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00:00In the intense world of medical emergencies...
00:03Is the patient breathing?
00:04No! She's lying!
00:06There's nothing more extreme...
00:08His lips are blue.
00:10...than an immediate threat to life.
00:12Massive, massive burn. Skin's peeling.
00:15Responding to the most severe 999 calls.
00:18This lady is reporting pain in her head
00:21and is becoming less talkative.
00:23The rapid response vehicles of the Thames Valley Air Ambulance...
00:26The woman's had a seizure and the whale crashed into some people.
00:29..are at the front line delivering life-saving medical treatments.
00:32The big decision is for us whether we need to put a tube in, again,
00:35to 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. It's a very good painkiller.
00:44Reacting to emergencies.
00:45You've been super brave, darling.
00:47The critical care teams...
00:48You've had a pretty big blow to the head.
00:50..are equipped to provide hospital-level treatment.
00:53So we'll give you some ketamine.
00:54That will mean that you don't know what we're doing
00:56whilst we straighten your ankle out.
00:58Whenever...
00:58Do you think he's fast?
00:59Potentially, yeah.
01:01..and wherever...
01:02Oh, my leg!
01:02..it's needed.
01:03Oh...
01:04You are doing a fantastic job.
01:06..filmed over three months...
01:08Let's have your arm, my darling.
01:09Let's give you some of this morphine.
01:11Just be aware he might stop spontaneously ventilating.
01:14I have the tube.
01:15..we captured every vital second...
01:18That's OK.
01:18You're safe.
01:19..as these highly trained critical care teams...
01:22Can you take a deep breath in for me?
01:24..fight to save lives.
01:26Your birthday present is surviving a cardiac arrest.
01:29..when every second counts.
01:32Let's go, go, go.
01:33Tonight, a broken and dislocated ankle...
01:36The biggest risk here is I won't be able to get this ankle back in.
01:39..leaves an elderly man facing life-changing consequences.
01:43It's very unstable and spontaneously re-dislocated.
01:47OK, OK.
01:48..a seizure puts a young boy in serious danger.
01:52The decision is whether we need to put a tube in to protect us that way or not.
01:55..multiple injuries and amnesia...
01:57I literally, like, woke up and was not aware of this.
01:59..for a motocross rider after a crash at speed.
02:02I can't tell you, like, right now, everything is going to be fine.
02:05..and...
02:05I feel I'm going to conk out.
02:07..a climber's arm is crushed after a fall.
02:10Can you see yourself?
02:11Oh, shit!
02:12That hurts!
02:28Hamlet's emergency. Patient breathing?
02:30Yes, I'm breathing.
02:32To your patient?
02:34Yes.
02:35Can I ask no reason for the call?
02:37I think I've broken my ankle.
02:38My foot is sticking out at 90 degrees tomorrow.
02:41Have you fallen? What's happened?
02:44I don't know.
02:45I just woke up on the floor by the bathroom.
02:48My foot is sticking out at 90 degrees.
02:50And I take it you're still on the floor?
02:53I'm on the floor.
02:54OK. Do you know how long you've been on the floor, sir?
02:57Do you know how long?
02:57No idea.
02:58No idea.
03:00OK.
03:01OK.
03:01OK.
03:01Any other multiple major injuries that you've got at the moment?
03:05No, it's fine.
03:06OK.
03:07OK.
03:07What more to get than I have to pay?
03:11Hello?
03:12Can you hear me?
03:16Hello?
03:16Can you hear me?
03:17OK.
03:19OK.
03:20A loss of consciousness and a badly broken ankle is an emergency that requires the advanced
03:25skills of the critical care team.
03:27So in addition to an ambulance, Dr. John Bailey and critical care paramedic Andy Ludlow are dispatched.
03:34So we're on our way to a court.
03:37It's for a man who's woken up on the floor, not sure how long he's been there, with his ankle
03:44facing in the wrong direction.
03:46Fractures can be serious injuries.
03:48However, the loss of consciousness could be a bigger concern.
03:52Clearly breaking your ankle is reasonably stimulating as experiences go.
03:55So it's unusual to do that whilst unconscious and not realise.
03:57So he must have been genuinely unconscious, which probably means he's had some kind of dysrhythmia
04:02or maybe a seizure.
04:06There's a bit more to consider in terms of what's happened to him medically around what's
04:10caused him to get the fracture.
04:13An ambulance crew is already on scene and updates John and Andy.
04:18The last thing he remembers is getting up, going to the bathroom, and then he woke up
04:23on the floor, has bumped his head, doesn't know what on.
04:26Can't remember the fall at all.
04:29Semi-retired CEO Dave was looked after by his wife Sally and their housekeeper Helen until
04:34help arrived.
04:35BP is high.
04:37OK.
04:38I'm not surprised your BP is high.
04:40Hello.
04:42I am.
04:43My name's John Bailey.
04:44Hi.
04:45John.
04:45How are you doing?
04:47Pretty uncomfortable.
04:49You don't remember anything about what happened?
04:51No.
04:52I passed out.
04:53Is it dislocated?
04:54Probably fractured and dislocated.
04:56But we need to straighten that out.
04:58First, John needs to consider Dave's loss of consciousness.
05:02And you've been having a few episodes where you've been passing out.
05:04One at the beginning of May.
05:07Yeah.
05:07And one on Monday.
05:09Yeah.
05:10Have you seen anybody about that yet?
05:12I was going to have an ECG at my doctors next Friday.
05:16Well, you're definitely going to get one today.
05:18If the ECG reveals a problem with Dave's heart, it could have serious complications for how
05:24they treat his ankle.
05:25Get an ECG to make sure he's not got some drastic abnormality.
05:32The Thames Valley Air Ambulance Charity has a team of 34 doctors all trained in pre-hospital
05:38emergency medicine.
