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00:00There's nothing more extreme
00:03These lips are blue
00:05Than an immediate threat to life
00:07Massive, massive burn, skin peeling
00:10Responding to the most severe 999 calls
00:13This lady is reporting pain in her head and is becoming less talkative
00:18The rapid response vehicles of the Thames Valley Air Ambulance
00:22Wanted to have a seizure, the whale crashed into some people
00:24Are at the front line delivering life-saving medical treatment
00:27The big decision is for us whether we need to put a tube in again to protect us that way or not
00:31Working day
00:32We're going to give you some strong medication
00:34And night
00:36It should not hurt, it's a very good painkiller
00:38Reacting to emergencies
00:40You've been super brave, darling
00:42The critical care teams
00:43You've had a pretty big blow to the head
00:45Are equipped to provide hospital level treatment
00:48So we'll give you some ketamine
00:49That will mean that you don't know what we're doing whilst we straighten your ankle out
00:52Whenever
00:53Do you think it's bad?
00:55Potentially, yeah
00:55And wherever
00:56It's needed
00:58You are doing a fantastic job
01:00Filmed over three months
01:02Let's have your arm, my dad
01:04Let's give you some of this morphine
01:05Just be aware
01:06He might stop spontaneously ventilating
01:08I have the tube
01:10We captured every vital second
01:13That's okay
01:13You're safe
01:14As these highly trained critical care teams
01:17Can you take a deep breath in for me?
01:19Fight to save lives
01:21Your birthday present is surviving a cardiac arrest
01:24When every second counts
01:26Let's go, go, go
01:28Tonight, a motorway pileup
01:31Leaves a badly injured woman trapped
01:35She definitely is less conscious and alert than she was before
01:39A man in agony after a serious fall
01:42How bad is your pain at the moment?
01:43If you score it out of ten
01:44And ten being the worst pain you can imagine
01:45There being no pain at all
01:46Ah
01:47An elderly woman with a suspected stroke
01:50My feeling is this looks neuro
01:52And I think she's quite frail
01:55And
01:55The critical care team responds to a woman suffering multiple seizures
02:00Okay, Claire, you're alright
02:01Have we done that easy journey?
02:03No, John, for your time
02:03Hold on, just watch your head
02:05Ambulance, emergency, suppression, freebay
02:23There's a lot of cars, I don't know
02:25How many cars is there?
02:29What road are you on?
02:32Were you involved in the accident?
02:36Yes, I am
02:37Someone's hit me up the back
02:38Is anyone trapped in a car?
02:40I think there is
02:41Can you see if anybody is injured?
02:44Hello?
02:46Hello?
02:47Sorry, the line comes out
02:49Can you repeat that?
02:52Hello, can anyone hear me?
02:59There's been a road traffic collision on the motorway
03:01Multiple vehicles have crashed
03:04And there's a high probability of serious and potentially fatal injuries
03:08That will need the specialist skills of the critical care team
03:11And Seth, go ahead
03:13So Dr. Laura Douglas-Beverage
03:16And critical care paramedic Andy College are dispatched
03:19So it's a seven-car RTC
03:21Yeah
03:22But the information's a bit patchy
03:24Some people are saying that everyone's out
03:25Some people are saying that someone trapped
03:27And there's a state report
03:28A person who's severely injured
03:29So if you get there in your first time
03:30Just a quick report back
03:31So that we all know up here
03:32What the state of play is
03:33Lovely
03:34And I think you'll also get two, six running if needed
03:36Okay, mate
03:37I'll give you a sick rep as soon as we're there
03:39All right
03:40All right
03:41Catch you soon
03:42Thanks, mate
03:43Over 29,000 people are seriously injured or killed in car crashes in the UK every year
03:50RTCs involving multiple vehicles carry a greater likelihood of death
03:55Okay, we've got a hard shoulder action
03:57Yeah
03:58Heavy braking
03:58Yeah, no problem
03:59You're okay, left
04:00Turn behind
04:01Thank you
04:02We've been sent to a seven-car collision on the M40
04:08We are going to be the first on scene
04:10So a lot of this initially will be about assessing
04:13How many significant patients there actually are
04:15And then delegating to additional resources
04:18As and when they arrive on scene
04:19So my feeling would be if we're first on
04:22That anybody who can walk
04:23We direct to the side
04:25And to move back
04:26Unless we need additional pairs of hands
04:27Yeah
04:28I'll report back to the desk
04:29Lovely
04:29Yeah, and then I can get eyes in for initial
04:32Just seven minutes after receiving the call
04:35Andy and Laura arrive at the scene
04:37Oh, yeah, you're all right
04:43You're all okay
04:44Are you guys injured?
04:46No, go to her
04:47They immediately need to assess any injuries
04:50And prioritise who needs their help the most
04:53Any of you injured?
04:54This is my vehicle
04:55Lovely
04:56Lovely
04:57Anybody still inside the vehicle?
04:59Anybody injured?
05:01Fine, okay
05:02Please stay where you are, all right
05:04Hello, mate, you all right?
