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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.
00:19This 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.
00:33The big decision is for us whether we need to put a tube in there to protect us that way or not.
00:36Working day and night.
00:41It should not hurt. It's a very good painkiller.
00:44Reacting to emergencies.
00:46You've been super brave, darling.
00:47The critical care teams.
00:49You've had a pretty big blow to the head.
00:50Are equipped to provide hospital level treatment.
00:53So we'll give you some ketamine.
00:54That will mean that you don't know what we're doing whilst we straighten your ankle out.
00:57Whenever.
00:58Do you think it's fast?
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.
01:08Put this up your arm, my darling. Let's give you some of this morphine.
01:11Just be aware you might stop spontaneously ventilating.
01:14I have the tube.
01:15We captured every vital second.
01:18That's okay.
01:19You're safe.
01:20As these highly trained critical care teams.
01:22Can you take a deep breath in for me?
01:24Fight to save lives.
01:26Your birthday present is surviving a cardiac arrest.
01:29When every second counts.
01:31Let's go, go, go.
01:33Tonight.
01:34Over there we've got three further patients.
01:37Two of which have been collected and gone over the planet.
01:41Multiple casualties.
01:42Don't be scared.
01:43When a driver blacks out behind the wheel.
01:45I don't understand what's happened. I don't understand you.
01:48Just a little bit of oxygen for you.
01:50Okay.
01:51A man suffers a badly broken leg after a fall.
01:53Actually quite close to being open.
01:55Yeah, it looks properly threatened, doesn't it?
01:57Yeah, yeah.
01:58Let's do the rhythm check now.
01:59The critical care team fight to save an elderly woman's life.
02:03We don't have a part yet. Let's continue.
02:05And...
02:06Where's the pain?
02:08Suspected internal injuries after a high-speed crash.
02:12Right, which way side?
02:13Stop.
02:14Stop right.
02:15Okay.
02:19It'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
02:31in 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.
02:40Yeah, normal, fine.
02:41Fog light.
02:42Yeah, fine.
02:43Fitted 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.
02:56Any time.
02:57Cool. Good to go.
02:58Alright, mate.
02:59For the next eight hours,
03:00they'll be attending the most critical 999 emergencies
03:03over an area spanning three counties.
03:11I'm just gonna say this is a special breathing.
03:12Right, um...
03:13There was just a car accident and I think someone's having a seizure.
03:14My teeth are like vibrating now.
03:15I don't know what to do.
03:16Is it just because it's injured?
03:17Um, no, there's a bunch of people on the floor I think.
03:21Hi, there was just a car accident and I think someone's having a seizure.
03:25I think they're like vibrating now, I don't know what to do.
03:28And it just says it's injured?
03:30No, there's a bunch of people on the floor, I think.
03:34Okay, so the car has hit people?
03:37Yeah, there's a lot of people.
03:39Alright, the other people that are dead, the other three injuries do they have?
03:43I wonder where it's going.
03:44Hello, I'm a doctor, she's the police officer.
03:46We've got the lady who's crashed into everyone, her eyes are rolling back
03:50and she's making these really, like, loud, gasping noises.
03:53Yeah, right.
03:54Is she out of the car?
03:56Yeah, she's out of the car, so we can see what's happened.
03:59Is it that the car has driven in to the people that are on the floor?
04:03Yes, they literally got flattered.
04:06We have already got multiple crews on the way, okay.
04:12With numerous lives at risk, it's a code red emergency,
04:15so Mark and Adam are immediately dispatched and updated via messaging.
04:20Apparently someone has collapsed at the wheel.
04:23They believe a medical collapse.
04:25Yeah.
04:26But potentially gone into a group of people.
04:29So there's potentially multiple patients and ND025 are on route as well.
04:35It's outside of school as well, so potentially paediatrics.
04:39If we need to do an anaesthetic, anyone over 30 kilos, so eight-year-old,
04:46we can do or just need a soccer call in with first.
04:49Yeah, understood.
04:50Happy?
04:51Happy.
04:52Multiple emergency service crews are rushing to the scene.
04:55It's a situation that will need careful management.
04:58These 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.
05:12Fourteen minutes after receiving the call, Mark and Adam arrive.
05:16Three, one, hat scene.
05:19Can you grab jackets, yeah?
05:20Where numerous ambulance and critical care crews are already in attendance
05:24treating the wounded.
