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00:00In the intense world of medical emergencies...
00:03Dissipation, breathing.
00:04Blood! She's blood!
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 and is becoming less talkative.
00:23The rapid response vehicles of the Thames Valley Air Ambulance...
00:26I wanted to have 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.
00:43..reacting 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.
00:57Whenever...
00:58Do you think it's harsh?
01:00Potentially, yeah.
01:01..and wherever...
01:02Oh, my leg!
01:03..it's needed.
01:04You are doing a fantastic job.
01:06Filmed over three months...
01:08Put this up your arm, my dad.
01:09Let's give you some of this morphine.
01:11Just be aware you might stop spontaneously ventilating.
01:14I have the tube.
01:15..we captured every vital second...
01:18That's okay.
01:19You're safe.
01:20..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.
01:30..when every second counts.
01:32Let's go, go, go.
01:34Tonight, a motorcyclist could be critically injured
01:37after crashing his bike.
01:39Ryan, have you got any pain in your chest?
01:41Oh-ho!
01:42Is he responding to you?
01:43No.
01:44..a toddler suffers a potentially life-threatening seizure.
01:47He's now got repetitive itics.
01:49I think he's still too easy.
01:51Yeah.
01:52The critical care team treat a woman unable to breathe.
01:55You've got...?
01:56Asthma.
01:57Asthma.
01:58COPD.
01:59A heart murmur.
02:00Emphysema.
02:01And...
02:02..a three-metre fall from hay bales ends in serious injury.
02:06I think the best thing for us to do
02:08is get you out of here and into hospital.
02:11It's 5pm at Thames Valley Air Ambulance HQ
02:23in Stoke and Church, Buckinghamshire.
02:25We can rest it on top of that, can't we?
02:27Dr Tom Porter and critical care paramedic Barry Walsh...
02:30Ready here?
02:31Yep.
02:32..are checking their state-of-the-art medical kit...
02:34I don't believe you.
02:35..containing specialist life-saving drugs
02:37not carried by regular ambulance crews.
02:40Mass penitentiary.
02:41Yes.
02:42They need to be prepared for every eventuality.
02:45All right, for now.
03:03Angulance, an urgency.
03:05Is the patient breathing?
03:06Yes, it's somebody...
03:08..he's had a motorbike accident.
03:10Yeah.
03:11Are the police required?
03:12I wouldn't know.
03:13We think he's broken his right arm,
03:15but he's in a lot of pain and he's crying.
03:17He hasn't got his helmet to come off.
03:19Does he look like he's struggling desperately for breath?
03:22Um, no, cos he's... I can hear him.
03:25He's in a lot of distress,
03:26so he's obviously drawing breath in as he's, um, crying.
03:29Is that him I can hear?
03:31Yes.
03:32Can you just reassure him,
03:33tell him that an ambulance is coming on blue lights and signs?
03:35Ambulance is on its way.
03:38With a serious motorbike accident on a busy road,
03:40Dr Tom and critical care paramedic Barry are scrambled to the scene.
03:43We go to a 21-year-old male who has reportedly come off his motorcycle
03:47and is reportedly in a ditch, screaming in pain.
03:49Motorcycles make up just over 3% of all registered vehicles on UK roads,
03:52yet they account for almost 20% of all road fatalities.
03:55You think about the scene, er, patients, it sounds like it could be in a challenging to access a place,
04:13you know, so physically if he's in a ditch, it might be quite hard to get to him.
04:18Injuries can be extensive.
04:20At this stage, there's lots of unknowns.
04:22From a life-threatening head trauma to internal bleeding that can prove fatal.
04:27Managing pain is certainly something we should, er, be focusing on doing as early as possible.
04:33One of the most commonly used painkillers that we use,
04:36which is a strong painkiller, is ketamine.
04:38You can typically give that, er, do an IV cannula, intravenously.
04:45With an ambulance crew already on the scene,
04:47I'm just going to leave the car here.
04:49It takes just 16 minutes for the critical care team to arrive,
04:53armed with their advanced life-saving drugs and expertise.
04:56Hi, guys.
04:58Hello, I'm Tom, and this is Barry.
05:00Hi, sir. Hi.
05:02OK.
05:03This is Ryan.
05:04This is Ryan, OK.
05:05He was just found by the general public.
05:07Yeah.
05:08The motorbike is found on his side on the road.
05:11A patient was found in the bushes here.
05:13After finishing work, 21-year-old factory employee Ryan went for an evening ride
05:18but lost control on a corner and crashed into a ditch.
05:22I've gone head-to-toe.
05:24I've got C-spine tenderness.
05:26I've got a head injury concern.
05:28He did have a helmet on.
05:30We can't find the helmet.
05:31We've got a right-side shoulder injury.
05:34Just started doing some odds.
05:36Ryan, I'm Tom, one of the doctors, mate.
05:38Where's all your pain?
05:39Your arm.
05:40Which one?
05:41This one?
05:42Unsure of what speed he was doing, Ryan's impact with the tarmac
05:45will have been significant for his helmet to come off.
05:49Clearly in agony, Tom needs to do a full body assessment
05:52to rule out anything life-threatening.
