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00:00After dark, while the nation sleeps, the A&E night shift begins.
00:11You never know what's going to come through the door.
00:15At night, you always have to be prepared for the unexpected.
00:19Multiple kicks to the face.
00:21They said if anyone approaches them, they're going to attack us all.
00:23Across the UK.
00:24We're trying to help you.
00:26With extraordinary access to three of the most challenged emergency departments in the country.
00:31Guys, I need help in here.
00:33He could have died.
00:34We follow the work of emergency medics who battle every night to save lives.
00:39Chuck in now.
00:41It's a stab wound.
00:42With drugs and alcohol rife.
00:45I've had five or six pints.
00:46Step back.
00:47Big man.
00:48The department's just on fire.
00:50The risk of violence and abuse looms large every night.
00:56And you?
00:57You're messing your ****.
00:58Stop.
00:59Try me, boys.
01:01They can be verbally aggressive, physically aggressive.
01:05I've been punched.
01:06I've been smacked at.
01:07You've got nothing on me, bro.
01:09There have been days when there have been more police officers than patients.
01:13I'll punch your head in, mate.
01:15What's going on?
01:16All hell's broken loose.
01:17Patients running around.
01:18Security everywhere.
01:19Shut up.
01:20I don't care.
01:21This is the sort of thing that we have to put up with.
01:23Get security to remove it.
01:25This chaos.
01:26Glorious chaos.
01:39There are 1,148 hospitals around the country.
01:43Most with a dedicated security team to help protect the over 500,000 doctors and nurses working in the UK.
01:51They are not coming in the building.
01:53Copy that.
01:54Night shifts are constant.
01:56There's been an increase in sort of drugs and alcohol.
01:59Increase in violence.
02:00And I think I've seen a lot more abuse towards staff.
02:05Shut the ****.
02:06You're still with you.
02:07I can normally tell when a patient's going to turn nasty by their body language, the way that they stand, the way that they probably stumble through the door.
02:17Friday, Saturday nights in many departments at times that are a bit busier, that we may have more police here with us.
02:23Drop this **** off!
02:36Hello, Annie.
02:37Yes.
02:38In Tunbridge Wells' waiting room, it's a busy night.
02:41What's this hot for me?
02:42Don't cross yourself.
02:44Don't want to come.
02:45With most of the patients waiting patiently for treatment.
02:48I have a lumpy milk.
02:50A cup of coffee.
02:51A cup of coffee.
02:52A cup of coffee.
02:53A cup of coffee.
02:54Lumpy.
02:55But a man in the queue with a hand injury is not happy about waiting to be seen.
02:59What was it?
03:00What was it?
03:01What was it?
03:02What was it?
03:03What was it?
03:04Cobbles as well, isn't it?
03:05Cobbles.
03:06I have a lumpy milk, yeah?
03:07What's this got for me out?
03:08Oh, that's shit.
03:09Don't give a ****, yeah?
03:11What are you going to do?
03:12You're not here.
03:13Come on.
03:14Come on.
03:15Come on.
03:16Let's go outside.
03:17Let's go outside.
03:18Let's go outside.
03:19Let's go outside.
03:24The security team joined the police officers in trying to calm the man.
03:29But he wants to smoke heroin outside while he waits instead.
03:33No, I'm not chilling.
03:34Don't wait for me.
03:35Am I being detained?
03:36Am I being detained?
03:37You **** with it.
03:38Don't wait.
03:39Don't wait.
03:40Over here.
03:41Over here.
03:42Don't wait.
03:43Back inside.
03:44I won't give it up.
03:45You need this test.
03:46You got me straight up.
03:47All for you.
03:48Please.
03:49Okay.
03:50I'm walking away.
03:51I'll bless me out, bro.
03:52We're all right.
03:53Lost her.
03:54Gone.
03:55I may have partial agitation or something.
03:56I'm not really quite sure.
03:57The staff are worried the man could need urgent medical treatment.
04:01But until he comes down, they can't risk letting him back in.
04:05Security is needed at the hospital because sometimes we have patients that can be aggressive.
04:11They kick off and the staff need to be protected to make sure that doesn't happen.
04:16Um, fingers severed.
04:17Right.
04:18He was cutting some steak when he had a barbecue.
04:21Right.
04:22And some of his fingers were severed.
04:23Well, he said it was bleeding, maybe about a litre of blood.
04:26But he said he wrapped it up.
04:28If I have to arrest you, I will.
04:29I'm not being detained, am I?
04:30Am I being detained?
04:31What's happening?
04:32Leave me alone then.
04:33So wrong.
04:34So what are you doing?
04:35Do anyone see what you're smoking or?
04:40No, we see a can.
04:41He says he's smoking something through a can.
04:44I don't think it's acceptable to start an A&E.
04:47I don't think it's acceptable to be rude to members of staff that are trying to help you.
04:51They go through enough already without being started on.
04:56There's concern the man could become violent if under the influence of heroin and be a danger to patients and staff.
05:02He's threatening to knock that man out.
05:06He's threatening to knock that man out.
05:07He's threatening to knock that man out.
05:08He's threatening to knock that man out.
05:09We've got quite vulnerable patients.
05:10We've got, obviously, shouting, screaming.
05:12He's being quite in trouble.
05:13He's like a gentleman's style.
05:14We can't let him in while he's being threatening.
05:16Dairy farmer Paul was referred to Norwich A&E from his local hospital as he needs urgent medical attention.
05:45Okay, so the whole hand will be like this, not the finger.