05:25Can you bring blood?
05:26Yeah.
05:43Yes, the patient's breathing.
05:45What's the meaning of your call?
05:47I have a gentleman here who seems to have tripped.
05:50I think he's broken his ankle.
05:52He's in a very awkward position.
05:55The ankle seems to be, like, very bent over.
05:57Okay.
05:58It's just in, like, a right-angled position, but his knee's up.
06:02Okay, is it possible for me to speak to it?
06:04Yeah.
06:05Okay, now, have you lost any blood?
06:08Did you caught yourself when you fell?
06:09No.
06:10We don't know.
06:11We don't think so.
06:12We can't see.
06:13It's very dark.
06:14It's very dark, very dark here.
06:15We can't really see.
06:16What happened?
06:17How did you fall?
06:18We're at a wedding.
06:19He's very drunk.
06:20It's very dark.
06:21And he's tripped over at the park.
06:22Okay.
06:23We'll get an ambulance there as soon as possible.
06:25Unless treated urgently, badly broken limbs can have life-changing complications.
06:33So, Dr. Tim Waite and critical care paramedic Matt Hale are dispatched.
06:38So, we're going to a 61-year-old man who is apparently intoxicated and has a broken ankle that's significantly angulated.
06:47So, it's kind of broken at an odd angle.
06:51The patient's stating he cannot feel foot.
06:54Loss of sensation may be due to nerve damage or restricted blood flow, potentially leading to tissue death and amputation.
07:01The man may also be at risk of hypothermia, which is dangerously low body temperature.
07:06It's dark.
07:07It's cold.
07:08It's raining.
07:09So, if the patient's still in that environment, we'll need to think about getting him warm and dry out of that environment at the earliest opportunity.
07:1625 minutes after receiving the call.
07:19Okay.
07:20Bring us a blanket.
07:21Tim and Matt are the first to arrive at the hotel, where the patient is still in the garden where he fell.
07:27Hello there, sir.
07:28Hello.
07:29Pleased to meet you.
07:30Good evening.
07:31I'm Matt.
07:32This is Tim.
07:33What can we call you, sir?
07:34Robin.
07:35Robin.
07:36Hi, Robin.
07:37What's happened this evening?
07:38I think I've broken my leg.
07:40Okay.
07:41He 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?
07:47No.
07:48Not really, no.
07:49I had a few sure, but don't be safe.
07:51All right.
07:5261-year-old Robin and his wife, Pat, were about to head home after attending a wedding at the hotel when he fell.
07:59Staff came to his aid, calling 999 and covering him with blankets.
08:04Have you hurt yourself anywhere else that you know of?
08:06No, no.
08:07You're going to give a good press on your chest.
08:09Do you remember falling?
08:10Not really, no.
08:12Okay.
08:13And did you bum your head?
08:14Um, not that I know of.
08:17Good.
08:18Any pain in your belly there at all?
08:21Not, not everything.
08:23So, left closed hip fib.
08:26Okay.
08:27Um, we've not got any significant critical skin, but it definitely is well aligned.
08:32Okay.
08:33Robin, I think what we're going to need to do, that's getting some monitoring on for you now for your blood pressure and stuff.
08:38Excuse my light shining in your eyes.
08:40We'll get a drip into your hands somewhere.
08:42We'll give you some strong painkillers that will make you sleepy and trippy and comfortable so that we can straighten out that leg.
08:50Does that sound okay?
08:51I'm fine.
08:52I'm fine.
08:53Robin's lower leg is badly out of line and needs to be straightened as quickly as possible to reduce the risk of permanent damage.
09:03What's been this evening?
09:04Yeah.
09:05We've been having fun.
09:06Oh, okay.
09:07Has it been a nice day?
09:08It's been a lovely day actually.
09:09Beautiful.
09:10I'm sure it's ended like this.
09:12Let's use all this tapping.
09:13I'm trying to persuade a, persuade a vein to come up.
09:16Because he's cold, Robin's body is diverting blood away from the skin to preserve his temperature, so his veins have constricted, making 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.
09:31No, don't worry.
09:32Don't worry.
09:33No, 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, but 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, so the bones not come through the skin, which is a good thing, but we want to avoid that happening.
09:49Okay.
09:50The longer the bones in Robin's leg are misaligned, the 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.
10:01Oh, it's okay.
10:02Okay, Robin, look at this side for me.