05:40When Dr Manjit Riyat isn't with the critical care team, he works in intensive care at Oxford
05:46University Hospital.
05:47So I do two weeks, basically two weeks in the hospital and then two weeks here.
05:52The jobs that we have here probably are more challenging.
05:55Like managing a cardiac arrest sort of on the floor propped up against a radiator in
05:59a narrow corridor where you've barely got access.
06:02Some of the patients' torso and airway is much more difficult.
06:06There's things that you just take rather than in hospital.
06:08Today, Manjit is on shift with critical care paramedic Hannah Hurst, responding to
06:13Code Red calls over a patch of more than 2,000 square miles.
06:30An ambulance emergency.
06:32Is the patient breathing?
06:34Yes, in the middle of having a spit.
06:36Right, okay.
06:37How old is the patient?
06:38Twelve.
06:39Okay.
06:39How long has he been sitting for?
06:41I don't know.
06:42I've just come in.
06:43I've heard some funny noises.
06:45He's been asleep.
06:45I just want to track his rate of breathing together to make sure it's all right.
06:49When I say go, you can watch him closely and say now every time you take the breath
06:53in until I tell you to stop.
06:55Yeah.
06:56Go.
06:58One.
06:59Going for me?
07:00Two.
07:01Keep going for me?
07:03Three.
07:04You can stop now.
07:05That helps and arranges the beginning with the call.
07:09Caused by sudden and abnormal changes to electrical activity in the brain, seizures can be
07:14life-threatening.
07:16Manjit and Hannah are dispatched.
07:18Just two minutes away, they arrive ahead of the ambulance.
07:22Hello.
07:26I'm Hannah.
07:27This is Manjit.
07:28Who's this?
07:28This is Lewis.
07:29Hello, Lewis.
07:31Twelve-year-old Lewis was found unresponsive in his bed by his younger sister, who alerted
07:36their mum Georgie.
07:38Okay.
07:38Tell us the story then, Mum.
07:40So, he had a TBI in September 23.
07:43He was run over by a car.
07:45Yeah.
07:45Was in a coma for eight days.
07:48Yep.
07:48Then he was fine.
07:49And then October last year, he had the first ever seizure that he's had at school.
07:54Yep.
07:54Was fitting for, well, they think it was over 30 minutes.
07:58They put him to sleep at school, took him back to hospital.
08:00Yep.
08:00And this is the first time it's happened since October.
08:03The TBI, or traumatic brain injury, left Lewis with the most extreme form of epilepsy.
08:09This causes prolonged non-convulsive seizures and fitting, which can be life-threatening.
08:15I don't know how long he's been fitting for.
08:17Okay.
08:17Me and my daughter just up and she said she could hear some funny noises.
08:20Yeah.
08:20So, I came in and found him.
08:21Found him fitting.
08:22I don't know when it started.
08:24It's over 11 minutes since Lewis's mum realised something was seriously wrong and raised the
08:29alarm.
08:30First, Manjit and Hannah need to carry out a quick assessment.
08:33Yeah.
08:34So, I think he's still fitting.
08:36Yeah, should we get some?
08:36Yeah.
08:37Sats are reading at 57.
08:40Lewis, I'm just going to pop a little bit of oxygen on for you, my darling.
08:45It's just going to be a little mask over your nose and mouth, okay?
08:50Ooh, you can probably hear my colleagues arriving as well.
08:52Mm-hm.
08:55He's moving a little bit.
08:56How's the chest sound?
08:58It's clear on the left-hand side.
09:00It's got a little bit wheezy on the right-hand side.
09:02I would say his refs are quite irregular, though.
09:04Okay.
09:04Quite slow.
09:06Yeah.
09:06I'll get you some adapts.
09:08Lewis's brain functions, including those that control his breathing, are being disrupted,
09:13resulting in his low oxygen levels.
09:16Muscle spasms in his chest and throat are making it hard for him to breathe.
09:20It was one of those things where my daughter goes, can you just check him, Mum?
09:23He's not standing, Mum.
09:24Oh, bless him.
09:26You might be in a bit of a sharp scratch, all right, mate?
09:28Just try and hold nice and still.
09:30You're doing really well.
09:30Well done.
09:31The team need to act fast.
09:34A portable ultrasound scanner allows Manjit to quickly find and insert a cannula into
09:39Lewis's tiny veins.
09:41There's five.
09:457.9 BM.
09:46So that's a 98.
09:48Excellent.
09:49So we're good.
09:49Manjit is giving Lewis midazolam, a powerful, fast-acting anticonvulsant, to help bring his
09:55seizures under control.
09:57Just going to get you feeling a bit better, all right.
10:00Going to make you quite sleepy.
10:02Stop these seizures.
10:04Okay, that's five in and flushed.
10:06With his breathing already compromised, and his brain at risk of damage, as long as
10:11he's seizing, Lewis's life is in danger.
10:15Just going to have a look at your eyes.
10:36It's 7am on Sunday morning, and Dr. Martin Weller and critical care paramedic Joe Jeffries
10:42are preparing for their shift.
10:48On duty for the next 10 hours, Joe is predicting a busy day ahead.
10:53We've had two weeks of warm weather, so we tend to think that that brings people out
10:58doing sort of leisure activities, and out and about walking, cycling, doing what they
11:05do.
11:05So sometimes I think these Sundays are a little bit busier, but I might add that today is
11:11the sort of end of the hot forecast.
11:13So maybe people are more inclined to get out today ahead of the rain.
11:31On duty.
11:33There we go.
11:42All right, take care.
11:44I think there was a short spout of where he went unconscious.
11:47And his helmet is cracked, so he told me that he was when he was cracked up.
11:51Yeah, thank you. OK, so your call has been categorised as a high priority.
11:54We are on our way on V-Lax and Siren.
11:58A motocross rider has crashed at speed and knocked unconscious.
