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Ambulance - Code Red (2020) Season 4 Episode 10
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FunTranscript
00:00There's nothing more extreme
00:03than an immediate threat to life.
00:10Responding to the most severe 999 calls.
00:14This lady is reporting pain in her head and is becoming less talkative.
00:18The rapid response vehicles of the Thames Valley Air Ambulance
00:22are at the front line delivering life-saving medical treatment.
00:27The big decision is for us whether we need to put a tube in
00:30again to protect us that way or not.
00:31Working day.
00:32We're going to give you some strong medication.
00:35And night.
00:36It should not hurt. It's a very good painkiller.
00:39Reacting to emergencies.
00:40You've been super brave, darling.
00:42The critical care teams.
00:44You've had a pretty big blow to the head.
00:45Are equipped to provide hospital-level treatment.
00:48So we'll give you some ketamine.
00:49That will mean that you don't know what we're doing
00:51whilst you straighten your ankle out.
00:53Whenever.
00:53Do you think it's bad?
00:55Potentially, yeah.
00:55And wherever.
00:56Oh, my leg.
00:58It's needed.
00:59You are doing a fantastic job.
01:01Filmed over three months.
01:03Let's have your arm, my dad.
01:04Let's give you some of this morphine.
01:06Just be aware he might stop spontaneously ventilating.
01:09I have the tube.
01:10We captured every vital second.
01:13That's okay.
01:14You're safe.
01:15As these highly trained critical care teams.
01:18Will you take a deep breath in for me?
01:19Fight to save lives.
01:21Your birthday present is surviving a cardiac arrest.
01:24When every second counts.
01:27Let's go, go, go.
01:29Tonight.
01:30Over there, we've got three further patients.
01:32Two of which have been collected and gone over the planet.
01:36Multiple casualties.
01:37Don't be scared.
01:38When a driver blacks out behind the wheel.
01:40I don't understand what's happened.
01:42I don't understand me.
01:44Just a little bit of oxygen for you.
01:45Okay.
01:45A man suffers a badly broken leg after a fall.
01:49Actually quite close to being open.
01:51Yeah, it looks properly threatened, doesn't it?
01:53Yeah, yeah.
01:53Let's do the rhythm check now.
01:55The critical care team fight to save an elderly woman's life.
01:58You don't have a part yet.
01:59Let's continue.
02:00And...
02:01Where's the pain?
02:02You're a little...
02:02Suspected internal injuries after a high-speed crash.
02:08Which way side?
02:08Stop.
02:09Stop right.
02:09Okay.
02:10It's 9am at the Thames Valley Air Ambulance Headquarters.
02:18Consultant paramedic Mark Hodkinson
02:20and Chief Operating Officer Critical Care Paramedic Adam Panter
02:24are preparing for a shift
02:25in one of the charity's five rapid response vehicles.
02:29Do the rear first and then I'll...
02:31Move around to the front.
02:34Normal light.
02:35Oh, yeah, normal fine.
02:37Fog light.
02:37Yeah, fine.
02:38Fitted with the latest advanced medical equipment,
02:41these cars respond to emergencies 365 days a year.
02:46Blues coming on.
02:47Yeah, good.
02:48Noise.
02:50Yeah, thanks for that.
02:51Anytime.
02:52Cool.
02:52Good to go.
02:53All right, mate.
02:53For the next eight hours,
02:55they'll be attending the most critical 999 emergencies
02:58over an area spanning three counties.
03:00Please.
03:11I'm just going to see a special treat.
03:16Hi.
03:17Um, there was just a car accident
03:18and I think someone's having a seizure.
03:20I see it's like vibrating now.
03:22I don't know what to do.
03:23And you decide it's injured?
03:24I know there's a bunch of people on the floor, I think.
03:29Okay, so the car's hit people?
03:32Yeah.
03:33That's a lot of people.
03:34All right.
03:34The other people that are dead,
03:35they're the other three injuries that they had.
03:38I wonder where it's going.
03:39Hello, I'm a doctor, you're the police officer.
03:41We've got the lady who's crashed into everyone.
03:43Her eyes are rolling back
03:44and she's making these really, like, loud, dasting noises.
03:48Yeah.
03:48Is she out of the car?
03:51Yeah, she's out of the car since there was a few.
03:53What's happened?
03:54Is it that the car is driven into the people that are on the floor?
03:58Yes, they literally got flattered.
04:01Yeah.
04:01We have already got multiple crews on the way, okay.
04:06With numerous lives at risk,
04:08it's a code-red emergency,
04:10so Mark and Adam are immediately dispatched
04:13and updated via messaging.
04:15Apparently, someone has collapsed at the wheel.
04:18They believe a medical collapse.
04:21Yeah.
04:21But potentially gone into a group of people.
04:25So there's potentially multiple patients.
04:27And ND025 are on route as well.
04:31It's outside of school as well,
04:33so potentially paediatrics.
04:35If we need to do an anaesthetic,
04:38anyone over 30 kilos, so eight-year-old,
04:42we can do or just need a soccer call in with first.
04:45Yeah.
04:45Understood.
04:46Happy?
04:46Happy.
04:47Multiple emergency service crews are rushing to the scene.
04:51It's a situation that will need careful management.
