Episode 4 A&E on the Road

Racing to treat a patient in need of critical care.

Yeah, 52, 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 a million 999 calls every year.

Fighting to save lives.

Basically went straight up in the air, crashing down.

Because some emergencies are so severe...

He's fractured his femur.

..treatment must begin out on the road.

I am grateful to every paramedic.

If I could give them a medal, I would.

Today, doctors race to treat a young stab victim.

Hello, matey.

-Hi.

-Left side, lumbar region, stab wound.

A factory worker takes a hard fall.

It looks like you've potentially dislocated or fractured your elbow.

Maybe this bone here as well.

And a diabetic man sustained serious injuries

after collapsing in the street.

I'm type one diabetic. My blood sugar has gone low.

I have ended up tripping over, knocking myself out.

Every year, thousands of victims are hospitalised

from knife attacks in the UK.

And numbers are on the rise.

Generally, I think over the past few years,

there's been a slow increase

in the number of stabbings being reported

and that we're responding to.

The patient has an isolated stab wound

-to the cardiac box, anteriorly. Over.

-'Roger.'

Typically now, we're seeing teenagers around school age

being involved in knife crime.

How many times were you stabbed?

It does shock you to see that people

are prepared to, you know, commit a crime and take someone's life.

To increase the patient's chances of survival,

a unique team of frontline staff are kept on stand-by.

The Merit team is a group of individuals

who have specialist training.

A trauma doctor, together with a critical care practitioner

who's had specialist training to work together as a team.

We can deliver advanced surgical skills.

We can deliver the advanced trauma care that the patient requires

in that first hour after they're critically injured,

which could make the difference between life and death.

Tonight, the Merit team of Neil Abeysinghe and Ryan James

are on their way to treat a stabbing victim.

'In 500 yards, take the third exit off the roundabout...'

We've just been tasked to a male who allegedly has been assaulted.

We believe that he has a head injury

and he's been stabbed multiple times.

It can be anything from a penknife all the way through to a machete.

Those injuries can be quite minor, from a razor cut,

all the way through to fatal injuries involving multiple organs.

There you go, look. There are the blue lights.

-Do you want to take the bag?

-Yeah.

First, they have to decide if the injuries are serious enough

to treat the patient on scene,

or to stabilise him before taking him to A&E.

-Hiya.

-Left side, lumbar region, stab wound.

I don't know what was used.

-Yeah.

-We've got a sledgehammer.

He has been hit to left-hand side forehead.

-Yeah.

-My name is Ryan and this is Neil.

We've just come to assist the crew here

-to make sure you are all right. OK? Are you normally fit and well?

-Yeah.

So when we arrived,

the patient was already being attended by a paramedic crew.

They've already made an initial assessment,

and they'd identified he'd got a wound to his head.

Dealing with head wounds is really challenging.

It's difficult to know how serious that head wound is

without the benefit of a scan.

All we're going to do is just ask a few more questions

to what the crew already has.

Just to make sure that everything's been done that needs to be done.

OK?

The worst-case scenario is the bleeding compresses the brain,

and, given sufficient amount of time,

that pressure will build to the point

that eventually they'll stop breathing and their heart may stop.

So where are your injuries? Where have you been stabbed, do you think?

Did you feel anything at all?

OK, you just felt your head, did you?

Anything else?

Stabbing victims will often focus in

on the area of their body that has been most severely injured,

but they can have injuries elsewhere.

Were you knocked out, do you know?

I don't know.

So it's important that we examine the patient fully,

to identify if there are any life-threatening wounds

that the patient hasn't identified themselves.

OK, as you lie there, mate, where is your pain?

-In my head.

-Where else?

-I don't know.

-OK, can I get you to sit up?

Is that OK?

Sit forward. Sit forward, sit forward, sit forward.

Well done, buddy.

OK. The back is clear. Lift your arms up, matey.

OK, armpit. On the other side, please.

OK. All clear. Right.

