Episode 1 A&E on the Road

SIREN WAILS Racing to treat a patient in need of critical care.

Can I have a crew, please?

This is the West Midlands Ambulance Service.

This could have been a fatal incident, 100%.

A dedicated team of doctors and paramedics.

-Hi there, ambulance.

-I don't like it when they cry.

They respond to 1 million 999 calls every year.

Fighting to save lives.

Went straight up in the air, crashing down.

Because some emergencies are so severe...

He has fractured his femur.

..treatment must begin...

-Take a deep breath.

-..out on the road.

I am grateful to every paramedic. If I could give them a medal, I would.

Today, paramedics treat a man hit by a lorry on the motorway.

He was lying on the floor rolling round when I got here.

This could have been a fatal incident, 100%.

A driver in pain fears for his life.

Whereabouts is it in your chest?

I laid down in the van and I thought my time had come.

And Cameron helps a young girl in excruciating pain.

If you could score the pain out of ten, ten being the worst pain

-you've ever experienced, how would you score it at the moment?

-Ten.

The West Midlands Ambulance Service

is one of the biggest in the country,

looking after over 5.5 million people in a 500 square mile area.

Its staff respond to over 3,000 999 calls each day.

And in the most serious cases

the West Midlands Ambulance Service

has its own mobile trauma unit known as MERIT.

MERIT stands for Medical Emergency Response Instant Team.

It's a team of two,

consisting of a senior doctor

from an emergency medicine background

or an anaesthetic background,

teamed together with a critical care paramedic.

Our remit is to respond to major trauma.

So major trauma could be lorry versus car,

road traffic accident on the motorway

or knife attack, machete attacks, gunshot wounds,

basically anything that is causing someone to have a severe injury

it's more likely than not we will be called to go and respond to it.

Tonight, the MERIT team of Greg Ambler and Nick Crombie

are on their way to a crash on the M6.

I would say between 30 and 50% of our work are road traffic accidents,

and that can include all manner of road traffic accidents.

Motor cyclists versus cars,

cyclists versus cars and pedestrians versus all manner of vehicles.

We are going to reports of a pedestrian versus a lorry

on the active carriageway of the M6

just north of Birmingham.

It's somewhere around junction nine or ten,

so as we get to that area we will obviously start to come upon

standing traffic and probably police.

When we get reports of a person hit by a lorry on a motorway

the immediate... hairs on your back go up.

The feeling is that it's a 60mph speed limit,

lorries obviously carry quite a lot of force.

Unfortunately they generally tend to be fatal incidents.

On the scene.

Surprisingly, the casualty is sitting up on the road talking.

It looks like, as you can see, a young chap, apparently intoxicated,

-walked into the road. He was hit by a lorry.

-OK.

He has got a head injury.

His breathing is OK.

His chest sounds clear.

When we arrived, the gentleman was seated in an

upright position with a couple of policemen around him.

His conscious level was fantastic, he was talking,

he was orientated and aware to sort of time and place.

We were very, very surprised that he was not more seriously injured.

Especially when we spoke to the driver of the vehicle

who stated that he was doing 40mph

when he hit the gentleman and he saw him fly

through the air and land on the ground.

I'm a doctor. I am going to have a little look at you, OK?

I am a doctor. I'm just going to have a look.

OK, in a minute.

-D you know what hit him?

-That lorry there.

-That one there?

-Yeah.

He was just lying on the floor rolling around when I got here.

Have you got any pain?

Does it hurt? Sore?

Ow?

What we're looking for at first is to see if there is any external

catastrophic haemorrhage,

to see if there is any obvious significant bleeding points.

We have a look to see if they've got an airway

and generally if they are talking, we are in a good place.

OK.

No limbs, no long bones, chest, abdo, neck, OK.

If you've got his legs,

I'm just going to sit up and he might be a bit more compliant.

OK.

Stop! Stop, stop!

Well done. Well done, mate.

-Relax, OK?

-The gentleman was obviously intoxicated.

He just wanted to go home.

He didn't realise that he had actually crossed the motorway.