05:05Yeah, yeah
05:06So this is Ellie
05:06Yeah
05:0729-year-old lady
05:08And this is Harry
05:09Hiya
05:10They were stationary
05:11Yeah
05:11And then this van here
05:13Yeah
05:13Okay
05:14I've had a quick feel around
05:15Just no C-spinal central
05:17Okay
05:18Watch your skill set, mate
05:19I'm a paramedic
05:20Off-duty paramedic Paul was driving back from an event when he saw the pileup happen
05:25And rushed to help
05:26So I'm just complaining of chest pain
05:29I better listen to the chest
05:31Just complaining of the sternum
05:33Yeah
05:33I'm trying to calm their breathing down, she's all right
05:35She's got a little bit of face pain underneath the eyes
05:37Okay
05:38Ellie and her husband Harry were travelling home from Birmingham when they were hit side on by a transit
05:44van while stationary and queuing traffic on the motorway
05:47Hello sweetheart, my name's Laura, I'm one of the doctors
05:51Where does it hurt, sweetheart?
05:53Round your face
05:55Round your face
05:56Okay, look at me, sweetheart
05:58You're doing really well
05:59Does it hurt anywhere else?
06:01Normally, like toes
06:03Round your toes
06:04Okay
06:05Ellie has injuries to her face, chest and potentially her spine and legs
06:10Dr. Laura urgently needs to examine her
06:13But that can't be done until she's been extricated from the vehicle
06:17I've got a sit-rep for you when you're ready, Ella
06:20Yeah, this is a three to four car RTC
06:24If you can make ambulances three at this stage, please, Ella
06:43Amber, emergency patient breathing
06:45Yes
06:46And if patient's awake
06:47That's correct, yes
06:49Is it possible for me to speak to him?
06:51Hello, can you hear me?
06:53Have you lost any blood?
06:54No
06:55And did you fall today?
06:57Yeah, I was stood in the bath, in the shower
07:00Okay
07:01And I just slipped
07:03And fell backwards, out of the bath
07:07Ah, the first contact
07:10What's on the left side?
07:12The rim of the toilet
07:14Okay
07:15Okay, so from the information you've given me, the appropriate help is still being arranged
07:19And this is now a high-quality ambulance
07:25An ambulance has arrived and is with the patient
07:27The crew are concerned the man's life is in immediate danger
07:31So request support from the critical care team
07:33The 69-year-old who fell backwards in the bathroom and he's striked his kind of posterior thorax on the toilet
07:40When the crew have got there, they say he's got a rest rate of 40 with severe difficulty of breathing
07:45Dr. Matt McGurran and critical care paramedic Andy Ludlow are dispatched
07:50They've had a look and he's got an obvious posterior flail segment, which is said, where the sema
07:56Um, and kind of a bubbling sound, how they described that on consultation
08:00They sat him out, he went for any cardiac, lost consciousness
08:03Okay
08:04Okay
08:05The ambulance crew think the patient has fractured ribs, causing air to leak into the tissues under the skin
08:11It's a severe and potentially life-threatening chest trauma
08:14Say what, say what they do
08:16Okay
08:17We're sort of six minutes away, so that's fine, isn't it?
08:21Okay, fine
08:23The patient's condition is critical
08:26So Andy and Matt arrange to meet the ambulance en route to the hospital
08:30They look okay
08:34I'm Matt, this is Andy
08:39So this is John, approximately at 5, uh, 5.50
08:43He's had a full, uh, in his shower
08:45So he slipped, hitting to the left side of his, uh, rib area
08:50He has obvious bruising, um, he's in a lot of pain, was on the left side when we got him
08:55Uh, query maybe a head stroke, but he remembers all events
08:58Neal C-spine tenderness
09:00Ex-serviceman John was away on a walking trip with a friend when he slipped in the hotel shower
09:06His shouts for help alerted other guests who called for an ambulance
09:10In a lot of pain they've given three milligrams of morphine, we're running IV, paracetamol now
09:16Okay, fine
09:17So John, my name's Matt, I'm one of the doctors with the Air Ambulance
09:19Um, we'll just do sort of a quick, uh, assessment of your chest, if that's okay
09:23If John has sustained multiple broken ribs, he's at risk of a punctured lung, damage to other vital organs and respiratory failure
09:31How bad is your pain at the moment, if you score it out of 10, and Thames being the worst pain you can imagine, there would be no pain at all
09:37Doctors on attachment with the Thames Valley Air Ambulance Charity receive specialist training in pre-hospital emergency medicine
09:57Today, senior critical care paramedic, and veteran of the service, Matt Jarman, is on shift with trainee, Dr. Andy Darby-Smith
10:06I'm one of the registrars, so I have a background in anaesthetics and intensive care medicine
10:11And I joined here probably one and a half years ago
10:14As part of a two year training program, so I'm kind of getting towards the end now
10:18Um, and I happen to live in Marley, which means that I'm only about 20 minutes away from base, which is really nice
10:25Because I'm married with a two year old, and he's lovely, and he sees the car go down Marley High Street a lot
10:31And shouts, Daddy Nino car, which I think is lovely, so that's really nice
10:37Prepped and ready for their first code red call, Andy and Matt hit the road on a late shift, which will take them into the early hours of the morning
10:46I have an emergency space of breathing
11:00Yes
11:01And the station awake?
11:02Yes
11:03Can you tell me about see what's happened?
11:05She's got an undiagnosed uric condition, where she has seizures
11:10Some of the codes are now, but the right side of her face has started to drop in
11:14She's complaining it's less strange
11:16Has she responded normally?
11:18No, she does, but Daisy, she can barely talk
11:22Is she breathing normally?
11:23Breathing's very shallow
11:25Can you tell me?
11:26Can you tell me?
11:27Can you tell me?