The man has a small stab wound in his back.

Ryan now has to find out what damage has been done.

You've not got any pain in your buttocks,

or the tops of your legs or anything?

You definitely got no problems around here?

All right.

OK.

Roll over to your left.

-Any pain here?

-Mm.

-OK.

Any pain there?

All right, OK.

At the time it was unclear what object had been used

to stab the victim.

For us, it's really important to try and identify the object if we can,

because that will give us an idea about the depth

that has penetrated the body,

and the types of body organs that has involved.

Key for me was to try and get to hospital as quickly as possible,

to try and give him that greatest chance of survival.

I'm just going to put this fluid in your arm, mate, all right?

Just in case you have any large amounts of bleeding.

This is just going to help you.

He has a penetrating stab wound

to the right lower lumbar.

As a doctor we try and stay as objective as we can.

I think personally the younger the patient is,

I think that's the harder to deal with.

Much to the relief of the Merit team,

the stab victim had been extremely lucky.

His wounds were treated in hospital, and he was discharged the next day.

Ste Hill has been a paramedic in his hometown of Stourbridge

for the past 14 years.

I think the profession paramedic is all about helping people.

Being valuable in your community,

particularly where I work in Stourbridge, it's where I grew up.

It's nice to give something back to the community

that I've always been a part of.

He's responding to a call from a man who's had a suspected heart attack.

We're on the way to a male patient who's 28 years of age.

He's in a public place.

The job's come through that he's having chest pain and palpitations.

Quite limited information at this time.

The man was driving when he felt chest pains,

so pulled into a car park and asked a passer-by for help.

I was driving down the road and he just flagged me down.

Asked if I could call an ambulance for him.

Hello there, mate. Is it Dave?

-Yes, yes.

-All right, mate, OK. Hello.

Do you want to come and have a seat, just on the back of the car

-and we'll have a chat?

-All right.

OK, so what's been happening?

I've started getting these flutters in my chest, my heart.

-Right.

-And it keeps making me want to cough.

-OK.

-Expel my air.

And I can feel it, like, speeding up and then thumping.

It's making me feel like it's going to stop.

And I keep coughing like that.

So the pain you had, how would you describe it?

-It was quite sharp.

-A sharp pain, all right.

-Yeah.

-Has that passed now?

-Yeah, it has.

-But my heart just keeps, like, it doesn't feel right.

-All right.

What I want to do, with the symptoms that you've explained,

-an ECG is the foremost thing. We'll have a look at your heart.

-OK.

We'll have a look at the heart rhythm and see what's going on.

-Is that OK?

-Yeah. I knew something was pretty serious at that moment.

And I needed to get help as soon as possible.

Pop your finger in there, mate.

I was very worried with my two children in the car,

for their safety as well, because I was driving the vehicle at the time.

If I were to have passed out or anything,

and the car was moving,

I could have caused a lot of injury to myself and my children,

let alone to the public.

-OK.

-Do you suffer with anxiety?

Um, I have had anxiety, yes.

But I've never had it on this scale.

-Never.

-Does this feel like anxiety but worse?

-Yeah, yeah.

-It does.

-Just my heart doesn't feel right.

-OK.

Dave is complaining of symptoms suggestive of sort of palpitations,

so potentially a cardiac problem.

There's four sticky dots, one on each ankle and one on each wrist.

And there's six sticky ones on your chest as well.

-Yeah.

-So we're going to do an ECG.

Have a look at the electrical activity in his heart.

See if everything is where it should be.

We'll take it from there.

Having a feel of his wrist, his pulse does feel fast.

Not excessively fast, but faster than what we would expect as normal.

Just let this settle down a moment.

He said he suffers with anxiety, he has done in the past.

So it may be something along the lines of that.

We'll have a further investigation and we'll see what's going on.

Your ECG is OK.

-All right.

-There's nothing abnormal,

apart from it's ever so slightly fast.

What sort of pain did you have yesterday?

