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00:00In the intense world of medical emergencies...
00:03Disappreciation breathing.
00:04Life! She's alive!
00:06There's nothing more extreme...
00:08These lips are blue.
00:10...than an immediate threat to life.
00:12Massive, massive burn. Skin 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, the whale crashed into some people.
00:28..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,
00:34again, 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. It's a very good painkiller.
00:44Reacting to emergencies.
00:45You've been super brave, Dallin.
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.
00:57..whenever...
00:58Do you think it's fast?
00:59Potentially, yeah.
01:01..and wherever...
01:01Oh, 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.
01:34..tonight...
01:35He looked a bit pale, didn't he?
01:37..a crash on the motorway leaves the passenger critically injured.
01:40So priority is to just get him in and out of the cold, yeah?
01:43..a man in cardiac arrest is fighting for his life.
01:47Right, everyone clear then, please.
01:48Clear.
01:49Wait.
01:50..a child suffers multiple seizures and is unresponsive.
01:54Elena?
01:55I'm one of the doctors.
01:57..and...
01:58..he doesn't record the events at all.
02:00..a pensioner out for a cycle ride is seriously injured
02:03after colliding with a car.
02:05Do you remember what's happened?
02:06No.
02:07No.
02:07No they are fine.....
02:22Uhm...
02:24Ambulent's
02:24is his station breathing? Yes! He is
02:27breathing.
02:28He's just collapsed.
02:29He is awake at the
02:30moment? No. Does his breathing
02:32sound noisy?
02:33Yes! Is he breathing in
02:35and out
02:35normally?
02:36no he's not breathing out no he's not he's not breathing he's not okay you need to listen to
02:44what I'm about to say to you if he's not breathing somebody's doing compression
02:50okay you have a defibrillator there right now he's got the deep rib on him now continue doing
02:57the compression and then you need to turn on the deep rib and listen to it but get the person
03:01to
03:02carry on doing the compression the person that's doing the compression can they say push out loud
03:07so I know how fast they're going please push push push push keep going at that rate follow what
03:13the deep is telling you to do okay so we've got crews already on the way
03:21with a man collapsed and unresponsive but vitally being given CPR on scene the specialist life
03:27saving skills of dr. Laura Douglas beverage and critical care paramedic Hannah Hurst are urgently
03:33required as every second counts we've been tasked to your patient who unfortunately has gone into
03:38cardiac arrest they've had immediate bystander CPR and the crew have now arrived on scene we had to
03:47travel some distance so at the time that we arrived there will have been potentially in cardiac arrest
03:51for quite a prolonged period of time so in the time frame if we haven't got rust then we're probably
03:58not going to have a huge amount of margin in terms of what's salvageable yeah every year there are over
04:0530,000 cardiac arrests outside of hospital early CPR and defibrillation can double a patient's chance
04:12of survival although time is critical as less than one in ten survives oh they've actually now just
04:19had one shot for VF in so TL said initially a systolic now VF one shock given an ambulance crew
04:28are on
04:28scene okay so that's a bit more of a favorable possibility they'd shock the patient to encourage
04:35his heart to restart as yet it hasn't but there is some faint electrical activity known as VF the critical
04:45care team are needed for their expertise in cardiac arrest emergencies hello hello there guys
05:0572 year old retired college lecturer Steve was traveling with his wife Liz when they stopped to
05:11stretch their legs in reading services on the m4 after stepping out of the car he collapsed and went
05:17into cardiac arrest a Lucas machine is now giving vital chest compressions yeah so we are back into an
05:28asystolic rhythm yeah asystolic rhythm means Steve's heart still isn't beating so we'll need further shocks in the hope
05:35it restarts itself okay everyone stand clear please everyone clear shocking
05:50it's early morning at Thames Valley Air Ambulance HQ and critical care paramedic Barry Walsh and Dr. Henry Knott
05:59are collecting vital equipment and drugs only they carry out on the road
06:08when the first emergency of the day comes in another but very different motorway incident
