Episode 5 A&E on the Road

Racing to treat a patient in need of critical care.

Yeah, 5-2, 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, got an ambulance.

-Don't like it when they cry.

-They respond to a million 999 calls every year...

-Oh...

..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...

-Take a deep breath in.

-..out on the road.

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

Today, a paramedic's worst nightmare.

There's a seven-year-old child that's been hit by a car.

A factory worker struggles to breathe.

Try and calm down a bit, all right? Try and control your breathing.

He didn't look well. He looked petrified.

And paramedics battle to help a man who's fallen in a busy street.

We'll go to the hospital. Just relax.

When we attend people

who are erratically breathing -

what we call hyperventilation syndrome, breathing fast -

there's can be many causes for it.

First and foremost, are his lungs working correctly?

Are they supplying his body with enough oxygen?

Is his breathing due to an underlying medical condition

or is he breathing like that down to an underlying injury?

So, we start from basics and work our way through full assessments

to rule out things before we come to a final decision.

It's Friday afternoon in Birmingham

and paramedic Ste Hill has been called to a man

who's having trouble breathing.

We're responding to a male of 30 years of age.

He's got breathing problems.

We're not entirely sure why he's got breathing problems at the moment,

whether it be through a medical problem, say asthma,

or whether it's a breathing problem related to where he's working,

environment factors, maybe like smoke or chemical inhalations.

We'll do a quick patient assessment

to try and find out what we're dealing with.

Is it this one here?

I don't actually know what happened.

-He just come over and say he felt ill.

-Hello there, mate. Hello.

-What's your name?

-Abdul Rahman.

-Abdul, all right.

-OK, Abdul, do you speak English?

-Yeah.

-You do.

Have you got any pain anywhere?

Do you mind taking your top off for me? Is that all right?

ABDUL WHIMPERS

-All right, all right. Calm down.

-Just relax.

Abdul, I'm going to have a listen to your chest. Just relax for me.

When I first arrived at Abdul's workplace in the factory unit,

it was quite clear that he was really struggling.

He was breathing pretty quick and he didn't look well.

He was quite pale and he looked scared. He looked petrified.

Take some deep, slow breaths.

ABDUL WHIMPERS

Have you had problems with your breathing before

or been to hospital with anything before?

-Two years ago, his chest was bad.

-What with, mate?

-Do you remember?

-What's the problem, Rahman?

OK, all right, what I need you to do, right,

is you try and calm yourself down, concentrate on your breathing.

Take a deep breath in and hold it for a few seconds.

At the moment, you're breathing way too fast.

I think you're having some sort of anxiety attack.

That's what it sounds like to me, all right?

We need to rule everything else out at this stage,

but that's what it's looking like, OK?

So, I need you try and calm down a bit, all right?

Just try and control your breathing.

It's only you that can do that.

Deep breath in for a few moments and hold it, OK?

I'm unsure as to what the cause for Abdul's anxiety was.

He may fall into one of those categories where we'll never know.

Subconsciously, he may have had some stress somewhere in his life,

which came to a head on that day in his workplace.

-Do your fingers feel cramped? Sorry?

-Can you move your fingers?

-ABDUL WHIMPERS

-OK, Abdul, listen.

The reason your hands are like this...

-ABDUL WHIMPERS

-OK, just listen.

Listen to me. Let me explain what's happening, OK?

Because you're breathing too fast,

you've caused your hands to spasm, the muscles in your hands.

-You're breathing too fast.

-You've got to calm down.

People can quite often experience a spasm in their hands and their feet.

Ultimately, that is because you've been breathing too fast.

By getting too much oxygen in

and getting rid of too many waste gases,

you actually change the pH of your blood

and that causes the spasms in your hands

and that can be quite frightening for people.

I can't give you anything to regulate your breathing.

You need to concentrate on that yourself, OK?

Deep breath in and hold it for a few seconds.

When you breathe too fast, you take too much oxygen in

and you get too much waste out, so it causes your hands to spasm.

-Deep breaths, deep breaths.

-All right?

-ABDUL WHIMPERS

-You concentrate on your breathing.

Although he suspects it's an anxiety attack,

Ste still needs to rule out heart or lung problems.

Your heart rate is OK, apart from being a little bit quick,

which we can account for because you're worked up.

It's OK, all right?

We're not suspecting this is your heart, all right?

Deep breaths, Abdul.

Deep breaths.

Keep going.

I've assessed your breathing. Your breathing's fine.

I've had a look at your ECG. Your heart's fine as well, all right?

So, we've ruled out the serious things.

So, if that's what's worrying you, don't worry.

Do you want to have a walk outside

and we'll see if we can get you some fresh air. Yeah?

-Come on.

-Stand up.

Eventually, Abdul's breathing starts to slow down.

We'll do another quick ECG, now your heart rate's calmed down a bit.

Just pop these on, mate. I'm sorry to press on your chest.

5-2? Patient's made a full recovery. It was an anxiety attack.