04:54These sorts of jobs can quickly overwhelm resources,
04:57and then we'll all obviously be going to a major trauma centre
05:00which can overload the major trauma centre.
05:02So lots of things to think about.
05:04Fourteen minutes after receiving the call,
05:09Mark and Adam arrive.
05:11Three-one, action.
05:14Can you grab jackets, yeah?
05:16Where numerous ambulance and critical care crews
05:18are already in attendance treating the wounded.
05:21You bring blood?
05:22Yeah.
05:22Yes, the patient's breathing.
05:40What's the meaning of the two-a-clock?
05:42What is it up?
05:42I have a gentleman here who seems to have tripped.
05:45I think he's broken his ankle.
05:47He's in a very awkward position.
05:50The ankle seems to be, like, very bent over.
05:53Okay.
05:53It's just in, like, a right-angled position,
05:56but his knee's up.
05:57Okay.
05:58Is it possible for me to speak to it?
05:59Yeah.
06:01Okay, now, have you lost any blood?
06:03Did you caught yourself when you fell?
06:05No.
06:06We don't think so.
06:07We can't see.
06:08It's very dark.
06:08It's very dark and dark here.
06:09We can't really see.
06:10So what happened?
06:11How did you fall?
06:12We're at a wedding.
06:13He's very drunk.
06:14It's very dark.
06:15And he tripped over at the park.
06:17Okay.
06:18We'll get an ambulance there as soon as possible.
06:23Unless treated urgently,
06:25badly broken limbs can have life-changing complications.
06:29So Dr. Tim Waite and critical care paramedic Matt Hale are dispatched.
06:33So we're going to a 61-year-old man
06:36who is apparently intoxicated and has a broken ankle
06:39that's significantly angulated.
06:42So it's kind of broken at an odd angle.
06:46The patient's stating he cannot feel foot.
06:49Loss of sensation may be due to nerve damage
06:51or restricted blood flow,
06:53potentially leading to tissue death and amputation.
06:56The man may also be at risk of hypothermia,
06:59which is dangerously low body temperature.
07:02It's dark.
07:03It's cold.
07:03It's raining.
07:04So if the patient's still in that environment,
07:06we'll need to think about getting him warm and dry
07:09out of that environment at the earliest opportunity.
07:1225 minutes after receiving the call...
07:15Okay.
07:16Bring me this a blanket.
07:17...Tim and Matt are the first to arrive at the hotel,
07:20where the patient is still in the garden where he fell.
07:23Hello there, sir.
07:24Hello.
07:24Pleased to meet you.
07:25Good evening.
07:26I'm Matt.
07:26This is Tim.
07:28What can we call you, sir?
07:30Robin.
07:30Robin.
07:31Hi, Robin.
07:31What's happened this evening?
07:32I think I've broken my leg.
07:35Okay.
07:35He had a few too many beers.
07:37He was looking for the car.
07:39He cut over this ledge.
07:40Okay.
07:41Do you remember falling, Robin?
07:42Not really, no.
07:44I had a few sherbets.
07:45All right.
07:4761-year-old Robin and his wife, Pat,
07:49were about to head home
07:50after attending a wedding at the hotel when he fell.
07:54Staff came to his aid,
07:55calling 999 and covering him with blankets.
07:59Have you hurt yourself anywhere else that you know of?
08:00No.
08:01No.
08:02I'm going to give a good press on your chest.
08:04Do you remember falling?
08:05Not really, no.
08:06Okay.
08:07And did he bum your head?
08:09Um, not that I know of.
08:12Your head.
08:15Pain in your belly there at all?
08:17Not that I have to.
08:18So, left closed hip fib.
08:21Okay.
08:22Um, we've not got any significant critical skin,
08:25but it definitely is well aligned.
08:27Okay.
08:28Robin, I think what we're going to need to do,
08:31that's getting some monitoring on for you now
08:32for your blood pressure and stuff.
08:33Excuse my light shining in your eyes.
08:35We'll get a drip into your hand somewhere.
08:39We'll give you some strong painkillers
08:41that will make you sleepy and trippy and comfortable
08:43so that we can straighten out that leg.
08:45Does that sound okay?
08:46I'm fine.
08:47I'm fine.
08:49Robin's lower leg is badly out of line
08:51and needs to be straightened as quickly as possible
08:53to reduce the risk of permanent damage.
08:57Where have you guys been this evening?
08:58What's...
08:59Yeah, I've been having fun.
09:00Oh, okay.
09:01Has it been a nice day?
09:02It's been a lovely day, actually.
09:03Beautiful.
09:04I'm sure it's ended like this.
09:07Excuse all this tapping.
09:08I'm trying to persuade a...
09:09persuade a vein to come up.
09:10Because he's cold,
09:12Robin's body is diverting blood away from the skin
09:15to preserve his temperature,
09:16so his veins have constricted,
09:19making it harder for Tim to insert a cannula.
09:22Oh, my ankle's killing me.
09:24Right, so we're going to give you some painkillers now, Robin.
09:26Don't worry, don't worry.
09:27No, no, we don't want you to be in pain.
09:29I'm all right.
09:30I'll be in worse pain.
09:31Well, that's fine,
09:32but we'll get your pain managed.
09:35Is it that broken?