12:02Martin and Joe are dispatched and updated via messaging.
12:06Motocross truck, I went over to jump about 40 miles per hour,
12:09knocked out and I'm complaining of chest and leg injuries.
12:12Uh-huh. Has what is described as a large deformity on his head.
12:16Oh.
12:17Right, he's stopping. Yeah, you're good.
12:21With speeds up to 60 miles an hour on off-road terrain,
12:25motocross is a high-risk sport.
12:28Injuries are common and often serious,
12:30varying from broken bones to life-threatening trauma to the head and spine.
12:35Hello. Hello. Hi.
12:36You all right?
12:37Death was initially unconscious, quite a large mechanism.
12:41Do have a cruise sign, but they're coming from quite a distance.
12:45They're 30 minutes away at the moment, 3-0.
12:47Yeah. Cool. That's all right. Cheers, mate.
12:49Thank you, guys. Thanks. Bye-bye.
12:50In the UK, there is a hospital admission for a head injury every four minutes.
12:56Unconsciousness after a blow to the head is dangerous,
12:58as it can signal swelling or trauma to the brain.
13:01Looks like somebody's expecting us, which is good.
13:04First to arrive at the scene, Martin and Joe are greeted by one of the other riders.
13:10Down on the bottom, I'll see you guys on the far left van, OK?
13:13OK, thank you.
13:14I assume he'd be somewhere in there.
13:16He's in the van. Probably in the van.
13:18Yeah.
13:20Let's take these two and then we'll decide everything else once we've seen him.
13:25With the help of his friends, the injured rider has made it back to his van.
13:29Hello there.
13:30Martin and Joe, you're the one who's done the jumping and the falling.
13:34What's your name, buddy?
13:34Hello.
13:35Charlie. Hello, Charlie.
13:37Where are you most sore?
13:39My head, my hips.
13:41Yeah.
13:43My arm, that's a little bit.
13:44Yeah. OK, fine.
13:46You obviously... Where did you fall just right on the track?
13:48Did you...
13:48I just jumped at the back.
13:49At the back. And you walked all the way back here?
13:51Yeah.
13:53Or did you... You walked in back, did you?
13:55OK, gotcha.
13:56Do you remember doing the jump?
13:57No.
13:58Or not?
13:58I remember hitting there.
13:59Yeah.
14:00I remember just doing...
14:02Yeah.
14:02I couldn't get anything.
14:03And then I must have just, like, nose-dived cracked.
14:06Mind if I check you over, is that all right?
14:07And we'll take some observations.
14:09Short-term memory loss after an impact to the head is a sign of a concussion,
14:13but could indicate a more serious brain injury.
14:16Any pain in the middle of your neck here?
14:18No, that's fine.
14:19And then, can you pull this up for me?
14:20Is that OK?
14:20OK, let's have a good look at your chest.
14:25Just have a good feel around that.
14:26Is that sore when I'm pressing anywhere?
14:28It's a little bit sore, yeah.
14:29Both sides?
14:30Yeah, that hurts.
14:31Which side?
14:32The front.
14:33The front?
14:34OK.
14:36Charlie's body has hit the ground at high speed with little protection,
14:40so Martin must carry out a head-to-toe assessment.
14:43Pop this in your finger, too.
14:44Any pain in the middle of your spine?
14:45No.
14:46No, that's OK?
14:47How about your tummy?
14:48Is that OK?
14:49Yeah, that's fine.
14:50OK, so that's sore when I pressed on there, but you were able to walk on it, were you?
14:53Yeah.
14:53OK.
14:54I'm going to just squeeze your arms.
14:55There we are.
14:56That's whereabouts?
14:58Down there.
14:58On there.
14:59The crash has left Charlie with injuries to his head, chest, leg and arm.
15:03But it's the risk of brain trauma that is the biggest concern.
15:07It's more just like, oh, fuck, I'm just in a different world, to be honest.
15:22We're going to move your position slightly in a minute.
15:24In Reading, critical care paramedic Andy Ludlow and Dr. John Bailey are with Dave, who has a badly broken ankle
15:31after a fall.
15:33There we are.
15:34So, have we got some fentanyl?
15:35The last thing Dave remembers is going to the bathroom and then waking up on the floor with his ankle
15:41facing the wrong way.
15:44I'm going to start feeling a bit better in a couple of minutes' time.
15:47That's fentanyl, which is a sort of faster act in the version of morphine.
15:52Do you mind grabbing some hands on?
15:54We're just coming a little further away from the top here.
15:57OK.
15:59You're shuffling.
16:00Oh, well done.
16:00That's it.
16:01I think this is how he got here, isn't it?
16:03Yeah, he shuffled on his bum up to the bed.
16:05There we go.
16:06Lie yourself down again.
16:08The pillows are behind you.
16:09It could be several hours since the injury happened.
16:12If the blood flow in Dave's foot is compromised, then it's at risk of permanent damage or amputation.
16:19He has actually got a pulse on that, and it is quite warm.
16:22But it clearly can't stay that way because of the skin.
16:24Yep.
16:25So, we'll sedate him, pull it straight.
16:27The blood supply appears to be healthy, but it's a particularly bad break.
16:32This will be quite difficult to reduce because I think his entire tailer joints there.
16:36John suspects that Dave's ankle is broken and dislocated, making realignment difficult and painful.
16:42To complicate matters further, there's an additional concern.
16:46Of course, there's a lot of pressure on the skin.
16:48We need to be able to reduce the ankle to take the pressure away from the skin,
16:52otherwise the skin itself will start to break down.
16:54And that then can cause a problem with an open fracture later on.
16:57So, we'll sedate him here, reduce it, and then once that's done, package him up,
17:02let him recover from the sedation, and go to the local hospital.
17:05Right.
17:06The team must act quickly.
17:07But Dave can't be sedated until they're confident his collapse wasn't caused by a problem with his heart.
