0:00:02 > 0:00:06From the Highlands of Scotland, to the coast of Cornwall,
0:00:06 > 0:00:09the Great British countryside is spectacular.
0:00:11 > 0:00:14But we work and play in it at our peril.
0:00:17 > 0:00:19And when things go wrong,
0:00:19 > 0:00:22the emergency services race to the rescue.
0:00:22 > 0:00:26This chap is having a heart attack and we need to get him in quickly.
0:00:28 > 0:00:30There's no police courses for this.
0:00:30 > 0:00:33Going hundreds of miles against the clock,
0:00:33 > 0:00:36battling the elements, and braving the weather.
0:00:38 > 0:00:39HE CRIES OUT
0:00:40 > 0:00:43From fields and forests,
0:00:43 > 0:00:45to cliffs and country roads,
0:00:45 > 0:00:48we'll be right at the heart of the action.
0:00:49 > 0:00:50With police fighting crime...
0:00:50 > 0:00:53I could seize your dogs, I could seize your van,
0:00:53 > 0:00:55but I'm going to summons you all to court.
0:00:55 > 0:00:57..paramedics saving lives...
0:00:59 > 0:01:02..and wardens safeguarding our lives.
0:01:02 > 0:01:03Come out of the way!
0:01:05 > 0:01:08We're there as the emergency services pull together
0:01:08 > 0:01:11to pick up, patch up, and protect the public.
0:01:13 > 0:01:15This is Countryside 999.
0:01:33 > 0:01:36Coming up, the Cornwall Air Ambulance
0:01:36 > 0:01:39take charge of some precious cargo.
0:01:45 > 0:01:48A man in agony is blue-lit to hospital in Dumfries
0:01:48 > 0:01:50for life-saving surgery.
0:01:53 > 0:01:58Acute abdominal pain. His abdomen is absolutely rigid to touch.
0:01:58 > 0:02:00Argh!
0:02:00 > 0:02:04And quite possibly the world's toughest 86-year-old
0:02:04 > 0:02:06soaks up painful treatment in Penzance.
0:02:06 > 0:02:08I've lost a chunk of my leg!
0:02:11 > 0:02:13It didn't feel all that painful.
0:02:23 > 0:02:25Lying on the southern lowlands of Scotland,
0:02:25 > 0:02:28Dumfries and Galloway is dominated by farmland.
0:02:30 > 0:02:36It's where over 40% of Scotland's dairy herd chew the cud,
0:02:36 > 0:02:38alongside 15% of Scotland's sheep.
0:02:41 > 0:02:45That makes for a lot of winding country roads fit for farmers...
0:02:47 > 0:02:49..but not for paramedics in a hurry.
0:02:54 > 0:02:56That doesn't stop the Dumfries and Galloway Ambulance Service
0:02:56 > 0:02:59getting to life-threatening emergencies
0:02:59 > 0:03:00in an average of eight minutes.
0:03:03 > 0:03:06Paramedic and ex-Londoner Paul Votier
0:03:06 > 0:03:08has been with the Scottish Ambulance Service for 10 years.
0:03:12 > 0:03:14'One of the best things about this job is,
0:03:14 > 0:03:16'you don't know what you're doing from day to day.'
0:03:16 > 0:03:19You can come in, sit and watch telly and not turn a wheel,
0:03:19 > 0:03:24or there's just the one job, and you go and you've made a big difference
0:03:24 > 0:03:25in someone's life.
0:03:27 > 0:03:32It's been a quiet morning for Paul and his partner Keith McWhan,
0:03:32 > 0:03:35but in the early afternoon, a call comes in.
0:03:45 > 0:03:50The call was given as this adult male collapsed with chest pains,
0:03:50 > 0:03:54so straightaway you're thinking, yes, you know, it's a cardiac pain.
0:03:54 > 0:03:57This has the potential to be a life-threatening condition.
0:04:12 > 0:04:15These small, country lanes, you know, there's lots of blind spots,
0:04:15 > 0:04:18lots of hazards. So we have to get there as quickly
0:04:18 > 0:04:20but as safely as we can.
0:04:22 > 0:04:25From their base in Lockerbie, the team are racing to a dairy farm
0:04:25 > 0:04:26a few miles south.
0:04:26 > 0:04:28It takes just six minutes.
0:04:31 > 0:04:34- Hi, there.- Hiya. - How you doing?- Hello.
0:04:34 > 0:04:39As we walked through the door, he was on the floor, on his knees, writhing.
0:04:39 > 0:04:43- Is he on medication, is he? - No.- Nothing at all?- No.
0:04:46 > 0:04:49Barbara called 999.
0:04:49 > 0:04:51Her 52-year-old partner Robert is on his knees,
0:04:51 > 0:04:53and in excruciating pain.
0:05:00 > 0:05:02Have you injured yourself at all?
0:05:02 > 0:05:04- No. Arrgghh!- Barbara?!
0:05:06 > 0:05:09Robert's neighbour Jennifer has heard his cries through the wall.
0:05:11 > 0:05:15Whatever's causing the pain doesn't seem to be coming from his chest.
0:05:17 > 0:05:20- Arrrgh...!- Is that sore for me to press your stomach there?
0:05:20 > 0:05:24- I can't... I...- It's quite hard.
0:05:24 > 0:05:27Robert's stomach is hard around the abdomen.
0:05:27 > 0:05:29Dead in the centre, is it?
0:05:29 > 0:05:32Paul and Keith have ruled out a heart attack,
0:05:32 > 0:05:35but there's clearly something very wrong.
0:05:35 > 0:05:39For someone to be that severe in pain, they've either got a very
0:05:39 > 0:05:44low pain threshold or what they're experiencing is life-threatening.
0:05:44 > 0:05:47Let's get him out and then we'll put him on the bed, eh?
0:05:47 > 0:05:49Within four minutes they move Robert to the ambulance
0:05:49 > 0:05:52for easier access to life-saving kit and pain relief.