09:37Yeah, it's broken,
09:38and it's off at a little bit of an angle,
09:39so the bones not come through the skin,
09:41which is a good thing,
09:41but we want to avoid that happening.
09:44Okay.
09:44The longer the bones in Robin's leg are misaligned,
09:47the greater the risk of nerve and tissue damage.
09:50So Tim and Matt must act quickly
09:52to restore good blood flow.
09:54A big scratch on your hand, Robin,
09:55while we're talking.
09:57Okay, Robin, look at this side for me.
09:59This is something called Penfox.
10:00It's a painkiller.
10:01Okay, so take it in your hand.
10:03I want you to seal your lips around here
10:05and take some nice, slow, deep breaths in for me.
10:08Penthrox will provide strong and immediate pain relief,
10:11but straightening a break as bad as Robin's
10:13will be excruciating.
10:15So before they can pull the bones back into line,
10:18he will need to be sedated.
10:20I'm keen not to leave that ankle any longer than we have to,
10:23so I feel like probably we've got good access to the airway.
10:27Okay, we're kind of in a position to manage complications in situ.
10:33Yeah.
10:33We've got care, we've got turvus,
10:35we've got an adequate oxygen supply.
10:37I'm going to plug this into a bit of oxygen,
10:38so you'll just feel that wafting up your nose.
10:42Patient position optimised, so we're in a good position.
10:44We're actually really quite well ramped
10:45in terms of airway already.
10:46No matter how urgent the emergency,
10:49critical care teams must always go through their safety checks
10:52before carrying out a sedation.
10:54Two vascular axes, so we've got one axis
10:56that we're very confident with and happy.
10:58Oxygen administered, we are on a master in the bag way to go.
11:01Such available and working is there.
11:03Perfect.
11:04So we don't think there's a skin breach, do we?
11:07Robin's bone is pressing against the skin.
11:10If it breaks through, then the fracture will be open,
11:12putting Robin at high risk of infection,
11:14which could result in amputation.
11:17Actually quite close to being open.
11:33In Stoke and Church,
11:35critical care paramedic Joe Epton
11:37and Dr Susie Stokes are preparing their kit.
11:41Susie has been with the Thames Valley Air Ambulance
11:44charity for over six years
11:46and is also a consultant in emergency medicine
11:49at the John Radcliffe Hospital in Oxford.
11:52I think I've always wanted to do it.
11:54Watching 999 when I was about 12,
11:57thinking I wanted to either be a paramedic or a doctor.
12:01And then I went down the emergency medicine
12:03training route in a hospital
12:04and it just fits perfectly to do this.
12:07Ready to go?
12:09Let's do it.
12:10Susie and Joe are starting a 10-hour shift,
12:14attending code red calls
12:15over an area of more than 2,000 square miles.
12:18And there's a emergency and patient breathing.
12:36My mother's...
12:37She's just completely collapsed.
12:39Okay.
12:40How long has she been?
12:42She's 75.
12:43She was fine.
12:43We were just literally having a coffee
12:45like 10 minutes ago.
12:46All right.
12:47Okay.
12:48Oh, Jesus.
12:50I think she's getting a bit blue.
12:53Is she still breathing?
12:56Um...
12:58Oh, I'm not sure she...
13:01I don't know.
13:03What?
13:04Yes.
13:06I'm sorry.
13:07That's okay.
13:08Have you made your chest laugh?
13:09Yes, I have.
13:11Yeah?
13:11Okay.
13:11Can you see her chest rise and falling?
13:14No, I think not.
13:16No?
13:17I think not.
13:18Okay, you're going to start CPR.
13:19So put me on loudspeaker.
13:22So lay her on her back on the floor,
13:24if possible.
13:25Yes.
13:25Nail by her side.
13:27And put one hand flat in the centre of her chest.
13:32Put the other hand on top
13:33and lock your fingers together.
13:36Keep your arms straight
13:37and push down hard and fast.
13:39Say push out loud with every push
13:40so I know how fast it's going.
13:42Push, push, push, push, push, push, push.
13:46Um, is an ambulance on its way?
13:49Yeah, we're on our way through your blue lights and sirens, okay?
13:52We're going to stay on the line
13:53and continue with the chest and pressure, okay?
13:56Yeah, I'm pushing.
13:56Perfect.
13:57An ambulance crew is now with the patient
14:05and they've requested the specialist medical skills
14:07of the critical care team.
14:10We're on our way to a 75-year-old lady
14:13who's collapsed in the garden
14:14and she's been in cardiac arrest
14:16and her heart's stopped for a while now.
14:19Um, but she's been having good CPR,
14:21um, and the paramedics on the scene
14:23have started advanced life support.
14:26So we're going to the job
14:28to provide any sort of enhanced critical care.
14:30There's other things we can do
14:31that the standard ambulance crew aren't able to do,
14:34like ultrasound, um, arterial lines, intubation.
14:4175-year-old Jacqueline
14:42has been given continuous CPR
14:44since her son Justin called 999
14:47after she collapsed.
14:49This lady had a witness by the ramps.
14:53Yeah.
14:53Her son's assisted her to the floor
14:55and her which boy has been called 999.
14:58Yeah.
14:58Total downtime now has been around 56 minutes
15:01since first, um, resource was on scene.
15:03Okay.