It was when I was lying down in bed.

I was getting a bit of sharp chest pain.

-It was sort of radiating around the centre of my chest.

-Yeah.

I'm thinking, after looking at his ECG, his ECG looks OK.

Cardiac pain, we wouldn't expect it to pass on its own.

Somebody would have to intervene and do something.

So, everything's looking OK at the moment,

but I think there's an element of anxiety,

so we'll calm him and put his mind at rest.

Right, your chest sounds nice and clear.

Now, your heart rate has reduced a little bit.

It's not quite as fast as it was. All right. And your ECG is fine.

With everything we've checked, and what we've found, or not found,

-I don't think there's any reason for you to go to the hospital.

-OK.

-That peace of mind for you?

-Yeah, yeah, it is. Thank you.

Ste, the paramedic, he was a very calm, relaxed...

Knows what he's doing.

That, to me, picking up those vibes, you know,

was kind of telling me that he wasn't too concerned.

I think in everyday life, in modern-day society,

stresses and strains of home life, work life, social life,

become sort of greater.

I'd say that anxiety is on the up, really.

We can associate fast heart rate and palpitations with anxiety symptoms.

You know, they're one of the observations

-that we tend to see with anxiety.

-OK.

-All right. You do seem quite anxious as well.

-I am a little bit.

Just worried. I had my two boys in the car.

Are they still there now?

-Yeah. They're eating food.

-Did your boys know what's happening?

They... I'll explain to them later.

I think they think it's pretty cool,

because obviously kids and ambulances and fire fighters and...

I feel a lot better now.

And obviously, the gentleman said anxiety and that,

so I'm going to go to the GP and talk to him, really,

and see what they can do for me, and that.

Because I've never had that sort of episode before.

Do you want me to follow you back, or...?

-I'll be OK.

-Are you sure?

-Yeah, yeah.

-OK.

As well as calling 999, good Samaritan Anthony

has been keeping an eye on the kids.

You can tell when someone's not feeling good,

so he didn't look too well.

So, you're not going to keep driving, are you?

You are going to stop and help somebody out.

It's what you have to do.

Touch wood, everything's all right.

They've given him the all-clear. Good news at the end of the day.

Anybody with chest tightness and palpitations,

they do need to get it checked out.

Anxiety isn't the only cause for them.

You can obviously have an underlying heart condition.

If those symptoms do occur, then it is always important to have an ECG.

You know, or see your GP or, you know, the Ambulance Service,

so the guy has done the right thing in getting checked over.

You know, to rule out anything more serious.

But, yeah, we are quite happy that he's sort of like... He's OK.

They started to listen with my chest,

and that's when they picked up on something that was abnormal

with my heart rate.

And that's when they told me that it was a diastolic murmur.

From what I believe,

a diastolic murmur can be a result of

your valves in your heart being faulty.

Basically, I've got to go and see a cardiologist.

Currently at the moment, I'm wearing a heart monitor.

Ste, that night when he advised me to go to my GP,

it's almost like a bit of a blessing in disguise,

that that happened and, you know, kind of it was fate

for this to happen and for him to be there.

Because otherwise, I may have not ever found out.

Front-line staff are under increasing pressure

to meet eight-minute emergency response times.

You really do have to kind of be on top of your game.

You're pushed to your limit.

You are put under a lot of pressure.

Personally, I feel like I thrive under pressure

and enjoy that kind of, a little bit of a stressful situation.

Yeah, understood. Thanks a lot.

Paramedic Cameron McVittie is en route to a factory

just outside Birmingham city centre.

So it's come through,

a 41-year-old male who has injured his arm somehow at work,

and now there's reports that he has difficulty in breathing.

Could be some significant trauma...

..if he's trapped his arm in a machine, or something like that.

Hello, mate. How are you? Are you all right?

-What do we think has happened?

-He climbed onto a paper roll...

-Yeah.

..to put a ladle onto a larger roll...

-OK.