05:57Ryan, have you got any pain in your chest when you take a breath in?
06:02And out.
06:03Does it hurt your chest?
06:04No, OK.
06:05Take breath in for me.
06:06OK.
06:07And again, take breath.
06:10On top of the pain in Ryan's arm,
06:12signs of confusion could indicate potential brain trauma.
06:16He needs strong pain relief and extracting fast.
06:35Ambulance emergency.
06:36Is the patient breathing?
06:38No, she's not.
06:39She's collapsed on the sofa.
06:41She's an asthmatic.
06:42She's a COPD.
06:43I'm just going to hold on a mobiliser now.
06:46OK.
06:47So is she breathing at the moment?
06:48She's very wheezy.
06:50She's struggling to breathe.
06:52Right.
06:53Is she awake?
06:54She is awake, but she won't be so long.
06:56We've got the health arranged.
06:57It is our highest priority response.
06:59Are you staying with her until that health arrives?
07:02I am staying with her.
07:03Yeah, I'm her daughter.
07:04Come on.
07:07In the UK, almost one and a half thousand people a year die from asthma attacks.
07:12The powerful drugs carried by the critical care team could mean the difference between life and death.
07:17So Dr. Henry Knott and critical care paramedic Charlie Shorthouse are dispatched.
07:22There's a 48-year-old female who's having difficulty in breathing.
07:26So, and there's quite noisy breathing by the sounds of things.
07:31So that could be sort of an asthma attack or COPD.
07:35So we get, yeah, we've been sent because she's in quite significant respiratory distress.
07:41COPD, or chronic obstructive pulmonary disease, are a group of progressive and incurable lung conditions
07:48that cause breathing difficulties.
07:50If not treated properly, it can be fatal.
07:53Previously, she's had similar episodes that have sort of resolved by the sounds of things.
07:59But we'll see how she looks.
08:00Here we are.
08:04Nice.
08:05Good driving.
08:07Just 19 minutes after receiving the call, Henry and Charlie arrive,
08:11where an ambulance crew is already on scene.
08:17Hello.
08:18Oh, hi, come on this way, sorry.
08:20How you doing?
08:21Yeah, good.
08:23Thanks, mate, for coming out to find us.
08:25That's all right, no worries. They're just in here.
08:28I'll let you go in this big crowd.
08:29No worries.
08:30Hi, everyone.
08:31Now they're here.
08:32Dr. Henry and critical care paramedic Charlie need bringing up to speed.
08:36This is Trisha.
08:37Trisha's got quite a complicated history with asthma.
08:39Initially, it starts with a little bit low, around about 80.
08:42But we've popped her onto a nebuliser.
08:44She's still had the pauses, still had quite a silent, sounding chest.
08:49She's previously been given adrenaline and hydroxychloroquine, which we've done today as well.
08:54Okay.
08:55And one with blood-brain asthma.
08:57Hello.
08:58Colour's improved a bit.
09:00And the pausing isn't there at the moment.
09:03Okay.
09:04Hello.
09:05I'm Henry.
09:06I'm one of the doctors.
09:07What's your name, sir?
09:08Trisha.
09:09Although the ambulance team have already treated 48-year-old Trisha with a nebuliser and drugs,
09:14a silent, sounding chest is a potentially fatal situation.
09:18Yeah.
09:19Trisha, can I just ask you a few questions?
09:20Dr. Henry needs to do a rapid assessment.
09:23In Bicester, Dr. Tom and critical care paramedic Barry are treating Ryan,
09:52who's trapped in a ditch in serious pain with a possible fracture and potential brain trauma
09:57after coming off his motorbike.
09:59So, we're on the road somewhere near Bicester.
10:03Okay?
10:04That's where you are at the moment.
10:06Okay, mate.
10:07I understand why you're confused.
10:08You're going to have a bit of an accident.
10:09All right?
10:10I'm going to take good care of you, mate.
10:12ND026 patient side.
10:15Can I request a second DCA?
10:17Can I get a TVA for traffic control?
10:20And can you also get the fire brigade down here to assist at extrication?
10:24So, we're going to pop in a cannula, give you some strong painkillers,
10:28and before that, we're going to give you something to breathe in.
10:30Okay.
10:31I'm going to pop this in your mouth.
10:32What is it?
10:33What is it?
10:34It's called Penthrox.
10:35It's like...
10:36Have you ever seen gas and air that people take when they're given birth?
10:41It's like that, but better.
10:43Penthrox is often the critical care team's first step in relieving pain.
10:48Inhaled, it's fast-acting, offering temporary pain relief before a cannula can be fitted,
10:53which will allow instant access if they need to administer stronger drugs intravenously.
10:58You keep going with that.
10:59Now, for a minute or so, you'll just start to feel the effects.
11:01It's good stuff.
11:06Sarah, thanks.
11:07The helmet is right in the head, so...
11:09Was he wearing it, did you think?
11:11Obviously, he was wearing it, but like...
11:13It wasn't here when the bystanders found him.
11:16Can you keep going with the light?
11:17Just like that.
