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Ambulance - Code Red (2020) Season 4 Episode 10
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Short filmTranscript
00:00In the intense world of medical emergencies, there's nothing more extreme than an immediate threat to life, responding to the most severe 999 calls.
00:18This lady is reporting pain in her head and is becoming less talkative.
00:23The rapid response vehicles of the Thames Valley Air Ambulance 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, and night, reacting to emergencies, the critical care teams are equipped to provide hospital-level treatment.
00:53So we'll give you some academy. That will mean that you don't know what we're doing whilst you straighten your ankle out.
00:58Whenever...
00:58Do you think it's fast?
01:00Potentially, yeah.
01:01And wherever...
01:02Oh, my leg!
01:03It's needed.
01:04You are doing a fantastic job.
01:06Filmed over three months...
01:08Let's have your arm, my darling. 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.
01:19As these highly trained critical care teams...
01:23Can you take a deep breath in for me?
01:24...fight to save lives...
01:26Your birthday present is surviving a cardiac arrest.
01:30...when every second counts.
01:32Let's go, go, go.
01:34...tonight...
01:35Over there, we've got three further patients...
01:37Two of which have been collected and gone over the planet.
01:41...multiple casualties...
01:42Don't be scared.
01:43...when a driver blacks out behind the wheel...
01:45I don't understand what's happened. I don't listen to me.
01:49Just a little bit of oxygen for you.
01:50Okay.
01:51...a man suffers a badly broken leg after a fall.
01:54Actually quite close to being open.
01:56Yeah, it looks properly threatened, doesn't it?
01:58Yeah, yeah.
01:58Let's do the rhythm check now.
01:59The critical care team fight to save an elderly woman's life.
02:03You don't have a part yet.
02:04Let's continue.
02:05And...
02:06Where's the pain?
02:07You've got a little...
02:07Oh, oh, oh.
02:09...suspected internal injuries after a high-speed crash.
02:12Right, which way side?
02:13Stop, stop, right, right.
02:15Okay.
02:18It's 9am at the Thames Valley Air Ambulance Headquarters.
02:23Consultant paramedic Mark Hodkinson
02:25and Chief Operating Officer Critical Care Paramedic Adam Panter
02:29are preparing for a shift
02:30in one of the charity's five rapid response vehicles.
02:34Do the rear first and then I'll move around to the front.
02:39Normal light?
02:40Oh, yeah, normal fine.
02:42Fog light?
02:42Yeah, fine.
02:44Fitted with the latest advanced medical equipment,
02:46these cars respond to emergencies 365 days a year.
02:51Blues coming on.
02:52Yeah, good.
02:53Noise?
02:55Yeah, thanks for that.
02:56Anytime.
02:57Cool.
02:57Good to go.
02:58All right, mate.
02:58For the next eight hours,
03:00they'll be attending the most critical 999 emergencies
03:03over an area spanning three counties.
03:12I think it's just a car accident and I think someone's having a seizure.
03:25The seats are, like, vibrating now.
03:27I don't know what to do.
03:28Is it just that it's injured?
03:30No, there's a bunch of people on the floor, I think.
03:33Okay, so the car's hit people.
03:37Yeah, that's a lot of people.
03:39All right.
03:39The other people that are there,
03:40know the other of the injuries that they had?
03:43I wonder what it's doing.
03:44Hello, I'm a doctor, she's the police officer.
03:45We've got the lady who's crashed into everyone.
03:48Her eyes are rolling back
03:49and she's making these really, like, loud,
03:52dasting noises.
03:53Yeah.
03:53Okay.
03:54Is she out of the car?
03:56Yeah, she's out of the car,
03:57she's very confused.
03:58What's happened?
03:58Is it that the car has driven in to the people that are on the floor?
04:03Yes, they literally got flattered.
04:06Yeah.
04:06We have already got multiple crews on the way, okay.
04:11With numerous lives at risk,
04:13it's a code red emergency,
04:15so Mark and Adam are immediately dispatched
04:18and updated via messaging.
04:20Apparently someone has collapsed at the wheel.
04:23They believe a medical collapse.
04:26Yeah.
04:26But potentially gone into a group of people.
04:30So there's potentially multiple patients
04:32and ND025 are en route as well.
04:36It's outside of school as well,
04:38so potentially paediatrics.
04:40If we need to do an anaesthetic,
04:43anyone over 30 kilos,
04:46so eight-year-old,
04:47we can do,
04:47or just need a soccer call in with first.
04:50Yeah, understood.
04:51Happy?
04:51Happy.
04:52Multiple emergency service crews
04:54are rushing to the scene.
04:55It's a situation that will need careful management.
04:59These sorts of jobs can quickly overwhelm resources,
05:02and then we'll all obviously be going to a major trauma centre,
05:05which can overload the major trauma centre.
05:07So lots of things to think about.
05:0914 minutes after receiving the call,
05:14Mark and Adam arrive.
05:163-1, hat scene.
05:19Can you grab jackets, yeah?
05:21Where numerous ambulance and critical care crews
05:23are already in attendance treating the wounded.
05:26Can you bring blood?
05:26Yeah.
05:27Yeah.
05:41Yeah, the patient's breathing.
05:45What's the meaning of the fear call?
05:47I have a gentleman here who seems to have tripped.
05:50I think he's broken his ankle.
05:53He's in a very awkward position.
05:55That ankle seems to be, like, very bent over.
05:58Okay.
05:58It's just in, like, a right-angled position,
06:01but his knee's up.
06:02Okay.
06:03Is it possible for me to speak to him?
06:04Yeah.
06:06Okay, now, have you lost any blood?
06:08Did you caught yourself when you fell?
06:10No.
