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00:00In the intense world of medical emergencies...
00:03Is the patient breathing?
00:05There's nothing more extreme...
00:10...than an immediate threat to life.
00:12Massive, massive burn into people.
00:15Responding to the most severe 999 calls...
00:18This lady is...
00:20...pain in her head and becoming less talkative.
00:23The rapid response vehicles...
00:25...of the Thames Valley Air Ambulance...
00:27The woman's had a seizure, the whale crashed into some people.
00:29...are at the front...
00:30...at line delivering life-saving medical treatments.
00:33The big decision is for us whether we need to put a tube in...
00:35...to protect us that way or not.
00:36Working day.
00:37We're going to give you some strong medication.
00:40...and night.
00:41It should not hurt.
00:42It's a very good painkiller.
00:43Reacting to emergency...
00:45You've been super brave, darling.
00:47The critical care teams...
00:48You've had a pretty big blow today.
00:49You've had a pretty big blow today.
00:50...are equipped to provide hospital level treatment.
00:53So we'll give you some ketamine.
00:54That will mean that...
00:55...you don't know what we're doing...
00:56...whilst we straighten your ankle out.
00:57Whenever...
00:58Do you think it's bad?
00:59Do you think it's bad?
01:00Potentially, yeah.
01:01...and wherever...
01:02Oh, my leg!
01:03...it's needed.
01:04I thought you were doing apparently...
01:05...fantastic job.
01:06...filmed over three months.
01:07Let's up your arm, my dad.
01:08Let's give you some of this...
01:10...with morphine.
01:11Just be aware he might stop...
01:12...spontaneously ventilating.
01:13Yep.
01:14I have the cheek.
01:15We captured every vital second.
01:18That's okay.
01:19You're safe.
01:20As these highly trained critical care teams...
01:23Can you take a deep breath in for me?
01:24...fight.
01:25To save lives.
01:26Your birthday present is...
01:28...surviving a cardiac arrest.
01:30...when every second counts.
01:32Let's go, go, go.
01:34Tonight.
01:35A 16-foot fall from a ladder...
01:37...leaves a handy...
01:39...leaves a handy...
01:40...man with life-threatening injuries.
01:42Keep breathing there.
01:43Nice big inhale...
01:44...for the last pull, okay?
01:45Keep breathing.
01:46Oh.
01:47The critical care team responds to a woman...
01:50...who's collapsed.
01:51The probability that a stroke...
01:53...or a bleed on the brain...
01:55...is fairly high at the moment.
01:57A young rider breaks his leg...
01:59...in a motocross...
02:00...in a motocross accident.
02:01Wait, wait, wait a second.
02:02Try to do some manual traction.
02:03Okay, manual traction now.
02:04Okay, manual traction now.
02:05And?
02:06So Charles is 80...
02:07...and was found in his car having seizure.
02:09All right, Charles.
02:10An elderly man with heat stroke...
02:12...fights for his life.
02:13Sounds really...
02:14...weezy.
02:15...and crackly in mid to upper lows.
02:20So...
02:21...weezy.
02:22...weezy.
02:23...weezy.
02:24...weezy.
02:25...weezy.
02:26...weezy.
02:27...weezy.
02:28...weezy.
02:29...weezy.
02:30...weezy.
02:31...weezy.
02:32...weezy.
02:33...ambulance emergency is the patient free...
02:35...of what do you think?
02:36He's talking...
02:37...but I think it's not normal.
02:39Would he be able to speak with me?
02:40Hi.
02:41Hello.
02:42That's awesome.
02:43It's all about that.
02:45Okay.
02:46Cutting some red.
02:47There's my throat, my arm.
02:48My bones sticking out the arm.
02:49I know.
02:50You said the bone's sticking out.
02:52Yes, it is.
02:53Has it got any other wings?
02:55I could only see a wound to his arm, but it's a massive wound.
02:58In terms of the amount of.
03:00Blood that he's lost.
03:01Would you say he's lost that mug full of blood?
03:04Oh, no, no, no.
03:05It would take them a lot more than that.
03:06More than that.
03:07Would you say more than two mug fulls?
03:09Oh, absolutely.
03:10You can see like.
03:11All right.
03:12So it's a high priority response.
03:14They can.
03:15You can see a unit is being allocated at the moment.
03:17So we will endeavor to arrive with you as soon as possible.
03:20A man has fallen from height.
03:25Has an open fracture and heavy blood loss.
03:28It's a potentially life threatening emergency.
03:30So critical care paramedics Dudley Mobs and Lisa Brown are immediately disappointed.
03:35dispatched and updated via messaging.
03:37Going to a 60.
03:4024 year old male.
03:41From reports.
03:42Sounds.
03:43.
03:45Looks like he was trimming some trees on a ladder.