11:28Yes
11:29Can you tell me, please?
11:30Yes
11:31Can you tell me, please?
11:32Yes
11:33Can you tell me, please, please, please, please?
11:34Yes
11:35Yes
11:36Yes
11:37Yes
11:38The help has been organised for her, it has just down the line for me
11:41Prolonged or severe seizures can quickly develop into life-threatening situations that need critical care intervention
11:53Andy and Matt are immediately dispatched.
11:56So we've been tasked to a 32-year-old woman,
11:59and the information is relatively scanty at the moment,
12:03but it sounds like she's having recurrent seizures.
12:06The ambulance crew already on scene
12:09sends through an update via messaging.
12:12So they've done a sit-rep now, which is they're having seizures,
12:16and they're not known to be epileptic.
12:19So it might suggest that something more complicated is going on,
12:24but I always think it's so important not to become blinkered
12:27and assess the scene yourself before you make any decisions,
12:30and that's something that we're trained to do and do every shift.
12:33The patient had been out with her partner when she began to feel ill.
12:38As they were travelling home, she began seizing.
12:41Andy and Matt arrive at the address where the woman is still in the car.
12:45That's one of these.
12:51Hello. Very well. How are you? Are we in the car?
12:55The ambulance crew brief Matt and Andy.
12:58This is her 32-year-old female.
13:00She's got some neuro-neurological conditions going on,
13:03but it's been important to have seizures starting at 18.45.
13:07She's had 11 bilateral tonic clonics.
13:10All lasting sort of 10 to 20 seconds.
13:12A bilateral tonic clonic seizure causes a person to lose consciousness,
13:16followed by the body stiffening and shaking uncontrollably.
13:20We've already had 10 milligrams of buccal medazolam.
13:22We've just got another 10 milligrams of IV diazepam.
13:25We've got three points of excess.
13:27Oxygen on, but maintaining.
13:29Great.
13:30Multiple seizures in quick succession are rare and very dangerous,
13:34because the brain doesn't have time to recover between them,
13:37which can result in permanent damage.
13:39Hello, sir. Lovely to meet you.
13:41My name's Andy.
13:42Nice to meet you, Aidan.
13:43Just here to make sure that... Is your wife, partner?
13:45Yeah, my fiancée.
13:46Your fiancée. Okay, that she's okay.
13:48Claire's been unresponsive since the seizures started.
13:51So I've heard a little bit from the paramedics about what's going on.
13:54It's been going on for about three months.
13:56Okay.
13:57She started with stroke-like symptoms initially,
13:59and then she was admitted for about a week.
14:01To the John McLeod or to the Stoke Mandeville?
14:03To Stokes.
14:04They weren't sure what it was, whether it was a stroke or something.
14:06They expect potentially some mitochondrial disease or something along those lines.
14:10Okay.
14:11But now she has...
14:12She has seizures almost weekly.
14:14Mitochondrial disease is a genetic condition where the body's cells can't produce enough energy.
14:19It can lead to problems with the heart and brain, causing seizures and stroke-like symptoms.
14:23And then today it's got worse again?
14:25Yeah, we were in the Stoke last night.
14:26Because of the seizures?
14:27Yeah.
14:28Okay, that sounds really difficult, I'm sorry.
14:29It sounds like a nightmare.
14:31As you probably know, we can't really leave her here if she's having multiple seizures.
14:36Yeah, don't worry, it's not...
14:37So the plan...
14:38It's not my first idea.
14:39I bet.
14:40It sounds like you're very clued up.
14:41Yeah, this is probably going on our non-physics.
14:44Sure.
14:45So what I'd suggest is that we move from here to Stoke Mandoval Hospital.
14:50Yeah.
14:51Which is where they know her.
14:52With Claire barely conscious, the crew need to move her out of the car and onto the ambulance.
14:57I think the brakes are on there, mate.
14:59That's it.
15:03Right.
15:04I'm going to top and tail, she's got no strength in her legs.
15:06Okay.
15:07Claire, are you happy?
15:08Relax for us.
15:09Yeah, that's all right, I'm holding it.
15:10Okay.
15:11Happy?
15:12There we go.
15:13Well done.
15:14Good.
15:15I'm just going to pop this blanket from behind your head.
15:17Sorry.
15:18Sorry.
15:19As Claire is unable to communicate, Andy needs as much information from Aidan as possible.
15:24Do you normally wake up from her seizures?
15:27Yeah, at night.
15:28Normally after, sort of around ten seizures she'll wake up, but yesterday she didn't wake
15:33up for two hours.
15:34Okay.
15:35Is there normally a long delay for her to wake up, or is it normally something that happens
15:38quite quickly?
15:39It do still happen quickly.
15:40It's getting longer and longer each time.
15:42Sure.
15:43Okay.
15:44Sometimes yesterday she actually came into and then she went back into another one.
15:48Yeah.
15:49Okay.
15:50So we're going to load her up into the ambulance now and hook up to the monitoring.
15:53And we'll just do another assessment and talk to the ambulance crew about our next steps.
15:59With no diagnosis for the cause of Claire's seizures, Andy and Matt need to carry out a series
16:04of tests to ensure she's stable enough to travel.
16:07Maybe.
16:08Yeah.
16:09If you want, yeah.
16:10What was that?
16:11Thanks.
16:12Thanks.
16:13Thanks.
16:14Thanks.
16:15Chest pain.
16:16Chest pain.