06:11We don't think so.
06:12We can't see.
06:13It's very dark.
06:13It's very dark, very dark here.
06:14We can't really see.
06:15So, what happened?
06:16How did you fall?
06:17We're at a wedding.
06:18He's very drunk.
06:19It's very dark.
06:20And he tripped over the path.
06:23Okay.
06:23We'll get an ambulance there as soon as possible.
06:28Unless treated urgently,
06:30badly broken limbs can have life-changing complications.
06:34So, Dr. Tim Waite and critical care paramedic Matt Hale are dispatched.
06:38So, we're going to a 61-year-old man
06:41who is apparently intoxicated and has a broken ankle
06:44that's significantly angulated,
06:47so it's kind of broken at an odd angle.
06:51A patient's stating he cannot feel foot.
06:54Loss of sensation may be due to nerve damage
06:56or restricted blood flow,
06:58potentially leading to tissue death and amputation.
07:01The man may also be at risk of hypothermia,
07:04which is dangerously low body temperature.
07:07It's dark, it's cold, it's raining.
07:09So, if the patient's still in that environment,
07:12we'll need to think about getting him warm and dry
07:14out of that environment at the earliest opportunity.
07:1725 minutes after receiving the call...
07:20Okay.
07:21There's a blanket.
07:22Tim and Matt are the first to arrive at the hotel,
07:24where the patient is still in the garden where he fell.
07:28Hello there, sir.
07:29Hello. Pleased to meet you.
07:30Good evening.
07:31I'm Matt. This is Tim.
07:33What can we call you, sir?
07:35Robin.
07:35Robin. Hi, Robin.
07:36What's happened this evening?
07:38I think I've broken my leg.
07:40Okay.
07:40He had a few too many beers.
07:42He was looking for the car.
07:44He cut over this ledge.
07:45Okay.
07:46Do you remember falling, Robin?
07:47Not really, no.
07:48I've had a few sherbet's.
07:50All right.
07:5261-year-old Robin and his wife, Pat,
07:54were about to head home after attending a wedding at the hotel when he fell.
07:59Staff came to his aid,
08:00calling 999 and covering him with blankets.
08:03Have you hurt yourself anywhere else that you know of?
08:05No, no.
08:07I'm going to give a good press on your chest.
08:09Do you remember falling?
08:10Not really, no.
08:12Okay.
08:12And did you bum your head?
08:14Um, not that I know of.
08:16Your head.
08:19Any pain in your belly there at all?
08:22Not, not everything.
08:23So, left closed hip fib.
08:26Okay.
08:27Um, we've not got any significant critical skin,
08:30but it definitely is well aligned.
08:32Okay.
08:33Robin, I think what we're going to need to do,
08:36that's getting some monitoring on for you now
08:37for your blood pressure and stuff.
08:38Excuse my light shining in your eyes.
08:40We'll get a drip into your hand somewhere.
08:44We'll give you some strong painkillers
08:46that will make you sleepy and trippy and comfortable
08:48so that we can straighten out that leg.
08:50Does that sound okay?
08:51Yeah, I'm fine.
08:52I'm fine.
08:54Robin's lower leg is badly out of line
08:56and needs to be straightened as quickly as possible
08:58to reduce the risk of permanent damage.
09:02Where have you guys been this evening?
09:03What's...
09:04Yeah, we've been having fun.
09:05Oh, okay.
09:06Has it been a nice day?
09:07It's been a lovely day, actually.
09:08Beautiful.
09:09I'm sure it's ended like this.
09:12Let's use all this tapping.
09:13I'm trying to persuade a...
09:14persuade a vein to come up.
09:16Because he's cold,
09:17Robin's body is diverting blood away from the skin
09:20to preserve his temperature.
09:22So his veins have constricted,
09:24making it harder for Tim to insert a cannula.
09:27Oh, my ankle's killing me.
09:29Right, so we're going to give you some painkillers now, Robin.
09:31Don't worry, don't worry.
09:32No, no, we don't want you to be in pain.
09:34I'm all right.
09:35I've been in worse pain.
09:37Well, that's fine.
09:37But we'll get your pain managed.
09:40Is it that broken?
09:42Yeah, it's broken and it's off at a little bit of an angle.
09:44The bone's not come through the skin,
09:46which is a good thing,
09:46but we want to avoid that happening, okay?
09:49The longer the bones in Robin's leg are misaligned,
09:52the greater the risk of nerve and tissue damage.
09:55So Tim and Matt must act quickly to restore good blood flow.
09:59A big scratch in your hand, Robin.
10:00Right.
10:01Oh, we're talking.
10:02Okay, Robin, look at this side for me.
10:04This is something called Penthrox.
10:05It's a painkiller, okay?
10:07So take it in your hand.
10:08I want you to seal your lips around here
10:10and take some nice, slow, deep breaths in for me.
10:13Penthrox will provide strong and immediate pain relief,
10:16but straightening a break as bad as Robin's
10:18will be excruciating.
10:20So before they can pull the bones back into line,
10:23he will need to be sedated.
10:25I'm keen not to leave that ankle any longer than we have to.
10:28So I feel like probably we've got good access to the airway.
10:32So we're kind of in a position to manage complications in situ.
10:38Yeah.
10:39We've got an adequate oxygen supply.
10:41I'm going to plug this into a bit of oxygen,
10:43so you'll just feel that wafting up your nose.
10:47Patient position optimised, so we're in a good position.
10:49We're actually really quite well ramped in terms of airway already.
10:52No matter how urgent the emergency,
10:54critical care teams must always go through their safety checks
10:57before carrying out a sedation.
10:59Two vascular axes, so we've got one axis
11:01that we're very confident with and happy.