11:18When time and clarity of thought is crucial, bystanders are an unhelpful distraction for
11:24the critical care team.
11:25Who are you?
11:26Sorry.
11:27I thought it was my God's plan.
11:28Okay.
11:29Is it?
11:30No.
11:31Can you give us some space, please?
11:32Excuse me.
11:33Do you want to know him?
11:34No.
11:35Do you want to step away, then?
11:36Yeah.
11:37Hi, Hemp's Desk.
11:38It's 2-6 here.
11:39Can I just get an ETA for the police?
11:40Because there's now lots of people just randomly showing up.
11:43We really need help with some crowd control.
11:44We really need somebody to close the road.
11:48Tom and Barry urgently require help to clear the public and extract Ryan.
11:53I'll get a blizzard on the bed and I'll get all that kind of set up.
11:57Well, I'd like to make you feel like that much.
11:59Yes.
12:00Sorry, I should have warned you.
12:01It makes you feel a bit woozy.
12:02And that is quite normal.
12:03I'm just driving.
12:04You just go with it, mate.
12:05Just go with it.
12:06No.
12:07Ryan, what is your pain like now?
12:10You've had that penthox on board.
12:12How bad is it?
12:13So we've put a number on it.
12:14So 10's worst pain ever.
12:16Zero's no pain.
12:18What's your number at the moment?
12:19It feels like it's five.
12:20Five.
12:21Okay.
12:22Although the penthox is dulling his pain, stronger painkillers will be needed before Ryan can
12:27be lifted out of the ditch.
12:29I reckon we can give you a little bit of this drug we've got called ketamine, which
12:33is a very good, good painkiller.
12:35You've probably heard of it.
12:37Is it dangerous, though?
12:38It's not dangerous when it's given by us.
12:40Yeah.
12:41But it is a powerful drug.
12:42You're correct.
12:43On the road, Barry is preparing for Ryan's extraction so he can be cared for in the ambulance.
12:50If we try and get the scoop sized up, that'd be brilliant.
12:53Thank you so much.
12:54Bye, mate.
12:55I've got fire coming to just help with extrication with more hands.
12:58What I would really appreciate is just keeping people out of my scene and just keep public awake.
13:03Now the fire brigade need bringing up to speed quickly.
13:08Hello, guys.
13:09Hi.
13:10How's it going?
13:11He's got right-sided injuries, including his shoulder, so it's going to be a delicate lift
13:15out with hand passing and lots of assistance.
13:16Okay.
13:17So then, essentially, that's why you're here.
13:20I wonder if you could help us, please.
13:22Yeah.
13:23Would you be able to get two grams of TXA drawn up, please?
13:26Yeah, absolutely.
13:27Because we're going to give that.
13:28Of course.
13:29I'll leave this with you.
13:32To counteract any potential internal bleeding, TXA, or tranexamic acid, stops blood clots
13:38breaking down and reduces blood loss.
13:41I'm going to have to strip off these, okay?
13:43I'm going to have to cut through them to take off your trousers.
13:46I'll leave your jocks on for now, but in case you need to put something around your hips,
13:50you need to get down to your skin.
13:52Do you have pain in your neck?
13:54At least.
13:55Before Ryan can be moved onto the scoop stretcher, Dr Tom carries out a final series of checks.
14:01Do you have any pain when I press here?
14:02Yeah.
14:03What, when I press on there?
14:04Yeah.
14:05It's sore, is it?
14:06Yeah.
14:07Okay.
14:08It's like dead in the middle.
14:10Okay.
14:11He's moving his legs.
14:12Yeah.
14:13His legs are fine.
14:14My right.
14:15I'm going to have to help you straighten your neck a bit.
14:17Can I do it very, very gently?
14:19If it's really painful, we'll stop.
14:21Okay there?
14:22Yeah.
14:23You're still in a bit of a twisty position.
14:25We're going to straighten you up.
14:26Uncross your legs, Ryan.
14:27Sorry.
14:28You're fine, mate.
14:30Keep going with this.
14:32I'm thinking ketamine when we, as soon as we start moving in.
14:36So if we get three people on the left-hand side here, folks, or the patient's right,
14:40should I say, and get yourselves nicely out, nussled up next to him in comfort,
14:44and then we're going to roll towards you when we're ready.
14:47Almost set for the extraction, it's time to administer the ketamine.
14:51I'm going to give you a bit of injection of the strong painkiller.
14:54Yeah?
14:55So I'm just going to give him 10 milligrams to begin with.
14:57Relax that arm, Ryan.
14:58That's it.
14:59So this medication makes you feel a bit wheezy, but it's a good painkiller.
15:02All right?
15:03So I think that's going to help when we move you, just in case it's a bit sore.
15:06Okay?
15:07Good man.
15:08A sedative and strong analgesic, ketamine can only be administered at a scene
15:12by the critical care team.
15:14Everybody ready?
15:15Good.
15:16On row.
15:17Ready, brace, row.
15:18Stop.
15:19Well done, mate.
15:20Well done, mate.
15:21Take the gas.
15:22Take the gas, buddy.
15:23Take the gas.