16:17Chest pain.
16:18Chest pain.
16:19Yeah.
16:20Okay.
16:21Have we done an ECG?
16:22Yeah.
16:23You might as well.
16:24Well, we'll just take a little picture of your heart, okay?
16:25But suddenly, Claire takes a turn for the worse.
16:28Oh, watch your head.
16:30Watch your head.
16:31Every time she has a seizure, Claire's brain, and her life, is at risk.
16:47It's comfortable, right?
16:48Not too deep.
16:49Okay.
16:50Just enough.
16:51In Maidenhead, Dr. Matt and critical care paramedic Andy are with an ambulance crew who
16:56are concerned that 69-year-old John's life is in danger.
16:59After breaking several ribs, slipping out of the bath.
17:02Well done.
17:03Is it on your left side?
17:06It's got good air, isn't it?
17:07Yeah, we've had fairly good air.
17:09It's just a bit bubbly on the lower basement.
17:11Yeah, sure.
17:12Is it still here?
17:13No.
17:14No.
17:15It's okay here?
17:16Yeah.
17:17And here.
17:18Okay.
17:19I'm not going to examine the back of his chest, because I don't...
17:22No.
17:23Sorry?
17:24Do it flail.
17:25You might be sick.
17:26Can we get a bowl, please?
17:27I think the top two ribs are...
17:29Sick bowl.
17:30Sorry.
17:31Up there.
17:32John's nausea is one of the side effects of morphine.
17:35However, vomiting with rib fractures is dangerous, because the broken bones can damage the lungs
17:40and surrounding organs.
17:42I'm just going to give you an anti-sickness medication to help with that nausea feeling.
17:45Is that okay?
17:46Matt and Andy need to get John's pain under control, and keep him as still as possible
17:51to prevent any further internal injuries.
17:53John, how are you feeling?
17:55Oh...
17:56We're going to give some stronger pain relief.
17:58Okay.
17:59That's why we're coming, so we can give you ketamine, which is a stronger pain relief.
18:04Ketamine is a powerful sedative and painkiller that critical care teams are specially trained
18:09to administer.
18:11It will help John to breathe more comfortably.
18:142-7, thank you.
18:17Andy updates the dispatch desk of their plans.
18:21We're not really going to be able to manage this patient's pain with the cruise morphine,
18:26so we're going to ground escort this chap with ketamine and maybe fentanyl analgesia.
18:38John, you said you were doing the Thames path?
18:40You said you were walking the Thames path?
18:41Yeah.
18:42To assess the effects the ketamine is having, Matt talks to John.
18:46Are you doing it with other people?
18:48Yeah.
18:49Bye.
18:50My...
18:53lifelong friend with her pinkies, because...
18:56Des.
18:57You're a lifelong friend, Des?
18:59Yeah.
19:00We're close.
19:02You don't need to carry on talking if it's uncomfortable.
19:08John?
19:09John!
19:11John!
19:13You alright, buddy?
19:18I've only given him 10.
19:20In less than a minute, the ketamine takes effect, and John relaxes into a dreamlike state, unaware of any pain.
19:26Too fast, Scannon?
19:30En route to hospital, the team check for internal bleeding using a portable ultrasound scanner.
19:35John, I'm just going to move your arm out to the side with me.
19:38And then my colleague's just going to scan your tummy.
19:42You alright there, John? Can you open your eyes?
19:43He's sort of behaving in a ketamineised way in terms of, he's a bit sedated, so it's almost like he's had a procedural sedation where we've made him less responsive to external stimuli.
19:53You're getting leather and kidney, yeah?
19:54Yeah.
19:55Check you this side.
19:56Drop that side down, might be easier.
19:5945 minutes after rendezvousing with the ambulance, and with the ultrasound not showing any other trauma, the team arrive at the John Radcliffe Hospital in Oxford.
20:05John?
20:06John?
20:07John?
20:08John?
20:09John?
20:10John?
20:11We've just arrived at the hospital.
20:12Okay?
20:13Is that oxygen still next to him over there?
20:14Yes.
20:15Yes.
20:16Right, brace yourself.
20:17Okay, John, a couple of bums.
20:18Wow.
20:19Still sedated, John will undergo a CT scan and thorough examination of the patient.
20:23And with the ultrasound not showing any other trauma, the team arrive at the John Radcliffe Hospital in Oxford.
20:25John?
20:26John?
20:27John?
20:28John?
20:29John?
20:30John?
20:31John?
20:32John?
20:33John?
20:34John?
20:35John?
20:36John?
20:37John?
20:38John?
20:39John?
20:40John?
20:41John?
20:42John?
20:43John?
20:44John?
20:45John?
20:46John?
20:47»
21:1429 year old Ellie is trapped in her car
21:17Dr. Laura needs to assess if she has injuries that could be made worse by being extricated
21:23A quick feel over the tummy if I have a little look
21:25Any pain there?
21:28No? Okay, fine
21:30Any pain when I'm pressing over the pelvis?
21:34Okay, what about over this leg here?
21:37What about this one?
21:39Okay, and when I'm pressing here?
21:41Fine
21:42Let me have a little look around your face at all
21:43Any pain when I'm pressing?
21:45It's sore in there. What about on this side?
21:47It's mostly this side
21:49Okay, fine
21:50While Laura examines Ellie, Andy continues to manage the scene
21:54and liaise with the other emergency services now arriving
21:57Hi mate, you alright? I'm Andy
21:59Hi, I'm Tom. What have we got?