11:03Oxygen administered, we are on,
11:05and master in the bag way to go.
11:06Such an available and working is there.
11:08Perfect.
11:09So we don't think there's a skin breach, do we?
11:12Robin's bone is pressing against the skin.
11:15If it breaks through, then the fracture will be open,
11:17putting Robin at high risk of infection,
11:19which could result in amputation.
11:23Actually quite close to being open.
11:24In Stoke and Church,
11:40critical care paramedic Joe Epton
11:42and Dr. Susie Stokes are preparing their kit.
11:46Susie has been with the Thames Valley Air Ambulance Charity
11:49for over six years
11:51and he's also a consultant in emergency medicine
11:54at the John Radcliffe Hospital in Oxford.
11:57I think I've always wanted to do it.
11:59Watching 999 when I was about 12
12:02and thinking I wanted to either be a paramedic or a doctor.
12:06And then I went down the emergency medicine training route in a hospital
12:09and it just fits perfectly to do this.
12:13Ready to go?
12:14Let's do it.
12:15Susie and Joe are starting a 10-hour shift,
12:19attending Code Red calls
12:20over an area of more than 2,000 square miles.
12:23Andy, the emergency is the patient breathing.
12:41My mother's...
12:42She's just completely collapsed.
12:44Okay.
12:45How long has she been?
12:47She's 75.
12:48She was fine.
12:48We were just literally having a coffee like 10 minutes ago.
12:51All right.
12:52Okay.
12:52I think she's getting a little bit blue.
12:58Is she still breathing?
13:01Um...
13:01Oh, I'm not sure she...
13:06I don't know.
13:08What?
13:09Yes.
13:11I'm sorry.
13:12That's okay.
13:13Have you made your chest laugh?
13:14Yes, I have.
13:16Yeah?
13:16Okay.
13:16Can you see her chest rising and falling?
13:19No.
13:20No, I think not.
13:21No.
13:22I think not.
13:23Okay, you're going to start CPR.
13:24So put me on loudspeaker.
13:27So lay her on her back on the floor if possible.
13:30Yeah.
13:30Nail by her side.
13:32And put one hand flat in the centre of her chest.
13:37Put the other hand on top.
13:38And lock your fingers together.
13:41Keep your arms straight and push down hard and fast.
13:44Say push out loud with every push so I know how far she's going.
13:47Push.
13:48Push.
13:48Push.
13:48Push.
13:48Push.
13:48Push.
13:49Push.
13:49Push.
13:49Push.
13:49Push.
13:51Um, is an ambulance on its way?
13:54Yeah, we're on our way through your blue lights and sirens, okay?
13:57Okay.
13:57We're going to stay on the line.
13:58Just continue with the chest and pressure, okay?
14:01Yeah, I'm pushing.
14:01We're on our way through a 75-year-old lady who's collapsed in the garden and she's been
14:21in cardiac arrest and her heart's stopped for a while now.
14:24But she's been having good CPR and the paramedics on the scene have started advanced life support.
14:31So we're going to the job to provide any sort of enhanced critical care.
14:35There's other things we can do that the standard ambulance crew aren't able to do, like ultrasound,
14:41um, arterial lines, intubation.
14:4675-year-old Jacqueline has been given continuous CPR since her son Justin called 999 after she collapsed.
14:54This lady had a witness, I don't know, the rats.
14:58Yeah.
14:58Uh, son's assisted her to the floor, um, at which point it was then called 999.
15:02Yeah.
15:03Total downtime now has been around 56 minutes since first, um, resource was on scene.
15:08Okay.
15:08We've had a total of 16 shots.
15:11Oh, right, okay.
15:12The ambulance crew have deployed the Lucas machine, which automatically applies chest compressions
15:17and helps keep blood flowing around Jacqueline's body.
15:20We've had amiodarine full and half.
15:23Yeah.
15:23BN's dirty, ketones low.
15:25Yeah.
15:26Cupil spits dilated.
15:28Yeah.
15:28We're going to charge and shock through the loop as we have been doing.
15:32I want to charge.
15:34Shop, shopping now.
15:37There's blood coming up.
15:38Do you want to swap?
15:39Yeah, swap.
15:39I'll get the airway bag.
15:40To maintain Jacqueline's airway and provide continuous oxygenation, Dr. Susie prepares
15:46to insert a tube into her windpipe.
15:49Pause now for the rhythm check now, yeah?
15:50Yeah.
15:50Let's do the rhythm check now.
15:53Okay, so that's PEA now.
15:54That's PEA, yeah.
15:55So let's feel for a pulse.
15:59We don't have a pulse.
16:00Yeah, let's continue.
16:01PEA is pulseless electrical activity, which means although Jacqueline's heart is generating
16:07signals, it can't produce a pulse on its own.
16:09Can I have our suction, please?
16:11Yeah, that's fine.
16:14We've got 10 seconds for a rhythm check.
16:17Susie, you focus on the airway, our managers.
16:18Yeah.
16:20We're rhythm fixed now.
16:21Let's try and do it all at once, can we?
16:23PEA?
16:24Very minimal flickering off the heart.
16:26No heartbeat.
16:27Back on the breath.
16:28That's PEA.
16:28Thank you, Lord.
16:28I'm just going to flush some water through this strip, Robin.
16:40In Chesham, a day of celebrating at a wedding has turned into a disaster for 61-year-old Robin
16:46after he fell and broke his ankle.
16:49Very nice respiratory function.
16:51Before Robin can be moved, critical care paramedic Matt and Dr. Tim need to straighten
16:56his leg to maintain blood flow and prevent permanent damage.
16:59However, the bone has almost pierced the skin.