10:04This is something called Penfox.
10:06It's a painkiller, okay?
10:07Take it in your hand.
10:08Yeah.
10:09I want you to seal your lips around here and take some nice, slow, deep breaths in for me.
10:13Penthrox will provide strong and immediate pain relief, but straightening a break as bad as Robin's will be excruciating.
10:20So before they can pull the bones back into line, he will need to be sedated.
10:25I'm keen not to leave that ankle any longer than we have to, so I feel like probably we've got good access to the airway.
10:34We're kind of in a position to manage complications in situ.
10:38Yeah.
10:39We've got kit, we've got an adequate oxygen supply.
10:42I'm going to plug this into a bit of oxygen so you'll just feel that wafting up your nose.
10:46Pace and 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, critical care teams must always go through their safety checks before carrying out a sedation.
10:59Two vascular axes, so we've got one axis that we're very confident with and happy.
11:03Oxygen administered, we are on a master in the bag way to go.
11:06Suction 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, putting Robin at high risk of infection, which could result in amputation.
11:22It's actually quite close to being open.
11:39In Stoke and Church, critical care paramedic Joe Epton and Dr Susie Stokes are preparing their kit.
11:45Susie has been with the Thames Valley Air Ambulance Charity for over six years and is also a consultant in emergency medicine at the John Radcliffe Hospital in Oxford.
11:56I think I've always wanted to do it.
11:58Watching 999 when I was about 12, thinking I wanted to either be a paramedic or a doctor.
12:05And then I went down the emergency medicine training route in hospital and it just fits perfectly to do this.
12:12Ready to go?
12:14Let's do it.
12:16Susie and Joe are starting a 10-hour shift, attending code red calls over an area of more than 2,000 square miles.
12:24And the emergency is patient breathing.
12:41My mother...
12:43She's just completely collapsed.
12:45Okay. How old has she been?
12:47She's 75. She was fine. We were just literally having a coffee like 10 minutes ago.
12:51No.
12:52Alright. Okay.
12:53Oh...
12:54She's...
12:55I think she's getting a bit blue.
12:58Is she still breathing?
13:00Um...
13:01Oh...
13:04I'm not sure she...
13:06I don't know.
13:08What?
13:09She has...
13:11I'm sorry.
13:12That's okay. Have you made your chest laugh?
13:14Yes, I have.
13:15Yeah?
13:16Okay. Can you see her chest rise and falling?
13:19No.
13:20No.
13:21I think not.
13:22No.
13:23I think not.
13:24Okay, you're gonna start CPR, so put me on loudspeaker.
13:27So lay her on her back on the floor, if possible.
13:30Yeah.
13:31Nail by her side, and put one hand flat in the centre of her chest.
13:36Put the other hand on top, and lock your fingers together.
13:40Keep your arms straight, and push down hard and fast.
13:43Say push out loud with every push, so I know how fast to go in.
13:47Push.
13:48Push.
13:49That's an abusive case.
13:50Push.
13:51Um...
13:52Is an ambulance on its way?
13:54Yeah, we're on our way through your blue lights and sirens, okay?
13:57Okay.
13:58We're on the line.
13:59Just continue with the chest compressors, okay?
14:00Yeah.
14:01I'm pushing.
14:02Perfect.
14:03We're on our way through a 75-year-old lady who's collapsed in the garden, and she's been
14:08in cardiac arrest, and her heart's stopped for a while now.
14:10Um...
14:11But she's been having good CPR, um... and the paramedics on the scene have started advanced
14:17life support.
14:18So we're going to the job to provide any sort of enhanced critical care.
14:23There's other things we can do that the standard ambulance crew aren't able to do, like ultrasound,
14:28and the other people are doing.
14:29And so we're going to the job to provide any sort of enhanced critical care.
14:34There's other things we can do that the standard ambulance crew aren't able to do,
14:39like ultrasound, um, arterial lines, intubation.
14:4475-year-old Jacqueline has been given continuous CPR since her son Justin called 999 after she
14:53collapsed.
14:54This lady, you know, the witness, I don't know, the ramps.
14:58Yep.
14:59Her son's assisted her to the floor, um, at which point he's been called 999.
15:03Yep.
15:04Total downtime now has been around 56 minutes since first, um, resource was on the scene.
15:08Okay.
15:09We've had a total of 16 shots.
15:11Oh, right.
15:12Okay.