He just thought it was a busy road and he misjudged the fact that the

vehicles were going at the speed they were

and he just wanted to get to the other side of the motorway to go home.

OK, that's all right. It's OK.

You're OK.

Where is home? Where home?

Where is home?

You're a rigger?

Has he got any ID on him at all?

Nick checks the man's pelvis and spine for fractures.

-Nothing's hurting.

-Well done, mate. Well done.

Listen...

You are OK. You are OK.

Even though he is presenting really well you still need to do a thorough

top to toe check, so we go from the head to the feet,

have a good feel of all his bones,

and we make sure that we, for example

the gentleman's moving all four limbs

with no pain, that they have no sort of serious spinal injuries

or spinal problems.

We also have a look at their chest,

so we are making sure that they are breathing well for themselves,

if it does not cause any extra pain.

We have a good poke and prod at their belly, etc.

More than 1,700 people were killed on the roads last year.

This man's had a lucky escape.

If you think about it, a 7.5-12.5 tonne vehicle

moving 40mph and you are a person,

so that force hits you and all your internal organs move,

so it's going to get this wave of movement.

That's his primary injury.

His secondary injury then happens

is he then falls backwards onto the motorway, so this massive mechanism

goes ten foot and then hits the ground.

That is where he gets his secondary injury.

So the index of suspicion's massive, really.

But miraculously, the man doesn't appear to have any serious injuries.

Upon checking things like his heart rate,

how well he was moving oxygen around the body, his blood pressure,

having looked at a picture of his heart,

we felt quite confident that he was in quite a stable state, really.

I know.

I'm English. I don't speak Russian.

He's done some miraculous dance move to be in the position where he was.

We were both, as a crew, myself and Nick

were incredibly surprised that he was in the state he was.

This could have been a fatal incident, 100%.

If this lorry was doing 60mph, as it's allowed to do,

and hit that gentleman at 60mph, he would have died.

We are going to go into the ambulance now.

Have you been briefed?

Only what I've heard on the radio.

This guy we believe is Russian.

-OK.

-He was intoxicated.

He's been crossing the carriageway and got hit by the lorry.

That one? That one that's there, the red one. Speed - don't know.

It's almost like a glancing blow and he's spun but obviously he's been

thrown forward by where he landed where the lorry is.

He's got a bleeding lump to the back of his head but no haematoma,

it's not boggy, it's a graze.

All of his limbs are absolutely fine, pelvis, abdomen, chest area,

BP is good, stats are good on air.

Drunk and very, very lucky as far as I can tell.

Let's have a clean of your eye.

We're going to give you a clean, OK?

He might have a fractured cheekbone.

He did have a fracture to his eye socket, he did not require any

immediate definitive care

and fortunately he didn't have a time critical head injury either.

He just had a slight concussion.

The man was taken to hospital

where a CT scan confirmed he had no internal injuries.

We did actually call because we were so surprised that he was

quite well and so we did call the hospital later in the evening.

The gentleman was staying in overnight just as a precaution

but he had no time critical injuries.

He just had the fracture which we suspected to his left eye socket,

but it wasn't time critical.

And didn't require any surgical intervention at that time.

I am incredibly surprised that the gentleman did not have any more

significant injuries.

The West Midlands Ambulance Service

has recruited more than 430 paramedics in the last three years.

One of these recent recruits is 25-year-old Cameron McVittie.

It's Saturday afternoon and he's been called to a woman who's

suffering from extreme pains.

This is one of the most rewarding jobs in the world.

It's the old cliche that, yeah, I'm here to help people.

And I like, you know, delivering that bit of extra compassion

and I care for people.

But it's also a bit of a personal challenge to work under pressure

and use such a kind of unique set of skills to deliver, in some cases,

you know, that life-saving, life-saving techniques.

You're pushed to your limit in work in this area, I think.

The volume of cases, or the volume of calls

that we get on a daily basis,

it's quite high and we're all under a lot of pressure to....

to deliver.

-Hello.

-She's in the loft. That's the problem.

-She's what?