06:29hi how can I help this emergency call is between two control centers in neighboring counties just take a call
06:37for an
06:38after you see on the m40 just border in with ourselves and you not a problem what details have
06:44you got so it's come through as a car flipped over into a verge so car roll over into that
06:50it's
06:51a junction 11 down to 10 and obviously may need some quick care both fire and police have confirmed that
06:59they're on me is that correct yes that's correct and it's unknown if patients breathing awake
07:20a serious crash with patients in potentially critical condition means the specialist life-saving
07:26skills and drugs carried by the code red team are instantly requested
07:32it's a road traffic collision RTC or the m40 it sounds like one car's come off the road and rolled
07:40and overturned down the sort of embankment and there seems to be two patients who are injured one who's
07:47still in the car maybe with pelvis or abdomen injury and the other one who's actually got themselves out
07:52of the car but um we don't know the extent of their injuries at the moment on average someone is
07:59killed or
07:59critically injured every 17 minutes on uk roads with their advanced training thames valley air
08:06ambulance critical care teams can deliver hospital level care at the roadside
08:15so they tell me that one patient is uh in the vehicle they're about to execute them and they've got
08:20concerns around pelvis and fever injuries the second patient is out of the vehicle
08:26henry and barry arrive on scene good job of getting in stuck in there where multiple emergency vehicles
08:33are in attendance yeah yeah operations commander steph white has been coordinating the ambulance
08:50service's immediate response to the incident and briefs dr henry so he's traveling 17 miles an hour
08:59this gentleman uh this gentleman uh was initially the p1 however i think they're probably both p1s
09:07given his blood pressure now as well okay a p1 designation means the casualty is of the highest priority
09:14this team have a line in access uh they have uh given one gram of txa and they are just
09:21popping a
09:22pelvic binder on because the position that we were in was quite tricky
09:25the driver of the car is already being treated in an ambulance on the hard shoulder
09:31fortunately the passenger has now also been extracted from the vehicle
09:35and you're both worried about their blood pressures and yeah yeah the one's more tachycardic
09:39than the other one tachycardic means their heart rate is fast hello causing blood pressure to drop
09:45can you open your eyes for me good man preventing vital organs like the brain and heart from getting
09:51enough oxygen to function normally what's your name okay gonna borrow your arm tom thank you sir
09:5828 year old tom was the passenger in the car when it crashed rolling down an embankment
10:03at the time he was asleep with his legs resting on the dashboard i'm henry one of the doctors just
10:09come to have a look at you this position could cause serious injuries to the lower half of tom's body
10:14do not let me delay you get the pelvic binder on potentially he's broken his pelvis and that risks
10:21life-threatening internal bleeding but there could be further undiscovered problems he looks a bit pale
10:56doesn't he
10:58she's having a seizure she's having a seizure and how old is she she's seven should we get this help
11:03arrange now stay on the line with me i'm going to ask a couple of questions has she been diagnosed
11:07with epilepsy yes she has got epilepsy she does move any objects out of the way to protect her head
11:13system hurt herself lose any tight clothing at her neck don't try to move her while she's having a
11:18seizure we have emergency treatment to use if the seizure doesn't stop yeah but this is her fourth
11:25seizure it's a fourth seizure back to back yeah and now this is the longest one you've got high
11:32priority ambulance range for her and you're staying with her until we get there i am with her
11:41you stay on here for six miles anyway okay with the patient just seven years old and suffering
11:47prolonged and potentially dangerous seizures dr tom porter and critical care paramedic lisa brown
11:53are instantly dispatched so we are um going to a seven-year-old girl who's having seizures the
12:01information suggests that it's a fourth seizure in a row it sounds like this girl is known to have
12:08seizures or to have epilepsy because they have some medications at home beyond that we don't have much
12:14more information in the uk epilepsy is one of the most significant long-term neurological conditions