15:13The 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 anioid rain full and half.
15:22Yep.
15:23The end's dirty.
15:24The end's low.
15:25Yeah.
15:26The pupil spits dilated.
15:27Yeah.
15:28We're going to charge and shock through the loop, as we have been doing right.
15:33Okay.
15:34There's blood coming up.
15:38Do you want to swap?
15:39Yeah.
15:40I'll get the airway bag.
15:41Yeah.
15:42Yeah.
15:43And provide continuous oxygenation, Dr. Susie prepares to insert a tube into her windpipe.
15:48Pause now for the rhythm check now, yeah?
15:49Yeah.
15:50Let's do the rhythm check now.
15:51Okay.
15:52So that's PEA now.
15:53Yeah.
15:54So let's feel for a pulse.
15:55Don't have a pulse.
15:56Yeah.
15:57Let's continue.
15:58PEA is pulseless electrical activity, which means although Jacqueline's heart is generating
16:03signals, it can't produce a pulse on its own.
16:04Can I have our suction, please?
16:05Yeah, another one.
16:06Yeah.
16:07We've got ten seconds for a rhythm check.
16:08Susie, are you focusing on the airway, our managers?
16:09Yeah.
16:10The rhythm checks now.
16:11Let's try and do it all at once, can we?
16:12PEA?
16:13Very minimal flickering off the heart.
16:14No heartbeat.
16:15Back on the ground.
16:16That's PEA.
16:17Same thing for the boards.
16:18Just kind of flush some water through this trip, Robin.
16:19In Chesham, a day of celebrating at a wedding has turned into a disaster for 61-year-old Robin.
16:24After he fell and broke his ankle.
16:25Very nice respiratory function.
16:26Before Robin can be moved, critical care paramedics are going to do a job of a
16:51Robin can be moved critical care paramedic Matt and dr. Tim need to straighten his leg to maintain
16:57blood flow and prevent permanent damage however the bone has almost pierced the skin if it does
17:04it could become dangerously infected so we're going to go cautious small increments i'll do
17:0920 milligram increments until we get to where we need to be i think there's there's multiple
17:13risk factors not to be too aggressive so i think we'll go cautious and steady
17:17tim will be giving robin ketamine a very strong painkiller which causes dissociative sedation
17:25so robin will have no memory of the procedure all right so what we're going to do a little
17:29bit at the time all right so you'll notice a little bit to start with and if it's all going
17:34smoothly we'll give you a little bit more and we'll just keep going like that all right
17:38so you just nice deep breaths we're with you you're safe yeah and we'll just take a few minutes getting
17:46to where we um getting to where we need to be tim's closely monitoring robin because the alcohol
17:53he's consumed combined with ketamine could slow his brain signals to breathe and trigger vomiting and
17:59choking well been you doing all right there mate good so a little little bit more sleepy if you're
18:06having sort of hallucination type feelings all of that's normal with this medicine and it'll go
18:11completely back to normal as you wake up so just deep breaths and think about somewhere you'd rather
18:18be but here the ketamine is taking effect but it may be too late to prevent robin's bone from puncturing
18:25the skin looks properly threatened doesn't it yeah yeah they must act fast an open fracture is much more
18:32complicated to treat and carries greater risks of long-term complications which could lead to permanent
18:38disability are you happy if i start getting this straight yeah i think so we've lost a verbal
18:43contact yeah okay so when i lift the whole leg up oh with robin fully sedated matt can begin the
18:55process of realigning the bones in his leg helped by one of the hotel staff you're doing well there robin
19:02so they're just straightening out that broken leg for you now mate it looks like it's all going
19:07beautifully down there so you just nice steady breaths so you're really safe you're doing really
19:13well with this hand i want you to hold here be careful not to flex it this hand here and you're
19:20keeping it steady there for me okay so is that okay in a good position a beautiful pedal pulse lovely
19:27i'm in beautiful shape down here from the sedation perspective fantastic so i'm going to take his leg so
19:33if you let go i've got control of his leg would you come put your hands underneath for me you're doing
19:38okay there robin no no it's gonna support your jaw a little bit sedation can compromise breathing so
19:45tim is supporting robin's jaw to ensure his airway is open and unobstructed happy tim yeah needing a little
19:53bit of a jaw thrust on it but breathing nicely satsa hundreds et co2 5.5 okay it puts back in and toe is
20:00in line with kneecap excellent and then maintain pedal pulses grand brilliant and that skin was
20:06never breached was it no not breached but close okay i'll protect the weight upon his leg so you can
20:11let go now thank you thank you so much for that robin's leg is straight the skin is intact and it's
20:18been successfully splinted for the trip to hospital robin you're doing really well all right and this
20:26send to you please mate okay thanks i'm going to support your jaw again there robin a touch
