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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.
00:18This 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, we're going to give you some strong medication, and night.
00:41It should not hurt, it's a very good painkiller.
00:44Reacting to emergencies, the critical care teams are equipped to provide hospital level treatment.
00:53So we'll give you some ketamine, that will mean that you don't know what we're doing whilst you straighten your ankle out.
00:57Whenever, and wherever, it's needed.
01:04You are doing a fantastic job.
01:06Filmed over three months.
01:08Let's have your arm, my dad, let's give you some of this morphine.
01:11Just be aware, you might stop spontaneously ventilating.
01:14I have the tube.
01:15We captured every vital second.
01:17That's okay, you're safe.
01:20As these highly trained critical care teams.
01:22Will you take a deep breath in for me?
01:24Fight to save lives.
01:26Your birthday present is surviving a cardiac arrest.
01:29When every second counts.
01:32Let's go, go, go.
01:34Tonight.
01:35Ah, stop, stop, stop.
01:37A man is left with potentially life-changing injuries.
01:40Ah, fuck.
01:42After a road traffic accident.
01:44Listen to me, alright, and you need to relax.
01:46A woman fights for her life.
01:48She's not taking regular breaths.
01:49After a cardiac arrest while driving.
01:53In the event of a sudden deterioration or cardiac arrest, are you happy to do CPR while we get the Lucas on?
01:57A punch to the face.
01:59What's your name?
02:00Moby.
02:01Knocks a woman out and leads to a seizure.
02:03Ready, brace and move.
02:06Oh.
02:06And we're going to have a look at you, okay?
02:09A ten-year-old boy is critically injured.
02:12We're going to sort your leg out.
02:13When a motorbike jump goes badly wrong.
02:16You're not going to remember it and you're not going to feel it.
02:18Ambulance emergency.
02:35Is the patient breathing?
02:36Yes.
02:37Patient awake?
02:39No.
02:39Is the patient currently unconscious?
02:41Yes.
02:42She's in her car.
02:43I was driving down and I saw her go across the verge and onto the path.
02:48Breathing is shallow.
02:49She's not breathing well now.
02:51She's not breathing.
02:52I need you to get her out of the car and on the floor, flat on her back.
02:55Yeah, we're just doing it now.
02:56So I have another lady's foot over to help me, thank you.
02:58Oh my lovely, I'm just going to bring you out.
03:01Do you need advice on how to give basic life support?
03:03We're probably going to need some guidance.
03:04So kneel by her side and put one hand flat in the centre of her chest.
03:09Put the other hand on top and lock your fingers.
03:12Keep your arms straight, push down hard and fast.
03:14Don't be afraid to push too hard.
03:16Push about two times a second and say push out loud with every push
03:20so I know that's how fast you are going.
03:22Push, push, push, push, push, push, push.
03:26Keep pushing hard and fast, you will not hurt her.
03:31Keep going.
03:32OK, we've got an NHS nurse here now.
03:35We do have a unit that's just under two minutes away
03:37to keep going with the chest impressions.
03:44A woman in cardiac arrest is a code red emergency.
03:48So critical care paramedic Nick Cole and Dr Susie Stokes
03:51are immediately dispatched.
03:54Adult female witness to crash car into central reservation.
03:58Bystanders are 999 callers found patient apnoe,
04:01chronic CPR commenced.
04:03Less than one in ten people survive a cardiac arrest outside of hospital.
04:08I think it's just there and the traffic is rubbish.
04:11But fortunately, the quick thinking of the woman who found the driver
04:15means that CPR is underway.
04:18This early intervention could prove life-saving.
04:21Blood pressure, 170, tolerating eye gel, two times IV,
04:27approximately 60 for age, GCS 3.
04:30GCS 3 means the woman is still unresponsive.
04:34I'll go here.
04:36Police and an ambulance crew have arrived on scene
04:39and the critical care team aren't far behind.
04:422-5, patient side.
04:44The patient's life is hanging by a thread.
04:47A bike stand has pulled out of the car.
04:49I'll be in CPR when we arrive.
05:07Is the patient breathing?
05:09Yes, he is.
05:11He thinks he's broken his leg.
05:12I've just come across him.
05:13He's a motorcycle and he's in another road.
05:16And is he awake?
05:17Yes, he's awake.
05:18And how old is he?
05:20How old are you, bud?
05:21He's 19.
05:23Can I just speak to him?
05:24Yeah.
05:25Hello?
05:26Hello, it's the ambulance service.
05:28Yeah, I understand that.
05:30My leg doesn't feel normal.
05:32Just please, come over.
05:33We are getting you the help.
05:34A young man has come off his motorbike on a country road.
05:43He has a potentially timed critical injury,
05:46requiring the advanced medical expertise
05:48of Dr. Laura Douglas Beveridge
05:50and critical care paramedic Andy College.
05:53Okay, so we have a 19-year-old male
05:56fallen from a motorbike,
05:58suspected of femur fracture,
05:59potential reduction and sedation requirements.
06:02There are medical personnel in the scene.
06:06Isolated injury to left thigh
06:08with potential deformity,
06:12distal pulses,
06:13nil neurology,
06:13nil open wounds.
06:15Last year on UK roads,
06:17around 5,500 motorcyclists
06:20sustained serious injuries,
06:21including fractures,
06:23spinal and head injuries,
06:25even loss of limbs,
06:26with 70% of fatalities on rural roads.