12:21affecting over a hundred and ten thousand children in the country seizures are extremely serious and
12:28can prove fatal unless quickly dealt with there's certainly significant harm that can be caused if a
12:33child is having a prolonged seizure if that's the case we call it status epilepticus the priority is to
12:38stop the seizure also when people are fitting they may have a reduced level of consciousness which can
12:45mean that it's difficult for them to support their own airway and breathing and so sometimes we need
12:50to intervene from that point of view as well just 10 minutes later the critical care team arrive at
12:56the patient's house where an ambulance responder is already in attendance
13:04well hello how is she seven-year-old diagnosed with epilepsy she's not having seizure at the moment
13:11she is reacting to pain uh mom and dad give some buccal midazolam uh and just because the episode was
13:20longer than normally that's why they called midazolam is a drug used to stop seizures it's already
13:27prescribed to elena oh hello hello okay to come in yeah thank you hello there sir we're we're the critical
13:35care team my name's tom my name is lisa what's your name sorry my name is camille thanks camille thanks
13:43camille and who and who is this it's malena seven-year-old seven-year-old elena is autistic and has
13:50had epileptic fits from six months old people with autism are significantly more likely to have epilepsy
13:56than most due to underlying genetic and biological factors she had today four episodes of seizure
14:03activity unusually today elena's had multiple seizures mom and dad given her the thank you sorry
14:11midazolam what time was um 5 23 5 23 the activity stopped so the last seizure started 17 12
14:21in 17 27 it stopped elena hello hello hello a common side effect of midazolam is drowsiness
14:32so dr tom has to check she can breathe unaided well tom i'm one of the doctors okay so at
14:39the moment
14:39she's maintaining her own airway isn't she she is she is autistic she is not variable thank you
14:45that's really helpful to know so her baseline is is non-verbal not okay okay okay let's be breathing
14:51at an appropriate rate now had she stopped fitting by the time you got here she was not she's been
15:00like
15:01this yeah tom begins a primary assessment to check her vital signs she's got a nice strong radial
15:09good air entry she's got sat to 97 on air one two three four five she's warm and well confused
15:19she's got a normal tone at the moment although elena has stopped seizing elena hello darling there's
15:26further shocking news that could impact how the critical care team proceed around two weeks ago she
15:31has been involved in an rtc
15:44the airway's good breathing looks all right there are around 900 rtcs or road traffic collisions every day
15:53in the uk and on the hard shoulder of the m40 in oxfordshire dr henry and critical care paramedic
15:59barry attending to 28 year old tom yeah he's not breathing too quickly he's got a lot of bruising
16:07around his pelvis and no abdomen so i'm guessing abdominal can you ask him if he's got tummy pain
16:12if i press he doesn't okay okay tom was a passenger in a car that rolled down a verge the
16:18driver is
16:19already being treated in an ambulance although conscious tom's in critical condition with a
16:24potential pelvic fracture that could cause life-threatening internal bleeding tom i'm going to put a
16:30little candle in your arm sir so i can give you painkillers okay barry i know we said we'd stick
16:35together
16:35but he's intra-abdominal pelvis mainly isolated there is what am i working diagnosis and he's blood
16:41and go i'll have a quick look at him and then come and let you know the difference the team
16:46need to
16:46assess both patients to work out who needs their help the most so while henry checks on the driver
16:51in the ambulance barry prepares to administer morphine to tom for rapid pain relief the pelvic
16:57binder's on o2 is on he's got two points of iv access problem is c intra-abdominal pelvic five
17:03is these femur gone as well okay cool so we'll do start that out in the truck alongside the pelvic
17:09injury
17:10the ambulance paramedic also suspects a fractured femur the strongest and longest bone in the body
17:16that connects the hip to the knee so let's get him out of the cold because that's not going to
17:20help
17:20his coagulation we need another gram of txa txa is a drug to help tom's blood clot we'll start
17:27flooding the truck okay so priority is to just get him in out of the cold yeah i think just