05:50Dr. Anshad is concerned after Paul fell on his wrist and then worked a 12-hour day.
05:56The blood circulation to the area will be embedded.
05:59It's very rare, but we have to reduce it immediately.
06:03It is an emergency.
06:04Yeah, I will conduct my consultant also.
06:06Yeah, we'll prepare for the sedation.
06:08The wrist was plastered at his local hospital, but needs pulling back into a better position to restore the blood flow.
06:15The procedure that we're going to do is a painful procedure.
06:18So what we'll do is that we'll do some sedations.
06:20Yeah.
06:21So you'll not be completely knocked out, but you'll know the pain.
06:25Is that okay?
06:26Yeah.
06:27When you have the last meal, when you have the last food?
06:30We're doing that one just time about half past one.
06:32Half past one.
06:33So we have to remove your cast.
06:36Yeah.
06:37And I'm going to put the cannula and get some blood test.
06:40Then I will wait for orthopedic.
06:42And you can see it's curled around.
06:45There's a ligamentous disruption there.
06:49While Dr. Anshad discusses Paul's x-rays with his consultant, there's a sudden problem.
06:56He's having a seizure.
06:58If Paul is having a seizure, it could be a sign of an untreated head injury from his fall, which could be deadly.
07:04Are you still with me?
07:06Hey.
07:07Hello, sir.
07:09Where is Dr. Anshad?
07:10Dr. Anshad?
07:11Dr. Anshad?
07:12Dr. Anshad?
07:27NHS hospital staff in the UK experienced more than 150 incidents of violence and aggression every day.
07:35Listen, touch me, you know.
07:37This problem is particularly prevalent in high-pressure areas like A&E's.
07:41Yeah, fuck off!
07:42Oh!
07:43In Tunbridge Wells, a patient who claims to have severed his fingers is being aggressive and disrupting A&E.
08:00The medical staff can't treat him until he's calmed down and is no longer a danger to patients and staff.
08:17I'm just kidding.
08:18All right, we're fine.
08:19All right, we're fine.
08:20We're fine.
08:21We're fine.
08:22We're fine.
08:23We're fine.
08:24We're fine, but we don't know.
08:25We're fine, but we don't know.
08:26We're fine, but we don't know.
08:27We're fine, but we don't know.
08:28You're lighting up something in a can.
08:29Yeah?
08:30We're fine.
08:31Security have seen him smoking an unknown substance through a can, but the man claims it's a painkiller pill.
08:34This is the weirdest thing.
08:35I've never seen someone smoke a Coca-Cola more through a can.
08:40No, I've never.
08:41I've never.
08:42We have some seriously difficult people that come in here.
08:47But you've got to stay professional.
08:49You know, you can't let your personal feelings in, which at times is difficult.
08:56You have to leave my personal space.
08:58You've got people dying in this place.
09:01And the one thing you don't want is wasting nurses, doctors' time.
09:11With the man claiming he severed his fingers, he can't be removed from the hospital as they have an obligation to help him.
09:17I might be in a vision job.
09:18No, that's fine.
09:19What are you doing?
09:20What are you doing?
09:21There's vulnerable children.
09:22My hands are going to come off soon.
09:23No, that's fine.
09:24We're going to treat you.
09:25It's tingling.
09:26I'm going to treat you.
09:28You're just going to try and...
09:29The child will stop threatening me, would you?
09:31Great.
09:32Great.
09:33Please.
09:34We need to wait for a doctor to see you.
09:35No.
09:36Get away from me.
09:37Calm down.
09:38No, you're out of my breath.
09:39We're back.
09:40It's taking three medical staff, six security guards and four police officers to deal with one man, tying up the night shift's limited resources.
09:48At the moment, nobody's been able to have a look.
09:51I mean, quite clearly, he's got an injury that needs treating.
09:54So, I'll have a chat with him and I'll see if he will come in.
09:56Yeah.
10:01Site manager Sarah is going to try one last time to get him to come back to A&E quietly.
10:06You're the last line if you've got an aggressive patient.
10:10And your job is to make sure they don't get hit.
10:13So, technically, you are a bodyguard.
10:15Right.
10:16Cut that off.
10:17What do you need to do?
10:18Listen, I'm sorry to get offensive.
10:20I love you, girl.
10:21You've done too much for people loving me.
10:23Don't give it a pedal.
10:24There you go.
10:25See?
10:26Stay on my eyes, man.
10:27That's all right.
10:28Let's just agree to get you sorted out.
10:31That's fine.
10:32We're going to come in to A&E because I think it just needs proper people around.
10:35I'll be speaking around.
10:36All right.
10:37Under the supervision of security, the man is taken in for treatment.
10:42You've got to go.
10:43You've got to go.
10:44This is a dog.
10:45I'll go.
10:46I'm going to do the supervision of this.
10:47You've got to do that.
10:48We're not leaving your own.
10:50Up in your front line.
10:51Up in the front line.
10:52Up in the front line.
10:53Up in the front line.
10:54Up in the front line.
10:55Up in front line.
10:56Security are still on alert.
10:57Ready in case the man decides to lash out or become abusive again.
11:01I need more for you now.
11:06I need more for you now.
11:09Great.
11:10I think we need to make them.
11:13Yeah?
11:14He's on the self-discharge.
11:16Now he's just actually being too wise.
11:18The man has been treated for his wound,
11:20which turned out to be minor, but continues to be abusive.
11:24Come on.
11:25Come on, let's get you out.
11:26Let's get you out of here.
11:27I was about to fight with heroin.
11:29That's OK.