22:01So this lady, once she's out, I think he'll be able to scramble across
22:04Yeah
22:06Get orders made safe
22:07Okay, perfect. Thank you
22:09Having carried out her initial assessment
22:12Dr. Laura prepares to move Ellie out of the car
22:15But as she does
22:17When you're ready, let's count to three and just gently sit up
22:19One, two, three
22:21There you go
22:23Well done
22:24Well done
22:25So she's got a lovely radial pulse
22:27But it's immediately feeling quite lightheaded
22:28Okay
22:29At the minute that we sit her up
22:30I think ideally if we can get hands on to just get her out onto the stretcher
22:33Yeah
22:33Would be really helpful
22:34Yeah
22:34I don't think she's necessarily going to be able to stand to support her own weight herself
22:38Lightheaded
22:39And unable to get out herself
22:42Ellie will need the help of the fire service to extricate her
22:45All right, sweetheart
22:47Big noise
22:48That's just because we're moving the door so we can help you out a little bit easier
22:51Okay
22:52You're doing ever so well, Ellie
22:54Lovely stuff, chaps
22:55Hello
22:56So this lady's just feeling quite lightheaded
22:58If we bring the trolley in
22:59Then we just get hands on to sit her up
23:01Legs round and then up and onto the trolley
23:04So if we maybe can bring the trolley alongside
23:05And we'll move our bags out the way
23:07Until Ellie is released
23:10Her husband Harry remains trapped in the car
23:13Have you got any pain, Tella?
23:15I know you're a bit shaken up
23:16Okay, we'll look after you
23:18We'll look after your other half
23:20It's all going to be fine, all right?
23:22Are you guys all right to do the lifting?
23:23You're probably a bit better at it than me
23:24Bring your legs out for me, sweetheart
23:26We need to get you out of the vehicle, all right?
23:29Yeah, it's going to hurt
23:30All right
23:31Until we can get you out and get a better look at you
23:34Then we can do something about that, all right?
23:37You're doing ever so well
23:38That's it, well done
23:40Well done
23:41Yeah, it's going to hurt, sweetheart
23:45We need to get you out of the cars
23:47So we can sort your head out
23:50That's it, well done
23:52Brilliant, well done
23:55That's it, well done
23:56Well done, well done, sweetheart
23:57You're doing all right, sweetheart
24:00All right, well done
24:01There we go
24:02Okay
24:03Scoot your bum all the way along
24:05Excellent
24:06Let's get access and monitoring and so on here
24:09Are you able to get yourself across, fella?
24:12I think so
24:13Come on out, fella
24:14That's it
24:15Excellent, all right
24:18With Ellie now out
24:20Dr. Laura can carry out a proper examination
24:23You got any pain anywhere, sweetheart?
24:26Your head hurts
24:28Have a little look at your pupils, sweetheart
24:30Look on your eyes for me
24:31The lightheadedness
24:33And now headaches following the impact from the crash
24:36Are worrying signs
24:37So this lady has been alert and talking
24:40But it's reporting pain in her head
24:42And it's becoming less talkative
24:44All right, so my concern would be
24:46This is an evolving picture with this lady
24:47Critical care paramedic Matt and Dr. Andy are with 32-year-old Claire
25:12For the past six months
25:14She's been suffering from an as yet undiagnosed condition
25:17That causes her to have multiple seizures
25:20Okay, well done
25:22You're all right
25:24Well done
25:25The abnormal activity in Claire's brain has subsided for now
25:29But without knowing the cause
25:31She is still in danger
25:32Claire, I'm just going to pop something in your nose
25:34My name's Andy, I'm one of the doctors
25:35Hello
25:36Hello
25:38No worries
25:39All right, well done
25:42Yeah, I'm just going to say
25:44I'll just go to BM if you pass me
25:46Oh no, it's there
25:47It's right there
25:47Okay
25:47I'm just going to put something next to your head, okay
25:49Just so you don't bang in there
25:50Just do some notes
25:51Cool
25:51I'm going to pop your hand out, Claire
25:54I'm just going to do a sugar reading, okay
25:57And it just involves a little pinprick in your finger
26:00Sharp scratch on your finger, Claire, okay
26:05Just a drop of blood I need
26:06All right, I burn
26:06Blood pressure 120 on 60
26:09Respirate 22
26:11Sat 97 on there
26:13And end tidal 4.6
26:16And a BM 4.4
26:18After a seizure
26:20The body's vital functions can be unstable
26:23Causing irregular breathing
26:24Fluctuating heart rate
26:26Slowed brain function
26:27And disrupted body chemistry
26:29I'm just going to take your temperature in your ear, okay
26:3237 to
26:37All right, Claire, you okay?
26:44Sorry, hang on
26:45Can't really hear you
26:47Say again
26:47In your head at the moment
26:52Or you have before
26:54Oh, do you?
26:57It's a lot worse now
26:58Oh, okay
26:59All right
26:59She's got pins and needles in her head
27:02In her head?
27:03Yeah
27:03Worse now than normal
27:06Okay
27:07And your chest
27:11The pins and needles sensation Claire is experiencing
27:15Is due to her brain and nerves being fatigued from repeated seizures
27:18So all of your numbers
27:19So all of your numbers look really good
27:22So your oxygen levels are very good
27:24Your breathing is very good
27:25And your heart rate and blood pressure are very good
27:28And the electrical tracing of your heart
27:30Your ECG also looks completely normal
27:33It's really positive
27:34It always does
27:36Sorry, I'm a bit confused
27:39And how I go into that
27:40Is that my son's school?