15:03We've had a total of 16 shots.
15:06Oh, right, okay.
15:07The ambulance crew have deployed the Lucas machine,
15:09which automatically applies chest compressions
15:12and helps keep blood flowing around Jacqueline's body.
15:15We've had anioid rain full and half.
15:18Yep.
15:18The end's 30, he turned low.
15:20Yeah.
15:21Pupil spits dilated.
15:23Yep.
15:24We're going to charge and shock through the Lucas
15:25as we have been doing.
15:27I want to charge.
15:27Okay.
15:29Stop shopping now.
15:30Yep.
15:32There's blood coming up.
15:33Do you want to swap?
15:34Yeah, swap.
15:34I'll get the airway bag.
15:36To maintain Jacqueline's airway
15:37and provide continuous oxygenation,
15:40Dr. Susie prepares to insert a tube into her windpipe.
15:44Pause now for the rhythm check now, yeah?
15:45Yeah.
15:45Let's do the rhythm check now.
15:46Okay, so that's PEA now.
15:49Yeah, yeah.
15:50So let's feel for a pulse.
15:54We don't have a pulse.
15:55Yeah, let's continue.
15:56PEA is pulseless electrical activity,
15:59which means although Jacqueline's heart is generating signals,
16:02it can't produce a pulse on its own.
16:05Can I have our suction, please?
16:06Yeah, never mind.
16:07Yeah.
16:08Yeah.
16:09We've got ten seconds to a rhythm check.
16:12Susie, you focus on the airway, I'll manage this.
16:13Yeah.
16:15We're rhythm fixed now.
16:16Let's try and do it all at once, can we?
16:18PEA?
16:19Very minimal flickering off the heart.
16:21No heartbeat.
16:22Back on the front.
16:23That's PEA.
16:23I'm just going to flush some water through this strip, Robin.
16:35In Chesham, a day of celebrating at a wedding
16:38has turned into a disaster for 61-year-old Robin
16:41after he fell and broke his ankle.
16:44Very nice respiratory function.
16:46Before Robin can be moved,
16:48critical care paramedic Matt and Dr. Tim
16:50need to straighten his leg to maintain blood flow
16:53and prevent permanent damage.
16:55However, the bone has almost pierced the skin.
16:58If it does, it could become dangerously infected.
17:02So we're going to go cautious, small increments.
17:04I'll do 20 milligram increments until we get to where we need to be.
17:06I think there's multiple risk factors not to be too aggressive,
17:10so I think we'll go cautious and steady.
17:14Tim will be giving Robin ketamine,
17:16a very strong painkiller,
17:18which causes dissociative sedation,
17:20so Robin will have no memory of the procedure.
17:23All right, so what we're going to do,
17:24a little bit at a time, all right?
17:25So you'll notice a little bit to start with.
17:28And if it's all going smoothly,
17:30we'll give you a little bit more,
17:31and we'll just keep going like that, all right?
17:33So you just nice deep breaths.
17:36We're with you, you're safe.
17:38Yeah.
17:39And we'll just take a few minutes
17:41getting to where we need to be.
17:45Tim's closely monitoring Robin
17:47because the alcohol he's consumed
17:49combined with ketamine
17:50could slow his brain signals to breathe
17:52and trigger vomiting and choking.
17:54Robin, you doing all right there, mate?
17:56Oh, I'm fine.
17:57Good.
17:58So you'll be a little bit more sleepy
18:01if you're having sort of hallucination-y type feelings.
18:03All of that's normal with this medicine,
18:05and it'll go completely back to normal as you wake up.
18:09So just deep breaths
18:11and think about somewhere you'd rather be but here.
18:14The ketamine is taking effect,
18:17but it may be too late
18:18to prevent Robin's bone from puncturing the skin.
18:21Looks properly threatened, doesn't it?
18:23Yeah, yeah.
18:24They must act fast.
18:26An open fracture is much more complicated to treat
18:28and carries greater risks of long-term complications
18:31which could lead to permanent disability.
18:35Are you happy if I start getting this straight?
18:37Yeah, I think so.
18:38We've lost a verbal contact.
18:40Yeah.
18:41Okay.
18:42So I'm going to lift the whole leg up.
18:44Oh.
18:48With Robin fully sedated,
18:50Matt can begin the process of realigning the bones in his leg,
18:53helped by one of the hotel staff.
18:55You're doing well there, Robin.
18:57So they're just straightening out that broken leg for you now, mate.
19:01It looks like it's all going beautifully down there.
19:04So you're just nice, steady breaths.
19:07So you're really safe.
19:08You're doing really well.
19:09Now this hand, I want you to hold it here.
19:12Be careful not to flex it.
19:14This hand here.
19:15And you're just keeping it steady there for me, okay?
19:17So is that okay?
19:18You're in a good position.
19:19A beautiful pedal pulse.
19:21Lovely.
19:22I mean, beautiful shape down here from the sedation perspective.
19:26Fantastic.
19:26So I'm going to take his leg.
19:29So if you let go, I've got control of his leg.
19:31Would you come and put your hands underneath for me?
19:33I'm doing okay there, Robin.
19:35No, no.
19:36You'll support your jaw a little bit.
19:38Sedation can compromise breathing.
19:40So Tim is supporting Robin's jaw to ensure his airway is open and unobstructed.
