scan, like an invasive scan, to show what's actually there.
14:19Okay.
14:20Scan's free, so let's go scan.
14:21So, as far as we're concerned, he's not really engaging with us, so as long as we confirm it's not life-changing or life-threatening, it's not a lot much for us here.
14:30The patient is not talking to the police, and they need to get him to the scanner quickly to see what damage has been done to his back.
14:38Nice to meet you.
14:39Until his torso and spine are scanned, Dr. Jake has no idea if the shooting has caused any serious injuries.
14:53Please breathe in and hold your breath.
15:00You're a disgrace!
15:02Last year in the UK, one million people experienced a violent act.
15:06He's on his back room in the left Lumber region.
15:11With 160,000 of those resulting in injury.
15:15Ah, so we need three more people then, don't we?
15:23Whoa!
15:24Stop resisting!
15:31Can you remember what happened?
15:33Yeah, like, I was just on the train and then I got jumped.
15:36But, like, these group of boys, they just started punching my head in and, yeah, just punching me up.
15:45Yeah, it was pretty bad.
15:46I don't really remember what happened after that, to be fair.
15:49In the waiting room, 27-year-old Ollie has been brought into A&E by Mum, Emma, with multiple wounds to his head.
15:56I got a call from the station, say, been assaulted.
16:05Could I come?
16:06An ambulance is waiting.
16:09That is crazy.
16:09Yeah.
16:10Yeah, I felt sick.
16:12Platform's covered in blood.
16:14Head injuries can result in serious complications.
16:17Hello.
16:20Hi, Dad.
16:22So it's crucial Dr Aisha gives Oliver a thorough examination.
16:28Right, so what happened?
16:29Uh, I just got assaulted, basically.
16:32Punched, kicked.
16:34Mm-hmm.
16:34I don't even, I don't remember what happened.
16:36I just got hit in the back of the head.
16:38Someone came from behind.
16:39Mm-hmm.
16:40Did he go on the floor?
16:41I don't know.
16:42I don't remember anything.
16:42You don't remember anything?
16:43Okay, so you lost the consciousness.
16:47Right.
16:47Yeah.
16:48Nobody knows how long he passed for.
16:50No.
16:50No.
16:50When someone has been assaulted, we worry about loss of consciousness, especially if it's
16:56more than five minutes, because that worries if there is an injury in the, you know, in
17:00the inside the brain.
17:02Any visual disturbance at all?
17:03No, nothing.
17:04No double vision, no floaters or bright lights at all?
17:07Fine.
17:08Let's shine the lights in your eyes.
17:11What do I look?
17:12The state looks right.
17:14Okay.
17:15We are looking into the reaction of the pupils.
17:18Any changes in a not equal and reactive pupils, both sides, if one is not reacting as well
17:25as the other, you worry about a bleed in the brain or injury to the brain.
17:30And just keep looking.
17:32Without moving your head, just follow my finger.
17:38Right.
17:39Okay.
17:39So I'm just going to ask you to close your eyes tightly.
17:42Okay.
17:43Raise your eyebrows for me.
17:44Buff your cheeks.
17:46Good.
17:47Show me your teeth.
17:47Stick your tongue out and move it side to side.
17:50Good.
17:51And I'm going to press your face.
17:52Push it down for me.
17:54Good.
17:55Shrug your shoulders up.
17:57Fine.
17:58And do that.
17:59Push me away.
18:01Good.
18:02Can you do that for me now?
18:03Perfect.
18:04And if there's some memory loss, which he had in his scenario, we like to scan the head
18:10to ensure that there is no sort of bleeding going on.
18:13Just over there.
18:13Over there.
18:14Yeah.
18:14A bleed on the brain can cause increased pressure in the skull, leading to permanent brain damage.
18:21You're also going to scan the face because obviously there is an obvious deformity of the nose,
18:25but you might have other fractures around the skull.
18:27Yeah.
18:28And because he's lost consciousness, any trauma like that, we need to make sure there is no bleed in the brain.
18:33The car has projected him onto the road.