17:03If it does, it could become dangerously infected.
17:07So we're going to go cautious, small increments.
17:09I'll do 20 milligram increments until we get to where we need to be.
17:11I think there's multiple risk factors not to be too aggressive.
17:15So I think we'll go cautious and steady.
17:19Tim will be giving Robin ketamine, a very strong painkiller, which causes dissociative sedation,
17:25so Robin will have no memory of the procedure.
17:28All right.
17:29So what we're going to do, a little bit at a time, all right?
17:31So you'll notice a little bit to start with.
17:33No problem.
17:33And if it's all going smoothly, we'll give you a little bit more.
17:36And we'll just keep going like that, all right?
17:38So you just nice deep breaths.
17:41We're with you.
17:42You're safe.
17:43Yeah.
17:44And we'll just take a few minutes getting to where we need to be.
17:50Tim's closely monitoring Robin because the alcohol he's consumed,
17:54combined with ketamine, could slow his brain signals to breathe
17:57and trigger vomiting and choking.
17:59Robin, you're doing all right there, mate?
18:01I'm fine.
18:02Good.
18:03So you're a little bit more sleepy if you're having sort of hallucination-y type feelings.
18:08All of that's normal with this medicine.
18:11And it'll go completely back to normal as you wake up.
18:14So just deep breaths and think about somewhere you'd rather be but here.
18:19The ketamine is taking effect, but it may be too late to prevent Robin's bone from puncturing
18:25the skin.
18:26It looks properly threatened, doesn't it?
18:28Yeah, yeah.
18:29They must act fast.
18:31An open fracture is much more complicated to treat and carries greater risks of long-term
18:36complications, which could lead to permanent disability.
18:39Are you happy if I start getting this straight?
18:42Yeah, I think so.
18:43In a good place with lots of verbal contact?
18:45Yeah.
18:46Okay.
18:47So I'm going to lift the whole leg up.
18:52With Robin fully sedated, Matt can begin the process of realigning the bones in his leg,
18:58helped by one of the hotel staff.
19:00You're doing well there, Robin.
19:02So they're just straightening out that broken leg for you now, mate.
19:05It looks like it's all going beautifully down there.
19:09So you're just nice, steady breaths.
19:12So you're really safe.
19:13You're doing really well.
19:14With this hand, I want you to hold it here.
19:17Be careful not to flex it.
19:19This hand here.
19:20And you're just keeping it steady there for me, okay?
19:22So is that okay?
19:23You're in a good position?
19:24Beautiful pedal pulse.
19:26Lovely.
19:27I'm in beautiful shape down here from the sedation perspective.
19:31Fantastic.
19:31So I'm going to take his leg.
19:34So if you let go, I've got control of his leg.
19:36Would you come and put your hands underneath for me?
19:38I'm doing okay there, Robin.
19:40Cool.
19:40No, no.
19:41You'll support your jaw a little bit.
19:43Sedation can compromise breathing.
19:45So Tim is supporting Robin's jaw to ensure his airway is open and unobstructed.
19:51Happy, Tim?
19:52Yeah, needing a little bit of a jaw thrust.
19:54But breathing nicely, SATs 100, ETCO 2.5.
19:57Okay, puts back in and toe is in line with kneecap.
20:02Excellent.
20:03And then maintain pedal pulse is grand.
20:05Brilliant.
20:05And that skin was never breached, was it?
20:07No, not breached, but close.
20:10Okay, I'll protect the weight upon his leg so you can let go now.
20:13Thank you so much for that.
20:15Robin's leg is straight, the skin is intact, and it's been successfully splinted for the trip to hospital.
20:22Robin, you're doing really well.
20:24All right, I'll have this then to you, please, mate.
20:29Lovely, thanks.
20:33I'm going to support your jaw again there, Robin, a touch.
20:36Take a few deep breaths.
20:39An ambulance has arrived, but still under the effects of the ketamine, Robin needs to stay closely monitored until he comes round.
20:47Hey, how are you doing?
20:48Good evening.
20:49Hey, so we've got Robin, who's had a simple trip over the kerb here.
20:55He's got a closed fractured tip here.
20:57He's currently sedated.
20:57We've sedated him and pulled his leg.
21:00So we're in good shape.
21:03He needs to go to Wexham.
21:04So if we could have a trolley and a scoop from you guys, that would be awesome.
21:09You're just starting to wake up from the sedation drugs we gave you, and you'll feel completely back to normal before long as they wear off all right.
21:18We're all with you.
21:19You're very safe.
21:21As Robin emerges from the sedation, he can be loaded onto the ambulance.
21:27Are you ready, Tim?
21:30Yep.
21:30I'm ready.
21:31Brace and lift.
21:32Okay, good.
21:37Robin, you're doing great.
21:38We'll get you on the ambulance, all right?
21:47Okay, Robin, how are you doing?
21:50Um, too good.
21:52Do you remember what's happened?
21:54You've broken your leg.
21:56We've just given you some strong medicines, get it back in a splint.
21:59You're now on an ambulance, all right?
22:01You're in much pain, Robin.
22:03Look, it's jumping.
22:05It's not good.
22:06Okay.
22:06We'll get you some painkillers shortly.
22:08Okay.
22:09IVP and some morphine, yeah, it'll be great.
22:11An intravenous infusion of paracetamol and morphine will keep him comfortable as the effects of the ketamine wear off.
22:18How are you doing?
22:19We're good now.
22:20We've got verbal contact back.
22:22He's over to tell me he's in a little bit of pain, so we're just getting some IVP and some morphine set up.
22:26We're still a little hypertensive, but coming down, so I think we're in a good place.
22:31Good.
22:32Are you feeling okay, Robin?