11:30You need to do better for hospital crowds.
11:32Don't come back in here.
11:33No, you're not.
11:34With the man threatening to return,
11:36security need to make sure he leaves the premises.
11:39If you're not discharged me, go away.
11:40Look, he's a big man with a curly hair, yeah?
11:42I'm smoking over quiet. Watch this, yeah?
11:44There's a few that don't need to come to hospital.
11:49They just come for being a big head or a bully,
11:54thinking they can push around people in the hospital,
11:57nurses, doctors, security, they can't.
12:01And hopefully, we're here to stop it.
12:03Fuck off. All of you, go away.
12:04All right.
12:05Night-night. Take care.
12:06Be careful walking.
12:07He's having a seat run.
12:20Paul is having a possible seizure
12:32after coming into A&E with a broken wrist
12:34that needs immediate attention to restore the blood flow.
12:37Oh, thank you.
12:39Hello.
12:40Hello.
12:41Hey, mate, just some stickers going on, OK?
12:43Oh, wait, what?
12:44He had a seizure.
12:45Seizure?
12:45Seizure.
12:47You with me, mate?
12:48You OK?
12:49It's very sad, and then he said the friction in his eyes
12:53and then went long.
12:55It's 29, and I need to go.
12:57Paul's blood pressure dropped while having his blood taken,
13:00causing him to faint and convulse.
13:02Usually the heart rate will be between 60 and 100.
13:04Your heart rate initially was 52, but it just came down to 37.
13:10Paul needs to be put on oxygen
13:12and his blood saturations closely monitored
13:14as they dropped during the fainting.
13:17Any headache?
13:17Dr. Anshad and nurse Dave are concerned he may have had a head injury
13:34from the same fall that broke his wrist.
13:36This is the first time it happened to you that you passed out.
13:42I just passed out.
13:43I thought he's having a seizure.
13:45That's why I just shot for help.
13:48Probably just passed out because of the blood test.
13:51He needs to be observed closely,
13:53but with his hand continuing to discolor from a lack of blood supply,
13:57the medics need to move fast to treat it.
13:59So what the plan for him is we're going to correct his forearm through sedation.
14:05Hi, my name's Kiana.
14:08I'm one of the orthopedic doctors.
14:09I'm going to have a quick look at your skin on your hands, right?
14:15One of your bones is out of place.
14:17The idea is to spare you having to go to theatre.
14:21Okay?
14:21With no guarantees they can pull his dislocated wrist back into place,
14:33Paul is warned that he might be facing urgent surgery.
14:35If we're unable to do it for any reason,
14:38we'll have to post you for theatre, okay?
14:40Okay.
14:49So, on three, ready?
14:51One, two, three.
14:53We tried to go through them earlier.
14:55I think we need to look at five and six.
14:57This lady needs an ITM review.
15:00At Queen Elizabeth Hospital in Birmingham,
15:02Sister Rose is in charge of resus.
15:04At the minute we're full, in resus,
15:06so we just need to make sure that the patients who need resus
15:10are resus patients or whether we need to stop them out.
15:13It's where the most serious cases are brought for life-saving treatment.
15:17Ah, my arm then.
15:22What's the observation to be?
15:24They've just been told that a woman is on her way in
15:26with a suspected cardiac event.
15:28Can I get this to go to the navigation door
15:31and then we'll have a look at the usage here as well?
15:33So, we've got a chest pain coming in.
15:36Someone said, go to the front door, we can look at the ECG.
15:40An ECG is an electrocardiogram.
15:42It monitors electrical signals in the heart that affect its beating.
15:47Looks like it's developing inferior.
15:50Inferior.
15:51Dr. Arun will be investigating the patient's symptoms
15:54to see if they're linked to a life-threatening issue.
15:57The ambulance crew, she had a couple of changes on her ECG,
16:02which they were concerned about,
16:03which might be a heart attack.
16:05Hello, lad.
16:06Hello.
16:07Nice to meet you.
16:08I really need a lot to see.
16:09What's your name?
16:09I'm not Karen.
16:10Karen.
16:10Right, Karen.
16:11Can you tell me, Barbara, I wouldn't know you.
16:13Really, really short of time.
16:15That's okay.
16:15Really, really short of time.
16:17Really, really short of time.
16:18It's okay.
16:19It's okay.
16:20It's okay.
16:21White size, is it?
16:22Okay.
16:23Not everyone presents with the classical symptoms of chest pain.
16:26It varies from person to person.
16:28There can be people presenting even with just indigestion type of pain,
16:33which potentially could be a heart attack as well.
16:36So it's very subjective and it's really hard to say.
16:39Have you had any problems with your heart in the past?
16:42I've got AF.
16:43AF?
16:44Yeah.
16:45AF is atrial fibrillation,
16:47which is when your heart rate can be fast or irregular.
16:50Having it can increase your risk of a heart attack.
16:53Shall we have a quick listen to your chest, if that's okay, yeah?
16:55Yeah.
16:56Okay, see.
16:57Do you mind leaning forward a bit?
16:58Yeah, that's fine.
16:59Perfect.
17:00The history that we take is more important
17:02on what needs to be done for the patient
17:05and level of pain, what their numbers are,
17:08and all of those really matter.
17:12And you can't waste time,
17:14especially if it is an acute heart attack.
17:16Because you had this pain which was a bit compressing on your chest,
17:19relating to your shoulder and your arm,
17:21that heart attack is one of the main things
17:24that we would have to roll out in test.
17:26So for which we'll send some bloods off
17:28and we'll repeat a couple of ECGs,
17:31depending on what we see,
17:33and then see what we're going to do next.