18:45Faturations of 100% on high flow oxygen.
18:48Last year, 30,000 people in Britain were killed or seriously injured in road traffic accidents.
18:54Well done.
18:55In Birmingham, 43-year-old Abdullah has been rushed in by air ambulance after being involved
19:06in an accident at the car wash where he works.
19:08He was cleaning the car and then a man just running over.
19:12He's driving the car.
19:14He works at the car wash.
19:16And the moment he goes in the front, the driver just loses control.
19:21He's questioning me too.
19:22Another car.
19:23He's just asking, when can you get him some painkillers?
19:26I'm going to ask the nurse now.
19:27OK, thank you very much.
19:29Abdullah was fast-tracked through scanning and x-ray as soon as he arrived
19:33to look for internal bleeding and trauma to the pelvis and spine.
19:37But nothing life-threatening was found.
19:40At the time of the accident, he had pain from stomach all the way down there.
19:45Despite initial findings, Abdullah still has extreme pain in his legs
19:50and registrar, Dr. Dan, is on hand to investigate.
19:54Hello.
19:56Abdullah is Kurdish and needs help with his English.
19:59So his son, Reboah, is going to translate for his dad.
20:03Can you tell me at a minute, where have you got the most amount of pain?
20:05He has a lot of pain, especially the left leg.
20:14From here, starting from the thigh all the way up down, where he feels the most pain.
20:19On this side, starting from the knee all the way down, he feels a lot of pain.
20:22OK, good. Can you feel me touching your foot there?
20:25Has to feel the key.
20:26Yes.
20:27Good. Can you bend your knee for me?
20:29That's fine.
20:29Just a little knee.
20:31That's it?
20:31Ah!
20:32OK. Can you feel me touching?
20:34No.
20:36No?
20:36Has to feel the key.
20:37There?
20:38No.
20:39Can't feel anything?
20:41The side?
20:42No.
20:43OK.
20:44All right.
20:45A loss of sensation could be an indicator that something else is going on.
20:50And to be sure, they order further x-rays and scans on his lower legs immediately.
20:57He was stuck in there for quite a moment, if you look at it.
21:01Stuck there for at least 15 seconds, while the car is still pushing against his body.
21:08These could show if he has broken bones, nerve damage or something more serious.
21:15I'm just still shocked, to be honest.
21:20Sorry, mate.
21:22Sorry, hon.
21:24But hopefully it doesn't get worse.
21:27Yeah.
21:28Yeah.
21:28Oh!
21:29Oh!
21:29Oh!
21:29Oh!
21:29Oh!
21:30Oh!
21:30Oh!
21:31Oh!
21:31Oh!
21:32Oh!
21:32Oh!
21:33Oh!
21:33Oh!
21:34Oh!
21:34Oh!
21:35Oh!
21:35Oh!
21:36Oh!
21:36Oh!
21:37Oh!
21:37Oh!
21:38Oh!
21:38Oh!
21:39Oh!
21:39Oh!
21:40Oh!
21:40Oh!
21:41Oh!
21:41Oh!
21:42Oh!
21:42Oh!
21:43Oh!
21:44Oh!
21:45Oh! Oh!
21:45Oh!
21:46Oh!
21:47Oh!
21:48Across the UK, 45% of shootings are with handguns and 89% of the victims are male.
21:5421 male.
21:55Yeah.
21:56Just go.
21:57Just go.
22:05He's going to theatre.
22:07I need to make a space trauma or an air ambulance.
22:10In Birmingham A&E, a victim of the city's gum crime problem has come in after being shot
22:15in the back.
22:16Yeah.
22:17Yeah.
22:18Yeah.
22:19Yeah.
22:20That does indeed look like a bullet wound.
22:21a scan.
22:22As the entrance wound is so close to his spine, it could cause life-changing injuries.
22:28There it is.
22:29Breathe away normally.
22:30It needs to be my shot.
22:31Dr. Jake, who is treating him, has his scan results.
22:34He's got a single bullet with a few bony fragments in his spine around T12, so this sort of level.