15:24Breathe that gas in.
15:25Breathe that gas in.
15:26Nice deep breaths a bit.
15:27Good man.
15:28Well done.
15:29And we're going to very gently lower and roll back on command, okay?
15:32Ready, brace, lower.
15:34Brilliant.
15:37You okay there, Ryan?
15:38I know, mate.
15:41Once secure on the scoop...
15:44A bit sore again, Ryan?
15:46Uh-huh.
15:47Okay.
15:48...and extraction can begin.
15:49Okay.
15:50Ready, steady, lift.
15:51Smashing.
15:52Well done.
15:53Ready, steady, down.
15:56All right.
15:58Put this on your head just for a second, okay, dude?
16:00Are you okay?
16:03Right, let's go.
16:04Nice and gently.
16:06Well done, pal.
16:08Take some of the gas there if I move the mask, will you?
16:13Yeah?
16:14Good man.
16:15So, hold that for me.
16:17Nice and gently does it.
16:24Right, then.
16:25Ryan, we're in the ambulance now.
16:26Bit warmer for you, hopefully.
16:27Safely in the ambulance, but with Ryan still in agony from the fracture and the ketamine
16:34wearing off...
16:35Patients are in the back of the ambulance.
16:37...Barry calls the dispatch desk to brief them.
16:39Finished our assessment, so it's just ongoing analgesia requirement from us.
16:43So we will travel to the JR with the patient.
16:46Dr. Tom and critical care paramedic Barry accompany Ryan to the John Radcliffe Hospital in case
16:53his condition deteriorates.
16:55After a 20-minute journey, Ryan is handed over to the emergency team for urgent diagnosis
17:00of his injuries.
17:02In here, he'll probably get a trauma scan, just to see if he's bleeding or if he's got
17:07any obvious injuries anywhere.
17:08He'll get some more analgesia and just anything else that he might need.
17:13...Ambulance emergency, is the patient breathing?
17:32Yeah, he's having a t-shirt.
17:34How old is the patient?
17:35Two.
17:36Has he been going later after that, see?
17:38No, he hasn't.
17:40Okay, is he awake?
17:42No, I think he's asleep.
17:43Is he still breathing in a regular pattern?
17:45I wouldn't say it's regular, no.
17:47Okay.
17:48So if you just double-check for me, if you look at his chest, is it rising and falling
17:52in a regular pattern?
17:53It's rising and falling.
17:55Is he responding to you?
17:57No.
17:59Is he nice?
18:00We've got a high spread down, but I'm putting away for you.
18:02Are you okay?
18:08Dr John Bailey and critical care paramedic Lisa Brown are four hours into their night-time
18:13shift when the call comes in.
18:16This is a two-year-old status P1 request.
18:20With the patient just two years old, the emergency is given P1 status or priority one, indicating
18:26an immediately life-threatening situation requiring urgent intervention.
18:31The advanced life-saving skills of the critical care team are needed, so John and Lisa are dispatched.
18:38So this is almost certainly a febrile convulsion.
18:42So this is a child who has a high temperature, is currently having a seizure.
18:49Febrile convulsions can be common in very young children, affecting around 5%.
18:54So they're obviously quite terrifying to watch if you're a parent.
18:59And so they're quite stressful for crews.
19:02Almost nobody has profound levels of comfort with dealing with sick children, even if that's
19:08what you do for a living, they're still quite scary things.
19:11A seizure usually lasts anywhere between 2 and 15 minutes, much longer, and they can
19:18potentially cause brain damage.
19:20With a sustained seizure of now more than half an hour, it's likely that this child
19:26will require some degree of ventilatory support when we arrive.
19:29An ambulance crew is with the child, but seizures can lead to oxygen depletion.
19:3417 minutes have now passed, so before taking him to hospital around 40 minutes away,
19:39the young boy needs to be stabilised, meaning the crew needs a rendezvous with Dr John
19:44and critical care paramedic Lisa.
19:4627, go ahead.
19:4727, the crew have just closed this scene.
19:51We're just trying to establish a good RV point.
19:55We're three minutes away.
19:56Just keep going to the scene for now.
19:57I don't know if there's holes on the phone with me in case anything changes.
20:03Ed, can you hear us?
20:04Yeah.
20:05There's the ambulance.
20:06I've got them.
20:07I've got them.
20:08I've got them.
20:09Yeah.
20:10Yeah.
20:11We'll leave you now, Ed, thanks.
20:12Critically, John and Lisa have quickly located the ambulance's position, so can now assess
20:17this potentially life-threatening emergency.
20:19OK, we're going into Sainsbury's car park.
20:43In Chesham, Dr Henry and critical care paramedic Charlie are at the home of 48-year-old Trisha,
20:49who has chronic lung disease and is struggling to breathe after a life-threatening asthma attack
20:54whilst out walking with her daughter Chelsea.
20:57When did it start getting a bit breathless?
21:00We were just walking back home about nine o'clock.
21:02A bit of a walk.
21:03Where did you go?
21:04We literally just went down the road and back again.
21:06OK.
21:07And you were OK before that?