22:34I'm fine.
22:35Good, good, good.
22:37I'm not sure how much you remember of the last hour or so, but ankle's inner splint looks good.
22:44It's definitely broken, no risk of taking the obvious, but it looks like the kind of break that, with an operation, will have a pretty good outcome and will heal well, so I'd be pretty optimistic.
22:53The main thing now is to get you as comfortable as we can and get you off to the hospital.
23:00Whatever.
23:01What a night.
23:02All right.
23:03This is paracetamol, Robin, okay?
23:05I'm rubbish, I am.
23:06I really am.
23:07Not at all, sir.
23:08You've done great.
23:10With Robin's legs straight and his condition stable, he can be left in the hands of the ambulance crew, who will take him to Wexham Park Hospital, freeing up Tim and Matt for the next emergency.
23:20I mean, to us, it looks like what we call a closed tip-fib, so the two bones of the lower leg broken through, but the skin overlying, still intact.
23:31It'll need an operation, but I'd be very hopeful that it will have a really good outcome at the end of all of that.
23:36On a main road in Buckinghamshire, Critical Care Paramedic Adam and Consultant Paramedic Mark are one of several Critical Care teams at the scene of an accident.
23:57A car has crashed off the road and into pedestrians.
24:02Multiple crews from all the emergency services are in attendance.
24:05So, this lady's had a fit at the wheel.
24:08Yeah.
24:09She's impacted through defence and then somehow ended up back here.
24:13Okay.
24:14She's patient one, and then over there we've got three further patients, two of which have been collected on over the bonnet.
24:22All conscious, all breathing, all responding appropriately.
24:26Then we've got two other students that we've just been notified about with some bruises.
24:30So, I think we just all pitch in.
24:32We want to have a chat with this lady.
24:34This lady's reportedly had a fit that is responding at a boat for your knee.
24:38GCS of about 14.
24:40Now, that's all we know.
24:41We've been here a couple of minutes before you, and we've just done a very, very quick trial.
24:45So, if I can leave you with that, that'd be brilliant.
24:46So far, five pedestrians are confirmed to have been injured, while Mark assesses who most urgently needs the help of the critical care team.
24:56I've checked over the best I can at the moment.
24:58It's definitely not broken or anything like that.
24:59Just every day.
25:00It's not really short of what's going on.
25:01Okay.
25:03That's what we have at the moment.
25:04Okay.
25:04Adam is with 38-year-old Madeline, who's driving the vehicle that collided with cars and pedestrians.
25:11Hi, Madeline.
25:12My name's Adam.
25:12I'm one of the paramedics for the Air Ambulance.
25:14Can you tell me what's happened today?
25:18Sorry, I don't know what you mean.
25:19Can you tell me where you are and what's happened to you today?
25:23What, in general?
25:24Well, now, where are you at the moment?
25:29I'm not actually sure.
25:30Okay.
25:31Do you know why you're sat on the floor at the moment?
25:34Have you ever had a seizure?
25:36No, never.
25:37Okay.
25:38If Madeline had a seizure while driving, a burst of abnormal electrical activity in her brain
25:43could have caused her to lose control of movement, consciousness and memory.
25:48Can you tell me what day of the week it is at all?
25:53That's okay if not.
25:55No.
25:55That's all right.
25:56I'm really scared.
25:57That's okay.
25:57Don't worry.
25:58We don't know what's happened to you at the moment, but you've been involved in a car crash.
26:03So we need to look after.
26:04You and try and find out what's gone on.
26:06I've been involved in a car.
26:07You have, yeah.
26:09Seizures can be an indication of a serious medical condition, but with up to ten other
26:13casualties, Madeline isn't the only patient in need of urgent medical treatment.
26:18It was your head, wasn't it?
26:20A bit of a knock.
26:21But your legs and all that feel okay?
26:22Okay.
26:23Do you have any pain in your head?
26:41Do you have any pain in your head?
26:45Critical care paramedic Adam and consultant paramedic Mark are among the many emergency
26:50crews responding to the aftermath after a car veered out of control and hit multiple pedestrians.
26:56Are you okay if I touch your head and neck?
26:59No pain anywhere at all in your head?
27:02No?
27:02No.
27:03No pain in your neck?
27:04You have, yes.
27:0538-year-old Madeline was driving, but with no recollection of the incident, the critical
27:10care team thinks she blacked out after having a seizure.
27:13Any pain in your back?
27:15No.
27:16All the way down your back?
27:17No pain?
27:17No.
27:18No pain?
27:19Adam's carrying out a full examination, as Madeline may have injuries from the impact.
27:24No pain in your hips?
27:26No.
27:26In this part of you, can I just touch your hips?
27:28Yeah.
27:28No pain in your hips at all?
27:30Okay?
27:30Yeah.
27:31All right?
27:31Sorry, I'm really confused.
27:33That's okay.
27:33I had a calf crash with him.
27:35And you don't have any pain anywhere, you don't feel anything at all, and you have no
27:40recollection of what's happened at the moment?
27:41No, I don't know what the hell's going on.
27:43Okay.
27:43Immediately after a seizure, the brain goes into a recovery phase called the post-ictal
27:49state, which can involve confusion and memory loss.
27:52So she's going to need to go because she's got no recollection of the incident, no recollection
27:55of the event, but that's the only thing I can find.
27:58Yeah.
27:58So she can be discharged off the SCAS fairly quickly and just needs transport for being
28:02post-ictal.
28:02Everybody now.
28:03The examines that arrives, who do you want them to go to first?
28:05Seizure.
28:06Seizure first, yeah.
28:09Mark's assisting paramedics as they treat multiple casualties, who have been
28:13prioritised according to the severity of their injuries.