22:44There's no massive spinal injury, but it's nicked some of the peritoneum at the back of his abdomen.
22:52So, it'll be a discussion between neurosurgeons and general surgeons and the trauma team about what to do next.
22:59It's in a bit of a dodgy place to operate, so it may be that they leave it in, although most of the time they do take them out.
23:06So, all right, get your trousers off, and I'll do a proper check of all the nerves and see if any of the sensations impaired.
23:18As the scans aren't conclusive, Dr. Jake still needs to look for anything that could influence the surgeon's decision to remove the bullet or not.
23:27Can you feel here and here?
23:30Same both sides.
23:31Okay.
23:32Same both sides down here.
23:33There.
23:34And here.
23:35There.
23:36And there.
23:37Yeah?
23:38Definite?
23:39For sure, yeah.
23:40Cool.
23:41Fine.
23:42How close is it to my spine?
23:43Touching.
23:44Dangerously close.
23:46Yes.
23:47There's not many ways to get shot that I wouldn't say are dangerously close.
23:51I think so.
23:52What am I telling you about?
23:53Think so.
23:55Put your trousers up and I'll show you your scan.
23:58Often when people present who have been stabbed or shot, there's an element of bravado.
24:03And they still know that this is something big, bad and nasty.
24:08So this is like a slice through from the top down.
24:11So your head's at that end and your feet are this end.
24:14So this is your right hand side.
24:16Dr. Jake is showing the patient just how close he came to being paralysed or killed.
24:21And it's probably just taken off a tiny bit of bone there and it's sitting right on the side of your spine.
24:28So yeah.
24:29You don't get much closer without it just being in your spine.
24:32So it's coming in that sort of direction.
24:38Just below the level of the lungs.
24:41So it's just in front of your liver.
24:43If it had hit your liver, that would be a much bigger problem.
24:46Because that's when you bleed a lot.
24:50With the facts presented to him, the patient seems to understand how serious tonight could have been.
24:57I think a lot of patients do know that it takes a little while for it to sink in.
25:02I think once they get here and they have this whole team on top of them.
25:07They go through scanner, they have all the discussions about surgery.
25:10They tend to see how big it is.
25:13What we'll do, I'm going to keep you in for a while.
25:17We'll get the neurosurgeon's just gone to theatre.
25:20But they'll come and have a look because we need to work out whether we need to take you to theatre, take it out.
25:24Sometimes they do, sometimes they don't.
25:28He's been shot in an area that doesn't have any major vessels, that doesn't bleed a lot and they haven't hit a nerve.
25:35So he's probably going to get away without anything major beyond some scar, right?
25:39Yeah, lucky on that side, although not as lucky as someone who didn't get shot.
25:53Hello!
25:54Have you gone through the bone? Not there.
25:59It's a cut through an artery.
26:01Oh, yeah. It's all coming through underneath, isn't it?
26:05I think we might have ended the cricket season fairly early, haven't we?
26:11But, oh well, we still have a beer.
26:14In 2023, one and a half million people were treated for minor injuries in A&E.
26:20So you don't know what they're going to do yet?
26:23No, they've just got the x-ray back.
26:25So he's having a look at the x-ray now and then they'll call me through.
26:29Emily was rushed through radiology earlier after an accident with a wine glass.
26:33Oh, right, OK.
26:34So, hopefully, I just care about getting some pain relief at this point.
26:38She's been brought in by her dad, Kevin.
26:41Emily?
26:42I'm now getting called in. Are you coming?
26:43Yeah.
26:44Hi.
26:48Dr Mohamed will be assessing Emily's hand for serious damage.
26:52Do you want to tell me how did it happen?
26:54Yeah.
26:55Opened my cupboard in the kitchen to get a glass out.
26:57A wine glass fell off the top shelf, bounced on the kitchen counter.
27:01As it smashed and bounced back up, it's just cut straight into my finger.
27:05OK.
27:06Whenever a patient comes to us in the A&E and we have an open wound,
27:12we worry about any foreign body retained there,
27:15some dirt or bacteria that got into the wound.