19:46Happy, Tim?
19:47Yeah, needing a little bit of a jaw thrust on it.
19:49But breathing nicely.
19:50Sat to 100.
19:51ETC O2 5.5.
19:53Okay.
19:54Puts back in and toe is in line with kneecap.
19:57Excellent.
19:58And then maintain pedal pulses ground.
20:00Brilliant.
20:00And that skin was never breached, was it?
20:02No, not breached, but close.
20:05Okay.
20:05I'll protect the weight upon his leg so you can let go now.
20:08Thank you so much for that.
20:10Robin's leg is straight, the skin is intact, and it's been successfully splinted for the
20:15trip to hospital.
20:17Robin, you're doing really well.
20:20All right.
20:21I'll just send to you, please, mate.
20:24Okay, thanks.
20:28I'm going to support your jaw again there, Robin, a touch.
20:31Take a few deep breaths.
20:32An ambulance has arrived, but still under the effects of the ketamine, Robin needs to
20:39stay closely monitored until he comes round.
20:42Hey, how are you doing?
20:43Good evening.
20:44Yeah, so we've got Robin, who's had a simple trip over the curb here.
20:50He's got a closed fractured tip here.
20:52He's currently sedated.
20:52We've sedated him and pulled his leg.
20:55So we're in good shape.
20:58He needs to go to Wexham.
20:59So if we could have a trolley and a scoop from you guys, that would be awesome.
21:04You're just starting to wake up from the sedation drugs we gave you, and you'll feel completely
21:10back to normal before long as they wear off all right.
21:13We're all with you.
21:14You're very safe.
21:15As Robin emerges from the sedation, he can be loaded onto the ambulance.
21:19Well done.
21:24Are you ready, Tim?
21:25Yep.
21:25I'm ready.
21:26Brace and lift.
21:28That's better.
21:30Okay.
21:31Good.
21:32Robin, you're doing great.
21:33We'll get you on the ambulance, all right?
21:34Okay, Robin, how are you doing?
21:45Um, not too good.
21:47Do you remember what's happened?
21:49You've broken your leg.
21:51We've just given you some strong medicines, get it back in the splint.
21:54You're now on an ambulance, all right?
21:56You in much pain, Robin?
21:58Look, it's not good.
22:00It's not good, okay.
22:01We'll get you some painkillers shortly, okay.
22:04IVP and some morphine, yeah, it'll be great, thank you.
22:06An intravenous infusion of paracetamol and morphine will keep him comfortable as the effects
22:12of the ketamine wear off.
22:13How are you doing?
22:14We're good now.
22:15We've got verbal contact back.
22:17He's able to tell me he's in a little bit of pain, so we're just getting some IVP and
22:19some morphine set up.
22:21We're still a little hypertensive, but coming down, so I think we're in a good place.
22:26Good.
22:27Are you feeling okay, Robin?
22:29I'm fine.
22:31Good.
22:31Good, good.
22:32I'm not sure how much you remember of the last hour or so, but ankle's inner splint looks
22:38good.
22:39It's definitely broken, no risk of stating the obvious, but it looks like the kind of
22:43break that with an operation will have a pretty good outcome and will heal well, so I'd be
22:47pretty optimistic.
22:50Main thing now is to get you as comfortable as we can and get you off to hospital.
22:55Whatever.
22:56What a night.
22:57All right.
22:57This is paracetamol, Robin, okay?
23:00I'm going to have a show.
23:01I agree.
23:01I'm going to have a drink.
23:03Not at all, sir.
23:03You've done great.
23:05With Robin's leg straight and his condition stable, he can be left in the hands of the
23:09ambulance crew, who will take him to Wexham Park Hospital, freeing up Tim and Matt for the
23:14next emergency.
23:15I mean, to us, it looks like what we call a closed tip fib, so the two bones of the lower
23:21leg broken through, but the skin overlying, still intact.
23:26It'll need an operation, but I'd be very hopeful that it will have a really good outcome at the
23:31end of all of that.
23:32On a main road in Buckinghamshire, critical care paramedic Adam and consultant paramedic
23:48Mark are one of several critical care teams at the scene of an accident.
23:52A car has crashed off the road and into pedestrians.
23:57Multiple crews from all the emergency services are in attendance.
24:00So, this lady's had a fit at the wheel.
24:03Yeah.
24:04She's impacted through the fence and then somehow ended up back here.
24:08Okay.
24:09She's patient one, and then over there, we've got three further patients, two of which have
24:14been collected on over the bonnet.
24:17All conscious, all breathing, all responding appropriately.
24:21Then we've got two other students that we've just been notified about with cuts and bruises.
24:25So, I think we just all pitch in.
24:27If you want to have a chat with this lady, this lady's reportedly had a fit that is responding
24:32appropriately, GCS of about 14.
24:35Now, that's all we know.
24:37We've been here a couple of minutes before you, and we've just done a very, very quick
24:39trial.
24:40So, if I can leave you with that, that'd be brilliant.
24:42So far, five pedestrians are confirmed to have been injured, while Mark assesses who most urgently
24:49needs the help of the critical care team.
24:51I've checked over the best I can at the moment.
24:53It's definitely not broken, nothing like that.
24:54Just every day, it's not really sure what's going on.