03:47Has then had an accident fallen off it.
03:50There is an ambulance on scene and they report.
03:55And that he has a, um, an open fracture to his right forearm.
03:59And.
04:00Possibly a right leg injury as well.
04:03Um.
04:04This guy is going to be in quite.
04:05a significant pay even just with the forearm.
04:07The ambulance crew on scene have carried out.
04:10An initial assessment of 64 year old Paul.
04:13And brief Dudley and Lisa of their findings.
04:15So far.
04:16He's got a significant compound fracture of the forearm there.
04:19Yeah.
04:20Okay.
04:21Clear.
04:22Normal.
04:23Um.
04:24Air entry.
04:25When he straightens his legs, he gets.
04:25A significant pain somewhere in his hips.
04:26He can't tell us exactly where.
04:27Fine.
04:28So.
04:29We figured.
04:30In the interest of a significant fall.
04:31Absolutely.
04:32Yeah.
04:33Yeah.
04:34Absolutely.
04:35Yep.
04:36Okay.
04:35The pain in Paul's hips could be a broken pelvis.
04:38A potentially life threatening injury that.
04:40can cause catastrophic internal bleeding.
04:42So.
04:43Knees in line.
04:44There's no.
04:45obvious deformity to the females, is there?
04:47A slight rotation of his right slice.
04:49A slight rotation of his right slice.
04:50Yeah.
04:51But.
04:52It's debatable if it was the position or not.
04:53Yeah.
04:54Although they open.
04:55fracture to Paul's arm is the most obvious injury.
04:58Stabilizing his pelvis is the priority.
05:00What was your name?
05:01I'm his wife Pam.
05:02Hello Pam.
05:03So what I'm.
05:05I'm going to do Paul.
05:06Can you hear me?
05:07Yeah.
05:08So this is an anesthetic gas okay.
05:09And it works a lot more effectively.
05:10I'm going to give the pain.
05:11So breathe.
05:12It will taste strange.
05:13It's a real big suck of that.
05:15if you can for me my lovely.
05:16The team are fitting a device that stabilizes the pelvic bone.
05:20And holds them in place.
05:21To hopefully slow any internal bleeding.
05:25Keep breathing there.
05:26Nice big inhale for the last pull okay.
05:28Keep breathing.
05:29Nice big inhale for the last pull okay.
05:30Keep breathing.
05:31Keep breathing.
05:32Keep breathing.
05:33Keep breathing.
05:35Keep breathing.
05:36It's Thursday morning and Dr. Manjit Riyat and critical care paramedic Barry
05:40Walsh are preparing for a 10 hour shift.
05:42Maybe up.
05:43Sharp's box.
05:44Sharp's box.
05:45Sharp's box.
05:45Sharp's box.
05:46Sharp's box.
05:47Equipped with advanced drugs and life saving surgical kit.
05:50I.O.
05:51Access.
05:52To our cost to meet.
05:53To our cost to meet.
05:54To our cost to meet.
05:55To our cost.
05:56A great deal.
05:57Cool.
05:58Cool.
05:59We're good.
06:00They are prepped for whatever emergency the day may bring.
06:00You
06:05You
06:10You
06:15Ambulance emergencies. Is the patient breathing and awake?
06:18He's breathing, but I'm watching
06:20I'm happy about this condition
06:22He's having the connection. He's having the feet
06:24Now he's in his car
06:25How old is the patient?
06:26Okay. I don't know. He's my neighbor. I don't exactly how old is he
06:30Look
06:31Maybe 80
06:32Has he been diagnosed with epilepsy? Do you know?
06:35I don't know. I don't exactly. I don't know details
06:37Is he still having a seizure currently?
06:40Yeah, yeah, yeah, yeah
06:42Yep
06:45Unless unavoidably delayed, they're about three minutes away
06:50Seizures are uncontrolled bursts of electrical
06:55Energy in the brain that can have life-threatening consequences
06:58So the critical care team of
07:00Manjit and Barry are dispatched
07:02So we've just been alerted over the radio
07:05To an elderly gentleman in his 80s who is having
07:10A seizure in a vehicle we believe
07:12We're quite close to the location of the incident
07:15And a paramedic crew have requested a P1 backup
07:18So that's a high priority backup
07:20For assistance with this gentleman in the car
07:25The ambulance crew has removed the patient from the vehicle
07:28But he is still extremely abjured
07:30So he's been irritated
07:31So Charles from 80 was found in his car having a seizure
07:35I'm not sure how long it's gone on for
07:37Neighbours say that they don't know that he's a gnome
07:40Epileptic
07:41Ops-wise, BP's failed because of shaking
07:45Sats have been okay on oxygen so...
07:48Retired accountant Charles...