06:30So we have been sent there
06:32to see if we can support
06:33with some pain relief,
06:35potentially some sedation
06:36and to try and move the limb back
06:39into a more and a safer position.
06:43There we go.
06:45It takes Andy and Laura 22 minutes
06:47to arrive on the scene.
06:49That's off-road.
06:51An ambulance crew are already in attendance.
06:55Grab the monitor as well.
06:57Yeah.
07:0127 at scene.
07:03Hi guys, how we doing?
07:05We're okay.
07:06We've had a crash at approximately 15 miles an hour.
07:10Our main concern is our femoral fracture displays.
07:16That's where our main pain is.
07:19Helmet was removed prior to us arriving.
07:22We've been mobilising neck.
07:24We haven't got any c-spine concerns.
07:26Lovely.
07:27Okay.
07:27Okay, fine.
07:28Pain is our main concern.
07:30And what have you given him so far for pain?
07:32We're just giving him morphine.
07:33We're just giving him morphine now.
07:35We're having the Entonox.
07:36We've got the TXA ready to make up.
07:39TXA is a drug that helps to clot the patient's blood
07:43should he have internal bleeding.
07:45What's your name?
07:46Gleilu.
07:47Gleb.
07:47Gleb, nice to meet you.
07:49My name's Laura.
07:50I'm one of the doctors.
07:51I'm just going to quickly check that there's not anything else,
07:53any other injuries anywhere.
07:55Apart from your leg, does anywhere else hurt?
07:58Just a few girls.
08:0019-year-old Ukrainian car mechanic Gleb
08:02went out for an evening ride on his motorbike
08:05when he crashed on a dark country lane.
08:07We'll get you feeling a bit better soon, mate, all right?
08:10The couple Gleb's lodging with rushed to his aid
08:13when they heard of the accident.
08:15So I just need to have a little listen in to your breathing.
08:17Any pain in your chest at all?
08:18Well, Dr Laura has to perform a primary assessment
08:21to check for other injuries he's possibly sustained
08:24before anything else.
08:27Nice deep breaths for me.
08:29Lovely.
08:29And out.
08:31And again.
08:32Big deep breath in.
08:34And out.
08:37OK.
08:37And then I'm just going to have a gentle feel over the chest wall.
08:40Any pain when I'm pressing at all?
08:43I'm coming over this side.
08:45And round into the back there.
08:47Any pain there?
08:48What about on this side?
08:50Fortunately, it appears Gleb hasn't broken any ribs
08:53and he's breathing well.
08:55Just having a gentle feel over your tummy.
08:57When I'm pressing the tummy, any pain at all?
08:59OK, fine.
09:01Just going to have a quick little look.
09:04OK, let's just get that up.
09:05Any pain round into the side there?
09:07Or on this side?
09:09Feeling over the pelvis.
09:10Any pain when I press?
09:12A broken pelvis is extremely serious
09:14because it means Gleb could have internal bleeding.
09:18If he does, his life is on the line.
09:21I'm just going to have a little look
09:22to make sure there's no bleeding.
09:23So he's got no pain on the pelvis at all.
09:45OK.
09:46On a dark country road near Wallingford, Oxfordshire,
09:5019-year-old car mechanic Gleb crashed his motorbike.
09:53Potentially fracturing his left femur
09:55and injuring his hand.
09:57Fortunately, his pelvis appears intact.
10:00So what we can do is maybe if we get the Penterox on board
10:03and then let's see if we can bring the legs out
10:05and see if they're symmetrical in length.
10:07Critical care paramedic Andy and Dr Laura
10:10must realign his left leg
10:11so blood flow isn't compromised.
10:14He's already been given morphine
10:16by the ambulance crew to combat pain.
10:19But he's in absolute agony.
10:21You need to listen to what I'm going to explain to you
10:24how to use it, all right?
10:26So I want you to grip it
10:27but I need you to breathe in and out of it
10:29like you're a deep-sea diver.
10:32Andy administers Penthox.
10:34It's a drug similar to gas and air
10:36but it offers immediate stronger pain relief.
10:39Laura's just going to have a look on your legs.
10:41I just want you to keep going on that whistle
10:42like you have been.
10:43Ah, fuck!
10:44Is there pain in this leg?
10:46In your right leg?
10:47I was just hurt in the other leg.
10:49Take, listen, listen, listen, keep taking the pain relief.
10:53Keep taking the pain relief.
10:53Straight, I'll ask you to move back.
10:54Okay, okay, that's fine.
10:55Keep taking that whistle, okay?
10:57That's all I want you to do, all right?
11:00All right, well...
11:01Hey, wait, wait, ah!
11:02Okay, okay, I'm not, I'm not...
11:03Stop, stop, stop, stop, stop, stop!
11:06I've stopped.
11:06Stop.
11:07Hang on, everyone, just stop a second.
11:08I can say...
11:09Just stop a second, sir.
11:11Laura and Andy have to take control of the situation
11:13and quickly.
11:15Yeah.
11:15Listen to me.
11:16Fuck!
11:17He can do it, sir.
11:17Listen, listen, listen.
11:18Keep that working, all right?
11:20And you need to relax
11:21because the more you're getting agitated,
11:24the more your muscles are going to tighten in that leg
11:27and the more it's going to hurt.