17:33go just go
17:34yeah yeah with the driver sent straight to hospital henry's priority is now with tom
17:42okay how are we getting on here with that sort of plan of pelvic spend obs a suspected broken pelvis
17:48and pain in his abdomen indicates tom does have internal bleeding this can lead to organ failure
17:54even death i just want to confirm what we think is our blood pressure is our problem here just pelvic
18:00lab day he'll need a vital blood transfusion before he can be taken to hospital i think the volume and
18:07go
18:07is what it looks like
18:20that's his third shocking time fine third and total in the car park of reading services on the m4
18:27critical care paramedic hannah and dr laura are attending to 72 year old steve who's had a cardiac
18:33arrest currently he has no heartbeat or pulse and with every minute passing his chance of survival is
18:40decreasing so just to confirm we've still got oxygen in the cylinder okay so we'll need the next cylinder
18:46ready if we can get a new cylinder of oxygen please the team are using a lucas machine for chest
18:52compressions and shocking his heart using the ambulance crew's defibrillator get this pad behind
18:58once we've got that adrenaline on adrenaline is vital during a cardiac arrest it increases blood flow
19:04to the heart improving its chances of regaining a rhythm okay so my suggestion would be then hannah
19:12if you're happy to do the deep from our machine now on the new pads and then subsequently hannah will
19:18do
19:18dual sequential on both machines if the single shock from hannah's doesn't work everyone clear
19:24shocking lovely she'll try giving dual shocks using both machines okay okay and do we have any next of
19:30kin who are here with him somewhere fine the increased energy of dual shocks could encourage steve's heart
19:38to restart bringing ros or return of spontaneous circulation can we get fingers on a pulse just in
19:45case that rhythm has changed before we stop please the lucas machine is switched off so the team can
19:50gather precise readings from the monitor hopefully the single shock and adrenaline have been successful
19:55okay that is via the monitor is showing some faint electrical activity in steve's heart
20:01are we going dual but it's not enough to sustain life okay so chaps we're going to do two shocks
20:07back
20:07to back we don't go back onto the chest or touching until hannah's delivered the second one and given the
20:12instruction okay and both will be delivered by hannah right everyone clear then please clear wait thank
20:21you okay lovely stuff rhythm check fingers on pulses please first thank you okay we are asystolic back on
20:31even with the double shock steve is still asystolic his heart is yet to restart itself okay i've got fingers
20:38on a
20:38pulse pulse dr laura searches for any sign of life okay we have the odds complex i can't feel any
20:47pulse
20:47okay back on with the lucas sim please
20:52lucas battery after giving continuous chest compressions for 40 minutes the lucas machine's
20:58battery is running low and needs changing let's have a little bit of warning into the rhythm check so
21:03if you think aces is solid on the monitor steve's chances of survival are diminishing and whilst the
21:10lucas battery has changed okay i'm just gonna do some cp yeah hannah takes over
21:37nd25 message the hems desk over on the busy m40 motorway in oxfordshire
21:43critical care paramedic barry and dr henry are attending to tom a passenger in a car that's
21:49crashed down the embankment at the time he was asleep with his legs on the dashboard
21:56just an update here patient two the patient we are going to travel with um we're just getting into
22:03the dma probably going to start some volume and going to the jr but that's the update over tom's
22:09potentially broken his pelvis fractured his leg and has internal bleeding so the team need to
22:15give him a vital blood transfusion i want to get him on my monitoring guys please so he needs a
22:20blood
22:20pressure the critical care teams are the only people on the road allowed to do this do you want
22:25to start get some ketamine henry and i start doing some blood yeah yeah if tom has internal bleeding blood
22:33is seeping into body cavities instead of organs a transfusion restores red blood cells and the
22:38plasma that carries them vitally improving oxygen delivery what is this blood pressure
22:49okay right i need to keep him warm mates i'm closing the back here okay
22:59now i think this guy's femur's gone as well