20:36take a few deep breaths an ambulance has arrived but still under the effects of the ketamine robin
20:44needs to stay closely monitored until he comes round hey how you doing good evening yeah so um we've got
20:51robin who's had a simple trip over the curb here uh he's got a closed fractured tip tip he's currently
20:57sedated we've sedated him and pulled his pulled his leg um so we're in uh good shape and he needs to go
21:03to wexham uh so if we could have a trolley and scoop from you guys that'd be awesome and you're just
21:09starting to wake up from the the sedation drugs we gave you and you'll feel completely back to normal
21:15before long as they were off all right we're all with you you're very safe as robin emerges from
21:22the sedation he can be loaded onto the ambulance oh well are you ready tim yeah i'm ready brace and lift
21:32okay okay good robin you're doing great we'll get you on the ambulance all right
21:47okay robin how are you doing um do you remember what's happened you've broken your leg you just
21:56put we just give you some strong medicines get it back in the splint you're now on an ambulance all
22:00right you're in much pain robin it's not good okay we'll get you some painkillers shortly okay
22:09ivp and some morphine yeah be great thank you an intravenous infusion of paracetamol and morphine
22:15will keep him comfortable as the effects of the ketamine wear off we're doing we're good now we've
22:20got verbal contact back um he's able to tell me he's in a little bit of pain so we're just getting
22:24some ivp and some morphine set up we're still a little hypertensive but coming down so i think
22:29we're in a good place good are you feeling okay robin i'm fine good good good i'm not sure how much
22:38you remember of the last hour or so but ankles in a splint looks good it's definitely broken at risk
22:46of stating the obvious but it looks like the kind of break that with an operation will have a pretty
22:50good outcome and will heal well so i'd be i'd be pretty optimistic main thing now is to get you as
22:56comfortable as we can get you off to hospital whatever what a night all right this is paracetamol
23:03robin okay not at all sir you've done great with robin's legs straight and his condition stable
23:13he can be left in the hands of the ambulance crew who will take him to wexham park hospital
23:17freeing up tim and matt for the next emergency i mean it to us it looks like what we call a closed tip
23:24fib so the two bones of the lower leg um broken through but the skin overlying still intact and
23:31it'll need an operation but i'd be very hopeful that it will have a really good outcome at some
23:35at the end of all of that
23:48on a main road in buckinghamshire critical care paramedic adam and consultant paramedic mark
23:54are one of several critical care teams at the scene of an accident
23:57a car has crashed off the road and into pedestrians multiple crews from all the emergency services are
24:05in attendance so this lady's had a fit at the wheel yeah um she's impacted through defense and then
24:11somehow ended up back here okay um she's uh patient one and then over there we've got three
24:17further patients two of which have been collected all over the bonnet all conscious all breathing
24:24all responding appropriately then we've got two other students that we've just been notified about
24:29with some bruises so i think we just all pitch in we want to have a chat with this lady this lady's
24:34reportedly had a fit that is responding appropriately gcs of about 14 now that's all we know we've been here
24:42a couple of minutes before you and we've just done a very very quick trial so if i can leave you with that
24:46that'd be brilliant so far five pedestrians are confirmed to have been injured while mark assesses
24:53who most urgently needs the help of the critical care team i've checked over the best i can at the
24:57moment it's definitely not broken anything like that just every day it's not really sure what's
25:01going on okay um that's what we have okay adam is with 38 year old madeline who's driving the vehicle
25:08that collided with cars and pedestrians hi madeline my name's adam i'm one of the paramedics for the air
25:13ambulance can you tell me what's happened today sorry i don't know what you mean could can you tell
25:20me where you are and what's happened to you today what in general well now where are you at the moment
25:29i'm not actually sure okay do you know do you know why you're sat on the floor at the moment
25:34have you ever had a seizure no never okay if madeline had a seizure while driving
25:40a burst of abnormal electrical activity in her brain could have caused her to lose control of
25:45movement consciousness and memory can you tell me what day of the week it is at all
25:53that's okay if not no that's all right that's okay don't worry we don't know what's happened to
26:00you at the moment but you've been involved in a car crash so we need to look after you and try and
26:05find out what's gone on so you have yet seizures can be an indication of a serious medical condition
26:12but with up to 10 other casualties madeline isn't the only patient in need of urgent medical treatment