28:16Hello.
28:17My name's Mark.
28:18How are we doing?
28:19Yeah, good.
28:20There's some lower back pain.
28:21Okay.
28:22All right.
28:23Bump on the head.
28:24Yeah.
28:25We lifted our head so there's some pain.
28:26We've got a good flexion.
28:27Yeah.
28:28And numbers are all all right, yeah.
28:31Cool.
28:32The first of many ambulance crews that will take the casualties to hospital has arrived.
28:37Absolutely zero recollection.
28:38Zero.
28:39But in terms of everyone else, because we don't know the etiology of what caused it, she's
28:44one that needs to go first.
28:45Of course.
28:46Madeleine's seizure could be a symptom of a life-threatening problem in her brain that
28:50needs to be properly assessed as soon as possible.
28:53Just stay there.
28:53Just stay there.
28:54That's okay.
28:55That's okay.
28:55Get the bed.
28:56No.
28:56Just sit down and relax.
28:58Just sit down and relax.
28:59I know.
28:59Look.
28:59Look at me.
29:00Madeleine, listen to me.
29:01Madeleine, don't be scared.
29:06Madeleine will have x-rays and CT scans to check for internal injuries and tests to investigate
29:11what caused her seizure that nearly resulted in tragedy.
29:15This could have been a lot less.
29:17We've got ten patients in total and at the moment they're all okay.
29:23So we can clear.
29:25I think, yeah, we should go then.
29:27I'm going to re-pat our bags to the car and put us clear.
29:30We can then be available.
29:32Yeah.
29:32Yeah, it's very reasonable.
29:34All right.
29:35Miraculously, nobody has been seriously injured, so the critical care team can leave the casualties
29:40in the capable hands of the ambulance crews.
29:47The Thames Valley Air Ambulance Charity are called to at least one road traffic collision
29:52every day.
29:52He was going about 35 miles an hour down this road.
29:56Cars come out.
29:57From single vehicle accidents.
29:59Can you open your eyes for me?
30:01To multi-car pileups.
30:03Are you guys injured?
30:04Oh.
30:04Every 17 minutes, someone is killed or seriously injured on UK roads.
30:10Let's get your heads to her first.
30:11I'm excited.
30:12My back.
30:12With almost 50% of fatalities coming from crashes after dark.
30:17Ambulance emergency.
30:28Is the patient breathing?
30:33Yeah, we're both breathing.
30:36But I think the driver's severely injured.
30:38Have you been involved in a collision?
30:40We just came off the road.
30:41We skidded off.
30:42How many people are involved?
30:44Two.
30:45The car's smoking.
30:46Should he get out?
30:47If it's smoking, he does need to get out of the vehicle.
30:50Is it just the wrong car involved?
30:52Uh, yeah.
30:54Okay.
30:55And what injuries have you both sustained?
30:57I'm bleeding right now.
30:59I think my head or something.
31:02Okay.
31:03Do you have any worries?
31:04And the other patient?
31:06His hand's bleeding.
31:07I think his knee might have...
31:10His eyes are far too bad.
31:12Okay.
31:12So we have got that health arraigned and they will be dispatched as soon as possible.
31:16Emergency services at the scene have requested the enhanced skills of the critical care team,
31:25as they think this may be a life-threatening situation.
31:29So we've been tasked to a road traffic accident where two passengers, as far as we're aware, have been injured.
31:37So Dr. Andy Darby-Smith and critical care paramedic Matt Jarman are dispatched.
31:42The police and the fire crews have seen, they're concerned about the amount of damage to the car,
31:47and one of the men has collapsed.
31:49So there's concern that there's actually more significant injuries that were previously unidentified.
31:54Although the men got out of the car, the adrenaline rush after a major accident
31:59can temporarily mask pain, hiding serious and potentially fatal injuries.
32:04Oh, that's a lot of police.
32:06Oh, the car's over there, so...
32:08The car crashed on a country road after hitting a pothole.
32:14Andy and Matt are briefed on the findings so far by one of the fire crew.
32:18There's severe defamation on the front of the car.
32:22A post is intruded by about half a foot.
32:26How many patients are there, sorry?
32:27Two.
32:28Passenger was alert, conscious, has actually helped get the driver out.
32:33They've then moved to where they are now.
32:36Yeah.
32:36Passenger was fine, but he's now since deteriorating as well.
32:40So one car skid over there.
32:42He's impacted over here and bounced from there to here.
32:47OK.
32:4823-year-old Jay was driving back from the gym with his friend Charlie
32:52when he lost control of the car.
32:54Charlie pulled Jay from the wreckage but collapsed shortly afterwards.
32:57He has been treated by ambulance paramedics while Andy and Matt assess Jay.
33:03Hi, mate.
33:04My name's Andy.
33:04I'm one of the doctors.
33:05We're going to look after you and check you're OK.
33:07Is that all right?
33:08What's your name?
33:09Nice to meet you, Jay.
33:11Is this mum?
33:12Yeah.
33:12Hello.
33:13Hi, Andy.
33:14We're going to take good care of him, OK?
33:16Jay's mum and his sister rush to the scene
33:18and have been by his side since they arrived.
33:22So, Jay, we're going to just give you a quick once-over, if that's all right.
33:25All right.
33:26Do you have any pain anywhere?
33:27I've got a bit of a lower back.
33:30OK.
33:30My right collarbone and my sister.
33:33OK.
33:34Two six with patient.
33:35Before any treatment can be given,
33:37Dr. Andy needs to carry out a full-body assessment
33:40to identify any potentially life-threatening injuries.
33:44Take a very deep breath for me.
33:46Please be careful.
33:46I am.