-Slipped, fell backwards...

-Yeah.

-His arm is under his body.

-Underneath him? OK, fine.

All right, let's have a look.

Hello, mate.

His name is Hassan.

Hello, Hassan.

Need to do some very, very quick observations on you.

Can I just cut the length of this arm?

Is that OK? The jumper? Yeah?

When I looked at his elbow,

straightaway it was obvious to me that it wasn't in the right place.

He had loads of pain and all of his muscularity around his elbow,

it was all in like a spasm.

He was holding his elbow so tight.

It looks like you've potentially dislocated and fractured your elbow.

OK? Maybe this bone here as well.

All right? What I'm going to go and do

is get you some gas and air to try and take the edge of the pain away.

The speed of the gas and air is one of the biggest reasons

why we give people with fractures or other injuries -

they're in quite a lot of distress with - we give it to them first.

Have you ever had Entonox before?

This gas and air?

-A long time ago.

-A long time ago. You can control this yourself, OK?

So I'm going to give this to your other hand.

You simply put this in your mouth.

Make a tight seal around, and just breathe normally.

OK? When you breathe this in, I want it to make this noise...

RUSHING AIR

OK? It will start to work after a couple of minutes, all right?

Has the pain gone away a little bit? Taken the edge off?

-Still the pain.

-Still the pain.

When I asked for the crew to arrive, they came,

and they brought the most vital piece of equipment at that job,

which was the vacuum splint.

Something that I don't carry on my own as a responder in a car.

What we need to try and do is get you sat up, OK,

so we can have a good look at this elbow.

We want to vac splint it.

The vacuum splint is a great piece of equipment

that allows us to immobilise a limb, the whole length of the limb.

Basically, it's filled with beans, and we withdraw all the air

away from that mattress

so that the beans become tightly compacted together,

not allowing anyone to move the limb that it's wrapped around.

So, just deep breaths.

Deep breaths. You're doing really well.

Keep your arm still.

What it will do is just suck the air out, OK?

-Might feel a little bit strange.

-It does.

Can you feel it getting tighter?

Yeah? You won't be able to move your arm now.

-OK?

-It's coming out there.

So, to stand, I want you to try and bend your knees,

with your feet on the floor.

That's it. We're just going to stand up.

-Are you ready?

-Yes.

-After three.

One, two, three.

Brilliant. Well done. OK?

-Relax.

-Have a sit down on here.

All the best, Hassan. I'll see you soon, mate.

It might sound a crazy question, score out of ten.

If you imagined ten being the worst pain ever,

what would you rate it right now?

-Ten.

-Ten. I thought that was it.

Hassan, can I have a look at this arm?

I'm going to try and give you some better pain relief.

OK, just relax now.

Little scratch, OK?

Intravenous paracetamol is a great drug

that we can give people for significant pain.

The drug gets into the system quite quickly.

We're skipping the whole digestive system

and entering the bloodstream straightaway.

-Hassan?

-What?

Good luck to you. Any problems, Craig is your man.

-All right? See you later.

-Yeah, cheers.

-All the best.

See you later. Bye-bye.

An X-ray revealed Hassan had dislocated his elbow

and broken two bones.

After an operation and physiotherapy, he's back at work.

It happens, we're humans, we make mistakes.

We have accidents.

It's just fortunate that we were there to help him out

when he had his accident.

The West Midlands is one of the most diverse areas in the UK.

From inner-city Birmingham

to the sprawling countryside of Staffordshire,

hundreds of front-line staff are employed

to cover its 5,000-square-miles patch.

West Midlands is absolutely huge.

Can be lonely working in the car if you let it be,

but we just do so many miles

that we don't get chance to be lonely.

We're just so busy.

Paramedic Kathryn Davies is on her way to a job in Stourbridge,

just outside Birmingham.

We're going to a 71-year-old male, generally unwell.

Feeling very weak in his legs.

And he feels like his lips are numb.