26:18it was your head wasn't it a bit of a knock but your legs and all that feel okay
26:32you have any pain in your head critical care paramedic adam and consultant paramedic mark
26:49are among the many emergency crews responding to the aftermath after a car veered out of control
26:55and hit multiple pedestrians are you okay if i touch your head and neck no pain anywhere at all in
27:01your head no no pain in your neck you have yes 38 year old madeline was driving but with no
27:08recollection of the incident the critical care team thinks she blacked out after having a seizure
27:13any pain in your back no all the way down your back no pain no no pain adam's carrying out a full
27:20examination as madeline may have injuries from the impact no pain in your hips in this part of you
27:26can i just touch your hips yeah no pain in your hips at all okay all right sorry i'm really confused
27:32that's okay and 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 okay immediately after a seizure the brain goes into
27:46a recovery phase called the post ictal state which can involve confusion and memory loss so she's
27:53going to need to go because she's got no recollection of the incident no recollection of the event but
27:56that's the only thing i can find yeah she can be discharged off the scars fairly quickly and just
28:01needs transport for being post ictal everybody arrives who do you want them to go to first seizure
28:08mark's assisting paramedics as they treat multiple casualties who have been prioritized according
28:14to the severity of their injuries hello my name's mark how are we doing yeah good lower back pain
28:21okay all right bump on the head yeah we lifted our heads so there was some pain we've got good uh
28:27yeah like i'm going to look around and numbers are all right yeah cool the first of many ambulance
28:33crews that will take the casualties to hospital has arrived absolutely zero recollection zero but in
28:39terms of everyone else because we don't know the etiology of what caused it yeah she's one that
28:44needs to go first of course madeleine's seizure could be a symptom of a life-threatening problem
28:49in her brain that needs to be properly assessed as soon as possible just stay there just stay there
28:54that's okay that's okay get the bed no just sit down and relax just sit down and relax i know look
28:59look at me madeline listen to me madeline don't be scared
29:02madeline 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 this could have been a lot less
29:17we've got 10 patients in total and at the moment they're all okay so we can clear i think yeah we
29:26should go then i'm going to repart our bags to the car go go it was clear yeah we can then be available
29:31yeah yeah yeah it's very reasonable miraculously nobody has been seriously injured
29:38so the critical care team can leave the casualties in the capable hands of the ambulance crews
29:47the thames valley air ambulance charity a call to at least one road traffic collision every day
29:53he was going about 35 miles an hour down this road cars come out from single vehicle accidents
29:59can you open your eyes for me to multi-car pileups are you guys injured every 17 minutes someone is
30:07killed or seriously injured on uk roads let's get your head still first i'm excited my back with almost 50
30:13of fatalities coming from crashes after dark
30:31ambulance emergency is the patient breathing yeah we're both breathing but i think the driver's
30:37severely injured have you been involved in a collision we just came off the road we skidded off how many
30:42people are involved uh so the car's smoking should he get out if it's smoking he does need to get out of
30:49the vehicle which is the wrong car involved uh yeah okay and what injuries have you very sustained i'm
30:57bleeding right now uh i think for my head or something um okay you have any work and the other patient
31:06his hands bleeding i think his knee might have his eyes are far too bad okay so we have got that
31:13help to rain but they will be dispatched to doing as possible emergency services at the scene have
31:21requested the enhanced skills of the critical care team as they think this may be a life-threatening situation
31:28so we've been tasked to a road traffic accident where two passengers as far as we're aware have been
31:36injured so dr andy darby smith and critical care paramedic matt jarman are dispatched
31:43the 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 so there's concern that there's actually more significant injuries that
31:52were previously unidentified although the men got out of the car the adrenaline rush after a major
31:58accident can temporarily mass pain hiding serious and potentially fatal injuries the car crashed on a
32:12country road after hitting a pothole andy and matt are briefed on the findings so far by one of the fire
32:17crew there's severe defamation on the front of the car a post is intruded by about half a foot
32:26how many patients are there sorry two passenger yeah uh was alert conscious uh has actually helped
32:32get the driver out yeah they've moved to where they are now yeah passenger was fine but he's now