27:43Um, yeah, so you're in the car, I think
27:47With your husband
27:47I don't remember
27:49Yeah
27:49It's quite normal
27:50So don't worry too much
27:51That you can't remember
27:52The intense muscle contractions
27:55And physical strain from repeated seizures
27:57Are taking their toll
27:59I'm in a lot of pain right now, though
28:02Are you?
28:02Where's the most pain?
28:04I feel left arm
28:05Yeah
28:05I feel right side of my head
28:08I had 17 seizures first
28:10Yesterday
28:1217 yesterday
28:14My body's still recovering
28:16Yeah, definitely, definitely
28:17I feel like
28:18They say it's like running a marathon
28:19Yeah
28:20It's like you don't lose the calorie thing
28:23Is that right?
28:26Despite it being less than 24 hours
28:29Since she was last here
28:30Claire arrives at Stoke Mandeville Hospital
28:32In good spirits
28:34Take the monitor on the back of the stretcher
28:36Yep
28:38So everything's still fine
28:42All your obses are fine
28:43Okay
28:44It's amazing
28:45The obses are
28:46Yeah, I appreciate it
28:47Yeah
28:47Oh, can we do that
28:50Like that?
28:51It should just fit
28:52Is it?
28:52Just fit
28:52She's working at work
28:53She's fit
28:54Claire will be handed over to neurology
28:58Where hopefully
28:59They can get to the bottom
29:00Of what's causing her
29:01To have these seizures
29:02And look, it's emergency
29:20Is the patient breathing?
29:21Yes
29:22And is the patient awake?
29:25She is
29:25I think she's having a stroke
29:27And what makes you think she's having a stroke?
29:29She's just looking for both
29:30She is
29:30She's right with half on and half on the shoulder
29:34Is her face drooped to one side?
29:37Is her feet slurred?
29:38She's not talking
29:38Her face does look a bit distorted
29:41Okay
29:42In the last 24 hours
29:44Has she mentioned
29:45Any crushing
29:45Or severe aching pains
29:47In her chest
29:48Upper back
29:48Or upper abdomen?
29:50Yes
29:51Yes
29:51She's had all this
29:52She was in hospital
29:53She's been in the hospital
29:54Three or four times
29:55So I have got the help range for her
29:57It is an ambulance
29:58But in a high
29:59Pronecy response
30:00They will be with you
30:01As far as they possibly can
30:03An ambulance crew is on scene
30:08But the patient's condition
30:09Has become critical
30:10So Dr Tom Waite
30:12And critical care paramedic Matt Bailey
30:14Are dispatched
30:15So we're going to an 80 year old female
30:18Who's had chest and tummy pain
30:22For 24 hours or so
30:23And then a collapsing episode
30:25With some stroke like symptoms
30:27And then a brief cardiac arrest
30:30With the ambulance crew
30:31Has been resuscitated from that cardiac arrest
30:34But is deeply unconscious
30:35The chances of surviving
30:37An out of hospital cardiac arrest
30:39Are fewer than 1 in 10
30:41But early CPR and defibrillation
30:44More than doubles those odds
30:45So it's a little bit unclear
30:49What's going on
30:51And whether this is primarily
30:54A heart problem
30:56A head problem
30:57Or some other problem entirely
30:59I think we'll go with an open mind
31:02Get a good feel if we can
31:05For what's going on
31:06And try to make the best decisions
31:08We can for her
31:0925 minutes after being dispatched
31:13The critical care team arrives
31:14The ambulance crew
31:18Already with the patient
31:19Briefed Tim and Matt
31:20On their treatment so far
31:21Hi guys
31:23You okay?
31:24Matt and Tim with you
31:26This is Pat
31:278 year old female
31:28Roughly 9.20 began
31:30Kind of speaking nonsensically
31:32To her husband
31:33And then she proceeded
31:34To have chronic chronic
31:35Seizure like activity
31:36No neurological history
31:37No history of seizures
31:38Managed to get IV access
31:41Full set of odds
31:42And get some Diaz
31:43Approximately 2 to 3 minutes
31:46After administration
31:48Of said Diaz
31:49We went into what looked like a BT
31:52And I couldn't feel a pulse
31:53So we pulled Pat onto the floor
31:56Did two rounds
31:57And then had a pulse back
32:01It's unclear whether it was a stroke
32:04Or a problem with Pat's heart
32:06That caused her cardiac arrest
32:07But by giving her CPR
32:09And assisting her breathing
32:11The ambulance crew
32:12Saved Pat's life
32:13We've had a week long
32:16Like prominent history
32:18Of in and out of stroke
32:19Mandible for
32:20Abdo pain complications
32:23With no formal diagnosis
32:25And you're on the point
32:27Of extricating aren't you?