So we'll go and check him over, give the control a quick update.

And see if we need a crew or not.

Hello.

-My name's Kathryn, what's yours?

-David.

David. What's going on, David?

I don't know. I took the dogs for a walk and when I was coming back,

I felt very funny, my legs just went when I got to the gate.

Your legs buckled. Did you fall onto the floor?

No, I was hanging onto the gate.

-You just felt very weak?

-Yes.

Nothing wrong with your heart or anything?

No, the last thing I had, the heart thing, they said it was fine.

That's all clear. Right. OK, that's good.

Can we take your arm out of this?

Yeah? Nice and steady.

Okey-doke.

I had taken the dogs out for a walk

and just when I was coming back, there's a gate up in the field.

And my legs just seemed to go.

And I had to stand there for about five, six minutes.

I just didn't feel well at all.

My head started spinning a bit.

My wife Liz phoned up, you know, the ambulance.

Basically because, you know, she knows usually how fit I am.

And...

I think it worried her an awful lot.

Are you feeling sick at all?

-No...

-No?

David described his symptoms of feeling weak

and having numbness in his fingers and his toes.

That could be a sign of a TIA - a mini stroke.

So that did cause a worry.

David, can you raise this leg for me?

Go on, push against me.

OK. A bit shaky, aren't you?

Give me a smile.

Bob your tongue out at me. There's a reason for it!

Shut your eyes. Put your tongue away now.

Can you feel me touching your face?

-Yes.

-And that side?

-Yes.

-Does it feel the same both sides?

-Yes.

-All right.

-David, open your eyes?

Now, now! Can you open your eyes?

This finger, put it on your nose.

There, OK.

And just see if you can go away and come back.

To your nose. All right. Put it back to your nose.

And again. Away.

Back to your nose.

OK, that's fine.

It's just to check their senses.

If anybody's got a brain injury,

or if there's anything going on like a bleed,

sometimes these senses won't be precise.

And it does give us a good indication of what may be going on.

Can you sit yourself right up now, David?

Thank you. That's it.

That's it, OK.

What I want you to do...

Hang on. Hang on.

Oh, sorry.

Fold your arms, have a bit of a cough.

Right. And sit yourself forward so I can...

Good. Good, so I can have a good listen.

Nice, steady, deep breaths in.

And out.

OK.

Right, I'm just going to do the front now.

Hold on, I feel a bit...

It's all them deep breaths in and out.

-Shall we have a rest?

-Yes.

Yeah, I'll just have a little listen to the front.

No, no, no, that's fine.

Pardon? I missed that. What did you say?

No, you're all right.

I'd like you to go to hospital and have some further tests.

Is that fine by you?

You're not wasting nobody's time.

All right? All his observations are absolutely fine.

David has got a lot of ongoing problems at the moment.

He is waiting for a CT scan.

But he's almost collapsed on the way back

from walking his dog, which is unusual.

Enough for him to ask for an ambulance,

because he's not that sort of fella.

So, although everything is looking right here,

A&E may be not exactly the right pathway but it's...

At the moment, we will take him in,

and just see if they pick anything else up.

Well, we'll see, shall we?

I knew deep down I needed to go to hospital

because nothing like this had ever happened before.

It's a case that there's something going on,

there's nothing hitting us in the face.

But sometimes you've just got to go with your gut instinct.

Gut feeling says send him in.

In hospital, David underwent a series of tests.

I had to go and have an X-ray.

And it was actually through that they found out I had lung cancer.

It was only about a week, a week and a half after that

that they wanted me in for a Pet scan,

which gives a better view of your stomach and your lungs and that.

And they said...

..we believe you've got a tumour...

..on your diaphragm.

It's life-changing.

Life-changing, finding out that you've got, you know,

lung cancer and then a tumour.

It is frightening

because you hear about other people that have got tumours

and you know, they ain't got long to live and you think,

that can happen to me.

If I hadn't gone up to Russells Hall with my legs...