In the loft? What we doing in the loft?

I hope I don't have to carry her down!

Now, is it Chelsea?

Yeah? Now, then, how can I help you today?

Talk to me. Let me know what the problem is and I can help you.

Got pains all in the stomach and they're shooting down the legs.

She was heavily bleeding yesterday with period.

It was going straight through her but...

Is it that time of the month?

Yes. But she's suffers with endometriosis.

Endometriosis is a disease where tissue that normally grows inside the womb is growing outside the womb

and can cause ladies significant problems

and significant amounts of pain.

Pop your finger in there for me, Chelsea.

So you've been sick this morning as well?

-Yes.

-Yeah.

And where exactly is the pain at the moment?

And if you could score the pain out of ten.

Ten being like the worst pain you've ever experienced,

how would you score at the moment? Is it ten out of ten?

All right. Well, we'll get that pain sorted for you shortly. OK?

It's hard to see anybody in an amount of pain,

but when they've got clear distress and you can see that look in their

eyes, that look of help me,

you act a little bit quicker and you always try and go the extra mile for

those people that really, really want you to help them.

So have you ever been to hospital before with your endometriosis pain?

-Yeah.

-When was the last time?

Was it recent?

You've been in and out the last two years, isn't it?

I've had endometriosis and I've had it since I was 13 years old.

It's something that's always there.

You know when it's coming.

You don't know when it's going to go or when the pain's going to stop.

When womb tissue grows outside the womb,

for example in the bowel or bladder, it bleeds with menstruation.

This causes pain and inflammation.

Your belly bloats and you're sick.

You're passing out.

It stops you from doing everyday things.

Especially working, you can't make it to work.

I can't drive when my stomach's bad.

Even moving or getting out of bed.

You just can't do it.

Now then, with one finger, tell me where it hurts the most?

There. OK. I'm just going to have a little press of your tummy now,

all right? Any problems going to the toilet at all?

-No.

-No.

OK, just a light press now.

Just relax. OK?

Is that sore?

-Yes.

-Sore here?

And when I press here, where does it hurt?

In the middle.

Does it hurt when I let go or worse when I press?

When I let go.

I just need to lift this leg up.

Can you just relax it a minute?

I'll lift it up.

OK? Ready. So that's floppy leg.

Just relax your leg.

That's better. Just relax your knee.

Completely relax.

Does that make the pain worse or better?

Or just the same? Just the same.

As a paramedic, it's quite important that we not only focus

on the problem that we're presented with,

but we try and rule out other problems that may arise.

The reason I was moving her leg around was it was one of the tests for appendicitis.

And once I could rule that out, as that test was negative,

it was clear that the problem,

the chronic problem that she has was causing that acute flare-up of her

pain and not something more sinister.

So we can get you some pain relief sorted.

Have you taken any paracetamol or anything this morning?

You threw it all back up.

-And when you take paracetamol, how many do you take?

-Two.

You take two.

And when you go to the hospital,

what pain relief do they normally give you?

Oramorph?

OK, and does that normally help you?

-Yeah. I've actually got some.

-Do you?

Would you like to take some of your own? That might help you. Yeah?

How much do you normally have?

Just one spoon. All right.

Do you want to sit yourself up a little and I'll get some of this for you.

All right. Do you want this, then? Here it comes.

Ready.

OK. All right. Do you want a little drink of water to flush it down?

Yeah.

113.

Can you send an ambulance backup, please?

While Cameron waits for the ambulance to arrive,

he prepares Chelsea for the trip to hospital.

You need to keep it straight.

OK, just stay really still.

All right? OK.

It will be a little scratch.

Just wriggle your fingers a little tiny bit.

Keep going.

Very good. It's all sorted.

So what we're doing at the moment is we've just popped a little plastic

tube or a cannula into Chelsea's hand,

just in case we need to give her any further pain relief.

Obviously she's taken her own pain relief, which is great.

But you know, she says that the pain gets worse on movement.

So if we need to give any further medication, ie,

any paracetamol through the vein or anything like that,

then we can do that much more simply now.