32:38since deteriorating as well so one car skid over there uh he's impacted over here yeah and bounced
32:45from there here okay 23 year old jay was driving back from the gym with his friend charlie when he
32:52lost control of the car charlie pulled jay from the wreckage but collapsed shortly afterwards
32:58he is being treated by ambulance paramedics while andy and matt assess jay hi mate my name's andy i'm
33:04one of the doctors we're going to look after you and check you're okay is that all right
33:08what's your name nice to meet you jay this mum yeah hello i'm andy we're gonna take good care of him
33:15okay jay's mum and his sister rush to the scene and have been by his side since they arrived
33:22so jay we're gonna just give you a quick once over if that's all right all right do you have any pain
33:26anywhere okay okay two six with patient before any treatment can be given dr andy needs to carry
33:38out a full body assessment to identify any potentially life-threatening injuries take a
33:45very deep breath for me please be careful i am take a really deep breath and out i feel quite sick
33:51well i know you're doing great a high-speed impact can cause catastrophic trauma jay's nausea could be
33:58a warning sign of a brain injury and he may have multiple broken bones any pain when i touch around
34:04here though where's the pain a bit lower jay's also at serious risk of damage to vital organs
34:11and internal bleeding right which way side stop please stop okay
34:34he's going over the beauty in abingdon i've got the beauty i've got the tube tube seen through the
34:40cords bougie out close your eyes cute dr susie and critical care paramedic joe are working with
34:46an ambulance crew to try and resuscitate 75 year old jacqueline tube spogging the team have inserted
34:53a plastic tube into her windpipe so they can take control of jacqueline's breathing but sadly her heart
35:00is still failing to respond so unless we get back into bf and can do some dsd there isn't really anything
35:06else yeah worse than it was we did the last one only the right ventricle's moving yeah okay fine
35:16carry on okay ready for a pulse check someone looking at the monitor
35:23again it's just uh it's not enough to sustain life as time goes on jacqueline's heart activity
35:28is getting weaker and weaker it's only the right ventricle that's fluttering yeah optionation's not
35:36the problem ventilation's not the problem yeah pads were changed position at the right times drugs
35:43are given at the right time so i don't think there's anything else that's reversible and we've
35:47now had an hour of downtime i'll go have a chat with family and then we'll come out sadly despite the
35:54continued efforts of the ambulance crew and the critical care team there's nothing more they can
35:59do for jacqueline so joe updates her son justin at the moment although there is some electric
36:05activity under the ultrasound the heart is not moving and not doing enough that would sustain a
36:09heartbeat and and would would you know produce a pulse there's nothing more that anyone can add
36:14there's nothing more that any hospital would do even if you're five minutes from hospital they
36:17wouldn't add anything to her treatment we've bought everything that she needs here and unfortunately it's
36:21not work so what we'll do is we'll just make a bit of space for you and just clear up some by kit away
36:25so you've got some space i'm really sorry hello sir i'm susie one of the doctors with the air ambulance
36:33i'm so sorry to meet you under these circumstances whilst the critical care teams do everything they
36:39can for patients these are the kinds of decisions they have to make on a daily basis i think the decision
36:45to stop was was the right thing for her and for the family continuing resuscitation not only won't
36:51produce the outcome that we want i think is actually you know if anything more harmful for the
36:55families to see that for a prolonged period of time and is of no benefit to the patient and i think as
37:00a whole it's much nicer when we reach the point of futility to recognize that and and stop when it's
37:06appropriate and not carry on
37:18phil's parker please be really careful i will be really careful in whitney critical care paramedic matt
37:25and dr andy are examining 23 year old jay who crashed his car at high speed so press there it's
37:32fine all right you're doing great i'm gonna feel your legs does your tummy hurt at all wait wait wait
37:39i'm gonna gently press the tummy how's the tummy feel andy needs to ascertain if jay has suffered any
37:45broken bones internal bleeding or damage to vital organs i'm gonna feel your hips okay the hips all right
37:52wiggle your toes wiggle your feet good will your hands hold on jay's friend charlie was also in
38:04the car and is being treated by ambulance paramedics all right charlie well done jay's sister and mum
38:12have been with the lads since just after the crash this is a strong pain relief i want you to take deep
38:18breaths into your mouth okay no um if one of you can help hold it and what he's going to do is wrap