..I don't think they would have found out

about the tumour or the lung cancer.

David is now undergoing treatment for both conditions.

Some sticky dots, just to keep a look at your heart, all right?

Doctors across Britain volunteer their time

to help the Ambulance Service through the charity Basics.

Basics is the British Association for Immediate Care schemes.

And its prime focus is to provide advanced care

in the prehospital field.

We've got the major haemorrhage stuff, some swabs and some gauze.

Basics doctors train medical students and assist paramedics

out on the road.

Paramedics are trained to deliver excellent care,

but there are limits to what they are allowed to do.

Doctors can do procedures that paramedics would not be able to do.

We've just got a call, we're on our way to a male who's having a fit.

And we've also got reports of a head injury, so he might have fallen,

sustained a head injury, and is now seizing.

Or he might be that he's having a fit and has bumped his head

on the way down.

-Hello there. Hiya. All right? Shall I pop on?

-Come on, yeah.

Thank you very much. Hello, sir.

All right? I'm Mike, I'm one of the doctors with the Ambulance Service.

-What's your name, sir?

-Wayne.

What have you found out so far?

-Diabetic.

-Diabetic chap.

Right. Do you know what happened, Wayne?

Do you know what happened to you?

I'm type one diabetic.

I'd gone into town. My blood sugar has gone low.

Started getting confused.

I ended up tripping over, knocking myself out.

Do you have this a lot when you have a hypo, the low blood sugar?

-Not like that.

-Not like that.

You just suddenly collapsed and banged your head on the way down.

Wayne's low blood sugar levels have caused him

to have a hypoglycaemic incident, known as a hypo.

When we first met Wayne, he was awake and talking,

but he was still finding difficulty in finding the right words.

He was slurring his speech a little bit.

Can you still see all right, Wayne?

Yes, it's just...

It's just a bit swollen, isn't it?

And you could think that he was drunk.

These are all possible consequences of having a low blood sugar.

Did you manage to get up and walk into the ambulance, did you?

-Yeah.

-OK.

If the brain is not getting enough food, it's not working fast enough,

and people can seem slow and slurred

and that's why they go off balance in the first place and fall over.

You hurt your wrist as well? Here? This is obviously sore here.

It is possible he's broken his jaw

but he certainly caused some wounds, which are gaping open,

and were going to need stitches.

The wound itself has got a small laceration next to the eye,

involving the eyelid, it's gone through the layers of the skin,

it probably needs a couple of fine sutures to stitch it up,

something he'd probably need to get to A&E for.

Can we just check your blood sugar, see what it's like now?

What was it like before, when you knew you had to get something?

-I haven't tested it.

-Not tested it, just felt like it was a hypo.

Can you still see all right, Wayne?

-1.1.

-1.1?

-Yup.

-Wow!

Okey-dokey. There we are. That's pretty low.

1.1 is really low.

It should normally be four.

It's no surprise that he felt unwell.

In Wayne's case we gave him some gel but ideally he would eat something.

He'd just been to the shops and had a carrier bag of chocolate bars.

He tried to eat it, but the wounds that he had got

made it difficult to eat.

They could sort him out more at hospital with more pain relief.

Right, well, I think you're in capable hands here.

It is a day-to-day battle for people with diabetes

and they're always at risk of having either a high or low blood sugar,

and there are problems with both.

Thanks, Wayne.

-All right?

-All right.

-Yup, thanks very much.

-Cheers.

I'd expect Wayne to make a full recovery

and he just needs to live with his diabetes

and work with his GP to find the medication that works for him.

At hospital, Wayne received treatment for his wrist

and head injuries, before being discharged.

The hardest thing about being a paramedic

is the suffering you deal with.

From experience, you know when people aren't coping.

Sometimes it takes a stranger to come and say,

"You're tired.

"You can't keep dealing with this.

"Let's put something in place to help you."

Paramedic John Cobb is on the late shift,

en route to treat an elderly lady with Parkinson's,

in pain from an infected pressure sore.