21:08She was all right, because she met me...
21:10Originally, she met me from work.
21:12OK.
21:13I finished work at half past seven tonight.
21:15And obviously, it takes us...
21:16Even though it's not that far, but it takes us a little while to get back home.
21:19Did it sort of come on quite quickly?
21:21Yeah.
21:22And that was what time?
21:23Around nine o'clock tonight.
21:24OK.
21:25So you started getting breathless, walking home.
21:28Walking home.
21:29You managed to walk home and you sat here and felt breathless.
21:31Yeah, I...
21:32She...
21:33She kept...
21:34My daughter kept me up.
21:35OK.
21:36Because this is similar to what's happened before.
21:37Yeah.
21:38And have you got any pain?
21:39Every now and again, she will get pain in her chest.
21:42Yeah, OK.
21:43Recently, she's been diagnosed with every semiah.
21:46OK.
21:47And have you had a cough or fever today or anything?
21:48She's had a cough.
21:49I've had a cough.
21:50And you've had similar episodes like this?
21:52Yeah.
21:53OK.
21:54How are the medical problems you've got?
21:55Asthma.
21:56Asthma.
21:57COPD.
21:58A heart murmur.
21:59Emphysema.
22:00And emphysema.
22:01Tricia has had asthma since childhood and was diagnosed with chronic lung disease five
22:06years ago.
22:07Just have a look at you.
22:08Right.
22:09Just look at your lower legs first.
22:10I'm going to get out of the way of these guys, OK?
22:11I'll just have a listen to your chest now, OK?
22:13Let them work on you, OK?
22:14Just have a listen.
22:15You're OK?
22:16I'm her youngest daughter.
22:17OK.
22:18Nice to meet you.
22:19But I've got a dead foot.
22:20OK.
22:21Sorry.
22:22Thanks.
22:23So I'm going to let you guys work.
22:24And if you need me, give me a shout.
22:25How do you find the inhalers?
22:26Do they help the salbutamol and things?
22:28Sometimes.
22:29Yeah.
22:30I've got my own nebuliser.
22:33Nebulisers enable high doses of liquid medication to be quickly delivered by turning it into
22:39a fine mist that is inhaled directly into the lungs.
22:42But despite using it, Tricia is still struggling.
22:46I can't hear a wheeze.
22:48So obviously there's difficulty breathing.
22:50I might have a bit of a chest infection which just exacerbated your asthma a little bit.
22:54That seems the most likely thing.
22:56With a suspected chest infection and a risk of further attacks, Tricia needs to get to hospital.
23:02With asthma attack, that would probably be the safest place.
23:06Yeah, I know.
23:07But every time I get there, there's nothing.
23:10OK.
23:11And you're aware that if your asthma was to get worse at home, that you could be potentially
23:15sort of, like, fatal and get worse.
23:17Yeah, but I've got my daughter here with me.
23:18I've got my daughter here with me.
23:19I've got someone here with me all the time.
23:21Yeah.
23:22So the benefit of going to hospital would be they can keep an eye on you and get an asthma
23:25specialist nurses to see you.
23:26Yeah, but I'm on the respiratory team.
23:27If you were to get worse, they've got treatment.
23:28I'm on the respiratory team myself.
23:30And they give you antibiotics in the vein if you needed.
23:32Yes.
23:33So I'm just saying that would be the benefit of going to hospital tonight.
23:35What do you think?
23:36Yeah.
23:37No.
23:38And why not?
23:39You also have some adrenaline, Tricia, which can improve your asthma symptoms.
23:40Yeah.
23:41But once that kind of wears off, you can get worse again.
23:44Yes, I know.
23:45And that could be when we've all left.
23:46I know.
23:47I know.
23:48I mean, obviously, normally when I've had the adrenaline, I'm fine.
23:53But have you got antibiotics?
23:54I'm on them now.
23:55Okay.
23:56I started it this morning.
23:57And steroids?
23:58Prednisolone?
23:59Yes.
24:00You got that?
24:01You started that?
24:02Yeah.
24:03Because I get an emergency pack from the doctors.
24:04Yeah.
24:05So I've always got it with me.
24:06Okay.
24:07And you could make an appointment with the GP tomorrow or something.
24:08Yes, I will call the GP tomorrow.
24:09Or call your specialist nurse or something like that.
24:10Yeah, I will call them tomorrow.
24:11And I've also got a respiratory investigation team.
24:14Excellent.
24:15Yeah.
24:16That's good.
24:17It sounds like you've got a good team looking after you.
24:18Yeah.
24:19That our advice is to go to hospital.
24:21Now, like I said, it's entirely your decision.
24:23Yes.
24:24If you don't want to go to hospital, that is fine.
24:26Yeah.
24:27But you just need to understand that if we do leave you here, you may deteriorate.
24:31Yeah.
24:32Which is why our advice is to go to hospital.
24:33Yes.
24:34But if you...
24:35So you understand you might deteriorate.
24:36You might become very poorly once we've left.
24:39Yes.
24:40That's a possibility that that might happen.
24:41Well, obviously...
24:42We'll make sure your daughter keeps a close eye on you tonight.