0:05:53 > 0:05:57See if you can start walking him out and I'll get the...
0:05:57 > 0:05:59We'll get something for the pain.
0:06:03 > 0:06:07'There's a lot of guarding and rigidness to his tummy,'
0:06:07 > 0:06:10which indicates there's something severe going on.
0:06:10 > 0:06:12Either he's got a bleed inside his stomach...
0:06:12 > 0:06:16'He's got some sort of leakage in there that's causing this irritation
0:06:16 > 0:06:18'and this pain.'
0:06:19 > 0:06:23Paul and Keith think the leakage may be caused by a stomach ulcer.
0:06:32 > 0:06:34Sharp scratch coming up.
0:06:35 > 0:06:37Nice and still, mate.
0:06:39 > 0:06:42Did this pain come on all of a sudden, Robert, or was it gradual?
0:06:42 > 0:06:44I... I...
0:06:44 > 0:06:47Has it been building up all day?
0:06:47 > 0:06:50Argh! After lunch.
0:06:50 > 0:06:51After lunch?
0:06:51 > 0:06:54- Was it after you had something to eat?- Yep.
0:06:57 > 0:07:00Their worry is the ulcer might have burst,
0:07:00 > 0:07:03allowing stomach acids and bacteria to infect the abdomen.
0:07:05 > 0:07:07Infection that can spread
0:07:07 > 0:07:09and quickly lead to multiple organ failure.
0:07:12 > 0:07:14It becomes a time-critical situation for us.
0:07:14 > 0:07:19It's a condition that can progressively get worse in minutes.
0:07:20 > 0:07:22Can you get some tape as well?
0:07:22 > 0:07:24He's so sweaty, it isn't sticking.
0:07:26 > 0:07:29The pain is unbearable for Robert...
0:07:29 > 0:07:31Argh...
0:07:31 > 0:07:34And the wait agonising for his partner Barbara.
0:07:35 > 0:07:37I was really worried.
0:07:37 > 0:07:41I don't think I was panicking until he was actually in the ambulance,
0:07:41 > 0:07:43and I saw how much sweat. Cos it was just lashing off him.
0:07:45 > 0:07:48Fix that the best you can. You might have to dry him. He's quite sweaty.
0:07:49 > 0:07:53Robert's agonised writhing and sweating is making it difficult
0:07:53 > 0:07:55to give him the morphine he desperately needs.
0:07:56 > 0:08:00Whoa, whoa, whoa, Robert, just a wee second, son...
0:08:02 > 0:08:05Here we go, Robert. Thank you.
0:08:07 > 0:08:10Here comes the pain relief, all right?
0:08:10 > 0:08:14- Cheers.- Just takes a bit of time. It's coming in now, all right? Ready?
0:08:15 > 0:08:18- Nice and slowly this goes in, Robert. - Argh...
0:08:20 > 0:08:23You've had the first bit of pain relief go through.
0:08:23 > 0:08:25You'll feel that work straightaway.
0:08:25 > 0:08:27That'll take the edge right off it.
0:08:28 > 0:08:31We'll have some more ready to go when we get you to the hospital.
0:08:31 > 0:08:36- But 10 minutes later...- Arrrgh!
0:08:36 > 0:08:39..Robert's still in agony.
0:08:39 > 0:08:43There's a question we ask patients to gauge their level of pain,
0:08:43 > 0:08:45and it's a scale from zero to 10,
0:08:45 > 0:08:48zero being no pain, 10 being the most excruciating pain
0:08:48 > 0:08:52'they've ever experienced. And just by looking at this gentleman,'
0:08:52 > 0:08:56the way he was behaving, you could safely say that he was nine, 10.
0:09:04 > 0:09:08Argh...argh!
0:09:08 > 0:09:10Where is it exactly, Robert?
0:09:10 > 0:09:12In there! Arrgh...
0:09:15 > 0:09:17There's no let-up for Robert.
0:09:17 > 0:09:19Paul tries more pain relief.
0:09:22 > 0:09:25Robert, we're not going to hang around.
0:09:25 > 0:09:27We'll get you sorted out for this pain.
0:09:29 > 0:09:31- Argh!- Lie back a wee bit, Robert.
0:09:31 > 0:09:33See if that's any... Is that any better?
0:09:33 > 0:09:35- No.- No?- No.
0:09:44 > 0:09:47- Has that 15 helped him at all? - No.
0:09:49 > 0:09:51Yeah, blood pressure 111 over 76.
0:09:53 > 0:09:56Paul and Keith now only have one option,
0:09:56 > 0:09:59to get Robert into accident and emergency...
0:09:59 > 0:10:00fast.
0:10:01 > 0:10:05Best place this gentlemen needed to be was in hospital, where the
0:10:05 > 0:10:07surgeons would need to see him.
0:10:09 > 0:10:14- For Barbara, it's an agonising separation.- I was kind of worried
0:10:14 > 0:10:17I wouldn't get to Dumfries quick enough to see him,
0:10:17 > 0:10:20in case he didn't make it. Cos I didn't know whether
0:10:20 > 0:10:21he'd make it there or not.
0:10:21 > 0:10:24SIREN
0:10:38 > 0:10:41Cornwall is home to some of Britain's most romantic
0:10:41 > 0:10:43and evocative landscapes.
0:10:45 > 0:10:48It's got its own language and its own myths.
0:10:50 > 0:10:54King Arthur and his Knights are said to have held court here.
0:10:54 > 0:10:56And it's easy to see how legends come about
0:10:56 > 0:10:58against such a dramatic backdrop.
0:11:02 > 0:11:05It's a landscape perfect for dreaming in,
0:11:05 > 0:11:07but not very easy to get around.
0:11:07 > 0:11:09Unless you've got one of these.