11:28So I just need you to keep taking long, deep breaths.
11:33We're here to help you, all right?
11:35So I need you to calm down.
11:37With Gleb overwhelmed by the pain,
11:40the team have to get his pain relief under control
11:44before they can manipulate his leg.
11:47I think probably, I think probably ketamine.
11:49So I'd probably suggest rather than more morphine,
11:52I think ketamine would be a good option for this.
11:53Yeah, so I've got it here, ready.
11:55Just so that we get everything nice and calm, all right?
11:58You need to calm down.
12:00I'm trying to, I'm trying to, I can't relax.
12:03Too many people.
12:04No, there isn't.
12:05We need to help you.
12:05Straighten the arm out.
12:07Let's just hold on.
12:08Stop, stop, stop.
12:10All right.
12:11Can everybody just give them space?
12:14Shall I tell you what we're going to do?
12:17We're going to give you some strong medicines
12:19that help everything feel more comfortable
12:21and more relaxed.
12:23We've got to straighten your leg.
12:25Ketamine is a strong sedative
12:27but can have unpredictable effects on patients.
12:30And Laura needs Gleb calm before it's administered.
12:34Your heart rate is good.
12:36Your blood pressure is good.
12:37Your oxygen level is great.
12:40Lots of things are really good.
12:42I've got the frog.
12:43You're going to throw up.
12:44Have we got some Ondansetron, please?
12:45Yeah.
12:46And have we got a little sick bone that we need it?
12:50Ondansetron is a strong anti-sickness drug.
12:52So we'll give you some anti-sickness.
12:55All right, darling.
12:55All right, all right.
12:56Turn this way.
12:57Turn your head to one side, buddy.
12:58Turn this way.
12:59All right, all right, all right.
13:01So I think that's probably the morphine
13:02that's made you feel a bit sickly.
13:04All right, we'll get that anti-sickness on board.
13:06Let's see if you can get a line in the other side for us.
13:09Yeah.
13:09A cannula has been inserted,
13:12but critical care teams prefer two lines of access
13:15to ensure a backup
13:16and to allow simultaneous delivery
13:18of life-saving drugs and fluids.
13:21I'm just going to give him 10 of ketamine now.
13:23Yeah, I think that's a good shout.
13:24And that on Ondansetron's in?
13:25Yeah, it's in there.
13:26Yeah, so that was at 21.13.
13:29Fast-acting ketamine is a drug only carried
13:32by the critical care teams out on the road.
13:36All right, darling, how are you doing there?
13:38Okay, so just while he's got ketamine on board,
13:40we'll just keep things as calm and quiet as possible.
13:43Little bit of a sharp prick there.
13:45Well done.
13:48Sorry, darling.
13:51And let's just switch over
13:53onto some oxygen via the nasal cannula.
13:56Can I have the oxygen cylinder on this side?
13:58Oxygen is vital to keep Gleb's organs
14:00and brain functioning during the sedation
14:03as ketamine can slow breathing down.
14:05Okay, so we're just on four litres
14:06via the nasal cannula there as well.
14:09Okay.
14:10And have we got that SATs trace there?
14:12It's on.
14:13Lovely, so yeah, that's coming through.
14:15Okay, saturation's 100%, heart rate's 80.
14:18Lovely.
14:18Okay, then let's try and bring the legs to length
14:20and just see how they compare
14:22one side to the other.
14:24You're doing really well, Gleb.
14:26I'm going to move your leg
14:28that's the right leg, okay?
14:30You're doing very well.
14:32Okay.
14:35Well done.
14:38Sorry.
14:38Good lad, buddy.
14:39Yeah, yeah, no, this is...
14:40Gleb has broken his left femur.
14:45It's the longest bone in the body
14:47joining the hip to the knee.
14:49So we'll need the KTD.
14:50So can we get the groin strapped first,
14:52then we'll put the pelvic binder on.
14:54As well as realigning his leg.
14:56Have we got a blanket or something
14:57that can go underneath just to support?
15:00The team decide to fit a pelvic binder
15:02to support Gleb's pelvis during extrication.
15:05Well done.
15:06All right, keep your legs still.
15:09But first, more ketamine is needed.
15:12So now, shall we bring the pelvic binder underneath?
15:16Just relax that leg down, Gleb.
15:18Well done.
15:18Gleb, you're doing really well, mate.
15:19Just relax that leg.
15:21Great at your cantus, yeah?
15:23Yeah.
15:23That's going to go...
15:24You're doing really well, mate.
15:27You're doing really well.
15:30Can we have another ten, please, Andy?
15:32Yeah, absolutely.
15:34Another dose of ketamine is administered.
15:37That's another ten, so that's 30 now.
15:3930 so far, yep.
15:41OK, yep.
15:42If there's anyone spare,
15:44we'll do a gram of paracetamol en route as well.
15:48Right, my lovely.
15:48It's going to be a bit uncomfortable for a minute, OK?
15:51It's just going to feel like it's pulling tight.
15:54Well done, Gleb.
15:56With the pelvic binder secure...
15:58Lovely.
15:59Just relax that leg down.
16:00It's time to realign Gleb's left leg
16:02using a Kendrick traction device.
16:05A splint designed to pull the leg straight
16:07and stabilise fractures.
16:10Right, your leg's back in the same...