17:34Okay.
17:35If it is a heart attack,
17:41keeping the patient on a monitor is important.
17:43We could see the changes on the monitor,
17:46in which case, if there is,
17:48then she'd possibly need to go straight to the cardiologist.
17:52If Karen's blood results indicate she's had a heart attack,
17:55it could lead to a deadly arrhythmia,
17:57an irregular heartbeat.
17:59These life-threatening types of arrhythmia
18:13can be a major cause of death
18:15during the 24 to 48 hours after a heart attack.
18:18Hello?
18:19I said,
18:21I can't like a real heart attack,
18:23but I'm hooked up to my shoulders.
18:25The end.
18:28Love you.
18:29Bye.
18:30Bye-bye.
18:31In England last year,
18:43more than one million people were treated in A&E
18:46for sprains, torn ligaments, fractures, brain trauma,
18:49and open wounds to the face.
18:51You all right for me to start?
18:53Yeah, carry on.
18:54And in a high number of serious cases,
18:56patients can have more than one of these injuries.
19:01Oh.
19:06Got some pain relief for you.
19:08Perfect.
19:09In Tunbridge Wells Majors,
19:1039-year-old Ryan has been rushed in by paramedics
19:13after coming off his bicycle at high speed.
19:16Slowly, suck it.
19:17I can't.
19:18I can't.
19:19It's OK.
19:20No?
19:21I can't.
19:22I can't do nothing.
19:24I'm melting.
19:25That's fine.
19:28Well done.
19:29Hi, Ryan.
19:30Hi.
19:31Hi.
19:32Nice to meet you.
19:33My name's Dr. Omar.
19:34I'm one of the A&E doctors.
19:35I can't see you so much.
19:36Don't worry, don't worry.
19:37You keep your head still.
19:38That's fine.
19:39Dr. Omar is the medic responsible
19:41for assessing the severity of Ryan's injuries.
19:44Can you tell me what happened today?
19:46Yeah, I was riding my bike,
19:47and I must have wobbled or hit something,
19:49and I went over.
19:50OK.
19:51And face planted.
19:52I kind of just wobbled and woke up with people around me.
19:54Right.
19:55Just to clarify, was that a bicycle or motorbike?
19:57Yeah, bicycle.
19:58Bicycle?
19:59Yeah.
20:00Do you know roughly how fast you were going?
20:01About 30, 35 miles per hour, I guess.
20:03OK.
20:04Normally I get down that hill.
20:05Right.
20:06OK.
20:07If you look at his face, he's pretty beat up at the moment.
20:10Looks like he's got some significant swelling of the left orbit.
20:14I mean, it looks like it was a pretty rough fall, to be honest.
20:17And where are you in pain at the moment?
20:19My back and my chest, on my face, my teeth.
20:22Yeah.
20:23All wobbly.
20:24OK.
20:25My mouth.
20:26All right.
20:27I need to have a press over your head to toe.
20:30It's fine.
20:31Just to see what kind of areas are potentially damaged, OK?
20:34Yeah.
20:36Is it sore?
20:37No.
20:38Ah, that.
20:39Yeah?
20:40Mm.
20:41And is your neck hurt when you turn it a particular side?
20:45Yeah.
20:46What side?
20:47Just turn it when I move, just move it in general.
20:49OK.
20:50Oh.
20:51All right.
20:52What we need to do is we need to pop your head in some blocks, OK?
20:55Yeah.
20:56Just to keep your head still.
20:57Yeah.
20:58OK?
20:59We don't want the patient to cause any more damage to their neck if they have a fracture,
21:02so the block stops that from happening.
21:05The danger is that you can have a bleed in the brain, broken spine, broken ribs, which
21:10can sometimes puncture the lungs.
21:11And he's complaining of pain in his neck.
21:13Is there any pain when I'm pressing?
21:15Yeah.
21:16Up here?
21:17Yeah.
21:18OK.
21:19And how about back here?
21:20Just more higher up on my back.
21:22Ah, there.
21:23Fine.
21:25We're going to do a head to toe scan.
21:27Yep.
21:28OK?
21:29Essentially to look for any trauma that you've got, all right?
21:32Yeah.
21:33This will involve you going through a CT scanner.
21:36Yeah.
21:37They'll inject some dye into your arm.
21:38Yeah.
21:39OK?
21:40And this will help us have a look at your brain, your chest, your tummy, and your pelvis
21:45as well, OK?
21:46Yeah.
21:47And also your neck.
21:48Yeah.
21:49All right?
21:50Ryan's situation could be serious.
21:52Until he's scanned, Dr. Omar can't give his neck and spine the all-clear and remove
21:57the blocks.
21:58Having the CT trauma series gives us a good visualisation of the organs as well as
22:03the bones.
22:04Essentially, at the moment, we have to establish, is there any fractures?
22:07Is there any bleeds going on?
22:09And ensure that he's stable.
22:16You got pain?
22:18I just don't like this on me.
22:20It's making me feel claustrophobic.
22:24Yeah, Ryan, let's get that scan done.
22:26Oh, yeah.
22:27And then that...
22:28The problem is, it's making me panic and move, and it's starting to hurt me more.
22:31That's the issue.
22:32I can't move my back.
22:33It's making me feel like I can't move at all.
22:36Can they at least loosen one?
22:39The blocks could be the only thing holding Ryan's spine in a safe position.
22:43Until he's scanned, any movement could cause permanent paralysis.
22:47Just breathe, all right?