17:14We're just looking at your heart rhythm.
17:16ECG's coming, that's it.
17:17Right.
17:18QRS is fine.
17:19That'll do.
17:20An ECG of Dave's heart is all clear.
17:23Right, Dave, I've got to put this mask on you, OK?
17:26So the team can proceed with the sedation.
17:30You won't feel strange straight away.
17:32Give it a minute or two and it'll start feeling a bit weird.
17:35When you wake up, your pain will have gone away, OK?
17:40Your ankle will be straight, right?
17:41Yeah, well, as long as we've been able to reduce it,
17:44which I'm reasonably sure we will be able to, then your ankle will be straight.
17:47Is it protein or is it just this like I think?
17:50It's both of those things.
17:52Andy's administered ketamine, a strong sedative that will allow John to try and straighten Dave's ankle without causing him distress.
18:00Dave, you're still with us?
18:01Open your eyes, Dave.
18:04A bit in the stagmus now, but still aware.
18:08You're very safe.
18:10Can you squeeze my hand?
18:11You're still with us, sir?
18:14I think you can...
18:16I'll start.
18:18So the biggest risk here, realistically, is that I won't be able to get this ankle back in,
18:21which means I'm going to have to pull it really, really hard.
18:24So when we do that, if I have to, I'm going to stand up and then I'm going to pull
18:28him with me standing and him still on the floor.
18:30If we get to that point, you need to hold his pelvis.
18:33So basically, whoever's going to support him, just keep his pelvis on the floor and I'll pull against that.
18:36The harder John has to pull Dave's ankle, the greater the risk of the skin rupturing, which could lead to
18:42infection and even loss of his foot.
18:51Well done.
18:53You're very safe.
18:56No, I don't think I can reduce it.
19:09I'm just going to put this on your arm.
19:11It's going to go a bit tight.
19:13In Stoke and Church, Dr. Manjit and critical care paramedic Hannah are treating 12-year-old Lewis, who has had
19:19a seizure and is struggling to breathe.
19:23Numbers are heart rate is 111, stats are 99 on the 15 litres.
19:28We've got a respirator of 8, end tidal 4, BP 126-64.
19:33Two years ago, Lewis suffered a traumatic brain injury that left him with a rare and severe form of epilepsy.
19:39OK, so I've got three grams of Keppra in 100ml. Happy?
19:43Happy.
19:44An ambulance crew is now on scene.
19:46The intravenous infusion of Keppra, an anti-epileptic drug, will also help to stop Lewis' seizure while they transport him
19:53to hospital.
19:57OK, nice and easy.
19:59Just keep coming.
20:00OK, come on, roll. Ready, steady.
20:02Roll.
20:03Roll.
20:07OK, OK, OK, OK, OK.
20:09Coughing and gagging.
20:11OK.
20:12Should we get suction?
20:13Yeah.
20:13One of the biggest dangers of the seizure is that Lewis can't control his body's gag and cough reflexes.
20:20So, just because he's had this vomit, the main thing we need to think about is his airway and making
20:25sure things aren't going down the wrong way.
20:27And the big decision is for us whether we need to put a tube in again to protect his airway
20:30or not.
20:32With his vomiting posing a threat to his breathing, maintaining Lewis' airway is the critical care team's first priority.
20:42All right, mate.
20:46So, we're going to move.
20:47What I'm going to do is I'm just going to support the airway.
20:49Yeah, great.
20:50And that's what we'll do with.
20:51We'll do the rest, OK?
20:53Now Lewis has stopped being sick, the team can begin moving him to the ambulance.
20:58Ready, steady, slide.
21:00Great job.
21:01But that involves navigating a narrow, steep staircase, whilst Manjid holds open Lewis' airway.
21:07All right.
21:08If you rest up there, I'll go down there and get the feet.
21:11Everyone happy for that?
21:12Yeah, I'll go in.
21:12OK.
21:13Ready, steady, slide.
21:15OK.
21:16Tell me if you need me to stop.
21:18No, you're OK.
21:19All Lewis' mum, Georgie, can do is watch on.
21:22Well done, Lewis.
21:24We're downstairs now, OK?
21:27Safely down, Lewis' breathing needs to be reassessed before they can move him any further.
21:32OK, sats are good, respirator is good.
21:37You're still needing to support the airway, yeah?
21:39Yeah, periodically, yes.
21:41OK.
21:42I think the main concern is airway en route.
21:45Yeah.
21:46Oh, hello, can you put me through to soccer, please?
21:50Concerned that Lewis can't breathe properly without his airway being supported, Manjid puts in a call for advice.
21:56So, 12-year-old, he was found by sister this morning and mum to be not right, not breathing properly.
22:03So, he has some respiratory depression, but we're correcting that with a jaw thrust and we're supporting him.
22:07The concern is just airway protection.
22:10Just looking at him now, so he's having some intermittent twitching of his arms, which, again, is a bit concerning,
22:17yeah.
22:17We're just going to give him another two milligrams of midaz now.
22:20His risks are quite irregular as well.
22:22Yeah, because now he's fitted again.
22:24As Lewis is still showing signs of fitting, another dose of the anticonvulsant midazolam is administered.
22:31Yeah, so if it's airway protection, we might be able to support the airway en route,
22:35but if we think there is some residual ongoing seizure activity, just for airway protection, we're just going to intubate.
22:40So, yeah, yeah.
22:42Intubating would mean anaesthetising Lewis to take control of his breathing.
22:47It's a high-risk procedure, but without it, his condition is critical.
23:11In Reading, Dave has been sedated while critical care paramedic Andy and Dr. John
23:20attempt to realign his badly fractured and dislocated ankle.
23:26No, I don't think I can reduce it because his bone's in his joint.
23:30It's a brutal yet delicate procedure, as the protruding bone could rupture the skin,
23:36turning it into an open fracture and compromising the blood supply to Dave's foot.