16:12the right direction, OK?
16:13And what they're going to do,
16:14they're just putting some traction in.
16:22I feel like that's not pretty much...
16:23That's looking good.
16:25Do you want to check, Andy, that you're happy with that?
16:29Yeah, I'm happy.
16:31That looks really good.
16:32Gleb's legs are now equal in length.
16:35He can now be prepared for the journey to hospital.
16:40Just going to waist height.
16:41Ready, steady.
16:42Lift.
16:45Lovely stuff.
16:46Well done.
16:47Side up on this side.
16:49Just going to keep you warm there, buddy.
16:52And we'll have a look at your hand as we travel, OK?
16:56Safely in the ambulance after an hour lying on the road,
16:59Dr. Laura can check Gleb's injured hand.
17:03There's no obvious deformity.
17:05Let's have a little look inside.
17:07OK, so we can clean that and just pop a fresh dressing on.
17:10Fortunately, Gleb's hand is relatively unscathed.
17:13No broken fingers, just minor abrasions.
17:16Lovely.
17:17OK, I think we are ready to go.
17:21Can we get that paracetamol running?
17:25As Gleb has been sedated,
17:27the critical care team choose to travel with him
17:29to ensure he remains stable.
17:31OK, IV paracetamol's just dripping through.
17:35Hello there.
17:35This is the HEMS team calling to pre-alert
17:37with a trauma call, please.
17:39So this is a gentleman who's had a motorcycle accident.
17:44He has sustained a left femoral fracture
17:47and a finger injury on his left hand.
17:50It takes the team 32 minutes
17:52to arrive at the Royal Bakshia Hospital.
17:54All right, Gleb, we're just arriving into hospital.
17:57Where Gleb is being handed into the care
18:00of the emergency department team
18:01who are awaiting his arrival.
18:05You're doing really well, buddy.
18:09So it may well be that this injury
18:12might need an operation.
18:14So the surgical team are assessing him at the moment
18:16and then they'll see if there's any further
18:18operation or procedure he needs.
18:20from central ambulance.
18:38How can I help?
18:40Hello, this is Tansani's police here.
18:41Someone's having a seizure.
18:43OK, are they male or female?
18:45A female.
18:46Well, she was punched in the head.
18:49We're attending because she was assaulted.
18:52But the patient has got a pre-existing brain issue,
18:57which the punch has then led to this.
18:59That's it.
19:00OK.
19:00Yeah.
19:00That's fine.
19:01I'm on the way.
19:02OK.
19:02Perfect.
19:03The report of a woman being punched in the head
19:09and having a seizure
19:10means consultant paramedic Mark Hodkinson
19:13and chief operating officer
19:14and critical care paramedic Adam Panter
19:16are instantly dispatched.
19:19What are we going to?
19:20An assault.
19:21Punched in the face.
19:24We're 19 minutes away.
19:27Around 26% of violent assaults in England and Wales
19:32result in serious injury,
19:34including head trauma and life-threatening blood loss.
19:37But just one punch can also kill a person.
19:40Our notes are saying there's potential pre-existing brain injury.
19:43So the worry is that an assault punch to the face,
19:47even as, like, you know,
19:48what would appear to be a relatively minor punch,
19:51can cause you to have a potential
19:53or a traumatic brain injury.
19:56Then you become unconscious,
19:58have a seizure,
19:59you lose your airway,
20:00you don't protect your own airway,
20:01so you're then not ventilating properly.
20:04So that's the worry.
20:06Adam and Mark arrive on scene
20:08with an ambulance crew and police already in attendance.
20:13Hello, you all right?
20:14So we've got a very limited history.
20:17What we understand, we've been assaulted.
20:19Whilst walking to the shops,
20:2220-year-old Mandy was hit in the face
20:24by a member of the public and knocked to the ground.
20:27She's had one police officer who then had to leave
20:30and had a seizure with that police officer.
20:33And then these ones she hasn't had a seizure with.
20:34But she does have C-spine tenderness.
20:37Mandy's seizure appears to have stopped,
20:39but C-spine tenderness or a pain in the neck
20:42could mean she's critically injured.
20:46Where's the pain at the moment?
20:49In your neck.
21:12This lady's Catherine.
21:13She was driving this car.
21:15She's come across here, had a medical event.
21:18Dr. Susie and critical care paramedic Nick are in Wokingham,
21:21where 57-year-old graphic designer Catherine
21:24went into cardiac arrest whilst driving.
21:28Fortunately, the car rolled to a stop
21:30and bystanders delivered early CPR.
21:32Really high-quality CPR, found in VF, had one shock.
21:38And then two minutes later, at the rhythm check,
21:40she had a pulse.
21:41Oh, amazing.
21:42The ambulance crew also gave Catherine a shock
21:45with a defibrillator that encouraged her heart to restart.
21:50But Catherine's life is still in danger.
21:52The car's been phoned in, and she's got no medical history.
21:58She's got two IV access.
22:00Amazing.
22:00So we're literally about to load and go to the box,
22:03but you turned up.
22:04Yeah, perfect.
22:05I assume you want to put a tube in her and take her all box.
22:07Yeah, is that right?
22:08Yeah, that's why we left her outside.
22:09Great.
22:10The critical care team need to take mechanical control
22:13of Catherine's breathing,
22:14so she's kept outside the ambulance
22:16to give them more room to work.