22:50Oh.
23:01There is a lot of clotted blood there.
23:04It's pub and club closing time in Birmingham, and A&E attendance is starting to rise.
23:09He's been assaulted with a broken glass wine bottle.
23:14So I had a bit of a tussle, a bit of a scrap in club in Birmingham.
23:19It's killing.
23:20It's painful.
23:2120-year-old builder Jake has arrived after hurting his shoulder in a fight.
23:25I've done it a few times.
23:27It's just the moment I throw a punch, and it's...
23:30It's never a jab, it's a hook.
23:32If I throw the hook, it messes the shoulder up real bad.
23:35So, yeah, it's weak now.
23:36So I'm guessing it's just gonna be a repeat if I keep doing it again.
23:40So I need to stop really.
23:42Left shoulder.
23:43Okay, left shoulder.
23:44Jake.
23:45Yeah, up on him.
23:46Yeah, I'll do that.
23:47No problem.
23:48He's already been sent by Dr Khan for an x-ray
23:50to find out if his shoulder's been broken or dislocated.
23:53X-ray shows no fracture,
23:55and it confirms what we were clinically worried about,
23:58that it was dislocation.
24:00So, basically, the bone...
24:02The humerus needs to sit in the joint capsule like that,
24:05and it came out a bit anteriorly.
24:08Let me take this off there.
24:10Hold that.
24:11Deep breaths.
24:12Jake will need his shoulder manipulated back into position.
24:16Nurse Samantha has given him a fast-acting painkiller inhaler
24:20called Penthox.
24:21We like to get them in and sorted as soon as possible,
24:24because a shoulder dislocation can be really painful.
24:27So we give them the Penthox,
24:28which helps with the manipulation back in.
24:31It will make him feel like he is not on this planet,
24:34but it will also help with the pain.
24:36Ow.
24:37Keep puffing on it.
24:38Ow.
24:39Keep puffing on it.
24:40That's okay.
24:41Monitoring okay.
24:42Yeah, spill it now.
24:43Just a bit, yeah.
24:44Just a bit.
24:45Carry on.
24:46This isn't on my first road, yo.
24:48Yeah.
24:49Yeah.
24:50I'm just gonna...
24:51Just do a gentle massage here, okay?
24:52Just relax.
24:53That's fine, bro.
24:54Yeah.
24:55Keep taking my eyes.
24:56It's excellent.
24:57If the medics try to correct Jake's shoulder
24:59before the Penthox has taken effect,
25:01it may not go back in,
25:03and be extremely painful.
25:05Ah!
25:06He's obviously hit the most tonight, isn't he?
25:22All NHS trusts aim to have 95% of patients
25:26seen within four hours.
25:28I need to bring the second one in first,
25:29because his ICD is fired.
25:31But the wait can be too long for some,
25:33with up to 50% of NHS staff not reporting
25:36the verbal abuse they receive.
25:38No!
25:39Because of you!
25:49Are you sure you didn't knock your head at any point?
25:51No, not so.
25:52In Norwich Resus,
25:54Farmer Paul is being closely monitored
25:56after his blood pressure dropped
25:57and he lost consciousness.
25:59You have to eat on the lower side.
26:01He was being prepared for urgent treatment
26:03to his dislocated wrist,
26:04which has restricted blood flow.
26:06Can you tell me what happened?
26:08I was at work with small then.
26:10I was at work with small then.
26:11I was at work with small then.
26:12I was at work with small then.
26:13I was at work with small then.
26:14I was at work with small then.
26:15I was getting ready to make affairs.
26:16I ended up pulling my hands
26:17and then answering my chest.
26:19Orthopaedic specialist Dr. Kiana
26:21has come to examine the injury
26:23before they attempt to correct its position.
26:25In around what time did this happen?
26:27Um, half past four this morning.
26:30Half past four in the morning.
26:31Yeah.
26:32So it's been quite a few hours.
26:33Yeah.
26:34Because Paul worked for over 12 hours
26:36after his accident,
26:37the strain on the brake has increased
26:39the risk of permanent damage
26:40to the function of his hand.
26:42Any tingling and numbness anywhere in your hand?
26:44Things take pain.
26:45I feel like I've got, um, 20 labels.
26:49Um, I can't guarantee they'll get it in.
26:52Yeah.
26:53We would like very much to get it in
26:55as soon as possible.
26:56Yeah.
26:57If we're unable to do it for any reason,
26:58we'll have to post you for theatre, okay?
27:00Okay.
27:01With no guarantees they can pull his dislocated wrist
27:04back into place,
27:05Paul may need an operation
27:07which could require a longer recovery.
27:09and we'll give them some sedation.
27:11Okay.
27:12So don't worry about you not knowing any pain.
27:19Yeah, I think you can start now.
27:20Yeah, I can.
27:21Senior doctor Sean is on hand
27:23to monitor Paul's procedure
27:24and keep a close eye on his sedation levels
27:27in case he loses consciousness again.
27:29How you feeling?
27:30Again.
27:31Take a deep breath every now and then for us.
27:35Mm.
27:36Well done.
27:37Here we go.
27:38Here we go.
27:39Here we go.
27:40Here we go.
27:41Did you feel it?
27:42Yeah.
27:43You felt good?
27:44I didn't feel it, didn't you?
27:47Aw.
27:48Aw.
27:49I don't know if it has been a long time.
27:51It's half four this morning.
27:52Half four in the morning.
27:53Yeah, yeah.
27:54If you want to play more, we'll get more.
27:56Just give a tiny bit more.