OK. Are you comfortable there for a second?

Negotiate the steps.

All right?

-Hello.

-This is Chelsea.

OK, Chelsea's 18 years old.

Unfortunately Chelsea suffers with endometriosis.

She, unfortunately, this morning,

about 10am, experienced a sudden,

very intense super pubic abdominal pain.

That's kind of where we are.

The only way she can safely come down is literally by walking.

There's no way that we could extricate someone through here.

It's too dangerous to use the carry chair and the extrication equipment.

Obviously if the patient deteriorates or was unconscious,

it would be a different scenario, but she's going to

make her way very slowly down the stairs.

OK, put your bum there.

What is your name again?

Hi there, Chelsea.

Now, you've been having the entonox and you've had your own Oramorph.

Legs up. If you had to score that out of ten, ten being the worst one,

where would you put it now?

It's about a five. OK.

All right, sweetheart?

Is it easier with that pain relief?

Yeah. You have some morphine now.

-OK?

-I don't remember much.

I don't even remember getting to the hospital or anything.

I was, I knew they were putting the morphine in my hand

when I was in the ambulance. And that was it then, I was gone.

I was out of it.

It's yet another visit to the hospital for Chelsea and her boyfriend, Ben.

It's horrible knowing I can't really do anything about it.

Anyway I can help, like, I can go into hospital appointments and that,

but I look at her and I see her and I can't do anything about it.

So it's upsetting, to say the least.

OK, Chels, they'll look after you.

All right? All the best.

See you later.

Been to see many ladies unfortunately who suffer with this medical problem.

Again, every single one I have seen,

the common factor is they are in excruciating pain.

And the only thing that I can do, you know, is provide that really

good level of pain relief to try and get it under control.

I hope she'll make a good recovery. Hopefully she'll be assessed

and I know she's awaiting some scan results, so fingers crossed for her.

I wish her all the best.

Following her visit to hospital,

Chelsea underwent surgery to treat her endometriosis.

They just said that they would laser it away, that was keyhole surgery.

And after I had that done,

everything was a lot better for about a few weeks.

I went back to work for a few months and ended up in hospital again with

the same pain. And they told me that it'd all grown back.

I've tried everything now and there's nothing else that I can try.

So I know that it's something I'll have forever and it won't get cured.

It's just something I have to learn to deal with.

The West Midlands Ambulance Service

employs thousands of front-line emergency staff.

Is that hurting there?

Can you bend it at all?

They also make use of volunteers.

BASICS is a charity that covers the whole of the UK.

In North Staffordshire, it's made up of six doctors who give their time

freely to provide that extra care

that can't be delivered by the roadside paramedics.

Right. Got the major haemorrhage stuff,

got some swabs and some set-up scores.

We can mobilise to anything that where the Ambulance Service think that we can make a difference,

so it's often trauma.

Motorcycle, car accidents, plane crashes.

But it could just as simply be somebody who's struggling medically

with difficulty breathing or another medical problem.

Today, Mike and medical student Jonathan Charles

are en route to a man who has suffered a suspected heart attack.

Yes. A red van. Thank you.

We're about three minutes away.

He could be having a heart attack, so we'll get there, assess him,

do an ECG and take it from there.

An ambulance backup crew has been dispatched to assist the doctors.

When we're sent to somebody who's got chest pain,

it could be a wide variety of different problems.

From mild indigestion to a full-on heart attack

that ends up into a cardiac arrest.

If you've got somebody who's in cardiac arrest

you've got a limited amount of time before brain damage sets in.

And you really need to get in there,

drag him out to the car and get going with CPR.

So, it's really important that we do some very rapid assessment and find

out how serious it is.

Red, is it?

Some people call them vans, don't they?

I guess so. Could be.

That looks like him.

-I think someone's in there.

-Are they?

OK.

Yeah.

Say hello.

Yeah. Hello, sir. Hi, there.

Want an ambulance?

Hi there. Are you OK at the moment?

You've got pains in your chest.

-And my arm.

-All right. We'll just come around the other side.