33:47Take a really deep breath.
33:49And out.
33:51I feel quite sick.
33:52I know.
33:52You're doing great.
33:53A high-speed impact can cause catastrophic trauma.
33:56Jay's nausea could be a warning sign of a brain injury
34:00and he may have multiple broken bones.
34:03Any pain when I touch around here?
34:04No.
34:05Where's the pain?
34:05A bit lower.
34:08Jay is also at serious risk of damage to vital organs
34:11and internal bleeding.
34:13Right.
34:13Which way side?
34:14Stop.
34:14We're stopping.
34:15OK.
34:15Keep going.
34:21Keep going.
34:34Keep going.
34:34Keep going.
34:35Keep going over the BG.
34:36In Abingdon.
34:37I've got the BG.
34:38I've got the tube.
34:39Tube seen through the cords.
34:41Bougie out.
34:41Close your eyes.
34:43Dr. Susie and critical care paramedic Joe
34:45are working with an ambulance crew
34:47to try and resuscitate 75-year-old Jacqueline.
34:51Tube's fogging.
34:52The team have inserted a plastic tube into her windpipe
34:55so they can take control of Jacqueline's breathing.
34:58But sadly, her heart is still failing to respond.
35:02So unless we get back into BF and can do some DSD,
35:05there isn't really anything else.
35:06Two, one, pause.
35:11It's worse than it was when we did the last one.
35:13Only the right ventricle's moving.
35:15Yeah.
35:15OK, fine.
35:16Carry on.
35:18OK, ready for a pulse check?
35:19Someone looking at the monitor?
35:23Again, it's just, uh...
35:24It's not enough to sustain life.
35:26As time goes on,
35:27Jacqueline's heart activity is getting weaker and weaker.
35:30That it's only the right ventricle that's fluttering.
35:34PA?
35:35Yeah.
35:35Oxygenation's not the problem.
35:37Ventilation's not the problem.
35:38Yeah.
35:39Pads were changed, position at the right times.
35:43Drugs were given at the right times.
35:44So I don't think there's anything else that's reversible.
35:47And we've now had an hour of downtime.
35:49I'll go have a chat with family and then we'll come out.
35:53Sadly, despite the continued efforts of the ambulance crew
35:56and the critical care team,
35:58there's nothing more they can do for Jacqueline.
36:00So Jo updates her son, Justin.
36:03At the moment, although there is some electrical activity,
36:05under the ultrasound,
36:06the heart is not moving and not doing enough
36:08that would sustain a heartbeat
36:09and would, you know, produce a pulse.
36:13There's nothing more that anyone can add.
36:14There's nothing more that any hospital would do.
36:15Even if we were five minutes from the hospital,
36:17they wouldn't add anything to her treatment.
36:19We've bought everything that she needs here
36:20and, unfortunately, it's not worked.
36:22So what we'll do is we'll just make a bit of space for you
36:24and just clear up some of our kit away
36:26so you've got some space.
36:27I'm really sorry.
36:31Hello, sir.
36:32I'm Susie, one of the doctors with the air ambulance.
36:34I'm so sorry to meet you under these circumstances.
36:37Whilst the critical care teams do everything they can for patients,
36:40these are the kinds of decisions they have to make on a daily basis.
36:44I think the decision to stop was the right thing for her and for the family.
36:49Continuing resuscitation not only won't produce the outcome that we want,
36:52I think is actually, you know, if anything more harmful for the families
36:55to see that for a prolonged period of time
36:57and is of no benefit to the patient.
37:00And I think as a whole it's much nicer when we reach the point of futility
37:03to recognise that and stop when it's appropriate and not carry on.
37:07So, Parker, please be really careful.
37:21I will be really careful.
37:22In Whitney, critical care paramedic Matt and Dr. Andy
37:26are examining 23-year-old Jay, who crashed his car at high speed.
37:31Just going to press the air?
37:32It's fine.
37:33All right, you're doing great.
37:34I'm going to feel your legs.
37:36Does your tummy hurt at all?
37:38Wait, wait, wait, wait, wait, wait.
37:39I'm going to gently press the tummy.
37:41How does the tummy feel?
37:43Andy needs to ascertain if Jay has suffered any broken bones,
37:47internal bleeding or damage to vital organs.
37:50I'm going to feel your hips, OK?
37:52Hips all right?
37:53Yeah.
37:53Wiggle your toes.
37:55Wiggle your feet.
37:55Wiggle your toes, darling.
37:57Good.
37:58Wiggle your hands.
38:00Holds to them.
38:01He's doing well.
38:03Jay's friend Charlie was also in the car
38:05and is being treated by ambulance paramedics.
38:08All right, Charlie.
38:09Well done.
38:11Jay's sister and mum have been with the lad
38:13since just after the crash.
38:16This is a strong pain relief.
38:18I want you to take deep breaths into your mouth, OK?
38:20Are they going to mop me off?
38:21No.
38:22If one of you can help hold it,
38:24and what he's going to do is wrap his lips around this bit
38:26and take deep breaths in and out, OK?
38:28Yeah, it's a bit stronger than that.
38:30Just breathe it in out.
38:31Yeah, just breathe it in.
38:32Yeah, just breathe it in.
38:34A bit like a vape, Jay, yeah?
38:35It's actually exactly like a vape.
38:37You breathe out into it as well, if that makes sense?
38:39I breathe out into it.
38:40And blood pressure is 129.
38:41Perfect.
38:43Scratching your arm now.
38:44Just a scratch coming in your arm, darling.
38:46Just an injection, OK?
38:47Well done.
38:48Inserting a cannula will enable Andy to administer fluids,
38:52stronger pain relief, and potentially life-saving medication.