27:57Is that all right?
27:58Yeah.
27:59Paul's wrist is not going back into place easily.
28:01He needs more sedation to relax the muscles,
28:04but it could affect his consciousness levels
28:06and even his breathing.
28:07Well done.
28:08Take a deep breath.
28:09Yeah.
28:10Mm.
28:11Yeah.
28:12Good cloud.
28:13Very good cloud.
28:14Oh, yeah.
28:15How do you feel now?
28:16I think.
28:17Better.
28:18Yeah.
28:19Take a deep breath, Paul.
28:20Well done.
28:21Well done.
28:22Well done.
28:23With Paul's hand back in the correct position,
28:38the last job is to wrap up his newly set wrist in a cast.
28:42Oh, sometimes we don't think we'll keep you.
28:44Who has to press out alone?
28:46If you don't fall, that would be ideal.
28:47Yeah, just turn it over.
28:49Oh, come on.
28:52It's all right.
28:53You did really well.
28:54Here you go.
28:57So it's all back in place.
28:59The plan now is to be admitted tonight.
29:01All right.
29:02Yeah.
29:03He'll be kept in overnight for observation and won't know if he's caused permanent damage
29:08to his wrist until he's out of his cast, which could be up to eight weeks.
29:13What cup of tea would you like?
29:15It's a nice hot one.
29:17Thank you very much.
29:24He's been having multiple hypos.
29:26The weekend night shift in A&E at Birmingham's Queen Elizabeth Hospital continues as more patients
29:32arrive.
29:33Can you make sure her SATs are 88 to 92?
29:37Aish!
29:38Yeah.
29:39Big pump.
29:40SATs okay, monitoring okay.
29:41Yes.
29:42Builder Jake dislocated his shoulder fighting and is about to have it put back into position.
29:47I'll speak back so much, Jake.
29:49He needs a moment with his pain relief inhaler of Penthox to relax him enough for this to work.
29:54Well, it's not.
29:55Okay?
29:56It's a bit, yeah.
29:57I'm just going to do a gentle massage here, okay?
30:00Just relax.
30:01If the shoulder doesn't pop back in, Jake could need surgery to correct it, keeping him off work for months.
30:07No, you're stupid.
30:08Go on, go on, go on, go on, go on, go on.
30:10Yeah.
30:11Okay.
30:12Okay.
30:13Okay.
30:14Okay.
30:15Okay.
30:16Okay.
30:17Let's see.
30:18Yeah.
30:19Okay.
30:20Feeling better?
30:21Yeah?
30:22Yeah.
30:23Yeah.
30:24Okay.
30:25It's gone in, okay?
30:26Yeah, you see.
30:27Okay, mate.
30:28I'll have it back.
30:30Feeling better?
30:31Yeah.
30:32It's great, to be honest.
30:34So now when you just arm down into a 90 degree position.
30:39Don't move the shoulder back.
30:40Okay.
30:41Just to move your elbow, okay?
30:43With the shoulder back in, nurse Samantha puts his arm in a sling to provide support and
30:48keep it in position.
30:49It feels a lot better.
30:50All right.
30:51It's not magic, that is.
30:52I'm going to get a repeat x-ray.
30:53Oh, he passed.
30:54That feels so much better.
30:56Okay.
30:57Well, you're welcome.
30:58It really feels good now.
30:59All we did was just pull it down a bit and rotate it internally so it's gone in, but
31:08we're going to get an x-ray now to confirm.
31:12If the x-ray shows the shoulder isn't in the right place, they may need to do the procedure
31:17again.
31:18We have done our post-trivet.
31:19It shows the bone, basically the head of your ass is gone in.
31:24That was the before one, and that's the post-trivet.
31:28Good news.
31:29One happy customer, we're going to send him home.
31:31What?
31:32All right.
31:33Shut up, man.
31:34I was there backing you, though.
31:35I only did that to fucking save your ass.
31:38Within, what, half an hour?
31:40He is seen sorted and he's on his way home, hopefully to bed and to rest.
31:45Your taxi is there.
31:47It's there, yeah.
31:48Have fun, babe.
31:49Thank you so much.
31:50No, I don't want to see you again.
31:51I know.
31:52Whether that taxi is going home, I am not quite sure.
31:55We will see how his night pans out.
31:58You take care.
32:02The night is busy in the waiting room of Tunbridge Wells A&E, as people arrive with cuts, broken
32:20bones and injuries.
32:21My head just really, like the whole thing just really hurts.
32:30One of the many wounded needing help is 23-year-old Hannah, who's been brought in by a mum and boyfriend.
32:36I've got to wait for a doctor to look over the x-ray and they're going to assess my head.
32:46Hannah was x-rayed upon arrival due to concerns after she fell playing sport.
32:51Right, see you at home.
32:54Dr. Amara will be looking at Hannah's wounds and assessing her x-rays.
32:58I was playing a netball match and I went to get a ball and kind of flew towards that side instead of falling forward.
33:05So that's why I couldn't put my arms out or anything.
33:08So it fell straight onto this side of my head and my shoulder.
33:13The x-ray will show if Hannah has damaged her shoulder.
33:16There's the collarbone.
33:17It's all okay.
33:18The bottles are all sharp and nice.
33:21The humour is here.
33:22It looks all fine, no cracks, nothing there.
33:25I don't think there's anything broken there.
33:27I think it probably bruised it quite a bit and that's why that much pain.
33:31So for the shoulder side of things, it's probably going to be regular painkillers for the next few days.
33:37With her shoulder okay, it's likely her head took most of the impact of the fall.