32:28I'm just thinking logistics wise
32:29What we don't want to do
32:30Is slow progress down
32:32I wonder if we should
32:34Get her down the stairs
32:35And do a primary survey
32:36On the back of the ambulance
32:38So we're going to rotate first
32:40Where we are
32:40And head towards the door
32:43Pat's husband Derek
32:44And their friends
32:45Were with her when she collapsed
32:46I'm pleased to meet you
32:48I'm Tim
32:48I'm sorry to be meeting you
32:49In this situation
32:50I'm one of the doctors
32:51From the air ambulance
32:52I'm just wondering
32:53Pat's just going down the stairs
32:55In a stretch room
32:56Just wondering if I'd get
32:57A bit more information
32:58About how she is normally
32:59When she's well
33:00It'll help us to work out
33:02How best to look after her
33:04Well she's normal
33:06When she's normal
33:08The two of you live together
33:10In this flat I take it
33:12We've been in this flat
33:13Since 2016
33:15We've been married for
33:18Since 1995
33:20Can she get up and down the stairs
33:22To the flat okay
33:23Under her own steam
33:24Yeah normally yes
33:26Okay
33:27Yeah
33:28And do you have any extra help at home
33:30Do you have carers
33:31Or anyone helping out
33:32Completely self caring
33:34Yes
33:34Good
33:35So let's walk past
33:37And then swing around
33:38We want to go this way guys
33:39I've got her
33:40You've got her
33:41Yep
33:41She's still making respiratory efforts
33:44Yeah
33:44Yes
33:44And I think what we need
33:47Is a really thoughtful examination
33:49Pat's medical history
33:51Hasn't revealed any obvious causes
33:53Of her sudden collapse
33:54So Tim needs to proceed
33:56With caution
33:57Pat I'm going to look in your eyes
33:59Alright
34:00My name's Tim
34:01You're very safe
34:02You're just on the back of an ambulance
34:04My feeling is
34:06This looks neuro
34:07And I think she's quite frail
34:10And I think we'd be doing her a disservice
34:12By doing aggressive and invasive things
34:15To her
34:16I'd like to
34:37I'd like TXA for this lady
34:39Critical care paramedic Andy and Dr Laura
34:42Are with teaching assistant Ellie
34:43Who is a passenger in a car
34:45That got hit side on
34:46In a multi-car pilot
34:48She has got a radial pulse
34:49I can't see any obvious head injury
34:52But she's got facial injuries
34:53She's got good air entry bilaterally
34:55And no increased work of breathing
34:56With good bilateral chest air entry
35:00Ellie has become less responsive
35:03And there's a risk her head injury
35:05May have caused a bleed on the brain
35:06Which could be fatal
35:08And who could get us some TXA
35:10Who could get us some TXA
35:10Who could get us some TXA
35:10Who could get us some TXA
35:11Who could get us some TXA
35:11Who could get us some TXA
35:12Who could get us some TXA
35:13Who could get us some TXA
35:14Who could get us some TXA
35:16TXA or tranexamic acid stabilises blood clots
35:19If Ellie does have internal bleeding
35:22This could be the difference between life and death
35:25Darling I'm just going to cut through your clothing
35:28So I can make sure we're not missing something important
35:30Okay
35:30Yeah please
35:31I think we just need to do top to toe
35:33Because for all we've started off
35:34We were so soon onto the scene
35:36And she definitely is less conscious and alert than she was before
35:40She was talking and now is complaining and feeling very tired
35:43But I just want to make sure that we've not missed anything else important
35:46One first gram TXA time is 17.30
35:49If we can do two grams that would be lovely
35:51Thank you
35:52Roger
35:52Question 113.75
35:54Excellent
35:55Thank you
35:55And saturations are 100
35:57Fantastic
35:57In trauma cases
35:59Tiredness can be an early warning
36:01That the patient has serious complications
36:03That need immediate treatment
36:05Can I have a little look into your mouth darling
36:07Open your mouth nice and wide
36:09Stick out your tongue for me
36:10Lovely stuff
36:11Okay I'm just going to have a little feel of those teeth
36:13Open wide for me
36:14Any wobbly teeth
36:15What about these top ones
36:17Anything wiggling, wobbling
36:18No?
36:19Okay fine
36:20What top to toe
36:21What are we thinking?
36:23Significant headache
36:24But otherwise pupils are responsive
36:25Observations are all within nice normal range
36:28Yeah
36:28Good error entry bilaterally
36:30Abdom soft, non-tender
36:32Pelvis is okay
36:32Femurs are okay
36:33No obvious limb injury
36:35Although Dr. Laura is happy
36:38Ellie can be moved
36:39She will need to be reassessed
36:41Once she's in the ambulance
36:42Ready
36:44Steady
36:44Roll
36:45If everyone's happy
36:48Yep
36:48Or lower
36:49Ready
36:50Steady
36:50Lower
36:51Maybe
36:52Ready
36:53Steady
36:54Roll
36:55Just a little brace there
36:57Only need a few degrees
36:58That's it
36:59Lovely
36:59Ready
37:01Steady
37:01Lower
37:02One
37:03Great job everyone
37:04It's possible that Ellie has suffered a spinal injury
37:07So her head is immobilised
37:09To prevent any movement during the journey to hospital
37:12And he updates Ellie's husband Harry
37:14Hi mate you alright
37:15So should we go to Wexham Park I think
37:18In Slough
37:19Okay
37:20Am I going with her?
37:21I suspect so
37:22One second my darling
37:24I'm just going to have a little look at your tummy
37:26Okay
37:26Now I'm going to undo a couple of straps
37:28Can I bring this arm right the way down to your side?