24:44Yeah.
24:45No, she will do.
24:46I'm sure she will.
24:47She will do.
24:48I'm sure she will.
24:49I'm sorry for wasting your time.
24:50No, no, you're not wasting our time at all.
24:51Not at all.
24:52Honestly.
24:53We're always available.
24:54It's no problem.
24:55Whenever you need to call, you need to call.
24:57While the critical care team believe Trisha should be treated in hospital, it's her decision.
25:02So Dr Henry and critical care paramedic Charlie ensures she's stable before leaving her at home.
25:08Trisha, nice to meet you.
25:10So you know who to contact if you get worse.
25:11Yes.
25:12And you've got your medications, your inhalers.
25:13Yes.
25:14And you're going to contact your team tomorrow.
25:16Yeah, I will contact...
25:17And if you get worse tonight, call 999.
25:19Yes.
25:20Cool.
25:21Nice to meet you.
25:23I'm sorry.
25:24No, that's all right.
25:25No problem.
25:26Henry and Charlie are now free for their next emergency.
25:29We did a sort of capacity assessment and she demonstrates capacity to make that informed decision
25:35and decided that she wants to stay here.
25:37And if she's got essential medications and someone's keeping an eye on her, that's kind
25:40of the best we can do for her at this point.
25:57In a supermarket car park in Bracknell, Berkshire, critical care team John and Lisa have rendezvoused
26:04with an ambulance crew carrying a two-year-old suffering a potentially life-threatening seizure.
26:09With the infant's mother in the front of the ambulance, the crew first briefs Lisa and John.
26:14So this is Rafi.
26:15Yeah.
26:16This is Hugh.
26:17Yeah.
26:18We arrived and he's been seizing for the last half an hour since our arrival now.
26:22He's had two other seizures in the last hour before we arrived.
26:25He vomited once after having his second seizure.
26:28Yeah.
26:29Temperature is 38 on arrival.
26:30It's now 37.3.
26:32The end is seven, just done now.
26:34Yeah.
26:35He's had 10 milligrams of diaz, 120 mil of fluid.
26:39Two-year-old Rafi has previously had small seizures.
26:43But this time with a high temperature and ongoing convulsions combined with vomiting,
26:48his mum called 999.
26:50What access has it got?
26:52We've just got it in the right arm.
26:55The ambulance crew have managed to insert a cannula in Rafi's right hand to administer fluids.
27:00Now the critical care team take the lead.
27:03So at the moment all we're going to do is just reassess to see what else we can add.
27:08We're going to add anything and then go from there.
27:10But you guys have done an amazing job, so well done to you all.
27:13When the seizure was happening, what was moving?
27:16So his eyes were sort of twitching backwards and forwards.
27:21And this movement with his arms.
27:23Both arms?
27:24Abdomen like this.
27:25It's basically the exact same.
27:26Both arms and both legs as well.
27:28So if you look, he's now got repetitive eye ticks.
27:31So I think he's still seizing.
27:32Definitely.
27:33Do you mind if I come where you are?
27:34A prolonged seizure can cause brain damage.
27:37So with Rafi still convulsing, the critical care team need to take urgent action.
27:42So is that a decent dose of benzodiazepines already?
27:46I need some Keppra.
27:47Keppra is a drug used to stop epileptic fits and seizures.
27:51I suspect we're going to end up pubing realistically.
27:54So why don't we now intubate and then we can do the Keppra post intubation.
27:59Intubating is an invasive procedure usually undertaken in hospitals.
28:04Let me swap out.
28:05But on the road, it's the critical care team who are trained for this.
28:09Dr. John needs to insert a tube into Rafi's trachea.
28:13But first, he'll be placed in an induced coma.
28:16Warehouse, have you already tried cannulation?
28:18I tried there.
28:19This is to protect his brain and allow them to take over his breathing.
28:23It's fine. We just need to see for the safety of his RSI.
28:26Can I use you as a buddy-buddy check for drugs, please, if that's okay?
28:30Yep.
28:31So he's going to have fentanyl, rock, and he's going to have ketamine.
28:35Whilst critical care paramedic Lisa prepares the anaesthetic drugs
28:39to place Rafi in the coma, Dr. John is ready to fit another cannula.
28:43I just want a spare in case when we're doing the anaesthetic this cannula fails.
28:46Yeah.
28:47And we don't want to be half sedated and half not,
28:49because that's the highest risk position to be in.
28:56Thames Valley Air Ambulance is a charity that dispatches critical care teams 365 days a year.
29:06The reality of what we're dealing with is it's often very intense.
29:11You're doing really well. You're doing really well.
29:13Founded in 1999...
29:15I can't feel a pulse.
29:16...their teams of doctors and specially trained paramedics...
29:19Fill up your lungs fully and then breathe out.
29:21...are able to perform procedures normal ambulance teams can't.
29:25We're going to give you some ketamine into your vein here.
29:29Last year they attended over 3,000 incidents.
29:32We're just giving you medicines that will just help you rest after sleep.
29:35Responding on average to nine call-outs a day.