27:20And most of the time, we do an x-ray.
27:23We worry about serious infection or losing the function of the finger.
27:28So, the wound is extending from the front side into this side aspect of the finger.
27:37Lovely.
27:38Yes, it's going all the way to the back side.
27:41So, the good thing is I can't see any foreign body at the moment.
27:45Lovely.
27:46OK.
27:47And I can't see any evidence for a fracture here.
27:51But you couldn't feel the touch sensation here properly.
27:55Yeah.
27:56And you couldn't flex the finger as normal.
27:59No.
28:00So, whenever we find these findings,
28:02we worry about damage to the underlying structures,
28:05like the tendons.
28:06Yeah.
28:07And one of the nails here.
28:08OK.
28:09OK.
28:11So, that's the reason we didn't close it immediately.
28:16We had to share these images with the plastic team.
28:20With potential nerve damage causing her numbness,
28:23Dr. Mohamed needs to call in the specialist plastic surgeons.
28:26It's all about detecting it early and delivering the concerns to the specialized team as soon as possible.
28:35My concern is sensation.
28:37So, in the distal areas to the site of the wound,
28:40loss of the function of the tendon might happen,
28:43which will lead to a lot of functional disability.
28:46So, at the moment, we will just wait for the plastic surgery to come here.
29:06Sorry, mate.
29:07This is out of here.
29:09Abdullah's having a scan after his legs were crushed between two cars at his job at a car wash.
29:15The driver just lose control.
29:19Still shocked, to be honest.
29:21His family have rushed to hospital, including his son Reboir,
29:24concerned if his dad will be able to walk again.
29:27I got there a bit later when I came in.
29:28There were already ambulances and the road was closed.
29:31I pulled into the car wash.
29:36I walked up to them and I told them,
29:38he's my dad and I need to see him.
29:40And when I went to see him, they had given him some medicine.
29:44So, he was responding, but very poorly.
29:47Nothing much, just an eye, movement of an eye.
29:52It was absolutely heartbreaking.
29:57Feels a bit weird.
29:59Yeah, normally he looks after me, but all the time he does.
30:02But today, I guess, the rules are reversed.
30:08Dr Dan has been treating Abdullah and found, despite his pain,
30:12he had a loss of feeling in his lower legs.
30:15If there are fractures as a result of the crush injury,
30:17then those can be fixed.
30:19But, unfortunately, for crush injury to soft tissue like muscle,
30:23there's not really an awful lot that we can do to treat that surgically.
30:26Yeah.
30:28Hello again.
30:29Hello.
30:30So, I've had a look through all of your imaging again.
30:32Okay.
30:33So, on this side, there's a fibular fracture.
30:36And on this side, it's also broken, but the bone position hasn't moved.
30:39Okay.
30:40They don't need any surgical intervention.
30:42All right.
30:43The feet look okay.
30:44The heels look okay.
30:45Okay.
30:46A lot of this is going to be bruising and muscle swelling after being crushed.
30:51Yeah.
30:52Okay.
30:53How long does it take to walk again, just normal?
30:55Walking normally could take a little bit longer.
30:58How long that is, I don't know.
30:59It all depends on how you go with physiotherapy, how sore it is.
31:02And that's guided by you.
31:04That has to be at the pace that's comfortable for you.
31:06Okay.
31:10Abdullah's injuries aren't life-changing,
31:12and he escaped permanent injury with stable fractures to both legs.
31:17Very, very good news for me.
31:19You know, all of the bones have been squashed together with the muscles,
31:21so in the next couple of days, his legs are going to turn blue and purple, definitely.
31:26Complaining about his pain in the legs, which is a good thing,
31:30then we know there's at least some pain in the legs and he's not paralysed.
31:33Could have been worse, much worse.
31:35And we'll get him to an orthopedic bed,
31:38and from there, he'll have some physio, some pain relief.
31:42On balance, the safest thing to do is keep him in overnight at least,
31:45keep an eye on him, monitor him,
31:46and just to ensure that his pain is well controlled.