24:56Okay.
24:57So, that's what we have at the moment.
24:59Okay.
25:00Adam is with 38-year-old Madeline, who's driving the vehicle that collided with cars and pedestrians.
25:06Hi, Madeline.
25:07My name's Adam.
25:07I'm one of the paramedics for the Air Ambulance.
25:09Can you tell me what's happened today?
25:13Sorry, I don't know what you mean.
25:14Can you tell me where you are and what's happened to you today?
25:18What, in general?
25:19Well, now, where are you at the moment?
25:21Um, I'm not actually sure.
25:25Okay, do you know, do you know why you're sat on the floor at the moment?
25:29Have you ever had a seizure?
25:31No, never.
25:32Okay.
25:33If Madeline had a seizure while driving, a burst of abnormal electrical activity in her brain
25:38could have caused her to lose control of movement, consciousness and memory.
25:42Can you tell me what day of the week it is at all?
25:48That's okay, if not.
25:50No.
25:50That's all right.
25:51I'm really scared.
25:52I'm worried.
25:52That's okay.
25:52Don't worry.
25:53We don't know what's happened to you at the moment, but you've been involved in a car crash.
25:58So, we need to look after you and try and find out what's gone on.
26:01I've been involved in a car crash.
26:02You have, yeah.
26:04Seizures can be an indication of a serious medical condition.
26:07But with up to ten other casualties, Madeline isn't the only patient in need of urgent medical treatment.
26:13It was your head, wasn't it?
26:15A bit of a knock.
26:16But your legs and all that feel okay.
26:37Do you have any pain in your head?
26:40Critical care paramedic Adam and consultant paramedic Mark are among the many emergency crews responding to the aftermath
26:47after a car veered out of control and hit multiple pedestrians.
26:52Are you okay if I touch your head and neck?
26:54No pain anywhere at all in your head?
26:57No?
26:57No?
26:58No pain in your neck?
26:59You have, yes.
27:0038-year-old Madeline was driving, but with no recollection of the incident, the critical care team thinks she blacked out after having a seizure.
27:08Any pain in your back?
27:10No.
27:11All the way down your back?
27:12No pain?
27:13No.
27:13No pain?
27:14Adam's carrying out a full examination, as Madeline may have injuries from the impact.
27:19No pain in your hips?
27:21No.
27:21In this part of you, can I just touch your hips?
27:23Yeah.
27:23No pain in your hips at all?
27:25Okay?
27:25Yeah.
27:26All right?
27:26Sorry, I'm really confused.
27:28That's okay.
27:28I can't crash with him.
27:30And you don't have any pain anywhere, you don't feel anything at all, and you have no recollection of what's happened at the moment.
27:36I don't know.
27:37I don't know what the hell's been.
27:38Okay.
27:39Immediately after a seizure, the brain goes into a recovery phase called the post-ictal state, which can involve confusion and memory loss.
27:47So she's going to need to go because she's got no recollection of the incident, no recollection of the event.
27:51But that's the only thing I can find.
27:53Yeah.
27:53So she can be discharged off the SCAS fairly quickly and just needs transport for being post-ictal.
27:57Everybody now.
27:58The next ambulance that arrives, who do you want them to go to first?
28:01Seizure.
28:01Seizure first, yeah.
28:04Mark's assisting paramedics as they treat multiple casualties, who have been prioritised according to the severity of their injuries.
28:11Hello, my name's Mark.
28:13How are we doing?
28:14Yeah, good.
28:15I mean, it's lower back pain.
28:16Okay, all right.
28:17Bump on the head.
28:19Yeah.
28:19We lifted our head so there was some pain.
28:21We've got good, like, we're able to lift around.
28:24And numbers are all all right, yeah.
28:26Yeah, yeah, yeah.
28:26Cool.
28:27The first of many ambulance crews that will take the casualties to hospital has arrived.
28:32Absolutely zero recollection.
28:33Zero.
28:34But in terms of everyone else, because we don't know the etiology of what caused it, she's one that needs to go first.
28:40Of course, yeah.
28:41Madeline's seizure could be a symptom of a life-threatening problem in her brain that needs to be properly assessed as soon as possible.
28:48Just stay there.
28:48Just stay there.
28:49That's okay.
28:50That's okay.
28:50Get the bed.
28:51No.
28:51Just sit down and relax.
28:53Just sit down and relax.
28:54I know.
28:54Look, look at me.
28:55Madeline, listen to me.
28:56Madeline, don't be scared.
28:57I'm scared.
28:58I don't listen to me.
29:00Madeline will have x-rays and CT scans to check for internal injuries and tests to investigate what caused her seizure that nearly resulted in tragedy.
29:10It could have been a lot less.
29:12We've got ten patients in total.
29:14And at the moment, they're all okay.
29:18So, we can clear.
29:20I think, yeah, we should go then.
29:22I'm going to repot our bags to the car.
29:24Yeah, go, go.
29:24Us clear.
29:25We can then be available.
29:27Yeah.
29:27Abby?
29:28Yeah, it's very reasonable.
29:29All right.
29:29Miraculously, nobody has been seriously injured, so the critical care team can leave the casualties in the capable hands of the ambulance crews.
29:42The Thames Valley Air Ambulance Charity are called to at least one road traffic collision every day.