23:03what i'm gonna do tom's i'm starting to give you some blood the blood bags will be attached to one
23:08of the cannulas i think you're bleeding in your tummy okay can i give you some fresh clean blood
23:14where does that hurt where is that hurt tom your tummy yeah okay mate that is flying through mate okay
23:23the transfusion is swiftly underway starting with the yellow plasma before the red blood cells are added
23:29tom they're going to give you some medical clean ketamine it's going to really help okay
23:34ketamine is then administered for rapid pain relief so blood pressure it's now cycling and connected
23:41and turned on with tom's pain now dulled with ketamine dr henry can properly assess his injuries
23:48i think he's done his left hip has he done his ankle maybe his pelvis yeah but it's not open
23:55no
23:55so i think we leave that it doesn't look that deformed the big bruising it's much shorter though yeah that
23:59left leg shorter uh femur swelling here so he might have done there was a lot of swelling there
24:06so he might have done his femur yeah let's do that tom just need to slip this up around your
24:12top of
24:13your leg okay pull your leg a bit straight because i think you've broken the big bone here in your
24:17legs
24:17sir it seems tom has broken his femur so it's critical the team realign his leg so the blood flow
24:24isn't compromised be as gentle as i can sorry sir give you more of that painkiller now all right
24:36okay sorry mate extremely painful but barry has to pull tom's leg down to straighten it using a
24:44kendrick traction device a splint designed to stabilize fractures so when you're
24:50in a position to tighten yeah i'll give him another 10. i'm ready tom just gonna put a little pressure
24:56on here mate okay stop sorry okay sorry tom sorry i'm just giving a bit more
25:05tom i'm gonna put some more pressure on this leg sir he might moan a bit but
25:16i'm gonna draw up some more ketamine yeah i am at the limit there now mate tom's legs are now
25:23equal
25:23in length and realigned i'll re-blanket him and then we're good to go yeah yeah mate blood pressure's
25:29good heart rate's okay sats has always been fine our primary survey just thinks pelvis left hip
25:35maybe femur maybe abs we'll just give him kits i mean on the way um do you want to start
25:40moving is
25:41that okay happy with that yeah man you're doing really well sir okay
25:52that rates now one two nine all right let's get the ivp on his left arm if we can please
25:58and can we get
25:59some undansetron up too please intravenous paracetamol will further help tom's pain
26:04while undansetron is an anti-sickness drug hello hello you're okay sorry you're in the ambulance
26:13going to hospital did you hurt your hip henry i'm one of the doctors we've given you some ketamine
26:20which is a good pen killer that's why you feel really weird but you're okay we're looking after
26:25you where am i you're in the ambulance going to the john radcliffe hospital oxford we're taking you
26:31to the hospital because you injured yourself it takes 32 minutes for the ambulance to reach the
26:36john radcliffe hospital yeah you'll be all right yeah where tom's admitted for further emergency
26:42treatment dr henry and critical care paramedic barry will shortly be ready for their next life-saving job
27:00she has been complaining of some abdominal pains okay in buckinghamshire critical care paramedic
27:07lisa and dr tom are attending to seven-year-old elena who's autistic and has epilepsy she has been in
27:13a
27:13hospital today she suffered multiple seizures there has been no history of head injury during
27:19that episode yeah two weeks ago she was hit by a car today before the the event she was actually
27:28holding her side which mom and dad says that it has been normal since the since the event okay elena
27:35ran in front of the car but fortunately it wasn't at speed and she was left relatively unscathed however
27:41it's possible the trauma could have sparked the seizures right now i think the picture we're
27:46seeing someone who's had the the benzos right but i think she's breathing in an appropriate way i don't
27:49think we need to intervene anyway at the moment one thing i was going to ask because we don't have
27:53one here can we get our nasal end tidal out and stick it on elena's airway is working normally but
27:58as a precaution tom wants to fit a nasal cannula to monitor her breathing in case things take a turn
28:04for
28:05the worse when is the last time before today that she had a seizure like this six weeks ago okay
28:14and