37:31Bring that arm out a little bit
37:32Sorry darling I'm sorry
37:34I'm going to do the same thing on the other side
37:36Okay
37:36Dr. Laura is using a portable ultrasound scanner
37:40This specialist kit will reveal whether Ellie has any excessive internal bleeding
37:46Or damage to vital organs that needs emergency intervention
37:50Okay so splenarine
37:52Okay so splenarine angle looks good on the left
37:54Sorry darling
37:56It looks really good
37:58Just need to have a good look there
38:00Sorry
38:03Sorry sweetheart that's sore in there
38:06I'm sorry my love
38:08Okay so no obvious tamponade there
38:11All right shall we just pop that one over
38:13Thankfully Dr. Laura can find no signs of internal bleeding or other serious injuries
38:20Okay so fast there's nothing particularly exciting there
38:23And otherwise observations have remained nice and settled throughout
38:28We're nice and responsive
38:29I think nothing's particularly changed in terms of deterioration
38:32So are you guys happy?
38:34Yeah
38:35The only other thing would be analgesia
38:36She hasn't had anything specifically
38:38Sounds good
38:39Yes
38:40Happy Ellie's condition is stable
38:42The critical care team leave her in the care of the ambulance crew
38:45Who will now transport her to Wexham Park Hospital for further treatment
38:50So one thing that was really reassuring
38:53These patients the passenger and driver of the vehicle both had their seatbelts on
38:58Which massively reduced the impact
39:01If they hadn't been wearing their seatbelts
39:03The injuries could have been so much worse
39:05I wonder if what we should do is
39:18Get her up to state man I feel
39:21He's moving that left side beautifully
39:23I think so Pat just have a listen to your chest all right
39:26Nice air entry
39:29In Chesham Dr. Tim is treating 81 year old Pat
39:33Who collapsed and went into cardiac arrest after a suspected stroke
39:37Let's try and transition her onto nasal catenoprongs and a reservoir mask
39:43And we'll see how we get to
39:45To maintain Pat's airway
39:47The team have fitted a device called an oropharyngeal airway or OP
39:52It's re-established monitoring properly
39:54So BP's on
39:56Sats are reading at 98 which is encouraging
40:00Is it all right if we get some ECG monitoring on as well?
40:06Critical care paramedic Matt updates Pat's husband Derek and their close friends
40:10So she's still not responding very much but she's responding more than she was
40:14So the trajectory is improving but the ceiling of that improvement is very hard to prognosticate
40:21Exactly
40:22You can't tell how much is going to come back to normal
40:24Exactly, yeah
40:25Is the reality
40:26Sorry Pat, lots of life, how are you doing my love?
40:30The numbers actually look pretty respectable without aggressive intervention
40:35We've got vascular access if we need to give her anything to settle her
40:39We'll make her peaceful en route
40:41I think we should be aiming to leave scene fairly promptly
40:44Although her vital signs are improving
40:47Pat remains critical
40:49Tim and Matt decide to travel with her in case she deteriorates
40:53And they need to urgently intervene
40:55She's not moving her right arm
40:57No, she's only moving the left arm
40:59I'm going to keep using it so I can get the details
41:01Oh yes, of course
41:03Hold on Pat, I'm just going to get the temperature, my love
41:1036.3
41:12The team continue to monitor Pat throughout the journey to Stoke Mandeville Hospital
41:1736.3
41:18Do we get any additional medical history?
41:21What I managed to gauge there was no neurological history
41:23There was no cardiac history at all
41:25The only prominent thing she's had in the past
41:28She's had chronic abdo pain
41:31And has been in our stoke twice in the past week
41:35For said abdo pain
41:36For the local diagnosis
41:37Yeah
41:38Interesting
41:39That's all that we know
41:40She was actively fitting when you arrived on scene
41:44Yeah, the arms are tonic-clonic
41:45Face was fairly tonic-clonic
41:47Eyes were flickering as well
41:49PCS-3
41:50Bopping in the mouth
41:52I'm not responding to anything
41:54Got it
41:55Dr. Tim puts in a call to the hospital
41:58So they can be fully prepared for Pat's ongoing treatment on arrival
42:01I have a medical pre-allert for you if that's okay
42:06Bring in 80, 80-year-old female
42:10Who's had a fairly sudden onset of speech disturbance
42:14And then slumped unconscious
42:17And then a prolonged seizure this evening
42:20Had a brief ventricular tachycardia
42:23Cardiac arrest with the crew with a couple of cycles of CPR
42:26And ROSC not moving her right arm
42:29Breathing okay, saturating okay
42:32The normal ECG
42:34Thank you ever so much
42:35And much appreciated
42:36Cheers
42:37Thanks
42:38Bye
42:39After a 20-minute drive
42:42The ambulance arrives at Stoke Mandeville Hospital
42:45Pat, we're going into the hospital all right?
42:47Are you happy to take...
42:48Yeah, do you want me to do stretcher if you do monitor?
42:53Pat will undergo a series of investigations
42:55Including CT scans, blood tests and further ECGs
42:59To diagnose exactly what's happened
43:02And to ensure she gets the correct ongoing care
43:06The hospital is being fixed
43:09Cool, with why we接 this up
43:10JETLES
43:12Me cursoلم
43:16To determine the safety
43:17How about the benefit
43:18Of Claim inonas
43:20Page 4
43:21And how about the hospital
43:22And how about the facility
43:24It pomodoul das
43:25And how about the facility
43:27And how this building
43:28Into office
43:29It takes care of the client
43:30A fire
43:32The campsite
43:33But how about the facility
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