0:11:14 > 0:11:17The Cornwall Air Ambulance Service deals with real-life drama
0:11:17 > 0:11:19across the county.
0:11:20 > 0:11:24Mark Fuzzard has been a paramedic for 10 years...
0:11:26 > 0:11:29..nearly eight of them in the air.
0:11:29 > 0:11:32I've actually taken more people to hospital in the helicopter
0:11:32 > 0:11:34than I have done by road.
0:11:34 > 0:11:36'You don't know what you're going to be dealing with
0:11:36 > 0:11:39'from minute to minute, let alone from day to day.'
0:11:41 > 0:11:44A 999 call has just come in.
0:11:44 > 0:11:47OK, mate. All right, mate. No worries, we're on our way.
0:11:47 > 0:11:51We're going to 23-year-old lady who's come off a horse
0:11:51 > 0:11:54and has been kicked in the chest by this horse.
0:11:54 > 0:11:57And they can be quite nasty accidents, actually.
0:11:57 > 0:12:00It's quite a powerful animal. So she's got breathing problems.
0:12:04 > 0:12:08The patient is 14 miles from the air ambulance base in Newquay,
0:12:08 > 0:12:09on a farm near Bodmin.
0:12:13 > 0:12:16It's just a short hop for the chopper, which could be crucial.
0:12:21 > 0:12:25It's an all too familiar emergency for second paramedic Ian Hooper
0:12:25 > 0:12:26and the team.
0:12:37 > 0:12:40Over the last five years, the air ambulance
0:12:40 > 0:12:44has been called to 134 incidents involving horses.
0:12:57 > 0:12:59A rapid response vehicle is on its way.
0:12:59 > 0:13:02Horses can do serious damage.
0:13:02 > 0:13:06I've seen quite a few incidents where horses have actually kicked out
0:13:06 > 0:13:10and kicked patients, and they've had horrendous injuries.
0:13:10 > 0:13:14So potentially, this lady could be in a lot of trouble.
0:13:26 > 0:13:29They're met by the patient's dad, Boris.
0:13:45 > 0:13:48She's got good air movement, from what I can feel.
0:13:50 > 0:13:5323-year-old Miranda had been walking her dad's prize horse
0:13:53 > 0:13:54when it kicked out.
0:13:56 > 0:13:59The blow hit her in the back.
0:13:59 > 0:14:01Miranda, we're going to have to cut your top off to have a look
0:14:01 > 0:14:03at your chest properly, OK?
0:14:03 > 0:14:05You just keep your head nice and still.
0:14:08 > 0:14:11- How any times did it kick you, do you know?- Once.- Just the once?
0:14:11 > 0:14:14So it's a swift kick right in your back here? And you weren't on it,
0:14:14 > 0:14:16you were just standing up? OK.
0:14:17 > 0:14:19Can we sit you up a little bit?
0:14:19 > 0:14:22We're happy that you haven't got an neck injury there.
0:14:22 > 0:14:25Mark needs to check Miranda's chest and breathing.
0:14:25 > 0:14:27Her boyfriend Kester holds her up.
0:14:30 > 0:14:33Deep breath. And relax.
0:14:34 > 0:14:35Deep breath. Uh..
0:14:37 > 0:14:40Does it feel difficult when you're breathing? Difficult to breathe?
0:14:47 > 0:14:50Could you give the pain a score, nought being no pain, 10 being the
0:14:50 > 0:14:53worst pain you can imagine? What score would you give the pain now?
0:14:53 > 0:14:58Um... Eight. About an 8/10, OK.
0:14:58 > 0:14:59Is that your house?
0:15:00 > 0:15:02I reckon we can stand you up, yeah?
0:15:02 > 0:15:03- Yeah?- Good to go?
0:15:11 > 0:15:14Miranda is helped to the house.
0:15:14 > 0:15:15Right, which way do we go?
0:15:15 > 0:15:17You live here, I've no idea where the front door is!
0:15:17 > 0:15:19Follow Dad.
0:15:21 > 0:15:24And the offending horse, Merlin, is locked in the stable.
0:15:27 > 0:15:31We're going to examine you properly, but on first looking, it looks
0:15:31 > 0:15:34like you possibly might have one,
0:15:34 > 0:15:38possibly two, fractured ribs. At worst, at the moment, all right?
0:15:38 > 0:15:40- We got a little bit of reddening here, haven't we?- Yeah.
0:15:40 > 0:15:43- I think it's just the one isn't it? - Yes, just the one rib.
0:15:45 > 0:15:47Your horse, is it?
0:15:47 > 0:15:49It's his fault.
0:15:49 > 0:15:50You've got a chest injury,
0:15:50 > 0:15:52but you don't need to be in hospital right now.
0:15:52 > 0:15:57They won't X-ray it at this point. There's nothing that will be done.
0:15:57 > 0:15:59It's a matter of managing your pain.
0:15:59 > 0:16:01And getting you to breathe deeply,
0:16:01 > 0:16:07- and, you know, treating you here really, all right?- OK.
0:16:09 > 0:16:13Miranda has been lucky. She's got away with a suspected broken rib.
0:16:15 > 0:16:20The paramedics are leaving her in her sister's capable hands.
0:16:20 > 0:16:24So you've got to take two Paracetemol, and then two Ibuprofen.
0:16:24 > 0:16:26- And then two Ibu...- Fantastic!
0:16:26 > 0:16:31- Yeah, you got it. You'll make a very good nurse.- Thanks.
0:16:31 > 0:16:34It's nice to be able to go to patients sometimes and they're
0:16:34 > 0:16:36not that injured, or not as poorly as first thought.
0:16:36 > 0:16:41Sometimes it's nice when you actually get there and they're not serious.
0:16:42 > 0:16:45But for the Cornwall Air Ambulance, cases like this
0:16:45 > 0:16:48are few and far between.
0:16:48 > 0:16:51OK, we've got a one-year-old, a little baby, who's not very well.