28:14can you tell me that it's normal for her um not to communicate verbally it's imperative that tom gathers
28:22all the information he can on elena's autism and epilepsy before making any decisions on how to proceed
28:29so today how has she been in herself then her lips went white and her face went pale and then
28:37she
28:37started going blue okay that must be really scary i think it's much more likely that what we're seeing
28:41is an epileptic seizure rather than a you know traumatic something from a traumatic injury tom's assessment is
28:48elena has most likely had a normal epileptic seizure not one triggered by possible brain trauma from the car
28:54accident which hospital does she normally go to for her epilepsy kit stoke mandeville she definitely
29:00needs to go to hospital and the reason she'd go to hospital is to be observed i don't think we
29:04need
29:04to do any sort of critical interventions to reassure you as elena doesn't require any further treatment
29:10at the scene tom is happy for her to be taken to stoke mandeville hospital okay okay there we go
29:17hello you
29:19ready prepare lift and i'll just load down now happy
29:31hello hello everyone on the back of an ambulance on you yeah
29:39i'll keep the blank off because hello we're clearly seeing a significant improvement yeah
29:45uh i'm i'm i'm more inclined to not go with that i'm i'm happy because she has nicely recovered
29:53happy to not go with happy to not go with yeah the very good news is that elena seems to
29:58be recovering
29:58well all the best mum you take care see you later the critical care team are confident they're not
30:05needed for the onwards journey the next steps now is for her to go to stoke mandeville hospital
30:10they will probably just do a period of observation but obviously if things do deteriorate then
30:14she's going to be in the right place with the right people to obviously manage manage her epilepsy
30:21two six hems there thank you just so that you know we are now clear on seeing a ground assist
30:27and if you are leaving yeah he's right then yeah i think he's unconscious he's unconscious yeah patient has been
30:52is he responding at all no he's not responding yet he's got a head injury and no helmet he may
30:58have a neck injury okay i was just uh walking past how long's the ambulance i'm just arranging
31:06the help now do you know how old roughly he is i don't know about 80. he's responding but not
31:13fully so he's making some noise but not verbalizing fully he's got any bleeding he's bleeding from a
31:20head injury with a report of an elderly gentleman who's semi-responsive with a head injury after
31:30being knocked off his bike and not wearing a helmet dr asha lewinson and critical care paramedic matt
31:36bailey are immediately dispatched right we're going to road traffic accident
31:4680 year old knocked off bush bike by car not wearing a helmet bleeding from head a little
31:52vehicle on scene anyway at the moment my heart goes out to this guy if he is actually seriously injured
31:58on average two cyclists die and 80 are seriously injured every week on uk roads although wearing
32:05a helmet can significantly reduce the chance of a serious head or spinal injury
32:11we don't know much information at the moment we know that it looks like it might be an 80 year
32:16old gentleman who's been on a push bike and been hit by a car 46 of bike fatalities result from
32:23collisions with cars sounds like he might have a head injury and possibly reduced conscious level
32:30we're not far from seen so we've been sent quite early basically head injuries can be extremely serious
32:37so keep your eyes peeled now for where we're heading potentially resulting in skull fractures and damage
32:43to the brain oh there we go there's a truck down the left i'll pull over just onto the other
32:49side of the rear red zone
32:57we'll come back for anything else we need sounds good
33:03hello guys you all right an ambulance crew are already in attendance and have moved the patient
33:08into their vehicle uh christian 84 year old gentleman was riding his bicycle around the roundabout this
33:13morning he's fallen to the ground bike's gone under him sustained a head injury left hand side
33:18approximately four minutes loss of consciousness um was assisted off the road by uh parcel by and we
33:26brought him in he has been quite significantly hypertensive with us he is not known hypertensive
33:32hypertension means 84 year old retired teacher christian has high blood pressure potentially as a result of