23:50It's a bit up here.
23:51Yeah.
23:54OK, so he is closed all round.
23:57OK.
23:57The skin on this side is probably ulcerating.
24:01It's probably been out a long time.
24:03It's very unstable and spontaneously re-dislocated.
24:07OK.
24:08Are you able to maintain circulation?
24:11Yeah, circulation's fine.
24:16That's probably as good as it's going to get.
24:18Right.
24:19To prevent any movement that could tether skin, Dave's ankle must be immobilised.
24:24So this needs to be really, really tight.
24:26OK.
24:29So it's going to hold fire, isn't it?
24:34Just trying to stay out because it's so unstable.
24:40In your house, and we're the ambulance people.
24:42You're very safe.
24:44The team are using a vacuum splint to try and hold the bones in place.
24:49I just can't keep him in joint.
24:50He basically just keeps slipping back out again.
24:52And when he slips, he slips into the skin threat position.
24:56Do you want any of the sandspin?
24:57Let's see how unstable it is.
25:01It's just...
25:04His lateral component's completely gone.
25:07So there's nothing to hold it in.
25:09I think, to be honest, if we pack this well enough, this will be just as good.
25:13It's just holding it in place while...
25:15While we do it.
25:17So...
25:20Right, let's try that.
25:21After several attempts, Dave's ankle is splinted and the skin is still intact.
25:26How are you doing, buddy?
25:28You're in...
25:30You're in your...
25:31You're in your bedroom.
25:33OK?
25:34We're the ambulance people.
25:35You're going to feel a bit strange for a little while.
25:38And that's perfectly normal.
25:40But you're safe.
25:41OK?
25:42Dave's feeling a bit whappy.
25:43But we're going to scoop him.
25:45All right?
25:45Ready, steady, roll.
25:48That's it.
25:50How's that?
25:52All right, perfect.
25:53He can now be moved downstairs and into the ambulance.
25:56I'm just going to add ketamine facial.
25:58Ready?
25:59Are you OK?
26:00Ready, steady, lift.
26:03Now.
26:05That's it.
26:06Super.
26:07OK, ready, steady, heave.
26:12That's it.
26:14Well done, folks.
26:16That's it.
26:17All right, everybody ready?
26:18Ready, steady, lift.
26:20John updates Dave's wife, Sally.
26:22So he'll go to Royal Barpshire.
26:24Now that he's awake,
26:25so if he was still not quite conscious from the ketamine,
26:29we'd come with him.
26:30Yeah.
26:30But he's waking up.
26:31He's appropriately orientated.
26:34He knows where he is.
26:35Happy that Dave's condition is now stable,
26:37John and Andy leave him in the care of the ambulance crew
26:40for the journey to hospital.
26:41We're going to get clear with you, all right?
26:43Yeah, thank you.
26:44All right.
26:45We had to pull the fracture quite hard
26:46to get it back into alignment
26:48because it was quite significantly displaced.
26:50And when we'd done that,
26:53the fracture's in lots of pieces,
26:55so it's very unstable,
26:56and it keeps slipping in and out of joints.
26:58So he will need surgery on his ankle.
27:00It's quite a nasty fracture.
27:12At a motocross track in Buckinghamshire...
27:14First ride back, mate.
27:16No.
27:16First ride back.
27:17...critical care paramedic Joe and Dr. Martin
27:20are treating Charlie,
27:21who has suffered multiple injuries
27:23after hitting a jump at 40 miles an hour.
27:26So that just looks like he's got a bit of bruise.
27:28His friends were first to the scene.
27:30Were you there immediately?
27:31I was just trying to wake him up, and he was...
27:33Well, I just tried to get some responses out of him,
27:35and he was nothing.
27:35And it took two minutes to...
27:37OK.
27:38And when he did respond, how was he?
27:40Er, non-verbal.
27:41And how have you got it back here?
27:43He walked himself.
27:44And how far off from where we are was...
27:46It's about 100 yards, 150 yards.
27:49Er...
27:49A loss of consciousness for two minutes
27:52is a sign of brain trauma,
27:53and we'll need investigating
27:55to rule out bleeding or swelling of the brain.
27:58You're obviously a little bit sore,
27:59but that's hopefully all just bruising, OK?
28:01But I think from a head perspective,
28:03and sometimes it just takes a little bit of time
28:05for that to develop.
28:05You definitely have to go to hospital, and then...
28:08To be honest, I think I'm half all right.
28:09I think you should go to hospital.
28:11I think I might.
28:12Do you know how it is?
28:12If anything, I'm a bit worried
28:13just because I've knocked out.
28:15Yeah, exactly, and I think that's where you should go.
28:18I literally, like, woke up thinking, like,
28:20where the fuck is this?
28:21Yeah.
28:22So we may well end up scanning your head
28:23when you come to a hospital
28:24to make sure you haven't done any damage,
28:26and that's the main reason to go at the moment.
28:28We need to observe you for a bit,
28:29so I think you should go to hospital, OK?
28:31An ambulance is on its way to take Charlie to hospital.
28:34Right, this is some pain relief.
28:36It's called Penthox.
28:37Everyone, it's starting to be neat.
28:38And just...
28:39Well, you were quite sore when I was patting you down, Laurie.
28:41Try it.
28:42Pop your hand through this,
28:43and then you breathe through this,
28:46in and out through it, yeah, in and out through it,
28:48keep your mouth nice and close, your lips doesn't close.
28:50I don't know about that.
28:50No? OK, that's fine.
28:51You know, like, when you take a bit of medication,
28:53you know, it's just not the way to find it.
28:55That's OK. That's OK. You don't have to have it.
28:56Pain relief isn't the only thing Charlie isn't keen on.
29:00We'll have to...