29:48He was going about 35 miles an hour down this road.
29:51Cars come out.
29:52From single vehicle accidents.
29:54Can you open your eyes for me?
29:56To multi-car pileups.
29:58Are you guys injured?
29:59Every 17 minutes, someone is killed or seriously injured on UK roads.
30:05Let's get your heads to the first.
30:06I'm excited.
30:07My back.
30:07With almost 50% of fatalities coming from crashes after dark.
30:12I'm up.
30:20We're back.
30:21We're both.
30:24We're now here.
30:25ambulance emergency patient breathing yeah we're both breathing but I think the
30:32driver's severely injured have you been involved in a collision we just came off
30:36the road we skidded off how many people are involved so the car's smoking should
30:41he get out if it's smoking he doesn't need to get out of the vehicle which is the one car involved
30:46uh yeah okay and what injuries have you both sustained I'm bleeding right now I think my head
30:56or something um okay you have any work and the other patient his hands bleeding I think his knee
31:03might have his eyes are far too bad okay so we have got that health arraigned and they will be
31:09dispatched to be impossible emergency services at the scene have requested the enhanced skills of
31:18the critical care team as they think this may be a life-threatening situation so we've been
31:25tasked to a road traffic accident where two passengers as far as we're aware have been
31:31injured so dr. Andy Darby Smith and critical care paramedic Matt Jarman are dispatched the police and
31:39the fire crews have seen they're concerned about the amount of damage to the car and one of the
31:43men has collapsed so there's concern that there's actually more significant injuries that were
31:47previously unidentified although the men got out of the car the adrenaline rush after a major accident
31:54can temporarily mask pain hiding serious and potentially fatal injuries the car crashed on a
32:07country road after hitting a pothole and the in matter briefed on the findings so far by one of the
32:12fire crew there's severe defamation on the front of the car a post is intruded by about half a foot how many
32:21patients are there sorry two passenger yeah uh was alert conscious uh does actually help get the driver out
32:28yeah they've moved to where they are now yeah passenger was fine but he's now since deteriorating
32:34as well so one car skid over there yeah and bounced from there 23 year old Jay was driving back from the
32:45gym with his friend Charlie when he lost control of the car Charlie pulled Jay from the wreckage but
32:51collapsed shortly afterwards he is being treated by ambulance paramedics while Andy and Matt assess Jay
32:57hi mate my name is Andy I'm one of the doctors we're gonna look after you and check you're okay is
33:02all right what's your name nice to meet you Jay this mum yeah hello I'm Andy we're gonna take good care of
33:10him okay Jay's mum and his sister rush to the scene and have been by his side since they arrived so Jay
33:18we're gonna just give you a quick once-over if that's all right all right do you have any pain anywhere
33:22okay two six with patient before any treatment can be given dr. Andy needs to carry out a full body
33:34assessment to identify any potentially life-threatening injuries take a very deep breath for me I am take a
33:42really deep breath and out I feel quite sick I know you're doing great a high-speed impact can cause
33:50catastrophic trauma Jay's nausea could be a warning sign of a brain injury and he may have multiple
33:57broken bones any pain when I touch around here well where's the pain a bit lower jay's also at serious
34:04risk of damage to vital organs and internal bleeding which way side stop please stop okay
34:27he's going over the beauty in Abingdon I've got the tube tube seen through the cords bougie out
34:36close your eyes okay dr. Susie and critical care paramedic Joe are working with an ambulance crew
34:42to try and resuscitate 75 year old Jacqueline she's fogging the team have inserted a plastic tube into her
34:50windpipe so they can take control of Jacqueline's breathing but sadly her heart is still failing to
34:56respond so unless we get back into BF and can do some DSD there isn't really anything else
35:01that's worse than it was we did the last one only the right ventricles moving yeah okay fine carry
35:11on okay ready for a pulse check someone looking at the monitor again it's just uh it's not enough to
35:20sustain life as time goes on Jacqueline's heart activity is getting weaker and weaker
35:25that it's only the right ventricle that's fluttering yeah optionation's not the problem
35:31ventilation's not the problem yeah pads were changed position at the right times drugs were
35:38given at the right time so I don't think there's anything else that's reversible and we've now had
35:42an hour of found time I'll go have a chat with family and then we'll come up sadly despite the
35:49continued efforts of the ambulance crew and the critical care team there's nothing more they can
35:54do for Jacqueline so Joe updates her son Justin at the moment although there is some electrical activity
36:00under the ultrasound the heart is not moving and not doing enough that would sustain a heartbeat and
36:05and would would would you know produce a pulse there's nothing more that anyone can add there's
36:09nothing more that any hospital would do even if you're five minutes from hospital they wouldn't
36:12add anything to her treatment we've bought everything that she needs here and unfortunately
36:17it's not work so what we'll do is we'll just make a bit of space for you and just clear up some
36:20bucket away so you've got some space I'm really sorry hello sir I'm Susie one of the doctors with
36:28the air ambulance I'm so sorry to meet you under these circumstances whilst the critical care teams do
36:33everything they can for patients these are the kinds of decisions they have to make on a daily basis I
36:39think the decision to stop was was the right thing for her and for the family continuing resuscitation not
36:45only won't produce the outcome that we want I think is actually you know if anything more harmful for the
36:50families to see that for a prolonged period of time and is of no benefit to the patient and I think as a
36:56whole it's much nicer when we reach the point of futility to recognize that and stop when it's
37:01appropriate and not carry on
37:12so please be really careful I will be really careful in Whitney critical care paramedic Matt and dr.