29:38We'll give you some really strong pain relief, OK?
29:40Saving many lives.
29:42Saving 5,000 bahamas 025,000قة infrastructures…
29:43Plus mind-wide-of-igeamos…
29:45I amatamente-saving philt opus.
29:46I am Cabin in 025,000́ƒ·, minus-saving…
29:59Timet.
30:02Apologian determination, what is the patient breathing?
30:06Yes.
30:07And are they awake?
30:08awake yes they've fallen off the haystack three story high haystack probably about three meters
30:15maybe a bit more um i think there's certainly a leg or foot injury or maybe a head injury i'm
30:22really not sure i didn't see before he didn't excruciate pain and is he stuck on the floor at
30:28the moment yes okay we do have assistance being arranged for him to be able to come and help him
30:33if someone able to stay with him then he'll help the ride yes
30:41i think it's up to junction pretty much with the report of a farmer falling from a stack of hay
30:47bales and in severe pain dr james rate and critical care paramedic james perks are hastily dispatched to
30:54the scene we were just uh ringing to see uh see what the score was um it's a 38 year old champion
31:01fallen from a hay bale so his main complaint is injuries left hip slash pelvis and left ankle
31:07he's 190 kilograms workplace falls from height are common in the uk every year it's estimated around
31:154 000 people suffer major injuries including head trauma spinal injuries and multiple fractures
31:22we're just outside of time and we're going to a gentleman who's fallen from some from a stack of hay bales
31:31and has sustained some kind of lower limb injury he's quite a large gentleman his pain sort of
31:37relief requirements are a bit different to maybe someone of less of his size
31:44here it is
31:45oh tell me he's in the ambulance
31:5638 year old farmer richard was moving hay bales when he fell three meters onto concrete
32:01being well over six foot tall he landed heavily on his left side so he sounds like he's in a bit of pain
32:07there's a lot of pain there's a lot of pain there's a lot of pain there's a lot of pain there yeah and in the
32:18left into the groin um he's also complaining of left medial ankle pain and left foot pain as well yeah
32:27there is some kind of deformity and some swelling there richard has potentially fractured his foot and
32:33pelvis which could cause life-threatening internal bleeding he's already landed flat on the foot and
32:39he's 190 and what have you done for him so far so um he's had 20 milligrams of ivy morphine he's
32:45had one gram of ivy paracetamol he's um on his fourth bottle of entonox right um he's got a pelvic binder in
32:53situ and his left ankle is splintered the ambulance crew have managed to support his pelvis and ankle
33:00and administered strong painkillers because of the amount of pain that he's in we're wondering if
33:06there's something else that you'd be able to offer the size of the body affects the concentration of
33:11drugs in the system as richard is 190 kilos the amount of analgesic given so far isn't enough to
33:18relieve his pain they're also now down to their last bottle of entonox or gas and air give him some more
33:24for being yeah yeah he's he's had the kind of dose you could give me yeah and he weighs more than
33:30twice what i do yeah do you want me to draw some morphine for you is that helpful yeah i'll get some
33:35more yeah right mate have you given him have you given him txa no we haven't all right let's give him
33:42two grams of txa hello sir as well as a much higher dose of painkillers richard needs txa or tranexamic acid
33:49to help the blood clot and prevent any excessive internal bleeding i'm dr rate i'm one of the uh
33:55air ambulance doctors where's your worst pain at the moment worse in your heel all right
34:01and it's all a bit difficult to tell exactly what's going on isn't it and that looks nice that looks
34:06nice and i won't i won't go rummaging in there because you've got that nicely splintered up um we're
34:12just gonna pop this it's just the spasms yeah and i think the best thing for us to do actually is get
34:18you um out of here and into hospital um because i think you need a ct scan to work out what's going on
34:27but with richard in agony first the critical care team need to get his pain under control
34:32before he can be moved anywhere
34:46in a supermarket car park in bracknell dr john and critical care paramedic lisa
35:05are about to place two-year-old raffi who's having a prolonged seizure into an induced coma
35:09so they can control his breathing but first a backup cannula needs inserting
35:14so 1.2 mils yeah so i'm going to drop 1.5 and discard because we get air in this
35:22before carrying out the rsi the team reassess raffi's condition
35:28not particularly tense anyway he's had another episode where his eyes have been uh behaving as
35:34if he was probably still fitting just look at his eyes just open his eye
35:38okay so those pupils are reacting contaminated or anything i'm just going to take this away
35:44yeah yeah you need a pen torch no it's fine just close the eyes again now open yeah they're both
35:52reactive you okay if i just pop out and talk to them up yeah yeah yeah yeah raffi's pupils are
35:58dilating due to over stimulation of his brain a sign he's still seizing hello
36:04um my name's john bailey i'm one of the doctors with the air ambulance um what do you know about
36:10what's happening somebody to explain things to you um i know that they've put him into
36:14um induced coma we're we haven't yet we're about to okay you're about to so the reason we're going
36:21to give him an anesthetic is because he isn't waking up and that's a combination of having a seizure
36:26for a long time so that's a very exhausting thing to do you okay i appreciate you're probably not
36:31very okay at the moment but we'll get you there all right i'm gonna pop back next door with the