29:00I think you should, because you were knocked out,
29:03and we often end up scanning your head
29:04if you've done something like that, OK?
29:06And it takes us a little bit of time
29:07to make sure that nothing has happened in your head.
29:10I can't tell you, like, right now, everything is going to be fine.
29:12It was clearly had a significant impact if you were knocked out, right?
29:15And I think our colleagues are saying you were going, what,
29:17sort of, 40 miles an hour?
29:18I've never been knocked out.
29:19Yeah.
29:20And I, like, literally...
29:22When I woke up and I had all these people around me,
29:24I thought, what?
29:25Like, how have I ended up here?
29:26Exactly.
29:27It's 45 minutes since Charlie's accident,
29:30and more injuries are coming to light.
29:32Yeah.
29:33Oh, my Jesus, why is that like that?
29:36Well, you've got a... It's like a big bruise, but underneath.
29:39Big bruise? That's all...
29:40Yeah. Yes, it will be.
29:42The lump is a hematoma,
29:44a pocket of blood that carries a risk of infection,
29:47nerve and tissue damage.
29:49So I ain't internal bleeding, is it?
29:50Well, it's... I mean, any bruise is technically internal bleeding,
29:53but not... Probably not what you mean.
29:55Oh, don't spoil it.
29:56So, well, again, that might get...
29:59That might swell up again a bit more over the next few hours,
30:01so that's another reason why we need to just keep an eye on you.
30:03An ambulance crew has now arrived
30:05and will take Charlie to Wexham Park Hospital.
30:08Hello, Martin Joe. Charlie here.
30:10He was going up on a jump over there, about 40 miles an hour.
30:14He remembers coming down,
30:15and then basically the guy's picked him up, he'd knocked himself out.
30:17But then he's walked from there to here.
30:19His ups are all right at the moment,
30:21and, yeah, just the abrasion stuff.
30:23On the side here, on the side here.
30:24No C-spine or any spinal tenderness, really,
30:26and no obvious immediate neurology.
30:28You guys are happy, I assume?
30:29Yeah. Yeah, yeah, yeah.
30:30Sweet. Thank you.
30:32I'll let these guys look after you.
30:33OK, we'll get you properly checked over.
30:35Satisfied that Charlie doesn't need any specialist treatment
30:38from the critical care team...
30:39He's going to look after you, all right?
30:41If you do want that pain relief, they do have it, OK?
30:43That's all right. Thanks, mate.
30:44All right, you take care.
30:45He's left in the hands of the paramedics,
30:47who will take him to hospital,
30:49where he'll undergo X-rays, a CT scan,
30:52and further examination.
31:10Sambulance emergency. Is the patient breathing?
31:13Yeah, they are.
31:13Do you really feel cool today, please?
31:15So, we are at a climbing centre,
31:17and we've just had someone come off the wall and land badly,
31:20and their elbow has hit to be dislocated.
31:22How old is the patient?
31:23Uh, mid-30s. Male.
31:25Yes!
31:26We're wondering if it's also maybe fractured,
31:28but definitely dislocated.
31:29OK.
31:30What do you think for the help of the range?
31:33UK hospitals treat over 2 million sports-related injuries each year.
31:39Climbing carries a particularly high risk of serious trauma,
31:42so the specialist skills of Dr Jasperit Rehatt
31:45and critical care paramedic Tracy Olden are required.
31:48This is a 28-year-old by the name of Matthew,
31:52who is at a rock-climbing wall.
31:55He's fallen off 2 to 3 metres.
31:56I think he's landed on his left hand,
32:00and it looks like a supracondular fracture dislocation.
32:04He's in a lot of pain,
32:05and it looks like something which needs to be pulled sooner rather than later,
32:09but you can obviously be the judge of that.
32:12OK.
32:13Super.
32:13A supracondular fracture dislocation
32:16means the upper arm has broken and the elbow joint is dislocated.
32:20Without urgent treatment,
32:21it can lead to loss of mobility, nerve damage and deformity.
32:25You haven't got an ambulance at the moment.
32:27OK.
32:28No problem.
32:29OK?
32:30Yeah, cool. Thank you.
32:33The accident happened at a climbing centre in Oxford.
32:36Just 30 minutes after receiving the call,
32:38the critical care team arrive on scene.
32:42Hello.
32:43What have you been doing?
32:44I fell off there, but if anyone asks, I actually did it.
32:47You did do it.
32:49OK.
32:49It was just you came down badly.
32:51Yeah.
32:51Any other injuries?
32:52No.
32:53What's your name? Sorry.
32:54Matthew.
32:54Matthew.
32:55I'm your house. This is Tracy.
32:56Hello, Matthew.
32:57Nice to meet you, guys.
32:57Nice to meet you, too.
32:58Nice to meet you.
32:5828-year-old robotics engineer Matthew
33:01fell over 3 metres onto his left arm.
33:04Centre staff put an ice pack on the injury.
33:07Are you left or right-handed?
33:07I'm left-handed.
33:09Left-handed.
33:09Are you able to make a fist?
33:11I can.
33:13Good.
33:13Can you squeeze my hand?
33:14Yeah.
33:15Good.
33:15Yeah.
33:16And just open your hand for me.
33:18Yeah.
33:18Feel me touching?
33:19I can feel you, yeah.
33:20There?
33:21Yeah.
33:21There?
33:22Yeah.
33:22There's a risk that the nerves in Matthew's arm
33:25have been crushed from the fall,
33:26so Dr Jaspreet must assess
33:28whether he has any loss of sensation or movement.
33:31Feels normal?
33:32It feels like it has, but it is normal.
33:35No numbness, tingling?
33:37I mean, it's a bit numb because I've had the ice.
33:39It's tingling.
33:39I think it's all just within the normalities
33:42of it looking messed up.
33:43So no numbness, tingling in the hand?
33:45No, I feel everything in the hand.