33:42I don't remember too much after I fell really.
33:46Just kind of the end when they were getting me into the ambulance is like the most I remember.
33:51And then I'm a little bit blurry after that.
33:55Apparently I was conscious the whole time but I don't remember too much.
33:59Any seizure like that, so any jerky moments of any sort?
34:03No.
34:04Any vomiting afterwards?
34:05Just a feeling of being sick but not actually being sick.
34:08And any numbness, tingling in the hands, fingers?
34:11Not at the moment.
34:13The most dangerous thing would be a bleed in the brain,
34:15which can happen sometimes if there's a really bad mechanical fall.
34:19Apart from that, if you are falling on the face, you can have fractures with the face,
34:23which has its own complications.
34:25So let's examine you.
34:27With Hannah's memory patchy after the fall,
34:30Dr. Amara will do a neurological assessment to look for any signs of brain injury.
34:34Look straight ahead for me.
34:36Any bleeding from anywhere that you've noticed?
34:38No, just obviously on my face.
34:40Yeah.
34:41Any pain here?
34:42No.
34:43Can you close your eyes for me?
34:45You must say yes whenever you can feel it.
34:47Okay.
34:48Yeah.
34:49Yeah.
34:50Yeah.
34:51Yeah.
34:52All right.
34:53Any pain in this area?
34:54No.
34:55No?
34:56Anything here?
34:57A little bit, like, just behind it.
34:58Just behind it.
34:59Yeah.
35:00Okay.
35:01Is there more tenderness?
35:02You're okay?
35:03Torea.
35:04Around that top part.
35:05So the main worry would be any bleed in the brain or a serious heart injury.
35:10Normally the criteria is if there's any vomiting, so multiple episodes of vomiting,
35:14any loss of consciousness, memory issues before the fall happened, but you remember
35:20what happened.
35:21Yeah.
35:22And a seizure activity, bleeding from anywhere.
35:25Fortunately, you don't have any alarming signs at the moment.
35:27I don't think there's a serious head injury happening.
35:31Hannah has fortunately been given the all clear of serious injury.
35:35Keep that with you.
35:37But still has various cuts and bruises to worry about.
35:40Do not play contact sports for at least three weeks.
35:43Well, it's not contact technically.
35:46I just seem to get contact.
35:49Over 18% of injuries in A&Es across the UK are sports related, with netball being one
35:56of the largest contributors for women.
35:58Sorry.
35:59It's okay.
36:00It stings.
36:01Mm-hmm.
36:02All good.
36:04Take care.
36:06Bye.
36:07Bye.
36:08Bye.
36:09Trying it in the morning.
36:10I know.
36:11I hope that I get a black eye.
36:19All right, don't worry.
36:20Just breathe, all right?
36:21In the past ages, Ryan has suffered multiple injuries after a serious fall off his bicycle.
36:25Where are you, sir?
36:26You are.
36:27His head has been secured in position as he could have a spinal injury, and he's being
36:32taken for an urgent CT scan.
36:34Where about is your pain?
36:35In the middle.
36:36Across.
36:37In the middle?
36:38Across.
36:39All right.
36:40I'm going to transfer you to our scanner bed, okay?
36:42Oh.
36:43Yeah.
36:44All right.
36:46Going into the scanner now, okay?
36:50Dr. Omar has instructed Ryan to be injected with a dye, which will show up on the scan
36:56if he has any internal bleeding.
36:58You may breathe tonight.
37:01I want to be back now, mate.
37:05While the CT scan report is processed, Ryan will be monitored closely.
37:10Ow.
37:11We're going to give you some more painkillers, okay?
37:16Where's the pain getting worse?
37:19In my head.
37:20In your head.
37:21Okay.
37:22Could you not tolerate the blocks any longer?
37:23No.
37:24I'm literally trying to scan.
37:25I'm in so much pain.
37:26All right.
37:27I'm going to give you some painkillers now, okay?
37:29So Ryan, at the moment, was still waiting for a scan report.
37:32His heart rate's on the higher side.
37:35His respiratory rate is high as well.
37:38Sometimes that can be, one, due to panic or stress.
37:43It can be due to pain as well.
37:45He's currently experiencing quite a lot of pain in his head.
37:48So we just want to make sure we get on top of the pain.
37:51And that might help settle him down.
37:54Ryan's had the spinal blocks removed before his CT results are back, leaving himself open
37:59to potential paralysis.
38:00He's not able to tolerate the blocks.
38:03So they were taken off.
38:05I believe he's aware of the risks around that.
38:08Back in Birmingham, the night shift continues to progress.
38:35And in majors, a patient is being closely monitored.
38:38Are you okay, Karen?
38:39You all right?
38:40Yeah.
38:41Earlier, paramedics rushed Karen to A&E after she complained of chest pain,
38:46which could be a heart problem.
38:48So pain-free at the moment.
38:50So just waiting for drops and second ECG and all of those.
38:54She's being treated by Dr Arun.
38:57This is the electric rhythm of the heart.
39:00Did you have chest pain?
39:02She's connected to an ECG machine, which records her heart's electrical activity.
39:09She says more sharp pain, going to her right shoulder and her right arm.
39:14But nothing at the moment.
39:17If the team confirms she's had a cardiac episode,
39:20she may need to go to the cardiac area for urgent tests or a procedure.
39:25All right.
39:26So each of you looks okay.
39:27Nothing obvious on it.
39:28All right.
39:30So, as I said, because you've had that pain,
39:33we'll just definitely have to wait for your blood results to come back.