38:56Most important thing is to keep you warm, OK?
38:58All right.
39:00Where's it hurting?
39:01I don't know.
39:02Sorry.
39:03Oh, yeah.
39:04Your right hand does look like you've broken a small bone in your hand.
39:07All right.
39:08I'm just going to have a look here.
39:11It's going to be quite cold.
39:12Sorry.
39:14Perfect.
39:14Can you take a really deep breath for me?
39:15Unlike regular ambulance crews, critical care teams carry portable ultrasound scanners.
39:21Did I say it again?
39:23Allowing them to detect any internal injuries that may need immediate intervention.
39:29I'm going to be really gentle.
39:30I'm going to look around the side of your chest, OK?
39:33Really careful.
39:34All right.
39:37I'm just waiting to lower part.
39:39That's pain.
39:40Yeah.
39:40All right.
39:41Yeah, lift your hand up for me.
39:44Oh, is that where I saw?
39:50All right.
39:51I'm probably really gentle, I promise.
39:54Just let me a quick look to see if there's anything I can see that's a problem.
39:57All right.
39:57That all looks normal too, OK?
40:00With no indication of internal bleeding or damage to his organs, Jay appears to have been
40:05extremely lucky.
40:06So the key thing now is just to stay warm and have lots of pain relief, OK?
40:10I think you've broken a bone in your hand.
40:14And you might have broken your collarbone.
40:18You let me know if there's any changes, but you're going to be completely fine, OK?
40:22All right.
40:23This is going to be a little bit cold, OK?
40:24It might be a little bit of a shock.
40:26Now Jay is stable.
40:27Matt can begin to assess Charlie.
40:29Cool, that looks good.
40:32Looks fine.
40:34My blood in there, that's good.
40:35I know you're nice and warm.
40:38I just want to have a look at your chest.
40:40Deep breath for me.
40:42Really deep breath.
40:43That doesn't hurt anywhere.
40:45No?
40:45All right.
40:47Matt's checking Charlie's chest and abdomen for any potentially life-threatening internal
40:51trauma.
40:52Excellent.
40:53Your tummies, I know you're a little bit sore down here, weren't you?
40:56You had a seatbelt on, did you?
40:58I assume that's from the seatbelt.
40:59Yeah, thank you.
41:00Yeah, cool.
41:01Any pain where I'm touching here?
41:03No?
41:04You sure?
41:04As a precautionary measure.
41:06So Jay, I'm just giving you some other medicine.
41:08It's not going to make you feel weird at all, OK?
41:10Andy's giving Jay tranexamic acid, which will help his blood to clot more effectively
41:15in the event that there is undetected internal bleeding.
41:18All right.
41:19Ready, steady, roll.
41:22I know you're doing really well.
41:24Yep, I'm ready, steady, down.
41:26As Jay's loaded onto the ambulance.
41:28Have you been up and walked?
41:29OK.
41:30And your left leg.
41:32Can you lift it in the air for me?
41:34Straight.
41:35And high.
41:37High.
41:38High, high, high, higher.
41:39Up, up, up, up, up.
41:40Matt is giving Charlie a top-to-toe examination to check for any broken bones
41:45or other injuries.
41:46Does that hurt anywhere?
41:49Does it hurt in your hip?
41:51No?
41:52And do the other one.
41:53Same thing, up in the air.
41:55That's it.
41:56Higher, higher.
41:58That's it.
41:59I'll help you.
42:00Does that hurt in your hips?
42:02No?
42:03Cool.
42:03Good, good, good, good.
42:05All right.
42:05Keep it nice and warm.
42:06Jay, I'm going to hand you over to the ambulance team.
42:09They're going to get you off to hospital.
42:11You're very safe, OK?
42:12Thank you for your help.
42:13You're welcome, mate.
42:13These guys are very, very, very good.
42:16They're going to look after you, OK?
42:17While Matt liaises with the ambulance crew...
42:20If he's happy to sit up, would you take him as well or not?
42:23Hello, mate.
42:24My name's Andy.
42:25You're right.
42:25I'm one of the doctors.
42:27Andy completes Charlie's assessment.
42:29Are you one of his friends?
42:30Yeah.
42:31Is he behaving normally?
42:32Yeah.
42:33Yeah?
42:33Not behaving in a way that is scary or weird or confused or odd for him?
42:38No, not really, no.
42:39All right.
42:40Did you stand up out of the car?
42:41Oh, I can't wait.
42:43No, I'll start going.
42:44You can see.
42:45Yeah.
42:45Can I have a quick look at your head?
42:48Don't be looking in your eyes, OK?
42:50All right.
42:50My feeling, buddy, is to get you up, all right?
42:52Because I think you've got away really, really lightly.
42:55Stand up.
42:56Stand up.
42:56Stand up.
42:57Good.
42:57Right.
42:57We're going to put these around you to keep you warm.
42:59It's difficult to believe looking at the accident site, but both Jay and Charlie seem
43:04to have been incredibly lucky.
43:06Yeah?
43:06Both will need to go to hospital to be checked out.
43:11So observation was stable, couldn't find any significant injuries, and he's not going
43:15to have no neck pain and can move his head all the way around, and he's fine.
43:18And he's been mobilising on scene before we got here, anyway.
43:21So I think he's good to sit there.
43:23You're going to be OK?
43:24The critical care team are happy to hand them over to the ambulance crew for the journey
43:28to John Radcliffe Hospital.
43:30These guys are going to take really good care of you, all right?
43:32Good luck, Jay.
43:33Good luck, Charlie.
43:33All right.
43:34Cheers, guys.
43:34Have a good night.
43:54Have a good night.
44:24Have a good night.
44:54Have a good night.
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