22:18Can you grab some adrenaline out?
22:20Catherine will be put into an induced coma,
22:23so they can insert a tube into her windpipe
22:25to maintain oxygen to her brain and other vital organs.
22:29All right, I'll start drawing up some drugs, if that.
22:31Are you all right to just have a quick top-to-toe?
22:34Yeah, yeah, yeah.
22:36OK.
22:37That felt like own respiratory effort.
22:40She's not taking regular breaths.
22:42Catherine is barely breathing.
22:46While Susie draws up the drugs
22:48for the pre-hospital emergency anaesthetic...
22:50So chest feels grossly intact.
22:52I can't feel any surgical emphysema at all.
22:54OK.
22:55Nick performs a primary survey
22:56to check for any other undiscovered injuries
22:58possibly caused by the car crashing.
23:01No injuries to the head at all.
23:03Much damage to the car?
23:04None.
23:05None. OK.
23:07Cut these off.
23:09So primary survey...
23:12Airways being maintained.
23:13It's got an appropriately sized eye gel.
23:14So that's 100%.
23:15Chest feels grossly intact with good air entry.
23:18Good.
23:18Skin is warm and dry.
23:20Abdomen soft and non-tender.
23:23Brilliant.
23:23Long bones look intact.
23:26So no indication...
23:27It looks like it's come to a slow rest.
23:29So no indication for a pelvic binder.
23:30It seems the car must have come to a gentle stop.
23:34Fortunately, Catherine appears to have no other injuries.
23:38I just drew up ketamine, rocuronium.
23:41We've got adrenaline.
23:42Fine.
23:42Um, want to omit fence?
23:46Yeah.
23:46Yep.
23:46Which is...
23:47I'm going to swap this over if that's OK.
23:52Lovely.
23:56Right.
23:57Ready for James?
23:58Yep.
23:58Yep.
23:59OK.
24:00So I've optimised patient position.
24:02Acceptable IV access and fluid attached.
24:04So there are two IVs.
24:05They're both working.
24:06I've used that one for meds and this one is attached to fluids.
24:08Can't make it.
24:09So monitoring.
24:11Can you see blood pressure cycling every three minutes?
24:13Yes.
24:14Sats?
24:15Yep.
24:15After running through their pre-anesthesia safety checklist.
24:19Uh, ECG.
24:20I can see three leads.
24:21It's time to put Catherine into the induced coma.
24:24A hospital procedure only the critical care teams are allowed to undertake out on the road.
24:31So in the event of sudden deterioration or cardiac arrest, are you happy to do CPR while we get the Lucas on?
24:36Have you got pain on your back?
24:49In Maidenhead, 20-year-old Mandy was punched in the face and knocked unconscious by a member of the public, resulting in a seizure.
24:57Just keep nice and still.
24:58She has pain in her neck, indicating there may be damage to her spinal cord.
25:03Critical care team Adam and Mark are assessing her injuries.
25:07So just here.
25:08Damage to the spinal cord can lead to paralysis.
25:12There.
25:14Mark needs to know if Mandy has any sensation in her neck and spine.
25:17Here.
25:19Here.
25:20Before proceeding with any medical intervention.
25:23What about here?
25:24Down your back.
25:25Is that sore?
25:27Yeah.
25:27You take a deep breath in for me.
25:30Does that hurt your chest at all?
25:32Yeah.
25:33Okay.
25:34All right.
25:34Can you wiggle your toes for me and move your hands?
25:41Any tingling or pins and needles or anything?
25:43In your arms.
25:44In your arms.
25:45Okay.
25:45All right.
25:46Although Mandy has pins and needles in her arm, she doesn't have any obvious pain.
25:50So Mark decides it's safe to lift her to the ambulance's stretcher.
25:55If you carry on, we'll get the scooping and stuff and then...
25:57Because you're happy to keep hold of the head.
26:00Yeah, of course.
26:01And we're going to just roll hard for the scoop.
26:03And then obviously we'll mobilize the head.
26:05Yep.
26:06Get on to the stretcher.
26:08Yeah.
26:08I'm just going to hold your head, okay?
26:11What we're going to do is roll you backwards and you're going to slide onto a hard board,
26:15okay?
26:17If it's really sore, just let me know, all right?
26:21Everybody ready?
26:21So we're going to go all the way in one movement, yeah?
26:25All right.
26:26Ready, brace and move.
26:28That's it.
26:30Well done.
26:31Well done, Mandy.
26:32What we're going to do is roll you slightly to your left and then onto the other side of
26:37the board, okay?
26:38And you'll hear a loud click behind your head, okay?
26:41Everybody happy?
26:42Ready, brace, roll.
26:45That's it.
26:45Perfect.
26:47How's that?
26:49Yeah?
26:50Just keep your head nice and still for me, okay?
26:52Safely on board.
26:53As a precaution, Mandy's head needs supporting to prevent any further movement of her neck
26:58and spine.
26:59I'm just going to hold your forehead while we pop these blocks in next to your head,
27:03okay?
27:03All right.
27:04Get that.
27:06Just going a bit closer.
27:08That's it.
27:09That's it.
27:10Perfect.
27:11Just keep nice and still, all right?
27:12With Mandy secure, she can be lifted onto the stretcher.
27:16All right.