38:25my lips around this bit and take deep breaths in and out okay yeah it's a bit stronger than that just
38:30breathe it in out so keep it in his mouth yeah just breathe yeah just breathe it in a bit like a vape jay
38:35yeah it's actually exactly exactly like a vape you breathe out into it as well if that makes sense
38:40blood pressure is 129.6 perfect scratching your arm now it's just a scratch coming in
38:45yeah i'm done it just injection okay well done inserting a cannula will enable andy to administer
38:51fluids stronger pain relief and potentially life-saving medication most important thing is to keep you
38:57warm okay all right where's it hurting oh yeah your right hand does look like you've broken a small
39:05bone in your hand all right i'm just gonna have a look here
39:09it's gonna be quite cold sorry perfect can you take a really deep breath for me unlike regular
39:17ambulance crews critical care teams carry portable ultrasound scanners did you say it again allowing
39:23them to detect any internal injuries that may need immediate intervention i'm gonna be really gentle
39:30i'm gonna look around your side of your chest okay really careful all right thank you all right it's
39:37maybe the lower part that's pain yeah all right yeah lift your hand up for me
39:47oh is that where i saw all right i'm trying to be really gentle i promise just let me a quick look
39:54to see if there's anything i can see it's a problem all right all looks normal too okay with no indication
40:01of internal bleeding or damage to his organs jay appears to have been extremely lucky so the key
40:07thing now is to stay warm and have lots of pain relief okay i think you've broken a bone in your hand
40:16and you might have broken your collarbone you let me know if anything changes but you're going to be
40:20completely fine okay all right this is going to be a little bit cold okay it might be a little bit
40:25of a shock now jay is stable matt can begin to assess charlie cool that looks good looks fine
40:34no blood in there that's good i know you're nice and warm i just want to have a look at your chest
40:40deep breath for me really deep breath that doesn't hurt anywhere no
40:45right matt's checking charlie's chest and abdomen for any potentially life-threatening internal trauma
40:52excellent your tummy's i know you've a little bit sore down here weren't you you had a seatbelt on did
40:57you i assume that's from the seatbelt yeah cool any any pain where i'm touching here no sure as a
41:05precautionary measure so j i'm just giving you some other medicine it's not going to make you feel weird
41:09at all okay and he's giving jay tranexamic acid which will help his blood to clot more effectively
41:15in the event that there is undetected internal bleeding all right ready steady roll i know
41:23you're doing really well yep i'm ready steady down as jay's loaded onto the ambulance have you been up
41:28and walked okay and your left leg can you lift it in the air for me straight and and and high high high
41:38high high higher up up up up matt is giving charlie a top-to-toe examination to check for any broken
41:44bones or other injuries does that hurt anywhere does it hurt in your hip no and do the other one
41:53same thing up in the air that's it higher higher that's it i'll help you does that hurt in your hips
42:02no cool good good good good all right keep your nose warm jay i'm gonna hand you over to the ambulance
42:08team they're gonna get you off to hospital you're very safe okay you're welcome mate these guys these
42:14guys are very very very good they're gonna look after you okay while matt liaises with the ambulance
42:19crew if we if he's happy to sit up would you take him as well or not hello mate my name's andy
42:24you're right i'm one of the doctors andy completes charlie's assessment are you one of his friends
42:30yeah is he behaving normally yeah yeah not behaving in a way that is scary or weird or confused or odd
42:37for him no not really no all right did you stand up out the car i was like waving when i started
42:44doing abusive yeah can i have a quick look at your head and then look in your eyes okay all right my
42:50feeling buddy is to get you up all right because i think you're doing i think you've actually done
42:53you've got away really really lightly stand up stand up good right we're gonna put these around just keep
42:58warm it's difficult to believe looking at the accident site but both jay and charlie seem to
43:04have been incredibly lucky yeah both will need to go to hospital to be checked out so observation was
43:12stable couldn't find any significant injuries and he's not gonna know neck pain and can move his head
43:17all around and it's fine and it's been mobilizing on scene before we got here anyway so i think he's
43:22good to sit there you're gonna be okay the critical care team are happy to hand them over to the ambulance
43:27crew for the journey to john rackliffe hospital these guys are going to take really good care of you
43:31all right good luck jay good luck charlie all right cheers guys have a good night
43:47so
43:51so
43:54you
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