We'll have a look. Is the door unlocked?

The fact that he was talking to us was a great sign.

It meant that he wasn't in cardiac arrest

and we had a few more minutes to work out what was going on.

-And whereabouts is it in your chest?

-There.

I first realised something was wrong when the pain in my chest

was spreading elsewhere.

I realised it wasn't heart burn.

This was something more considerable, something quite bad.

So at that point I pulled over and I phoned for an ambulance.

Is it spreading down your arms at all?

-There.

-Your left-hand side.

-Both hands are numb.

-Both hands are numb.

OK. And when did this start?

Five, ten minutes ago.

I hadn't got the strength to hold the phone to my ear.

My hands were tingly.

I put the phone down.

And I lay down in the van.

And I thought, my time had come.

I really did.

And are you generally fit and well.

Any medical problems at all?

-No.

-Normally, no heart problems in the past?

My heart misses every other beat and the occasional...

We couldn't assess him properly

while he was laid across the car like that.

Luckily the Ambulance Service turned up pretty much the same time as

we did, which was really helpful.

Because we needed to get him into an ambulance.

Into a nice warm place that we could assess him and examine him properly.

-What's your name, sir?

-Simon.

All right, Simon. You've got pain in that left arm?

-Just numb.

-OK.

-What sort of pain is it?

-Stabbing there.

Right through to the back.

Right through to the back. Have you ever had anything like this before?

I thought it was...indigestion.

OK. We'll get you help out the car

-and someone will be able to give you checks. OK?

-No worries.

Simon was well enough to suggest to us that he was able to sit up and

maybe get himself into, on to the stretcher

and get into the ambulance.

Right, so he's bringing the trolley round for you to climb on to.

No worries.

That's it. We'll lock the door for you.

-It felt like indigestion.

-Yeah.

And it kind of wasn't going away.

-Have a look at your chest.

-And it just got worse and worse.

Have you ever had anything like this before, Simon?

-No.

-No.

-Not like that.

-Nice and clear?

-If you could rate the pain, ten being very painful,

zero not being painful at all.

-What would you rate it?

-Escalated to a ten.

-It's gone off now.

-What would you say it is now?

-Nothing at all.

-Nothing at all.

-Just numb.

-Still got those tingly fingers?

Tingly fingers. Yeah.

How old did you say you were, Simon?

-52.

-52.

We've been able to get him into the ambulance. A bit more private.

A bit more secure and able to assess him properly.

He still has had these pains

giving him some tingling in his fingers and things.

So we're just doing a heart tracing now to find out if there are

any signs of it being a heart attack.

Right, really nice and still while this is just reading for me.

On Simon's heart tracing, there was some changes from normal.

It wasn't quite enough to really put our finger on it and say he's having

a big heart attack. But it was suggestive enough.

So we made the decision to take him to the hospital for further testing.

So, what we're going to do, Simon,

is we're going to give you some painkillers and hopefully take the edge off the pain.

-Yes.

-But you are going to need to go into the hospital,

to see what's happening with your heart.

-OK.

-As I say, there are some subtle changes on there.

They might be the old ones that you are talking about,

or they might be new ones. So, we're going to take you to A&E.

They'll be able to do some blood tests as well, just to see

if there's been any heart damage or anything like that.

-OK.

-Right. Thanks, Simon.

-Thank you.

-Hope you feel better soon.

-Catch you later.

-Bye-bye.

He certainly needs more investigation to find out exactly what the

cause of his pain is. It could easily have been a heart attack,

just a small one. So, he'll go to the A&E,

at the Royal Stoke University Hospital,

and they'll be able to take things from there.

Simon was kept in hospital overnight

until doctors could reach a clear diagnosis.

I had very extensive tests in hospital.

They say it was a heart attack caused by a virus.

Nothing wrong with my heart at all.

The tests, the ultrasound and everything said quite a good, strong heart.

It just makes you live every day when you wake up,

"Wow, it's another day, it really is another day

"and be thankful for it."

In Wolverhampton...

..paramedic Kathryn Davies is blue-lighting it to a teenager in distress.