39:35Yeah.
39:36Okay.
39:37All right.
39:38And depending on what your first blood result shows,
39:39we'll still have to do the second one as well.
39:41Yeah.
39:42So I'm just going to leave you with my colleague.
39:44She'll be taking over.
39:45Okay.
39:46All right.
39:47And then they'll follow it up, let you know.
39:48Yeah.
39:49Okay.
39:50All right.
39:51No problem.
39:52You take care.
39:53Cheers.
39:54Because she's had a pain that sounds more related to her heart,
39:57we'll still have to wait for her blood results,
40:00something in specific called a troponin level,
40:03which tells us if there's been any injury to the heart
40:06from lack of blood supply.
40:08Hi, my love.
40:09I'm going to take you across now.
40:11Okay, sweet?
40:12All right.
40:13With Karen stable,
40:14she can be stepped down to a less critical bay
40:16while she waits for her results.
40:18Where am I going?
40:19Oh, dearie.
40:20You're just moving to another cubicle.
40:21Oh, that's all right.
40:22Yeah.
40:23I've got you another patient.
40:42Ryan has landed on his face after coming off his bicycle
40:45at 35 miles an hour.
40:47So we've just got the report come back.
40:49I'm just going to have a read through it.
40:50Dr. Omar is worried he could have a head or spinal injury,
40:54so has requested a trauma CT scan.
40:56Ryan, how you doing, buddy?
40:58Good.
40:59If the results are bad news,
41:01he may have a serious spinal injury
41:03or need an operation on his head.
41:05Good.
41:06We've reviewed the scan.
41:07Yeah.
41:08Okay.
41:09And it looks like you've got a broken bone in your nose.
41:13Yeah.
41:14Okay.
41:15Um, and obviously with this eye swelling up quite a lot.
41:18Yeah.
41:19Can you see me with that eye?
41:20Yeah.
41:21100% see me, yeah?
41:22Yeah.
41:23Okay.
41:24All right.
41:25And you can perceive...
41:26What am I doing now?
41:27Am I...?
41:28Moving it around.
41:29All right, fine.
41:30It looks like the rest of the scan.
41:31Yeah.
41:32So your spine's okay.
41:33Cool.
41:34Um, the lungs and the ribs are okay as well, all right?
41:37Yeah, yeah.
41:38What we can do is get you out of this uncomfortable board,
41:41all right, and sit you upright.
41:42Yeah.
41:43And then we'll just reassess you from there, okay?
41:45Yeah, yeah, okay, cool.
41:46Yeah?
41:50In the UK, over 4,000 people are seriously injured
41:53from cycling each year,
41:55and around 100 of those are fatal.
41:59Let me just speak to the ear, nose and throat doctors.
42:02Yeah.
42:03Just about your nose, uh, situation as well.
42:04Yeah.
42:05In terms of your teeth,
42:06I'll have to speak to the Maxfax doctors.
42:09Yeah, yeah.
42:10Potentially removing them.
42:11Uh-uh.
42:12So they're gonna wanna see pictures of your mouth.
42:14Yeah.
42:15Okay.
42:16The impact of landing on his face
42:17means Ryan may lose all of his teeth.
42:20A facial specialist will be called down
42:22to determine if anything could be done.
42:24Hi, NT.
42:25It's, uh, Omar speaking, one of the A&E doctors.
42:28It's fucking naughty on the eye, innit?
42:31Hi.
42:32So I had a word with the ear, nose and throat doctors.
42:35Yeah.
42:36All right.
42:37And they've said they review you in clinic
42:39if it's affecting your, you know, look as well.
42:42I ain't worried about that no more, mate.
42:45Ryan's injuries are mild enough
42:47that he can wait to be seen on the day shift.
42:49At the moment, he's doing pretty well.
42:51He seems a lot more settled than he was earlier.
42:53His pain's under control.
42:54He would just need adequate follow-up
42:56for his teeth, for his nose and his eye.
42:59My back's in bits.
43:01Oh.
43:02I won't forget what I'm doing with a bath.
43:05There we are, sweet.
43:12Basically, they'll give you a phone call
43:14to make an appointment to follow this up, OK?
43:17Yeah.
43:18How are you feeling in the cell?
43:19I feel fine, yeah.
43:20How are you feeling in the cell?
43:21I feel fine, yeah.
43:22How are you feeling in the cell?
43:23I feel fine, yeah.
43:24Yeah.
43:25Well, that's a bit sore, obviously.
43:26How are you feeling in the cell?
43:28I feel fine, yeah.
43:29Yeah.
43:30Well, that's a bit sore, I've said.
43:31Yeah.
43:32Yeah.
43:33I feel fine, yeah.
43:34Yeah.
43:35Well, that's a bit sore, I've said.
43:36Yeah.
43:37It looks all right, though, in the cell.
43:38Yeah.
43:39Yeah.
43:40Yeah, yeah.
43:41Yeah.
43:42Yeah.
43:43Yeah.
43:44Yeah.
43:45Yeah.
43:46Yeah.
43:47Yeah.
43:48Yeah.
43:49Yeah.
43:50Yeah.
43:51Yeah.
43:52Yeah.
43:54Yeah.
43:55Yeah.
43:56Yeah.
43:58Yeah.
43:59Yeah.
44:00Yeah.
44:01Yeah.
44:02It looks all right, don't it?
44:14Any posse discharge, you come back and we recess.
44:26You're my public servant, then go away.
44:32He is now off-site.
44:58That's tomorrow night at 10.30.
45:02.
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