37:21Andy are examining 23 year old Jay who crashed his car at high speed suppress there it's fine all
37:29right you're doing great I'm gonna feel your legs does your tummy hurt at all why were you I'm gonna
37:35gently press the tummy how does the tummy feel Andy needs to ascertain if Jay has suffered any
37:41broken bones internal bleeding or damage to vital organs we're for your hips okay hips all right wiggle your
37:49toes with your feet good will your hands hold on Jay's friend Charlie was also in the car and is being
38:00treated by ambulance paramedics Jay sister and mum have been with the lab since just after the crash
38:09this is a strong pain relief I want you to take deep breaths into your mouth okay no if one of you can
38:18help hold it and what he's going to do is wrap my lips around this bit and take deep breaths in and
38:22out okay yeah it's a bit stronger than that just breathe it in out yeah just breathe yeah just breathe
38:28it in a bit like a vape Jay yeah it's actually exactly like a vape you breathe out into it as well if
38:34that makes sense I'm blood pressure 129 perfect scratching your arm now it's just a scratch coming in
38:40okay well done inserting a cannula will enable Andy to administer fluids stronger pain relief and
38:48potentially life-saving medication most important thing is to keep you warm okay all right where's it
38:55hurting oh yeah you your right hand doesn't like you've broken a small bone in your hand all right
39:03I'm just gonna have a look here it's gonna be quite cold sorry perfect can you take a really deep
39:10breath for me unlike regular ambulance crews critical care teams carry portable ultrasound scanners
39:16did save again allowing them to detect any internal injuries that may need immediate intervention I'm gonna
39:25be really gentle I'm gonna look around your side of your chest okay please be careful all right thank you
39:30all right it's made in the lower part that's paper yeah all right yeah lift your hand up for me
39:37oh is that where I saw all right I'm trying to be really gentle I promise just let me a quick look
39:49see if there's any I can see it's a problem all right oh that's normal too okay with no indication
39:56of internal bleeding or damage to his organs Jay appears to have been extremely lucky so the key
40:02thing now is to stay warm and have lots of pain relief okay I think you've broken a bone in your hand
40:09and you might have broken your collarbone you let me know if anything changes but you're gonna be
40:15completely fine okay all right this is gonna be a little bit cold okay it might be a little bit of
40:20a shock now Jay is stable Matt can begin to assess Charlie cool that looks good looks fine my blood in
40:30there that's good I know you're nice and warm I just want to have a look at your chest deep breath for
40:36me really deep breath that doesn't hurt anywhere no Matt's checking Charlie's chest and abdomen for
40:44any potentially life-threatening internal trauma excellent your tummies I know you've a little bit
40:50sore down here weren't you you had a seatbelt on did you I assume that's from the seatbelt yeah cool any
40:56any pain where I'm touching here no sure as a precautionary measure so Jay I'm just giving you some other
41:03medicine it's not gonna make you feel weird at all okay and he's giving Jay tranexamic acid which
41:08will help his blood to clot more effectively in the event that there is undetected internal bleeding
41:13all right ready steady roll I know you're doing really well yep I'm ready steady down as Jay's loaded
41:21onto the ambulance have you been up and walked okay and your left leg can you lift it in the air for me
41:28straight and and and high high high high higher up up up up up Matt is giving Charlie a top-to-toe
41:37examination to check for any broken bones or other injuries does that hurt anywhere does it hurt in
41:45your hip no and do the other one same thing up in the air that's it higher higher that's it I'll
41:54help you does that hurt in your hips no cool good good good good all right keep it nice and warm Jay
42:01I'm gonna hand you over to the ambulance team they're gonna get you off off to hospital you're
42:06very safe okay you're welcome mate these guys these guys are very very very good they're gonna look after
42:11you okay while Matt liaises with the ambulance crew if we if he's happy to sit up would you take him
42:17as well or not hello mate my name's Andy you're right I'm one of the doctors Andy completes Charlie's
42:23assessment are you one of his friends is he behaving normally yeah not behaving in a way that is scary
42:30or weird or confused or odd for him no not really no all right did you stand up out the car
42:36yeah look in your eyes okay all right my feeling buddy is to get you up all right so I think you
42:47didn't I think you've actually done you've got away really really lightly stand up stand up good right
42:52we're gonna put these around you to keep warm it's difficult to believe looking at the accident site
42:57but both Jay and Charlie seem to have been incredibly lucky yeah both will need to go to hospital to be
43:05checked out so observation was stable couldn't find any significant injuries and he's not gonna know
43:11neck pain and can move his head all around this fight I just been mobilizing on scene before we got
43:15here anyway so I think he's good to sit there you're gonna be okay the critical care team are happy to
43:21hand them over to the ambulance crew for the journey to John Radcliffe Hospital these guys are gonna take
43:25really good care of you all right good luck Jay good luck Charlie all right cheers guys have a good night
43:55there you all right yeah
44:00bye
44:09oh
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