0:16:51 > 0:16:54He's having some breathing problems.
0:16:54 > 0:16:55BABY CRIES
0:16:55 > 0:16:56Aw, mate.
0:17:06 > 0:17:10Back in Dumfries and Galloway, the ambulance paramedic team
0:17:10 > 0:17:13have been called out to 52-year-old dairyman Robert,
0:17:13 > 0:17:16who's suffering agonising abdominal pains.
0:17:17 > 0:17:19Argh!
0:17:21 > 0:17:25Paul and Keith suspect Robert has serious internal bleeding or leakage
0:17:25 > 0:17:28from an ulcer, which, if untreated, could be fatal.
0:17:35 > 0:17:39But they don't know how bad it is, and they're worried that the bleed
0:17:39 > 0:17:42from the ulcer might lead to cardiac arrest.
0:17:43 > 0:17:46Your heart will work faster and faster and faster
0:17:46 > 0:17:50until it's got no blood left to pump around, and it will just stop.
0:17:54 > 0:17:57The nearest hospital is Dumfries and Galloway Royal Infirmary,
0:17:57 > 0:17:5916 miles away.
0:18:01 > 0:18:05We knew we are 20-25 minutes away from a hospital.
0:18:05 > 0:18:06It's time-critical.
0:18:06 > 0:18:08You need to get the gentleman in as quick as possible,
0:18:08 > 0:18:10because we don't know
0:18:10 > 0:18:13how this is going to progress, how it's going to pan out.
0:18:13 > 0:18:17Keith calls the hospital to forewarn the trauma team.
0:18:17 > 0:18:24Acute abdominal pain, his abdomen is absolutely rigid to touch.
0:18:24 > 0:18:27He tells them pain relief isn't working.
0:18:27 > 0:18:29Seems to have no effect at the moment.
0:18:29 > 0:18:32The worst scenario is a patient goes into cardiac arrest.
0:18:32 > 0:18:38And then Keith has to start a basic life support in the back.
0:18:41 > 0:18:43Right now, Keith just wants to manage Robert's pain.
0:18:45 > 0:18:48He encourages him to use Entonox,
0:18:48 > 0:18:51a pain-relieving mixture of nitrous oxide and oxygen.
0:18:53 > 0:18:55Keep taking that. If you're able to take that,
0:18:55 > 0:18:58that should start to relax and get the edge off.
0:18:58 > 0:19:00Robert's starting to relax a little.
0:19:00 > 0:19:03The morphine and Entonox may just be working.
0:19:07 > 0:19:09Look at me, Robert.
0:19:09 > 0:19:11That's fine, your eyes are starting to...
0:19:11 > 0:19:12The pupils are...
0:19:12 > 0:19:14In an emergency like this,
0:19:14 > 0:19:17life in the back of the van can be pretty hairy.
0:19:17 > 0:19:20Oooh...
0:19:20 > 0:19:22Jeez.
0:19:25 > 0:19:26Argh!
0:19:28 > 0:19:30Right, we're just drawing into the hospital.
0:19:30 > 0:19:33So what will do is, we'll take you in on this bed.
0:19:33 > 0:19:35We'll not move you of this bed, then we'll get you
0:19:35 > 0:19:38transferred when we're inside the casualty unit.
0:19:39 > 0:19:45Within 22 minutes, Robert arrives at accident and emergency.
0:19:45 > 0:19:49- I'm just going to get some blood from you.- OK.
0:19:50 > 0:19:52There'll be a sharp scratch, OK?
0:19:54 > 0:19:58Consultant David Pedley thinks a ruptured stomach ulcer
0:19:58 > 0:20:00is the most likely cause of pain.
0:20:00 > 0:20:03You've got a hell of a lot of pain. you know that already, OK?
0:20:03 > 0:20:10The signs suggest that you might have had an ulcer in your tummy,
0:20:10 > 0:20:14which has burst, or ruptured into your tummy, OK?
0:20:16 > 0:20:19But he won't risk a major operation until he's convinced.
0:20:25 > 0:20:28A CT scan will give the medical team a clear picture
0:20:28 > 0:20:30of what's going on in Robert's abdomen.
0:20:31 > 0:20:35Just looking for free gas, for air where it shouldn't be, if you like.
0:20:37 > 0:20:40That will be diagnostic of what we think this chap's got.
0:20:42 > 0:20:45If you look very, very closely, there are a couple of small areas
0:20:45 > 0:20:48where there is gas leaked out of his duodenum.
0:20:48 > 0:20:51A little bit of extra fluid near his liver.
0:20:51 > 0:20:54That's convinced surgeons that he needs to go to theatre
0:20:54 > 0:20:58for an operation. So it looks like the initial hunch was right.
0:20:59 > 0:21:00They've found the ulcer.
0:21:02 > 0:21:06And Dr Pedley thinks he knows what caused it.
0:21:06 > 0:21:08This gentleman was taking anti-inflammatory tablets
0:21:08 > 0:21:12which have inflamed his stomach and caused it to rupture.
0:21:16 > 0:21:21Consultant surgeon Patrick Collins will be performing the operation.
0:21:21 > 0:21:24I'll cut up and down the middle of your tummy, so we'll make
0:21:24 > 0:21:26an initial incision at the top part of your tummy here, which is
0:21:26 > 0:21:29where the problem's likely to be.
0:21:29 > 0:21:34If it is a small ulcer, we'll just stitch it shut.
0:21:34 > 0:21:36Anything you want to ask?
0:21:37 > 0:21:40- No.- No. OK.
0:21:40 > 0:21:45I mean, sometimes we get surprises, but I would put my money on it.
0:21:45 > 0:21:49- There's obviously something causing the pain.- Yes, absolutely.
0:21:51 > 0:21:54It's a relief to find out what's causing Robert's pain,
0:21:54 > 0:21:59but now Barbara has to wait for him to get through the operation.