-Hello, sir.

-Hello.

-Where are we heading?

When we arrived at the address,

the house was full of family, neighbours,

everyone basically trying to sort the house out, moving beds -

it was evident she'd got so much support, they're a lovely family.

-Hello! What's been happening?

-She's gone off her legs.

-Right.

-She suffers with Parkinson.

-Okey-dokey.

Parkinson's is a debilitating degenerative brain condition.

The typical symptom is the shaking, but it's more of the mobility aspect

of it that we end up being called for.

-Other than Parkinson's, does she suffer from anything else?

-No.

How are you in yourself?

Do you feel bad in yourself?

-Just don't feel right.

-That's a good answer.

I'll get down to you. Have you got any pains anywhere?

Lower back. I've read about pressure sores.

Has that developed quite quickly?

-Yes, over the last three or four weeks.

-Okey-dokey.

-Quite a big one as well.

-I'm going to pop this in your ear. All right?

There we go. 38.2.

Can we have a look at your back?

If we just sit you forward slightly.

See how far we can get without up-heaving you.

Is that all right, sweetheart?

Come on, darling.

Just come forward a little bit, and let's move your packing...

Bless you.

Pressure sores are sore by their nature,

and some people, it is absolute agony for them.

She probably got this due to her reduced mobility and Parkinson's,

and if she's not able to get about,

these sores then can generate issues.

Has she lost complete use of her legs?

Is she able to do any weight-bearing at all?

It's like she tries, but it's as if she's trying,

she wants to, but it's not happening.

Her feet, it's just not happening.

All of her tests are fine. Her temperature is up slightly, 38.2,

it is classed as a high temperature, but not significantly high.

I'm thinking that if we get her into hospital tonight

and get a full assessment,

make sure that wound isn't causing any long-term infection,

we'll arrange for an ambulance to come and we'll get it sorted.

She's been gradually going off her legs over the last few weeks

and today, she just was hardly able to move at all.

So I decided to call for professional help.

For your mum to come back out, we can make sure there's a package

of care put in place, so Mum's safe here, and you are safe as well.

I know the bed's coming down and that's a good start,

but she's not really safe.

Without sounding horrible, you are your age,

you're going to do yourself some harm, really.

You've got to be careful that the husbands and wives

that are caring for their family members

don't become ill themselves due to the fact they're caring for them.

When that happens, we need to take a step back

and put something in place to help them.

Why wear yourself out doing something you don't need to do?

You haven't got to go very far now.

It is a difficult decision for the family

because they're acknowledging that they cannot cope.

As good as family are, they're not here 24 hours a day.

We'll get her assessed at the hospital, get some bloods done.

If it's an infection we can treat it,

and if it's not, then we can get her back home

with a package of care in place.

It's just there... It helps John, it helps the family.

Just keeping a bit of normality, really.

When we mentioned it to John, he sighed a bit of relief, deep down.

Whether he's been fighting this, I don't know.

A few little bumps on the way out.

We go to the right.

Well, hopefully they can just stabilise her.

Parkinson's is a progressive disease anyway,

so there's nothing they can do about that,

it will just have to run its course

till the other bits and pieces that need sorting.

So, just hope for the best.

There you go.

Just get you to shuffle along this way.

Melva spent the night in hospital before returning home,

but five weeks later she was moved into a care home.

The news that Melva's now gone into a care home

is kind of proof that her husband was struggling,

and the family were struggling.

To see them doing what they were doing -

trying to get the house ready - was lovely to see,

and they were doing everything they can to make sure she was safe.

It also shows that the package of care put in place

still wasn't good enough for her needs,

and that a care home is suitable,

and that it would be the best course of action for her.

It's the early hours of the morning.

Paramedic Ste Hill is blue-lighting it to get to an OAP in distress.

We're going to a 75-year-old lady who has breathing difficulties.

We've not been given any further info,

just Control saying it was an amber face-to-face job.