31:49It's going to take a few days for him to get mobilising a bit more comfortably,
31:52and then, yeah, I would hope that he'd be home in a few days.
31:57Could have been a lot worse, yeah.
31:59Luckily, it's not too bad.
32:08Assaults against police officers has been on a steady increase for over ten years.
32:16Get off me, f***ing.
32:18With around a quarter of those ending in injury to the police officer.
32:23That's the equivalent of one officer being assaulted every ten minutes.
32:28I ain't got nothing wrong.
32:30Joining the steady stream of ambulances arriving at A&E in Birmingham is a police van.
32:36This is the first time it's happened to me, really, to you.
32:42Yeah, it's good to me.
32:44Police Constable Ben has been attacked in the line of duty and bitten.
32:48He's been brought in by a colleague.
32:50Our support here is a big enough hope.
32:53It definitely hurt when it first happened.
32:55It still hurts a bit now.
32:56I think it's more just a shock.
32:57I might expect enough to happen to you, really.
32:59PC Ben needs to be triaged to check for any underlying injury.
33:05So you arrested someone, is that all right?
33:07Yeah, I want to call you, he's arrested someone.
33:09Yeah.
33:10And he got a bit tired and grabbed hold of another officer.
33:13As I went to take his hand away, he just latched onto him and his teeth, so...
33:18OK?
33:19So we're going to clean this, and because it's a human bite, it's a teeth, we're going
33:24to clean it, take some blood from you, just to make sure it's not infected or anything.
33:28I'll also get you some pain medication.
33:30Yeah, assault's quite common now, especially in today's place, and it happens most weeks,
33:37probably.
33:38Biting's quite unusual, but it's happened today.
33:41Someone polluted your blood, clean the wound.
33:44PC Ben needs a blood test to check if he's contracted anything serious or life-changing
33:49from his attacker.
33:51Right, have a seat.
33:54We do blood-borne viruses, so like Hep B, HIV, because we don't know who bit him.
34:02We don't know what they've got.
34:24So they've shot too much now.
34:28PC Ben has been bitten by an unknown man in the line of duty.
34:32Normally we'd like to get a blood test from the person that bit you, but I'm guessing that's
34:36not an option.
34:37Yeah, probably not, no.
34:39The medics are concerned he may have caught something from the attacker, and he's having
34:43blood tests.
34:44There's nothing worse than being bit.
34:46Biting is atrocious.
34:48The human mouth is disgusting.
34:50So, especially when he's doing his job, it's not a nice world.
34:56So you won't get these results tonight?
34:58They go to the lab and they run a few jobs.
35:01How long will it be directly?
35:03If nothing comes back from them, then you won't.
35:05I'll send it away.
35:06There you go.
35:07Take a seat back in the waiting room while the dogs have got you through.
35:10Thank you very much.
35:11What's up?
35:13Human bites can be even more dangerous than animal bites,
35:17because of the types of bacteria and viruses in the human mouth.
35:22It just requires very little addressing.
35:24Yeah.
35:25For the next few days, all PC Ben can do is hope he doesn't get a call from the hospital.
35:30Thank you very much.
35:31No one goes to work to get assaulted.
35:34Even though we're kind of in a unique position where we probably can't assault more in-place people,
35:40we still don't expect it when it happens.
35:44At least he knows his attacker will be held to account for their crimes.
35:48Yeah, that's it.
35:49Yeah, we know you did it.
35:50And, yeah.
35:51They'll be down with.
36:03Come on.
36:04You can't touch me, bro.
36:05Come on.
36:06Fuck off.
36:07All of you, go away.
36:08Back in Tunbridge Wells.
36:09Ah, there.
36:11The night shift is well underway, with a waiting room full of the walking wounded.
36:16That is sore.
36:1827-year-old Oliver has been brought into A&E with multiple head injuries,
36:23which he sustained in an unprovoked gang attack.
36:27This one seems clear.
36:30Okay.
36:31This one I can't visualise that well.