07:50The ambulance had just returned home when he blacked out in his car
07:53You're okay, sir
07:54Fortun-
07:55Unfortunately, he fell onto the steering wheel
07:57Which sounded the horn and alerted his neighbours
08:00I don't know how long he was in the car for
08:01Does it...
08:02Time of call 24
08:03It's now 14
08:04So you can pull up my hands, sir
08:05At least 20 minutes
08:06Yeah
08:07If Charles has been seizing for 20 minutes...
08:10Or more...
08:11His life is in danger
08:13You guys got the...
08:15Right now
08:16Yes
08:19Sounds really...
08:20Wheezy and crackly and mid to upper lobes
08:22How is it?
08:23I think we should get them off the...
08:25We should get them off this
08:27He needs to sit off
08:28Yeah
08:29Hello
08:30We've got temperature 39.9, yeah?
08:35We've got an exertional...
08:36It's essentially a heat stroke
08:38Yeah
08:39Heat stroke
08:40Is when the body overheats and can't cool down
08:42Charles' temperature is almost 3 degrees above...
08:45Normal
08:46His vital organs are in overdrive
08:48And without fast treatment...
08:49Will start...
08:50Not to fail
08:51He feels really hot
08:52Mmm
08:53His heart rate is going like the clappers as well
08:55He feels really hot
08:56He feels really hot
08:56I have eight different fumes
08:58The pain
09:14The pain
09:20The pain
09:22Yeah, but she's not really with it.
09:25She's had a migraine, and then all of a sudden...
09:27She just can't. She's not responsive at all.
09:31And how old is she?
09:32She's 53.
09:34And is she breathing at least one breath every 10 seconds?
09:37Yeah.
09:38She had a migraine, started about half past four.
09:42So we have the most appropriate help arranged.
09:47It's a high-quality ambulance, and it's coming on lights and sirens as soon as they can.
09:51Okay.
09:52Okay.
09:57So, Dr.
10:02Tom Porter and critical care paramedic Andy Ludlow are immediately dispatched.
10:07The information suggests that the patient is likely to be unresponsive.
10:12Or unconscious to some degree.
10:16And so they're probably...
10:17The possibility that a stroke or bleed on the brain...
10:22That probability is fairly high at the moment.
10:26In the UK, over 100...
10:27100,000 people a year suffer a stroke, and fast intervention is crucial to a positive...
10:32outcome.
10:33And when people are not as responsive as normal or unconscious...
10:37One of the things we'll try and make a decision about early is if we think that we might need to assist her.
10:42By taking over her breathing and performing a...
10:47pre-hospital anaesthetic, that's the reason we've been sent, because there's a likely...
10:52that this patient might need a critical care intervention that can't be delivered by a...
10:57Just 15 minutes after dispatch, Andy and Tom arrive at the...
11:02address where the 53-year-old woman has collapsed.
11:07Hello team.
11:08Hi.
11:09Hi.
11:10Hi.
11:11Hi.
11:12Hi.
11:12I'm Tom.
11:13This is Andy.
11:14Hello.
11:15I'm squeezing, who is this?
11:16This is...
11:17She's known to have migraines plus hemiplegic migraines.
11:22Hemiplegic migraine is a rare condition that causes stroke-like symptoms, including speech
11:27problems and temporary weakness or paralysis on one side of the body.
11:32She's had a typical migraine for her and she recovered from that.
11:37She was coming down the stairs and then she fell and collapsed in.
11:43Okay.
11:44And then had an episode of 20 to 30 minutes where she remained.
11:47She was kind of vacant and aphasic.
11:48There was some talk of seizure activity.
11:51Okay.
11:52Paula's failure to recover from her migraine, as usual, coupled with her collapse and unresponsive
11:57illness suggests this may be a stroke or another serious neurological problem.
12:02I'm hearing this term hemiplegic migraines.
12:04Yeah.
12:05That sounds like a diagnosis you've received from somewhere.
12:07So...
12:07Who told you you've got those?
12:08The hospital.
12:09It was Paula's husband, David, who called.
12:12999.
12:13She can have migraine.
12:14She'll go to bed.
12:15She'll lose feeling down one side.
12:17Okay.
12:18Lose her speed.
12:19She will tend to just have a bit of sleep.
12:22Come around, eventually, just come around after about an hour.
12:27Because hemiplegic migraines resemble stroke symptoms, Tom must quickly rule out whether...
12:32Paula has suffered an actual stroke.
12:33Paula has suffered an actual stroke.
12:37...
12:38...
12:39...
12:40...
12:41...
12:42...
12:43Dr.
12:44Manjit Riyat and critical care paramedic Barry Walsh are treating...
12:4884-year-old Charles.
12:49All right, mate.
12:50We've got you.
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