33:47OK.
33:48And you've got a nice, strong pulse.
33:49Fine.
33:49Good.
33:50With Matthew's hand responding normally,
33:52Dr Jaspreet turns his attention to the injury itself.
33:55I'm just going to pop these on your finger, OK?
33:57And do your blood pressure and bits.
33:58Is that OK?
33:59Yeah, that's true.
33:59Yeah.
34:00I'm just going to have a look at your elbow.
34:01Yeah, yeah, have a look.
34:02Whilst we're doing your observations.
34:03And how high do you think you were when you fell?
34:05I was on that hold there.
34:07The green one?
34:07And I was joking.
34:08I was actually at the top.
34:09OK, so reasonably...
34:10Should we be surprised?
34:11Do you not normally climb?
34:13It's the first time I've climbed in a while.
34:14Oh, no.
34:16The team need to check if Matthew's high spirits
34:18are masking potentially serious internal injuries.
34:21It looks a bit messed up, doesn't it?
34:23Yeah.
34:24Any pain here?
34:25No, no, not anymore.
34:26Is that good?
34:27It's not hit the nerve there?
34:28Stuff got to say at the moment.
34:29OK.
34:30And here.
34:32A tiny bit.
34:33Mm, OK.
34:34Unsure if it's safe to straighten Matthew's arm,
34:37the critical care team will have to proceed with caution.
34:40What you need is an X-ray to determine whether that's just a dislocation,
34:44whether that's fractured.
34:45All right.
34:45Or it could be both.
34:47Now you've got lots of important nerves and vessels that run through there.
34:51And I think pulling it here is probably not the best thing to do.
35:13So we're going to put the tube in.
35:14Just a bit.
35:15In Stoke and Church, Dr. Manjit and critical care paramedic Hannah are treating 12-year-old
35:21Louis, who has had a seizure.
35:23We're going to get a second line in.
35:25OK.
35:26More.
35:27He is also struggling to breathe, so the team are preparing to insert a tube into his windpipe.
35:33OK.
35:33Just going to get another line, and you're doing really, really well, mate.
35:36To do this, they need to perform a pre-hospital emergency anesthesia,
35:40which will allow them to secure Louis' airway and take control of his breathing.
35:46All right.
35:46All right.
35:46All right.
35:47Sorry.
35:48Sorry.
35:48Just hold my hand still.
35:56Nice and easy.
35:58You're doing really well.
35:59So Manjit inserts a second cannula to administer the drugs for the procedure.
36:04That's OK.
36:06All right?
36:07OK.
36:11Waking up a bit.
36:12I think it might be strong.
36:13It's close to the door now.
36:14OK.
36:15Louis' increased movement and awareness as the team insert a second cannula is a positive sign.
36:21Oh, you've been sick on...
36:24Rolling over.
36:27Well done.
36:28Sorry.
36:32Oh, no, it's not comfortable.
36:34I'm sorry.
36:34Well done.
36:36Just having a look at him, he had some much more purposeful movements,
36:39was trying to sit up a little bit ago.
36:41So he actually looks like he's, I think, much better from a transfer point of view
36:45and not seizing anymore.
36:47Yeah, I would agree.
36:48I think our risk-benefit has possibly...
36:50Has possibly just shifted.
36:52Yeah.
36:52Yeah.
36:53An hour after he was found by his sister,
36:55Louis' seizing has stopped and his level of consciousness is improving.
37:00I think, actually, at the moment, we don't need to intubate.
37:03I think you're absolutely right in terms of risk-benefit.
37:06I think it's safer not to, at the moment, and observe.
37:09And I think it'll probably, hopefully, make his journey a bit smoother as well.
37:12I'd agree with that.
37:13Cool.
37:14OK, great.
37:15Everyone happy?
37:15Yeah, yeah.
37:15I'm happy.
37:16Good.
37:16OK.
37:17Having decided it's more suitable to get Louis straight to hospital without intubating,
37:22Manchit updates Louis' mum, Georgie.
37:24You heard what we were talking about, so I think we're...
37:27We're going to the yard.
37:29Yeah, I think so.
37:30We've got all our things ready.
37:32So if anything changes when we're going out,
37:34or if anything changes en route,
37:36then we can do whatever interventions we need to do.
37:39OK.
37:40That's fine.
37:41Yeah.
37:42As you know, we're going to take really good care of him,
37:43and they're fantastic for J.R.
37:45I've had you experience twice, and I trust all of you.
37:50OK, we're going to lift on lift, hands on, ready, steady, lift.
37:55Happy?
37:55Due to the seriousness of Louis' condition,
37:58Manchit and Hannah will travel with him
38:00in case he deteriorates on the journey.
38:03All right, Louis, we're just going to get you in the ambulance.
38:07Mum's right here.
38:08Are you here, buggy?
38:09See? There she is.
38:10Hey, baby.
38:11No, not all the size.
38:12Just going to get you in the ambulance, mate.
38:14OK.
38:17How are we doing?
38:19Yeah, we're good.
38:19Oh, I know.
38:20It's a bit tickly in your nose, isn't it?
38:22Lewis has been taken to the John Radcliffe Hospital in Oxford
38:25as it has a dedicated paediatric critical care unit.
38:30The latest blood pressure reading is 76 over 47.
38:33He's got a good tempo pulse, yeah.
38:36Blood pressure, heart rate, and other vital signs
38:39can be unstable after a seizure,
38:40so Lewis is closely observed.
38:43See you again with an apology.
38:46Just need a little drop of blood.
38:47Thanks to the rapid response of the critical care team,
38:51Lewis is no longer seizing
38:52and handed over to the emergency paediatric team
38:55for urgent assessment.
38:57It was a real team effort between everyone, wasn't it?
38:59The ambulance service came in,
39:00they kind of picked up exactly immediately
39:03where we were headed,
39:05that we needed to get extrication sorted.