0:21:59 > 0:22:02They just told me that he was going to have surgery.
0:22:02 > 0:22:06And just said that he'd be down there for a wee while.
0:22:06 > 0:22:08It was quite frightening.
0:22:10 > 0:22:14Just four hours after Lockerbie Ambulance Station took the call,
0:22:14 > 0:22:17Robert is about to have major surgery.
0:22:17 > 0:22:21If left, this gentleman would become very unwell.
0:22:21 > 0:22:25He'd basically develop a severe infection, affecting
0:22:25 > 0:22:29most of his abdomen, and certainly a high risk that he would die
0:22:29 > 0:22:31if nothing was done.
0:22:32 > 0:22:36Patrick Collins and his team are now preparing to save Robert's life.
0:22:50 > 0:22:55Many of Cornwall's 4.5 million yearly visitors go there
0:22:55 > 0:22:59to walk, ride, or climb, and enjoy Cornwall's stunning scenery.
0:23:06 > 0:23:10It's a landscape crossed by 2,400 miles of pathways,
0:23:10 > 0:23:14taking you along clay trails and old miners' tramways,
0:23:14 > 0:23:17past deep lakes and over windswept moors.
0:23:25 > 0:23:29But being out and about in Cornwall's stunning countryside
0:23:29 > 0:23:30can be hazardous.
0:23:37 > 0:23:40West Cornwall Hospital in Penzance has an urgent care unit
0:23:40 > 0:23:44which provides treatment 24 hours a day, all year round.
0:23:51 > 0:23:54Over the high summer months, they can expect to see
0:23:54 > 0:23:57over 5,000 patients with a huge range of problems.
0:24:02 > 0:24:06Today, Marion has been brought in with a gruesome-looking leg injury.
0:24:06 > 0:24:09- It looks quite nasty.- We're going to get the doctor to review this.
0:24:09 > 0:24:12Staff nurse Kate Venning is first to see her.
0:24:12 > 0:24:15We'll see what we can do. How long ago did it happen, Marion?
0:24:15 > 0:24:19- About an hour ago.- OK. And it was on concrete?
0:24:19 > 0:24:21No, I was passing a stile,
0:24:21 > 0:24:25and my leg caught on a bit of bark on a tree.
0:24:25 > 0:24:29- Right. OK. And you're up-to-date with your tetanus?- Pardon?
0:24:29 > 0:24:33- You're up-to-date with your tetanus?- Yes, yes.
0:24:33 > 0:24:34And how is your health in general?
0:24:34 > 0:24:37I've been under a lot of stress lately,
0:24:37 > 0:24:39because I've just moved to Cornwall from the Midlands.
0:24:42 > 0:24:4486-year-old, Belgian-raised Marion
0:24:44 > 0:24:48has just moved to Cornwall to be closer to her son, Roderick,
0:24:48 > 0:24:51and to pursue her favourite pastime, hiking.
0:24:51 > 0:24:55So Marion, we might need to have a little look at it,
0:24:55 > 0:24:57and move it around a little bit.
0:24:57 > 0:25:00- Yes.- So would you like some pain relief, just in case?
0:25:00 > 0:25:02- I've got no pain.- OK.
0:25:02 > 0:25:06- So if it does get painful, then just ask, and we can give you some.- Yes.
0:25:06 > 0:25:08- All right?- I should be all right.
0:25:08 > 0:25:10'I didn't think it was serious.
0:25:10 > 0:25:14'I thought it was just a scratch. I did wonder why it bled so much.'
0:25:15 > 0:25:18My dirty shoes! I've been hiking today.
0:25:21 > 0:25:23Just a soaked gauze.
0:25:23 > 0:25:25Oh, it's come down a bit, actually.
0:25:25 > 0:25:27That was kind of up there when I first looked.
0:25:29 > 0:25:33Kate's concerned Marion must be in a lot of pain but, incredibly,
0:25:33 > 0:25:35Marion's not complaining.
0:25:36 > 0:25:39It looks pretty severe. I was a bit taken aback with it.
0:25:41 > 0:25:45- Kate's called in Dr Neil Davidson. - Hello, I'm Dr Davidson.
0:25:46 > 0:25:49And she's told him about the lack of pain relief.
0:25:49 > 0:25:53Have you had any pain relief, cos it must be sore, is it?
0:25:53 > 0:25:56- No, it's not hurting.- So you don't want any pain relief?- No, thank you.
0:25:57 > 0:26:02I've had a look at it. I've lost a chunk of my leg.
0:26:02 > 0:26:04It didn't feel all that painful.
0:26:06 > 0:26:08The blood just poured into my shoe.
0:26:08 > 0:26:10It will be full of blood.
0:26:10 > 0:26:13- How does one mend a hole like that?- Well, we have ways.
0:26:14 > 0:26:16NURSE LAUGHS
0:26:17 > 0:26:18Although the wound is deep,
0:26:18 > 0:26:21Dr Davidson thinks he can fix it.
0:26:22 > 0:26:24I think that will close quite nicely.
0:26:24 > 0:26:27The problem is, it's going to stop you walking for a wee while.
0:26:27 > 0:26:29You've got a good cut there.
0:26:30 > 0:26:35Yes, it's quite a big laceration that's gone through the skin
0:26:35 > 0:26:39and taken the fatty layer of the subcutaneous tissue as well.
0:26:39 > 0:26:40There's a thing in medicine
0:26:40 > 0:26:44where the solution to pollution is dilution, so you wash it out
0:26:44 > 0:26:47with about a litre of salt water,
0:26:47 > 0:26:49and that'll clean it out.
0:26:51 > 0:26:55Salt water washing over an open wound can be excruciating.
0:26:55 > 0:26:57It can make grown men cry.
0:26:58 > 0:27:01We're going to put about a litre through,
0:27:01 > 0:27:04just to give it a really good flush, get any bits out. All right?