33:39the accident it can elevate the risk of both a heart attack or stroke and there's also another
33:45concerning problem he doesn't look for the events at all
34:10he has been able to in the corner's address in high wickham 84 year old christian was riding his
34:16bicycle when a car knocked him off he lost consciousness as a large swelling on his head unusually
34:22high blood pressure and can't remember the event you guys happy i'll just do a quick doctor
34:27term we'll see what we're up to hello young man dr asher and critical care paramedic matt are on scene
34:33how are you doing no i don't remember what what went to all this memory loss or amnesia is extremely
34:41concerning it could mean christian has a traumatic brain injury okay what's your what's your name christian
34:49christian my name's ashton one of the doctors of the air ambulance all right this is matt one of
34:52my colleagues over here hi christian all right um do you remember do you remember what's happened
34:57no no okay when assessing for a brain injury medics use the glasgow coma scale or gcs
35:03to measure a patient's level of consciousness you're on your bike and you you've uh you've been knocked
35:09over you've fallen off basically and you've hit your head remember any of that no no no okay all right
35:14it evaluates three areas eye opening verbal response and motor response do you know where
35:21you are at the moment well i'm in an ambulance that's right it scored between three the worst
35:28and 15 the best do you know where you are at the moment other than the ambulance the area you're
35:34in
35:35well i mean i work them but i'm not sure exactly where i live okay all right do you know
35:40what day it
35:40is today uh no i'm not sure okay i normally i usually know what the day is all right mate
35:49you're
35:49if i just have a quick look at you if that's all right dr asher begins a primary assessment if
35:54i press
35:55down here no pain at all nothing there no nothing there and all over okay so no pain in the
36:00neck at all
36:01you've been moving your head and neck have you okay no that's good asher first wants to rule out
36:06any neck or spinal injuries and look the other way for me and back again and put your head back
36:13up look
36:13up towards the ceiling look up towards the ceiling and turn your chest and there's no pain anyway when
36:17you're doing any that put your chin down to your chest head down okay no pain at all when you're
36:23doing
36:23that no no okay let's have a quick listen to your my head hurts now he needs to assess christian's
36:29chest
36:29and look for injuries such as fractured ribs do you press in and out good okay you might bilateral
36:37air injury good and any pain if i press here no pain no pains no obvious chest injury matt i
36:45think
36:46from that point of view obviously the head injury a little bit dazed okay but not massively confused at
36:52moment the early signs are good right young man no pain in the no pain in the hips areas at
36:58all okay
36:59keep this leg straight i want you to lift this leg up off the bed for me if you can
37:02but keep it
37:02straight perfect good pop that down better than i can do that and this one as well perfect good okay
37:08so my abdomen's abdomen feels okay pelvis looks symmetrical long resort attack so actually apart
37:14from the head there's nothing else i think i've got at this point in time christian's motor skills are in
37:20excellent shape but he does have a head injury possible amnesia and high blood pressure do you
37:26know when the last time is you've had your blood pressure checked when the last time you've seen
37:30the doctor is no christian's high blood pressure could be a result of the accident or an underlying
37:39condition i wonder if that might be a long-standing background kind of issue from that point of view
37:44however as he is in a dazed possibly concussed state the crew are unable to confirm we're going to be
37:52taking you to the hospital all right yeah you've had quite a nasty bump on the head you've got you've
37:58got quite a nasty swelling over here we're probably going to need to do a scan of your head and
38:03the only
38:03place we can do that is in the hospital thank you mss from uh 25 asha radios the thames valley
38:09air
38:09ambulance dispatch desk yeah mate just let you know this gentleman's pretty much a gcs of 50 now
38:18he's had a bit of a knock and had a period of amnesia but he's uh he's doing okay at
38:22the moment
38:23asha estimates christian's gcs at around 15 the best possible number on the scale
38:32happy day happy guys all right brilliant thanks guys with christian stable asha is happy for the