39:07They managed all of that.
39:07He's actually sitting up now in A&E with his mum,
39:11doing really well, yeah.
39:13And most importantly in that scene, I think,
39:16is his little sister.
39:17Big kudos to her
39:18because she absolutely saved his life
39:21by raising the alarm this morning
39:22and highlighting to mum that something was wrong.
39:24So, yeah, well done, her.
39:37At a climbing centre in Oxfordshire...
39:40OK, I think probably the best thing we can do for you
39:42is some guests to breathe in and out.
39:45..critical care paramedic Tracey Olden
39:47and Dr Jaspreet Rea
39:48are treating 28-year-old Matthew,
39:51who has had a badly broken arm
39:52and dislocated elbow after falling three metres.
39:56So what you need to do is you can use your good hand.
39:59If you hold on to that for me,
40:00just pop your mouth around it
40:02and take some nice deep breaths in,
40:04but keep your mouth around it when you breathe out as well.
40:06With important nerves and blood vessels around the injury,
40:10it's too risky to straighten Matthew's arm here,
40:12so he's been giving a potent form of pain relief
40:15before they can move him.
40:17So breathing in and out through there, Matthew.
40:19It might make you feel a little bit funny,
40:21but that's normal, OK?
40:22And then what we'll do is we'll dose you up on that
40:24and then we'll try and get a splint round it
40:26just to get you a bit more mobile, OK?
40:28Is it taking the edge off a bit?
40:30Maybe. I'm not feeling any, like, high or anything.
40:32It's OK. Keep going.
40:33Take some nice deep breaths.
40:35Keep going. Keep going.
40:36Deep breaths.
40:37Deep breaths.
40:38Keep your mouth around it all the time.
40:40That's it. Good lad.
40:42Keep going.
40:43Dr. Reit is preparing a foam-covered aluminium splint
40:46that can be moulded to support Matthew's arm.
40:50I'm being a bit light-headed now, yeah.
40:51Yeah, that's perfectly normal.
40:53All right.
40:53Listen, you're not...
40:54Oh, fuck! That hurts!
40:55You're not going to go anywhere.
40:56You keep going on the gas.
40:58Keep going.
40:59You're not going anywhere.
41:00Deep breaths.
41:01Deep breaths.
41:03The splint is in place, but it needs to be secured.
41:07Fine.
41:07We're going to set you up in just a moment.
41:10All right.
41:11I'm going to pop this.
41:12Do you want to hold that and keep using that if you need it?
41:14I feel like I'm going to conk out this.
41:15No, you're not conking anywhere.
41:16You're on the floor, okay?
41:18All right.
41:18We've got you.
41:19Okay, on through.
41:20One, two, three.
41:21Can you see yourself?
41:22Ow!
41:23Sugar muffin!
41:25That's the politest thing I've ever heard anyone say.
41:28How's that?
41:29I don't know.
41:30Those drugs are probably quite good.
41:32Yeah.
41:32Wait, are those drugs actually affecting...
41:34Ow!
41:36I don't think those drugs have affected me.
41:38Are they actually supposed to do that?
41:40They can make you go funny.
41:41Now Matthew is upright.
41:43So if I'll pass this round to you...
41:46and enjoying the pain relief...
41:48Under the arm.
41:49Oh, a wee wha!
41:51They can finish immobilising his arm.
41:54We come round the...
41:55Just under the...
41:56More funny.
41:57Underneath?
41:57Yeah.
41:58Keep going.
41:59Amazing.
42:00All right?
42:01Good lad.
42:02With the splint now secure and holding Matthew's arm in place,
42:05he's ready for the trip to hospital.
42:09What the plan is, is we're going to see if somebody would be able to give you a ride down
42:12to the hospital.
42:13Take time.
42:15So if you have to take it here for us?
42:16He's doing really well.
42:18He doesn't really need an ambulance to take him to the hospital.
42:21So do you have a car here?
42:22We have his car here.
42:23Okay.
42:24Because somebody's...
42:24He can drive.
42:25Amazing.
42:26What we'll do is we write some notes and we'll send it to the hospital,
42:29so they'll be able to see that we've been out.
42:32All right?
42:32No problem.
42:33Okay.
42:34They're happy to drive him down once he's settled a little bit.
42:39Matthew's lift to hospital may be organised, but he's still enjoying the benefits of Penthox.
42:45You've been so good.
42:48I'm sorry I'm acting like an absolute dude.
42:50No, you're fine.
42:52I'm so sorry.
42:53Can we get you into the car?
42:55Come on then.
42:55I'm just being in here.
42:56Just take your time.
42:58Take it nice and steady.
42:59Watch where you're going because we don't want you to hurt anything else.
43:03Matthew is going to the John Radcliffe Hospital in Oxford, where he'll undergo further treatment.
43:09All right.
43:10Thank you, sir.
43:10You've actually been a start.
43:12Nice to meet you.
43:13Thank you so much.
43:13Take care, guys.
43:14Drive safe.
43:18He'll need x-rays in hospital to determine what the injury is, really.
43:22Possibly an elbow fracture or a dislocation elbow.
43:26It's slightly swollen, quite tender.
43:28I should imagine he'll make a full recovery once he's had his...
43:32fracture or dislocation treated, and he should be able to use his left arm again.
44:04He'll be right back.
44:16Be leech in hospital.
44:18Please, take care, guys.
44:18Okay.
44:20Keep your life.
44:20Bye-bye.
44:21Bye-bye.
44:22Bye-bye.
44:22Bye-bye.
44:29Bye-bye.
44:46Steve Wright is back in the headlines after 26 years,
44:49confessing to a sixth killing.
44:51Hear from those at the murder trial of the Suffolk strangler,
44:54new tomorrow at nine.
44:55Next, new skin A&E.
45:00Next, new skin A&E.
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