36:34Dr. Ayesha is concerned there may be a bleed on the brain, as Oliver lost consciousness during the attack.
36:41There's always a concern where somebody has assaulted a patient who has just left there bleeding.
36:48But most importantly, if it's a loss of consciousness for a significant period of time,
36:53we worry about a bleed in the brain, which can be a life-changing event.
36:57A bleed on the brain could be deadly.
37:00So Oliver has been sent to have an emergency CT scan with radiographer James.
37:05Hi, James.
37:06Hi, James.
37:07Hi, James.
37:08You all right?
37:09You're going to be scanning your head and face, yeah?
37:10Sure, no problem.
37:11First of all, you might need your chains up.
37:12Oh, yeah, of course.
37:13With your hand.
37:14Cheers, man.
37:16Ah, see you.
37:17Scanning this young man's head and face.
37:21They asked for a head scan to roll out bleed in the brain.
37:26We also do some facial bone x-rays, but it's quite difficult to roll out any facial injuries,
37:32especially for tiny fractures.
37:34I think they're all good.
37:37Can you get up?
37:38Get your bearings back first, yeah?
37:39Yeah, yeah.
37:40And we'll come back to you, mate.
37:41Hope you.
37:42Thank you very much.
37:43Of course.
37:44Dr. Aisha has received a CT scan report.
37:45It should tell her exactly what's happened in Oliver's head.
37:46Let's have a look.
37:47So, obviously, nose has deviated.
37:48Is that my point, then?
37:49No.
37:50Oh.
37:51Oh.
37:52Dr. Aisha has broken?
37:53Yeah.
37:54Dr. Aisha has broken?
37:55Yeah.
37:56Dr. Aisha has broken?
37:57Yeah, that's the sinuses.
37:58Okay, yeah.
37:59And then, I don't think there's any bleed in the brain.
38:03Oliver's injuries seem to be superficial, with no damage to his brain.
38:04But his nose still needs attention.
38:06But for this, you're going to be under the ENT, anyway.
38:07So, what their advice was, they put the tools in to settle down.
38:08Yeah.
38:09Okay.
38:10So, they will then manually move on.
38:11Dr. Aisha has deviated.
38:12Dr. Aisha has deviated.
38:13Is that my point, then?
38:14No.
38:15Dr. Aisha has broken?
38:16Dr. Aisha has broken?
38:17Yeah, and that's the sinuses.
38:18Okay, yeah.
38:19Dr. Aisha has broken?
38:20Dr. Aisha has broken?
38:21Yeah.
38:22Dr. Aisha has broken?
38:23Yeah, and that's the sinuses.
38:24Okay, yeah.
38:25And then, I don't think there's any bleed in the brain.
38:26Oliver's injuries seem to be superficial, with no damage to his brain.
38:27But his nose still needs attention.
38:28You're going to be under the ENT, anyway.
38:30So, what their advice was, they put the tools in to settle down.
38:33Yeah.
38:34Right.
38:35So, they will then manually maneuver it, and if it doesn't work, then they'll do a surgical
38:39procedure.
38:40Okay.
38:41But that's going to be as an outpatient.
38:42Right.
38:43Okay.
38:44Yeah.
38:45So, facial bones are looking.
38:47Yeah.
38:48Okay.
38:49He'll need to return to hospital to have his nose reset.
38:52Thank you so much.
38:53You're very welcome.
38:55At night, he's safe to leave A&E, and finally finish his journey home.
38:59We just need to rest for a few days now.
39:01Lovely.
39:02Yeah.
39:03Thank you so much.
39:04Mummy will look after you.
39:05Lovely.
39:07Cheers.
39:09See you next Wednesday.
39:18Not seen went home, yeah?
39:20Yeah.
39:21Yeah.
39:22In Norfolk and Norwich University Hospital's A&E, the night shift is in full swing.
39:28We're going to be full because we've got a trauma pre-alert.
39:32Every day is a busy day.
39:33Every day is business.
39:35And the waiting room is starting to fill up.