27:17Ready, brace, lift.
27:19We're going to just wrap you up so you get nice and warm, okay?
27:29Is that too tight on your chest?
27:31Is that okay?
27:32Okay.
27:35Mark and Adam are satisfied that Mandy doesn't need any further treatment on scene.
27:40Are you happy?
27:41Sure.
27:42Meaning the ambulance crew can take her to Wexham Park Hospital for x-rays.
27:47You're all good.
27:47You're all good.
27:48Leaving them ready for their next call-out.
27:533-1, clear at sea, never.
27:54And the emergency is the coach for breathing?
28:15Yes, he is, yeah.
28:18Are they awake?
28:19Yes.
28:20What's the reason for the ambulance, do they?
28:23We're at the motocross track.
28:24He's come over the jump, nose-diving, and he's come off his bike.
28:27How old is the patient?
28:28How old is the patient?
28:29No.
28:30Have you lost any blood at all?
28:32Are you bleeding anywhere?
28:33No bleeding.
28:35And where have you hurt him at the moment?
28:37On his left leg.
28:38Practice the femur.
28:39So don't move him from his current location unless he's in immediate danger.
28:43We do have cruise on route already, okay?
28:45With the report of a seriously injured 10-year-old boy at a motocross event, as well as an ambulance, the code red team have been requested.
28:57Ah, motocross.
29:01Hey.
29:01Nosedive post-jump.
29:03Critical care paramedic Charlie Shorthouse and Dr. James Raitt are dispatched.
29:09I've just had a quick chat with the on-site medics.
29:12This is a 10-year-old at a motocross event.
29:14Looks like he's wearing all of his appropriate PPE.
29:18Got over a jump, nosedived.
29:20He's on some gas of air.
29:23Cool.
29:24No worries, mate.
29:26Motocross racing comes with significant risks due to the rough terrain and nature of the competition.
29:32Injuries can include broken bones, head trauma, even fatalities.
29:38Right, let's go and do some work.
29:40It takes the team 28 minutes to arrive on scene.
29:43Hello.
29:44I'm Charlie.
29:45This is James.
29:46An ambulance crew is in attendance, and they're already administering oxygen to keep the boys' vital organs and brain functioning normally.
29:53So, basically, Harper's come through this jump, landed heavily on his left-hand side.
29:59The only thing that we are concerned with is a wobbly left femuss.
30:02Okay.
30:0310-year-old Harper was enjoying his favourite hobby, motocross.
30:07But as he tackled a jump, his motorbike nosedived, throwing him hard onto the ground.
30:12He was wearing a helmet and the correct protective clothing.
30:16I'm going to take really good care of him.
30:17Okay.
30:18His dad is at his side.
30:20Then we'll have a proper look at that leg.
30:21Yeah.
30:21It looks, just looking at it, like we probably need to sort it out now.
30:24Yeah.
30:24So we'll get it nice and straight and back in alignment, okay?
30:27We'll probably give him some nice drugs to make that happen, okay?
30:29But he's in good hands.
30:30The force of the impact was enough to break the strongest bone in Harper's body, the femur or thigh bone.
30:37And we're going to have a look at you, okay?
30:39If the team don't realign his leg and restore good blood flow, Harper's at risk of nerve damage, reduced mobility and permanent disability.
30:47I'll have a whole lot in the bed, please.
30:49Hi, Harper.
30:50Right, sweetheart.
30:50I'm Charlie.
30:51Hello, mate.
30:52Pop your mouth open for me and stick your tongue out.
30:54It's not every day someone asks you that, is it?
30:56Cool.
30:57All right.
30:59If I squeeze around your chest here, is this sore at all?
31:03No.
31:04No?
31:05James is trying to ascertain if Harper's fractured any ribs.
31:09How's your pain, Harper?
31:11It hurts.
31:12It hurts, okay.
31:13All right, is it?
31:13Not sore around here, no?
31:15No.
31:15All right, lovely.
31:17So, airway's fine, breathing fine, circulation is fine.
31:20We've got an obvious, deformed, rotated left femur.
31:24Yeah.
31:24Almost certainly a mid-shaft left femur fracture here.
31:27Fortunately, Harper hasn't sustained any other injuries, but now faces the painful procedure of having his thigh bone pulled back into line.
31:36We're going to do a procedural sedation, KTD, scoop, pep blocks, John Radcliffe.
31:42What we plan to do is give him some ketamine.
31:43A powerful, fast-acting sedative, ketamine is ideal for procedures like this, but must be given with care, as it can affect breathing and heart rate if not closely monitored.
31:55So, that's a drug that sedates him, makes him really sleepy, okay?
31:58And that way we can sort that leg out, pull it nice to length, because we can't keep it like that, okay?
32:04It's important to sort that out as soon as we can, okay?
32:06He shouldn't remember anything at all, okay?
32:09So, he'll just be really sedated.
32:11Wears off relatively quickly, and then he should come back to normal, okay?
32:14The sedative effects of ketamine only last around 15 minutes.
32:21Harper, if I touch your foot here, can you feel me touching that?
32:25Yeah.
32:26Yeah, good boy.
32:27Great.
32:28A positive sign.
32:29Harper has sensation in his foot, meaning his nerves are intact.
32:33So, is motocross your favourite thing to do?
32:36Yeah.
32:36It wasn't till today.