38:38ambulance crew to take him to the john radcliffe hospital around 30 minutes away he'll probably
38:45get some scans so a ct scan perhaps an x-ray um of any other areas of his body if
38:50he had some pain
38:50that didn't present initially and then from there they'll observe and go with the findings that those
39:07scans that those scans show
39:07we're going to go eyes in on this tube for a couple of minutes okay so you're happy with timings
39:12and
39:12drugs and yeah fab thank you in reading services 72 year old steve's heart has stopped after a cardiac
39:18arrest the lucas machine battery was also running out after 40 minutes of mechanical chest compressions
39:25it's now been changed when you're ready we're following the screen uh vl is down here thank you
39:31thank you and we've still got suction we've got everything ready to hand happy yeah lovely stuff
39:37dr laura wants to intubate steve so they can take over his breathing mechanically should he regain a
39:43heartbeat okay okay so view i'm through the chair that feels nice yeah lovely that's that feels really
39:54nice there okay okay i've got the bg a laryngoscope is inserted so laura can see steve's airways
40:01as the intubation is performed there we go when we're through first and second lines and that is
40:0724 at the teeth okay half is up lovely stuff let's connect up steve is successfully intubated
40:17can we just get fingers on that pulse david before we pause hey a sisterly but his heart isn't regaining
40:23rhythm we've been in a sisterly now for what about 12 12 minutes 16 minutes steve's had no heartbeat
40:31for a substantial period of time hannah i feel like we're starting to reach the point of futility but
40:36i'm just aware team-wise to bring that in yeah so this monitor's been on for 40 minutes fine okay
40:42yeah and the aed was on for some time prior yeah so i've got fingers on
40:49okay that is a sisterly on the monitor okay so just in terms of where we're at at the moment
40:55so we're now
40:55a good what time is it now 40 minutes in okay so we're 40 plus the bystander cpr time almost
41:03an hour
41:04in we've gone from a vf rhythm into now in a sisterly which has been sustained for approximately 14 minutes
41:10so i think we are at the point where everything that could be potentially done is being done and
41:16hasn't then gotten the rust and i think we are probably reaching that point of futility
41:21um and i think speaking with family making sure that they're aware of that is important
41:26with steve's heart's delayed systolic or flatlining after nearly an hour of critical intervention from
41:31the team there's sadly little else they can do laura speaks to his wife liz hello there is it liz
41:39yes i'm so sorry it's taken a little while to come to you my name's laura i'm one of the
41:43doctors
41:43so i'm sure i'm sure you've kind of been aware that unfortunately things have deteriorated quite
41:49quite drastically today we very much have been trying to do everything along with the ambulance service
41:55but i think everything that could be done has been but i'm so sorry we haven't been able to change
42:02the situation but at this point if it was that we think that continuing isn't going to change anything
42:07we would always want to give family the opportunity to be with them if that's something that you
42:13would want at the point that we stop i know it's an incredibly difficult thing no it would please
42:18yeah give me just a moment and i'll come straight back to you darling okay okay
42:25okie dokie so um here's wife is um aware and understanding of the situation she's in agreement
42:31that to continue on unnecessarily wouldn't be the right thing and she does wish to be present
42:35at the point that we would stop okay a sisterly on the monitor okay so i would suggest that we
42:42pause on any more adrenaline hannah are you happy for a family member to be brought to you yeah
42:46absolutely okay
42:51supporting the patient and their family through what then becomes the final stage of of their life
42:58is actually something that we would count as a real privilege and supporting family members through
43:03what inevitably will be the the hardest day of their lives is a real privilege too and something that
43:09i think we all would uh certainly not take lightly and take a great deal of care to bring as
43:16much
43:16dignity and and sensitivity to as we can
43:21you
43:49so
43:59so
44:27if you
44:30so
44:30you
44:30you
44:30you
44:30you
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