We're going to a young 14-year-old girl,

who's suddenly started vomiting and become breathless.

If she started vomiting first,

people can become very breathless through the physical effort of vomiting.

If the breathlessness come first before the vomiting, that's different.

So, you know, it's hard to make assumptions, but at the moment, hopefully,

it's something we can deal with on the scene.

Her mum must be really concerned, because obviously she's rung 999.

Like with the younger ones.

If it's something serious, I think it affects most of us.

Just such young lives.

You know, you think a bit differently.

But before she can deal with the medical problem,

Kathryn has a logistical problem of her own to deal with.

Houses without drives.

You can never park.

However, I think we're in luck.

Somebody waving to us.

Hello, my lovely.

Hello. What's going on then?

Finding it hard to breathe.

She keeps gagging now.

OK.

What's happened then?

I've just picked her up, brought her home. She's been sick.

High temperature.

Hard to breathe.

So this has all happened suddenly?

In the last 20 minutes.

OK. Let's have a look at you.

My name's Kathryn. What's your name?

Jessica.

That's lovely. Pop your finger in there.

Nice painted nails, aren't they?

When I hear it's somebody young,

if she's got no previous and she's breathless,

one of the main reasons

is that they could have got themselves very anxious.

That's good. So everything's working OK.

All right. Can we take some nice deep breathes in.

It does happen to a lot of people who don't suffer with anxiety

and it can just happen to us for no reason at all.

You take a deep breath in and count to two and blow out slowly.

Go on.

Come on, sweet heart. Come on.

Don't get yourself upset.

Although Jessica is conscious and communicating,

Kathryn's concerned by how distressed she is.

OK. Nice and steady.

Jess, look at me.

That's better.

While you're doing that, I'm going to have a little listen to your chest. OK? Yeah.

That heart's racing a bit.

We'll slow that down.

Nice and steady.

I did her oxygen levels just to make sure that she wasn't

lacking any oxygen and they were 100%.

I listened to her chest and that was clear.

With Jessica's heart and chest both appearing to be fine,

Kathryn now decides to check her temperature.

Sweetheart, I'm just going to pop this in your ear.

Oh, yes. She's got a raging temperature.

Is your throat sore at all?

-Yes.

-Can I have a look in your throat?

-Open, say "ah".

-Ah.

Yeah, you've got a red throat.

Oh, dear! Have a little feel here.

I think the problem was, yes,

she'd had a high temperature and she wasn't feeling too well.

She'd probably got a viral infection.

And being 14,

because of this she started to get herself very anxious,

which led to her hyperventilating, which frightened all the family,

because it's not a nice thing to sees.

I'll come and sit by ya. OK?

It seems that a simple sore throat is what's caused Jessica to get

into such a state.

Right, Mum, she's got reddening to her throat,

but there's no white pus on her throat at all.

So I don't think we're at the antibiotic level at the moment.

-No. Just viral.

-Yes.

Keep an eye on her throat.

If there's any white pus start on it,

that's the time to go and see your doctor.

I think because she's feeling unwell, she's got herself upset.

-Yes.

-You know? And hyperventilating,

it causes you have to pins and needles and feel sick,

but we're settling down now.

Colours going back down again.

You still look beautiful.

You're all right. OK?

She's been out playing with her friends at the park

and probably put a little bit of a brave face on.

Got herself home and started to feel really unwell and getting really

upset with it. Just coached her breathing, calmed her down,

and we've suddenly got a happy little girl,

where she was really upset before.

But hopefully, just with a paracetamol and plenty of fluid,

she should be feeling a lot better.

Jessica later visited her GP and found she had a virus.

She hasn't needed medical help since.

I think alcohol has a huge effect on the NHS.

We go out to so many alcohol-related problems

and we are tied up with them

and people who are drunk, they are difficult to assess.

In Dudley, the ambulance team of Tracey Hawthorne and Helen Parry

are on their way to deal with a man who has collapsed.

'Just ahead.

'Turn right.'

We're going to an unknown patient at the moment,

who's unconscious in the street, outside...