0:27:05 > 0:27:07But Marion isn't a grown man.
0:27:08 > 0:27:14- Is that OK?- Yes, that's fine.- Is it sore?- No, not at all.- Good, good.
0:27:14 > 0:27:17She's far tougher than that.
0:27:17 > 0:27:19When my friend sees this, he'll faint.
0:27:19 > 0:27:21NURSE LAUGHS
0:27:21 > 0:27:22You are coping very well.
0:27:22 > 0:27:25- Are you sure you're OK? - Yes, it's fine.
0:27:25 > 0:27:27'She's amazing.
0:27:27 > 0:27:28'She's not feeling that at all.'
0:27:28 > 0:27:30After Kate cleans the wound,
0:27:30 > 0:27:32Dr Davidson stitches it up.
0:27:35 > 0:27:38And this time, Marion is given anaesthetic.
0:27:40 > 0:27:42This is local anaesthetic.
0:27:42 > 0:27:46I'm going to just...what we call infiltrate, just around the edges.
0:27:46 > 0:27:49because I suspect there will be a little bit of feeling there,
0:27:49 > 0:27:51even though there doesn't seem to be very much.
0:27:51 > 0:27:54Can you actually feel me touching you there?
0:27:54 > 0:28:00- I guess not.- No? No? - I think I've gone numb.- Yeah.
0:28:00 > 0:28:02The stitches should dissolve in a week,
0:28:02 > 0:28:05long enough for the healing process to begin.
0:28:05 > 0:28:11- Sorry, was that pain again then? - Oh, not really. Just sensitive.
0:28:11 > 0:28:15- I'm impressed with your pain threshold.- Yeah, I'm impressed too.
0:28:15 > 0:28:18- Stop whilst we're ahead. - OK.- Thank you, Doctor.
0:28:18 > 0:28:21Thank you. You were a star patient.
0:28:21 > 0:28:23It's fascinating, watching an expert at work.
0:28:27 > 0:28:30Next, Kate provides the finishing touches,
0:28:30 > 0:28:32using sticky sterilised strips.
0:28:34 > 0:28:37You could do with like another pair of hands doing this,
0:28:37 > 0:28:40because it's a bit of unravelling, a bit of pushing,
0:28:40 > 0:28:43and kind of a bit of sticking at the same time.
0:28:43 > 0:28:46Brilliant. That went better than expected, really.
0:28:46 > 0:28:51The subcutaneous tissues came together very nicely.
0:28:51 > 0:28:52Exactly the same with the skin.
0:28:52 > 0:28:55It will actually heal beautifully.
0:28:55 > 0:28:57And surprisingly little pain as well.
0:28:59 > 0:29:01Three hours later, as Marion heads home,
0:29:01 > 0:29:05she does start to feel a little something.
0:29:05 > 0:29:06I'm hungry, yes!
0:29:08 > 0:29:10I haven't eaten since 12!
0:29:25 > 0:29:28As the chopper flies, it's about 15 minutes
0:29:28 > 0:29:32from Penzance to the air ambulance base in Newquay.
0:29:35 > 0:29:38From here, they deal with around 800 emergency calls a year.
0:29:39 > 0:29:43For the helicopter in Cornwall, horse incidents are quite common.
0:29:47 > 0:29:49From injuries to illness,
0:29:49 > 0:29:50no two calls are ever the same.
0:29:52 > 0:29:56- Can you say that? Ibuprofen? - I...bu...pro...fen.
0:29:56 > 0:29:58Brilliant. Fantastic.
0:29:59 > 0:30:02But some patients can affect the team more than others.
0:30:05 > 0:30:09No, that's fine. We'll be on our way, yep. Brilliant. Thanks, Kelly.
0:30:09 > 0:30:10Thanks, babe. Bye.
0:30:12 > 0:30:15OK, we've got a one-year-old, a little baby, who's not very well.
0:30:15 > 0:30:17Having some breathing problems.
0:30:30 > 0:30:32Once we got the call, and we realised that
0:30:32 > 0:30:36we were on our way to a one-year-old with breathing difficulties,
0:30:36 > 0:30:39it obviously gets your adrenaline flowing a little bit.
0:30:41 > 0:30:43From the air ambulance base in Newquay,
0:30:43 > 0:30:45its 20 miles to Tintagel,
0:30:45 > 0:30:47on Cornwall's far north-western edge.
0:30:51 > 0:30:53It's a ten-minute flight
0:30:53 > 0:30:55and it seems to be a familiar address.
0:30:59 > 0:31:02Their records show this little boy has been emergency lifted
0:31:02 > 0:31:05to hospital before, each time with breathing difficulties.
0:31:10 > 0:31:13Second paramedic Ian Hooper and the team are new to the case.
0:31:15 > 0:31:18But with respiratory problems causing a fifth of all deaths
0:31:18 > 0:31:22in children in the UK, Ian knows this is serious.
0:31:42 > 0:31:43They land as close as they can.
0:31:52 > 0:31:55Once we'd got to the scene and had a chat with Dad,
0:31:55 > 0:31:57he told me a little bit more in-depth about the little one's
0:31:57 > 0:32:01problems that he'd had, and he'd had since birth.
0:32:03 > 0:32:05One-year-old James has a medical condition
0:32:05 > 0:32:08that gives him severe breathing problems.
0:32:10 > 0:32:13He's had respiratory arrest which means he's actually
0:32:13 > 0:32:17stopped breathing, that needed intervention. That needed doctors
0:32:17 > 0:32:21to intervene to kind of start him breathing again.
0:32:21 > 0:32:24- What's this little chap called? - James.- James. Hello, James!
0:32:24 > 0:32:27Do you mind if I just have a little listen to your chest a minute?
0:32:27 > 0:32:30When you say he's had a bit of an uncomfortable night,
0:32:30 > 0:32:32can you explain that to me a little more?