39:38I just saw the blood squirt go flying past me, and I thought, that's going to be bad.
39:42Grab a flannel.
39:43A plastic surgeon is assessing Emily's badly damaged finger, which she sliced open in a freak accident at home.
39:50The wine glass fell off the top shelf, bounced on the kitchen counter.
39:54As it smashed and bounced back up, it's just cut straight into my finger.
39:58The medical team is concerned she's severed a tendon and sustained nerve damage that could result in her losing the use of her finger.
40:10All right, can you do the finger?
40:12Uh-uh.
40:13This is much as you can.
40:15That's what I can do.
40:16Can you straighten it up again for me?
40:18Straighten it up.
40:19Um, I'm trying.
40:21Sorry.
40:22Sorry.
40:23There you go.
40:25All right, can you bend just at the tip?
40:27Okay.
40:30All right.
40:31Oh, fuck.
40:32Sorry.
40:33All right.
40:34Um...
40:35Have I really done it?
40:36What am I looking at?
40:37From the examination, it looks like that you may have cut a little bit of it.
40:41Okay.
40:42So, normally, any cut about 50% through the tendon root, you tend to fix them, but it is just a nick.
40:47You tend to leave them alone, because they put together by themselves.
40:50Okay.
40:51So, we're going to open the finger up, make the wound a little bit wider, have a look and see the structures are damaged.
40:57What's every one might be?
40:58Right.
40:59Okay.
41:00The job of plastic surgery is to do early interventions to guarantee quick recovery and to prevent the complications.
41:10So, if it's dealt with ill, I think the complications can be minimised.
41:16I'm being such a wimp, but my gosh.
41:18You're in pain, aren't you?
41:19I'm in pain.
41:20I can see it.
41:23Let me just see what needs to be done, and then I need to be back.
41:27Before Emily goes home, she'll need to have the wound cleaned and dressed to help prevent an infection, which could make her finger even worse.
41:36It's now up to Nurse Dave to finish the treatment, starting with giving Emily a powerful dose of oxycodone for the pain.
41:43This is your antibiotic.
41:45It's quite big, though.
41:47Oh, that's a good one.
41:48That's a good big one.
41:49Oh, thank you.
41:50This is your pain, Emily.
41:51Wonderful.
41:53Perfect.
41:54Lovely.
41:56Now, let's dress your wound.
41:58Just brace yourself, darling.
41:59This is probably going to be the painful bit, isn't it?
42:02Wonderful.
42:03Drive it.
42:04It's my emotional support parent.
42:05Yeah.
42:06You can't leave me.
42:07Of course.
42:08We all need our parents.
42:11I miss them.
42:13Aw.
42:14Let's just clean them with water.
42:19Oh, dear.
42:20How does it feel?
42:22Not great.
42:23Yep.
42:24That has.
42:25Oh, dear.
42:30Oh, my God.
42:32Oh, shh.
42:34He's done that before, haven't he?
42:36Yeah.
42:37Right, let's do this.
42:41Oh, Dave, thank you.
42:42You've been so gentle.
42:44I tried because it's painful.
42:47Amazing.
42:48And you're good to come.
42:50You're welcome.
42:53So, Monday.
42:55Monday.
42:56Monday is when you know how much damage you've done.
42:59We're a bit better.
43:03Yeah?
43:04All right.
43:09Well, let's keep going.
43:12All right.
43:13Good.
43:17You've just got nothing to do.
43:18You've got nothing to do.
43:19But I'll save you.
43:20Yeah.
43:21I'm not gonna do it.
43:22You've got nothing to do.
43:23Oh
43:38It's very polite
43:53How the heck am I going to cook the kids dinner?
44:00I hope you have a good chef
44:10And if you or someone you know has been affected by the issues covered tonight
44:22Find information and support at channel5.com slash helplines
44:27True crime tomorrow
44:28Who landed a fatal punch?
44:30Detectives scrabble for hard evidence of murder suspect number one
44:34That's Wednesday at 9, next on 5 Surgeons
44:37A matter of life and death
44:39Stay with us
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