36:36ambulance now a temporary emergency department so nice and quiet better we just go for the checklist
36:42final checks are critical before raffi is anesthetized ivy access we've got one and we've got
36:48two and this one's got three-way tap on this one's what i'm going to use for um the drugs tightly
36:55controlled doses of powerful anesthetic drugs fentanyl and ketamine will place raffi in the induced
37:00coma an endotracheal tube can then be inserted so his breathing can be controlled by the critical
37:06care team all right so fentanyl going in now we're going to go for the full amount
37:14okay so ketamine going in now
37:20so rock you're going in now in a minute i'm going to say if you start the 30 seconds for me
37:23okay you're saying i'll start 30 seconds for me please lastly rocuronium a drug that will
37:30temporarily paralyze raffi 30 seconds now thank you and then give it another 15 seconds
37:4145 seconds thank you and then if you can just say the time make a note of this time now please
37:47okay visualize with the drugs now taking effect using a video laryngoscope dr john can guide the
37:53breathing tube into position
38:03the tube is successfully inserted however dr john discovers another potential problem
38:08here are rattle ears yeah i can hear that some of raffi's stomach fluids is in his lungs because his
38:15normal swallowing reflex isn't working following the anesthetics so the team clear it using a suction
38:21machine because he's got so much in his fluid yeah
38:25uh with his airways quickly clear raffi can be placed safely on the mechanical ventilator
38:36so you're ventilating effectively
38:41sucks coming up for the first time since arriving on scene raffi's seizure is finally easing
38:48happy day his breathing and heart rate now under control
38:55so we need to give some drugs to maintain anesthesia which are coming um and then we will
39:02be in a position to go safely to hospital
39:07whilst we're on the road we'll do capra raffi is finally ready to be transported to the john
39:13ratcliffe hospital thank you everybody all your help with its pediatric intensive care unit good job
39:19after an hour of roadside intensive care john and lisa ensure raffi has kept safe and stable on the journey
39:28so we've got a two-year-old dr john calls the hospital to alert them of the youngster's condition
39:35he has had a sustained period of what is probably a febrile convulsion with a atypia for which he has been rsi'd
39:43he has he's now intubated and ventilated so we're about 40 minutes 40 minutes away at the moment
39:51and i will call you when we're 10 minutes away on arriving at the hospital raffi is delivered into
39:56the care of the waiting emergency pediatric doctors
40:00as we arrived we were met by about 20 people which is quite an extensive team
40:09so what's likely to happen for him now he will probably have some imaging so he'll probably have
40:14a ct scan of his head and from that point we'll go to pediatric itu and from that point forward
40:20will depend on how he starts to wake up and how he starts to come back to normal and we're now back
40:25out there to see what else we can do for the rest of the evening
40:46in a farmyard near tame
40:47dr james rate and critical care paramedic james perks are attending to 38 year old farmer richard
40:56who fell three meters onto concrete fracturing his ankle and potentially breaking his hip
41:01all right um so his blood pressure is 98 on 44. how far away from john radcliffe are you
41:08the ambulance crew have given richard intravenous morphine and paracetamol and he's using their
41:13last bottle of gas and air nice deep breaths for me but because richard is tall and weighs around 190
41:22kilos he seems to need more drugs than most to dull his pain
41:33this is called penthrox it's actually an anesthetic gas it's about 10 times better than the end
41:40so i think this will really help you all right yeah i think what you might have done is break your
41:48heel bone extremely painful heel bone fractures are a common injury with falls from height
41:54so pop pop that in your mouth and take some deep breaths for me all right
41:59i'll tell you what i'll just draw it from here but critical care paramedic james is also drawing up
42:05more morphine all right let's get that morphine into and have you got a gram for him or two as richard
42:13may also have internal injuries the team are keen to get him to hospital quickly but first they need
42:18to give him txa to prevent excessive blood loss do you want to give him do you want to give him two and
42:25you can say that we've authorized that ambulance crews are only permitted to administer one gram of txa
42:31and how much more i mean i'd definitely hit him with five now with the combination of penthrox and
42:38morphine now working dr james is happy that richard is stable enough for the ambulance to take him to
42:44the john ratcliffe hospital right lovely thanks so and if you do have any problems on route just call
42:49the hems desk we'll come and join you all right lovely thanks so much
42:53i think our ambulance service colleagues have really achieved everything that he needed here at
43:01the scene um they've got him off the ground uh they've given him some painkillers and we've just
43:07been able to add a little bit of advanced painkilling medication to help him on the journey so the next
43:12steps for richard are assessment in the emergency department and some x-rays and a ct scan to fully
43:18determine what's going on
43:48so
43:52so
44:00so
44:02so
44:04so
44:18Foster Christian claimed he was attacked in his own home,
44:23but the evidence would tell a different story.
44:25A killer makes a call.
44:26The Canterbury murders.
44:28True crime tomorrow at 10.
44:29Next tonight, a nervous patient with a low pain threshold
44:32is a challenge in New Skin A&E.
44:34After the break.
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