0:32:32 > 0:32:35Normally he's quite happy, he goes to sleep at seven o'clock.
0:32:35 > 0:32:38- Top lip was swelling when he was trying to get the breath.- OK.
0:32:38 > 0:32:42- His nostrils were really flaring. - OK. Signs of distress breathing.
0:32:42 > 0:32:44Pulling right in here.
0:32:46 > 0:32:49James has Di Georges syndrome, a medical condition
0:32:49 > 0:32:51caused by an irregularity of the chromosomes.
0:32:53 > 0:32:55It can affect various areas of the body.
0:32:58 > 0:33:01Young children with the disorder may suffer from weak immune systems,
0:33:01 > 0:33:04heart defects, kidney and eye problems...
0:33:06 > 0:33:08..which can lead to even more complications.
0:33:10 > 0:33:13This little chap has problems with his airway.
0:33:13 > 0:33:17And his airway could collapse at any moment.
0:33:17 > 0:33:21And he also has been recently diagnosed with sleep apnoea,
0:33:21 > 0:33:24which means he stops breathing through his sleep.
0:33:24 > 0:33:27James, I'm just going to have a little listen to your chest.
0:33:30 > 0:33:33'So although the little child didn't look that poorly once we'd got there,
0:33:33 > 0:33:36'his respiratory was slightly elevated, and he had a little bit
0:33:36 > 0:33:39'of recession, which means you can actually see the skin
0:33:39 > 0:33:42'in between his ribs sucking in as he's breathing.'
0:33:42 > 0:33:46- Hey, you.- Yeah, he grunts with every...
0:33:46 > 0:33:51Yeah. His respiratory rate's quite high. It's up over 60,
0:33:51 > 0:33:53which is quite high.
0:33:54 > 0:33:57James's respiratory, or breathing rate
0:33:57 > 0:34:02is twice as fast as it should be for a child of his age.
0:34:02 > 0:34:05JAMES COUGHS Whoops!
0:34:05 > 0:34:07And the effort he has to put into breathing
0:34:07 > 0:34:09is making his heart beat faster.
0:34:10 > 0:34:12Well, I said his heart was high. That, for him,
0:34:12 > 0:34:17- it's normally about 105.- What was his heart rate on the SpO2?- 148.
0:34:17 > 0:34:20Yeah, I was going to say, it's ticking along around 150/160 now.
0:34:20 > 0:34:27- OK, and his sats are...?- 98.- 98, OK. Which is good for you!- Yeah.
0:34:27 > 0:34:29yeah, he's quite bright at the moment.
0:34:29 > 0:34:31Yeah, like we said, he's so happy.
0:34:31 > 0:34:33He could be on death's door
0:34:33 > 0:34:37and he still smiles. He's what we call a happy baby!
0:34:37 > 0:34:39I want to take his blood sugar,
0:34:39 > 0:34:41cos obviously he's been breathing quite rapidly.
0:34:41 > 0:34:43He burns up glucose quite quickly.
0:34:43 > 0:34:47- I'll just take his glucose level, if that's OK.- Now you're going to cry.
0:34:47 > 0:34:51Yeah, unfortunately this is where I become the nasty man.
0:34:55 > 0:34:56OK. I'm sorry, James.
0:34:59 > 0:35:01I think what we'll do is, we'll pop him in.
0:35:01 > 0:35:06He needed to go to hospital, but he didn't appear that poorly.
0:35:06 > 0:35:08Potentially, with his history,
0:35:08 > 0:35:11he could become very poorly very quickly.
0:35:11 > 0:35:14And that's why we decided that we really needed to get this little one
0:35:14 > 0:35:17into hospital quite quickly, in case anything deteriorates.
0:35:19 > 0:35:21This is little James, one.
0:35:21 > 0:35:24Respiratory rate's quite high, between 60 and 70.
0:35:24 > 0:35:28He's tapping along at around 160 beats a minute.
0:35:28 > 0:35:32James's condition means it's not his first time in a helicopter.
0:35:32 > 0:35:35And this'll be his sixth air ambulance trip in...?
0:35:35 > 0:35:38This will be the second in Cornwall. We've had Devon, and Air Sea Rescue.
0:35:38 > 0:35:40All right, OK. So four helicopter trips in? Right.
0:35:42 > 0:35:45One of those trips has already saved his life.
0:35:46 > 0:35:48Respiratory system...
0:35:48 > 0:35:50- JAMES COUGHS - ..just goes down the line.
0:35:50 > 0:35:52Oh, mate.
0:35:52 > 0:35:55- JAMES CRIES - Oh, mate.
0:36:08 > 0:36:13The air ambulance almost always sends small passengers to sleep.
0:36:20 > 0:36:22Ian Hooper has to be extra vigilant,
0:36:22 > 0:36:26making sure James doesn't drift into unconsciousness, or stop breathing.
0:36:33 > 0:36:35The worst possible outcome for a scenario like that
0:36:35 > 0:36:38is for the patient to stop breathing.
0:36:38 > 0:36:41For him to have been breathing so hard that he now becomes
0:36:41 > 0:36:44very tired, his respiratory rate will start to drop,
0:36:44 > 0:36:47drop dramatically, until the point where he stops breathing at all.
0:37:05 > 0:37:10Within 15 minutes, James is at the Royal Cornwall Hospital, Truro.
0:37:21 > 0:37:24It's a little short trip round to the front of the hospital.
0:37:24 > 0:37:26- You'll be there in a few minutes, OK?- OK, lovely. Thank you.
0:37:26 > 0:37:27No problem at all.
0:37:29 > 0:37:33He's in the right place now, and he's going to get seen by the docs.
0:37:35 > 0:37:39Now at hospital, James can get the steroids and antibiotics
0:37:39 > 0:37:40he badly needs.
0:37:53 > 0:37:57In the Scottish lowlands of Dumfries and Galloway,
0:37:57 > 0:38:01paramedic team Paul and Keith rushed to help a man in agonising pain.