32:37Ah.
32:38It's for that.
32:39But we're going to give you some nice medication, okay?
32:41And then we're going to sort your leg out, and you're not going to feel it, okay?
32:44You're not going to remember it, and you're not going to feel it.
32:47Administering ketamine to sedate 10-year-old Harper, then realigning the broken bone,
32:52is a procedure that has to be executed perfectly.
32:55Right.
32:55Blood pressure on a three-minute cycle.
32:57Lovely.
32:58So, Dr James runs through a vital checklist before starting.
33:01At the moment, we've got heart rate 90, SATs 99.
33:05Blood pressure's just cycling, but it was perfectly normal before.
33:08Great.
33:09128.
33:09Lovely.
33:09So, sedation checklist.
33:13Two times vascular access.
33:15Yes, we do.
33:16Monitoring attached and visible.
33:17Yes, it is.
33:19Now the team face giving an extremely powerful drug that can cause breathing difficulties to
33:23a young boy.
33:24So, I'm going to manage any airway issues, any emergence.
33:28Okay.
33:28Before performing a vital medical procedure, all in a muddy field.
33:33Oxygen administered.
33:35Yes, he's on 100% currently.
33:36Perfect.
33:37Perfect.
33:39So, I'll go 15 milligrams, Ketan, then.
33:59Perfect.
34:00At a motocross event, Dr James and critical care paramedic Charlie need to realign 10-year-old
34:07Harper's left thigh bone, but first need to sedate him.
34:11So, it just takes a few seconds to work, okay?
34:18Harper came off his motorbike after doing a jump.
34:21All right, Harper?
34:22Thankfully, he was wearing all the correct protective clothing.
34:26How do you feel?
34:28Can you talk to me?
34:29Yeah, okay, mate.
34:31Well done.
34:32As Harper is responding to Charlie, he isn't sedated enough for the realignment.
34:38Can you open your eyes again?
34:40Well done.
34:41Let's give him another five.
34:42More ketamine is needed.
34:45So, don't one lap.
34:48One lap too.
34:49How are you feeling?
34:55Can you talk to me?
35:01Can you tell me your name?
35:03101.
35:04And you're okay.
35:05We've lost verbal response.
35:07I think just very tentatively, James.
35:09We'll make a little start.
35:09So, first thing we're going to do is just really carefully weasel in this strap.
35:14Open your eyes, Harper.
35:16All right, mate.
35:16You relax.
35:17You're okay.
35:18Sorry.
35:19Good boy.
35:21A Kendrick traction device is called upon for the realignment.
35:24If you take this, feed it underneath.
35:26I'm going to let you leg up.
35:27All right, mate.
35:30Can you talk to me?
35:33Okay, mate.
35:34Once all the straps are in place, Harper's leg can be gently pulled back into line.
35:40So, what we'll do now, we'll put the ankle strap on.
35:43You can do the middle strap now.
35:44I just slide it upside.
35:46It's just above it.
35:47Okay, mate.
35:48It's all right.
35:49All right, buddy.
35:50Beautiful.
35:53How are you doing up the top, Charlie?
35:54Yeah, we're happy.
35:55We're happy.
35:56Yeah.
35:57All good.
35:58So, now his leg length is equal.
36:00And his knees are in the same place.
36:02The swift realignment is complete.
36:05And Harper's leg is straight.
36:07Great.
36:08Let's get him on the scoot.
36:09So, I'm going to roll towards me.
36:11Okay, everyone got a bit?
36:12Yeah.
36:12Okay, so, on roll.
36:13Very steady roll.
36:14That's fine.
36:16Harper is transferred onto a scoop stretcher.
36:19Oh, everyone happy?
36:20Yeah.
36:20Let's see.
36:21On rolling.
36:21Very steady roll.
36:24Lovely.
36:25In at the bottom.
36:27Right, these are just some blocks for your head.
36:28Okay.
36:29Securely strapped onto the scoop, with the head blocks to minimise any further injuries during
36:34transit.
36:35How are you doing, Harper?
36:36Harper is carefully carried to a waiting ambulance.
36:40Can you open your eyes?
36:42Well done, mate.
36:43Well done.
36:45A few little bumps, Harper.
36:46Okay, mate.
36:50He's waking up nicely, actually.
36:52As Harper begins to come round.
36:54Can you say hello?
36:57Good boy.
36:59It's time to say goodbye.
37:00We're going to go now, okay?
37:02I'm going to leave you with the ambulance crew.
37:04All the best, mate.
37:04Cheers, mate.
37:05Thanks, guys.
37:08The critical care team are happy for the ambulance crew to proceed to the John Radcliffe
37:12hospital without them.
37:16Harper was absolutely amazing.
37:18I've seen grown adults complain far worse than him, and rightly so.
37:23It's an extremely painful injury.
37:24So I was really, really impressed at how brave Harper was.
37:35I'll stay with the airway if you're happy to do the physical bits with the Lucas.
37:43Yep.
37:44Roadside on a busy roundabout near Wokingham, Dr. Susie Stokes and critical care paramedic
37:49Nick are about to put 57-year-old graphic designer Catherine into an induced coma after
37:55she suffered a cardiac arrest at the wheel.
37:58She's had, as you said, 30 minutes of sustained ROSC and no more ventric ectopics really since
38:02we've been here.
38:03No.