No other details at the moment.

Having breathing difficulties is sort of like,

one of the most common calls we go out to.

At all times of the day, but particularly at night times.

Patients' symptoms seem to get worse at night.

I've met this lady before,

and I don't remember her being a regular caller

for breathing difficulties.

Hello, sweet. What's the trouble?

OK.

Doreen is a familiar face. I've not seen her for some years.

So just to recap, you suffer with anxiety...

-Very bad.

-Very bad.

-And you suffer with palpitations because of your anxiety?

-Yes.

As soon as I stepped foot in her house, and I saw her face,

I knew who she was. She was quite happy to see me, I think.

Just describe the symptoms you've got?

Your body's throbbing, right.

Knowing how you feel, does it feel like panic and anxiety?

It could be. Can I have a listen to your chest, is that OK?

-Yes.

-Yeah? OK.

Take some deep, slow breaths for me.

And out.

Your chest's nice and clear.

-What I want to do now is do a heart tracing on you, is that OK?

-Yes.

And have your symptoms remained the same,

or have they got worse or got better?

Seemed to have eased off a bit.

Have I got that sort of face, have I?

We try our best, don't we?

Your ECG's good, it's perfect.

All right? It's not going fast, everything's where it should be.

Everything looks normal.

When you suffer with anxiety normally, what happens?

Does it normally pass of its own accord?

-Does that help?

-Yeah.

You've tried those a little bit this morning?

-Yes.

-Has it eased it off a little bit?

Looks like it, all right.

Would you say that you're feeling like you're starting to recover now?

-Yes.

-Yeah. Do you feel back to normal yet?

-Yes.

I think sometimes when people call for help

from the Ambulance Service,

they don't need any particular clinical intervention.

A couple of other things I want to do -

your temperature and your blood sugars, is that all right?

All right, thank you.

They don't need needles or drugs.

They don't even need assessment, sometimes.

It's just going to be a little scratch, OK?

I think just a kind word and passing the time of day sometimes

can reassure people enough to make them feel better.

Right, everything I've checked, literally everything, is normal, OK?

I don't think there's any reason to go to the hospital,

I don't suppose you want to go to the hospital, do you?

No, not really. I'm happy with everything, if you're happy?

-God bless you.

-Do you feel at ease now?

-Yes, I do.

-Do you want a cup of tea, Doreen?

-I'd love one.

-You'd love one.

This is the first thing we got taught at training school,

how to make a cup of tea.

I checked Doreen over, she's calmed down somewhat.

That quite happens with patients who have anxiety,

just to see the uniform, sometimes I think, before we've done anything,

it calms them down.

I just told Control that we're going to deal and we don't need a big

ambulance to take her to hospital.

This is proper ambulance tea.

Middle-of-the-night jobby.

The tea boy's here, Doreen.

All right. I've not made it too strong for you, that OK?

-Yes, thank you.

-That's OK?

Beautiful, thank you. Can you put it on the table, please?

Of course I can. Right.

I'm going to get some paperwork from the car

and I'll come back and just jot a few bits and bobs down.

-Is that all right?

-Yes.

All right, I won't be a moment, all right?

It means such a lot, Ste coming to visit me.

He's very pleasant

and he's got a nice personality.

And he puts people's mind at ease.

Same day as my dad's.

Not twins, are you?

-How old's dad?

-60.

Doreen, we're going to leave you in peace now.

All right? Lovely to see you again - it's been a while, hasn't it?

-Yeah.

-Yeah? I'm glad you're OK. You feel better?

-Yes, thank you.

-OK.

-OK.

You take care, Doreen.

All right, OK, bye-bye.

-Bye-bye, take care.

-Bye-bye.

We've assessed Doreen tonight, and it's not an acute problem.

The important thing is she's made a full recovery,

all of our observations are fine.

We've made her a cup of tea and she's happy to stay at home,

so we're clear here and we're going to move on to the next job.