0:38:01 > 0:38:03Argh!
0:38:04 > 0:38:07Suspecting Robert has life-threatening internal bleeding,
0:38:07 > 0:38:10they got him to Dumfries and Galloway Royal Infirmary
0:38:10 > 0:38:12in 22 minutes.
0:38:13 > 0:38:16He collapsed on the floor approximately 20 minutes ago
0:38:16 > 0:38:19with acute abdominal pain.
0:38:19 > 0:38:20His abdomen is absolutely rigid.
0:38:23 > 0:38:25Consultant surgeon Patrick Collins
0:38:25 > 0:38:27is almost certain it's a burst ulcer.
0:38:29 > 0:38:32- Is that what's causing the pain? - I think so. Can't be 100% sure.
0:38:32 > 0:38:34I would put my money on it.
0:38:36 > 0:38:39If it is a burst ulcer, this operation will save Robert's life.
0:38:43 > 0:38:44He's had a general anaesthetic,
0:38:44 > 0:38:47so he's had some drugs to put him off to sleep.
0:38:47 > 0:38:49- OK...- Yes.
0:38:50 > 0:38:54And he's had a breathing chip put down to do the breathing for him.
0:38:56 > 0:38:58A few minutes into the operation,
0:38:58 > 0:39:03Patrick Collins finds what he's looking for.
0:39:03 > 0:39:06We've opened up his abdomen via a midline incision which showed
0:39:06 > 0:39:08a perforated duodenal ulcer,
0:39:08 > 0:39:11so that's an ulcer in the first part of the small bowel
0:39:11 > 0:39:13has given way, or perforated.
0:39:15 > 0:39:18Around one in ten people have a stomach ulcer
0:39:18 > 0:39:20at some point in their lives.
0:39:20 > 0:39:23But they're usually spotted early and easily treated.
0:39:26 > 0:39:29These days, ruptured ulcers are extremely rare.
0:39:31 > 0:39:33Robert's been unlucky,
0:39:33 > 0:39:36but at least now he's getting the treatment he needs.
0:39:38 > 0:39:39So we've stitched that shut -
0:39:39 > 0:39:42quite a straightforward procedure - and patched it up,
0:39:42 > 0:39:45and washed everything out, and closed up his belly again.
0:39:45 > 0:39:46So he should do fine now.
0:40:04 > 0:40:06Ten days later, Robert is back home.
0:40:09 > 0:40:12He and his partner Barbara are recovering from the shock.
0:40:13 > 0:40:15The muscles went into spasm.
0:40:16 > 0:40:19And everything was just, you know,
0:40:19 > 0:40:23it was excruciating. I wouldn't wish it on my worst enemy.
0:40:23 > 0:40:26Well, he actually thought that was it, his days were numbered.
0:40:26 > 0:40:31He thought he was away, because he thought it was his heart.
0:40:31 > 0:40:34I'd actually said to Barbara, if I pass away here,
0:40:34 > 0:40:39tell the grandkids I love them. I remember saying that.
0:40:39 > 0:40:42Because I really thought, "I'm not getting out of here."
0:40:45 > 0:40:48But then, the ambulance arrived.
0:40:48 > 0:40:51And the next thing I remember, it had only been five, ten minutes,
0:40:51 > 0:40:53and the ambulance fellow came in.
0:40:53 > 0:40:55I thought they were really quick.
0:40:56 > 0:40:59I was kind of worried that it WAS his heart,
0:40:59 > 0:41:02and I wouldn't to Dumfries quick enough to see him,
0:41:02 > 0:41:04or anything like that.
0:41:05 > 0:41:09I think I panicked more after he was away, trying to get sorted out
0:41:09 > 0:41:13and get over to the hospital, in case he didn't make it.
0:41:13 > 0:41:15Because I didn't know whether he'd make it there or not.
0:41:17 > 0:41:20Oh, I just don't know what I would have done if I'd lost him,
0:41:20 > 0:41:22to be quite honest.
0:41:25 > 0:41:29I'm really grateful to the ambulance men for what they did.
0:41:31 > 0:41:34Now Robert is very much on the mend.
0:41:35 > 0:41:39They operated, from there to my belly button, and I had
0:41:39 > 0:41:43a tube sticking in there. I'm getting these stitches out today,
0:41:43 > 0:41:44these staples anyway.
0:41:44 > 0:41:47- So much for having a six-pack. - He's bored.
0:41:47 > 0:41:50He's a bad patient. He really is a bad patient. He's bored.
0:41:50 > 0:41:55It does your head in sometimes. But I don't mind that.
0:41:55 > 0:41:56He's still here!
0:41:58 > 0:42:01Funny enough, I said to Barbara, last night, "Do you know what?
0:42:02 > 0:42:06"I'm home a week now, but you could have been burying me this week."
0:42:06 > 0:42:11I said, "That's why you've got to live life to the full,
0:42:11 > 0:42:14"Cos you don't know what's around the corner."
0:42:14 > 0:42:16And I'm just thankful I've got another chance.
0:42:16 > 0:42:18And I'm going to make the most of it.
0:42:30 > 0:42:34It's been all go for the emergency services of rural Britain.
0:42:36 > 0:42:40Predictably, Marion recovered from her nasty leg wound quickly,
0:42:40 > 0:42:43and was out hiking again on Bodmin Moor in six weeks.
0:42:47 > 0:42:50After two nights in hospital, little James is back home
0:42:50 > 0:42:53and waiting to have an operation to remove his tonsils,
0:42:53 > 0:42:56which should help him breathe more easily.
0:42:59 > 0:43:02Robert got back to work in the dairy eight weeks after
0:43:02 > 0:43:04his life-saving operation.
0:43:05 > 0:43:08He's now planning to take Barbara on holiday.
0:43:10 > 0:43:13And you thought it was quiet in the countryside.