Outside a supermarket.

We've got no reports of any fitting, so possibly,

possibly alcohol-related at the moment.

Clear left.

It's all going on in this street!

They arrive to find the police already on scene.

-Where's the chap?

-In here.

Hello. Hello there.

Hello. Just been flagged down by the people there to say he's come in,

asking for alcohol. They've refused him and he's gone to the floor.

Semi-responsive, breathing.

Yeah.

-He's got his dots on.

-He's still got his dots on.

The dots, or heart monitoring pads,

show the man was recently treated by paramedics.

You can hear me.

We've met before, haven't we?

How long has he been on the floor?

-How long has he been, fellow?

-About five minutes before you arrived.

About five minutes. OK.

-About ten minutes.

-About ten minutes.

-Did he fall to the floor?

-No.

And he went down on the floor.

So he just lay himself down.

When he was lying down he was still talking, he was still wide awake then.

OK. So he didn't fall, he didn't...

OK. Can I have your finger.

Let's do some obs.

Got the ambulance crew, mate.

So it's not very comfortable down there, is it?

You don't want to be staying there all night.

Just going to take your blood pressure, OK?

Some days you will have drunk after drunk after drunk,

all alcohol-related jobs after one another.

We met you the other day. Do you remember us?

You sometimes, you don't know what's took them there

and you just see what their future is and it's not good.

You can't stay here all night, can you?

What I'll do is I'll go and get the stretcher, and then...

-We'll get him onto the stretcher.

-We'll get him onto the ambulance, out of the way.

We see so many homeless people that, er,

that drink, that have got nowhere to go.

They've got no toilet facilities.

They've got nowhere they can wash.

The only safe thing we can do is take them to hospital and that's

frustrating, as it has a huge knock-on effect with other patients

that genuinely are sick and need treating.

Yeah, I think it's pretty similar to what happened last time.

I think he went into A&E.

-OK.

-And was being discharged.

Our only option is to take him to A&E.

-Thanks for coming out, guys.

-No problem.

Thank you.

Thank you. This is a patient I've been to before.

The last time we went out to him,

he'd been discharged with some medication

to help with his alcohol addiction.

He's come out and tried to buy alcohol and a passer-by called,

so it's pretty much the same as the last time.

But at the moment he's not really safe to be left.

On arrival at A&E, Tracey and Helen discover that the man has already

been in hospital today, but discharged himself,

against medical advice.

And less than half an hour later,

he's discharged himself again.

People say that they are a waste of time, a waste of a resource,

but it might be their family, we don't know.

It might be their children.

They're part of society that we have to keep safe, so...

..that's what we do.

Kathryn Davis has been a paramedic for 17 years.

It's lovely to do your job when you know that you've really,

really helped somebody.

Whether it's just keeping somebody company and holding their hand,

maybe making them a cup of tea,

or whether it's physically, actually, saving their life.

When I left school, I wanted to be a hairdresser and nothing else was

going to stop me, and I did that.

But when the children got a little bit older, I thought,

"Right, it's time now."

So, I joined the Ambulance Service and it's the best thing I ever did.

It's early evening and Kathryn has been called to a hotel in Hagley,

just outside Birmingham.

We're going to a male in his 40s in a restaurant.

It's come through as choking,

but then he's actually said there is something stuck in his throat.

I'm being backed up with a crew,

but will probably be there first on scene, to render aid, if need be.

Oh, that's him there.

Richard Dawson was having dinner with his family

when he started choking.

What's happened then, my love?

I swallowed a chunk of steak.

A piece of steak?

-It's there.

-Right, you can feel it?

-Yeah.

-Can you still swallow?

He's had a bit of water but he's brought it back up.

Yeah. We've got an ambulance crew on the way, so we can get you on there.

Whatever you want to do for the best, all right?

Richard had got a piece of steak stuck at the back of his throat

and he just couldn't relieve it in any way.

He was starting to get anxious, which is not going to help,

and although he was able to speak in full sentences,

he was very uncomfortable.