38:04So things seem to be more stable.
38:05She's going to be at one point where they step down again.
38:07Perfect.
38:08Fortunately, after early CPR and a shock with a defibrillator, her heart restarted, but
38:14now the critical care team need to keep her alive.
38:17Is it OK if I take over the airway, please?
38:19They have to mechanically take control of Catherine's breathing to keep her brain and other organs
38:24oxygenated in case she has another arrest.
38:28Happy to proceed?
38:29Happy to proceed.
38:30This means strong drugs are needed to anaesthetise her before the intubation.
38:35So we're happy starting with one per kilo.
38:38Yeah.
38:38Go 17.
38:3917.
38:40Yeah.
38:41So we're starting on 15.
38:43OK.
38:43Yeah.
38:43I'm going to go down to eight.
38:44OK.
38:45First, Nick administers a powerful sedative that only critical care crews can use outside
38:51of hospital.
38:51Every now and then, we're getting a spontaneous breath.
38:55Happy to rock.
38:56That's followed by the muscle relaxant rocuronium.
38:59This combination will temporarily paralyze her, so a tube can be inserted deep into her
39:05airway.
39:06OK.
39:07Yeah.
39:07Definitely aware of that.
39:08Yeah.
39:08I'm going to continue ventilating through the apneic period.
39:13Yep.
39:13Sat to 100.
39:15Lovely.
39:15And tidals remained unchanged.
39:18We're pressure maintained.
39:20Yep.
39:21So we'll go back.
39:22Any difficulties, we'll go back to the eye gel, because we know it works.
39:24Yeah, yeah.
39:25OK.
39:27You happy?
39:28Yep.
39:28A little bit of blood in the eye gel.
39:33A laryngoscope gives Dr. Susie a clear picture of Catherine's airway as the breathing
39:38tube is inserted.
39:43Can you see?
39:46Oh, yes.
39:47Yes.
39:48Grade one.
39:48Bougie.
39:48Bougie through the cords.
39:50Amazing.
39:50Loading tube.
39:54I have the Bougie.
39:55I have the tube.
39:57OK.
39:58Tube's seen through, black lines, 22 at teeth.
40:01Bougie coming out, watch eyes.
40:04Right, Bougie's away, cuff going up.
40:06Cuff is up.
40:07Lovely.
40:09Amazing, thank you.
40:11OK.
40:15OK, fogging scene.
40:17Chest is rising and falling.
40:19Dr. Susie now has full control of Catherine's breathing.
40:23Right, can you swap them over now?
40:25That'd be great.
40:26That's perfect.
40:29That's perfect.
40:30OK.
40:32Nothing.
40:33She can now be switched onto a mechanical ventilator.
40:40Fine.
40:42OK.
40:43Main's O2.
40:44You're right connecting to main's oxygen.
40:47Yeah.
40:47So, propofol's in.
40:48So, propofol's in.
40:50Catherine's given propofol, a general anaesthetic only carried by critical care teams, which combined
40:56with ketamine provides deep, stable sedation with fewer side effects than either drug alone.
41:01OK, fine, that's recycling the blood pressure now.
41:06All the numbers are good, Susie.
41:07Great.
41:08Our internal has basically stayed the same from 4.8 to 4.9.
41:12We're on 450.
41:13I'm happy with that.
41:14Happy?
41:14Yeah, we'll keep it below 5.
41:16Catherine is stable and successfully ventilated.
41:19Temperature monitoring and OG, and then we're good to go.
41:23So, 999 was 0809, and ROSC was 0819.
41:30So, 10 minutes.
41:32That's great.
41:32Yeah.
41:33It's an amazing job.
41:34Hello, can I pass a medical pre-alert, please?
41:42November Alpha 431, but we're the HEMS team travelling with.
41:46Medical cardiac arrest with ROSC.
41:50Dr. Susie phones ahead to the Royal Berkshire Hospital, so they are prepared for Catherine's arrival.
41:56So, this young lady was driving her car, and it was seen to kind of veer off and come to a slow stop.
42:03So, no trauma.
42:05Pulled out by bystanders.
42:07Excellent CPR.
42:09One shock from VF to ROSC.
42:1110-minute downtime.
42:13She's been intubated and is being ventilated.
42:17Okay, see you then.
42:19So, quick top to toe.
42:21Airway we're happy with.
42:23Yep.
42:24Breathing is controlled.
42:25So, pupils are equal and reactive.
42:27The VM was normal.
42:28We've pre-alerted.
42:29Yeah.
42:30Cool.
42:30Okay.
42:31Let's drop ourselves in.
42:34On arrival at the Royal Berkshire Hospital, Catherine is handed over to the emergency department for scans and possible heart surgery.
42:47Okay, Catherine, we're at hospital now.
42:50Just in case you can hear me, we're going to go in and we're going to speak to the doctors about you and get you feeling better, okay?
42:54The people who saved her life were the bystanders.
42:58We know the things that make the big differences.
43:01Early, good quality CPR, which was definitely happening.
43:05She may need an implanted defibrillator.
43:07So, a little sort of shock box that sits under the skin.
43:10Should she ever have a similar event, the box would shock her out of it before.
43:14Do you feel really hopeful for her?
43:16Yeah.
43:16Do you feel really hopeful for her?
43:46You feel pitiful for her?
44:09Okay.
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