Let's just pop this on and have a little listen to your chest.

Are you normally fit and well?

-Yeah.

-Yeah, there you go.

That finger. There you go.

Let's have a little listen.

All right.

Giving you pain?

It comes and goes.

I checked his oxygen levels,

basically to see how much oxygen he was managing to get into his body,

and I wanted to listen to his chest to make sure he'd got

equal air entry.

Just breathe normal, don't...

HE WHEEZES

OK, don't worry.

-This is Richard.

-Hiya, Richard.

He's got sats of 98.

He's got a piece of steak stuck and he can actually feel it.

He has got a little bit of a wheeze at this side.

OK, yeah.

So, I think we just need to get him on and get it sorted.

Is it throat or is it...?

-No, it's here.

-OK, fine.

So, it's already gone down.

He's had some water and he's brought it back up again, so it is blocked,

but his sats are good and he's normally fit and well.

All right, shall we get you onto the motor?

Are you OK to walk, just to there?

Yeah? Come on then.

OK.

If somebody's choking and their airway is completely blocked,

they're at the danger of stopping breathing and we need to take

immediate intervention. But if that blockage is there,

but people are still breathing sufficiently, we leave it well alone

because if we start intervening and we move that foreign object,

it could be moved into a place where it completely blocks their airway,

and then we're in trouble.

-We don't touch anything that's not broken, OK?

-Right, OK.

So, that's why there's none of this going on,

because it could dislodge it...

RICHARD COUGHS LOUDLY

..and - it's all right - it could dislodge it and cause more problems.

OK, right.

Instead, the team decide to give Richard a fizzy drink.

We're going to get some Coca-Cola.

-Right.

-Because very often that helps, or a hot drink helps.

-PARAMEDIC:

-You might throw something up.

-All right.

-If you do, that's fine. That's fine.

That's it.

I can recheck his chest.

Daddy is fine. Do you want to come with me and see him?

-CHILD:

-I want...

-You want Mummy?

Do you want to go with Phoebe and see Daddy?

It's fine. What's your name?

-Phoebe.

-Phoebe.

Phoebe, look, Daddy's fine.

Give him a kiss.

-PARAMEDIC:

-It's all right.

-That's it.

-We'll follow Dad, shall we?

-There you go.

OK. They'll be a few minutes here anyway, so...

Bye, girls! Bless them.

When you've got children as well,

you've got other patients to look after.

You know, they're really upset, traumatised, but as well as the crew

looking after him now, we've got to reassure the children

that Daddy's OK.

-Bit of Coke?

-He went... He went, "That's gone."

-Oh, good.

I'm just going to assess him.

OK, right, we've just had some good news.

While we're waiting for the ambulance to assess the patient,

he's been drinking this Coca-Cola to see if it'll help,

and it has actually cleared the piece of steak that was blocked.

He's absolutely fine now.

A little bit shook up, but he's fine.

-See?

-Tell them to put another steak on.

All right.

Yes, girls, Daddy's better!

Yeah!

Definitely feel all right?

-Yes.

-It's definitely come up.

You can have the bag if you like?

-PHOEBE:

-I've seen enough today.

-You sure?

-Yeah.

One, two, three - wahey!

You all right?

-Yay.

-Hopefully, we won't see you again this weekend.

-Hopefully not.

-Enjoy your weekend.

Thank you.

Bye-bye.

I cut too big a piece, didn't chew it enough, swallowed and...

Stuck.

Straightaway, I knew I hadn't chewed it enough.

Stuck, stuck.

-It was stuck.

-And it just... Could just feel it there, lodged.

And, yeah, just hurt a lot

I just feel a bit silly now.

And hungry.

Oh, it's lovely to get a happy ending. It really is.

It makes the job worthwhile.

I've always enjoyed working with people.

It's because I'm so shy and retiring... Not!

You know, I've always enjoyed it and I am a people person.

Altogether, it's been 17 years I've been in the Ambulance Service now,

and it'll see me through till I retire.

I would want to do anything else.

We have ups and downs, like you do in every job,

but I do love my job.