No backup required.

I'm going to be on, probably in the next 15 minutes or so.

All right, your ECG's perfect, Abdul, all right?

We don't need to go to hospital

but we will recheck your observations again in a moment.

What I suggest is, you're probably best off going home.

-Are you on a late shift today?

-No, he was due off in a minute.

-OK.

Maybe get yourself home.

Is there somebody at home, somebody that can pick you up?

-His wife.

-OK.

And then you need to get yourself booked in

at the doctor's, at your GP, yeah?

Just discuss with he or she what's happened, yeah?

Just so it's on your medical record.

He's going to feel a bit naff for probably an hour or so,

but everything we can check is normal,

so it doesn't warrant a hospital trip.

It'll be a GP visit for him, if he can do.

I'm going to advise him, if the symptoms do return,

he can call us back later,

but there's certainly no reason for him to go to A&E.

Don't give him anything to eat or drink

and make sure he's kept nice and warm.

The West Midlands Ambulance Service is one of the largest in the UK,

looking after more than five million people

over a 500 square mile area.

We cover a massive area,

ranging from heavy industry and densely populated areas,

out to less populated areas, such as Shropshire and Herefordshire

and the workload gets reflected in that quite a bit.

I mainly work in a response car, mainly in Birmingham city centre.

The bonus, obviously, of having a car in the city centre

is that you're smaller than your conventional

double-crewed ambulance, which, obviously allows you

to have a bit more manoeuvrability and get to a patient quicker

and start providing that treatment that they need.

It's Thursday afternoon and Mike's been called to an incident

in Birmingham city centre.

I'm on the way now to a male, who's reportedly unconscious

outside The Square Peg, which is a pub in Birmingham city centre.

Obviously, given its location, it's probably involving alcohol.

It's quite an established area for street drinking.

It's just a passer-by that's called it in

and we'll see what it is when we get there, really.

-Do you know him, mate?

-No.

-You just stopped.

Put my coat under his head and that. His name's Ahmed, 55.

-He took some medication for his heart and that.

-All right. Ahmed.

-Ahmed!

-He's had quite a bit of a bleed.

Ooh, you've got quite a nasty bump there, haven't you, mate?

Do you remember what happened at all?

OK, stop poking it with your finger. Keep your hand off it.

You've got a nasty cut there, mate.

So, basically, Ahmed smells heavily of alcohol,

but he's obviously fallen. He sustained a head injury.

He's going to require onward treatment and observation

at hospital, due to the fact that he could vomit,

as a result of the alcohol and the head injury.

He's going to need a few hours of being watched.

Might even need a few stitches on his head there.

It's quite a deep cut.

Just bandage this up, so you're not bleeding everywhere.

-That looks really good.

-Plenty of practice!

Keep still, Ahmed, keep still.

Because of his levels of intoxication,

he was a bit agitated. He was constantly reaching for his head,

he was slurring his words, he was uncoordinated.

Is that because he's got a head injury

or is that just because he's had too much to drink?

Ahmed. Ahmed.

Who come up with Ahmed?

Yeah, in an ideal world, if people didn't drink too much,

I think our job would be a lot, lot different.

I think you would see a drastic reduction in the workload,

not only the Ambulance Service but the police as well.

Ready, one, two, three. Push yourself up. That's it.

Step backwards. That's it. Have a sit-down, have a sit-down. Go on.

-What's going to happen now, like?

-Trip to the hospital, mate.

Robert, open your eyes for me, mate.

We're just going to pop a new bandage on round your head.

Quite often with alcohol-dependent people -

which, given the medication he's on, he appears to be -

they can suffer seizures, so whether he's had a seizure

that's led to this,

and then is he in this confused-ish type state,

cos he's post having had a fit,

or is it just because he's intoxicated,

hence the need that he's going to be conveyed

up to the local A&E at City Hospital,

where he's going to be monitored and then further treated,

possibly with a bit of wound care for that cut on his head as well.

Right, cheers, guys, thanks. See you later.

Whilst his injury there appears quite minor

and the odds are it probably is,

I'm sure that our paths will cross again, yeah.

I'm sure I'll see him again,

quite probably on the floor in this square again,

in the not-too-distant future, sadly.

Thousands of medical students across the UK are currently in training

to become the next wave of emergency staff.

Today, Keele medic, Jonathan,

is joining volunteer doctor, Matt, for a shift on the front line.

We've got John. John's a medical student

who's attached to A&E at the moment. He's doing a year based in there,

seeing what's going on and what it's like to work in A&E.

As part of that, he's coming out with our scheme,

which is North Staffordshire BASICS.

It's a vital piece of education for the medical students,

to see what the world outside the hospital's like.

Yeah, looking forward to going out and working with the doctors

and seeing what they get up to outside of the hospital.

Fingers crossed, we'll have an interesting day,

-lots of stuff for you to see.

-Yeah.

They're soon called to a retirement village,

just outside Stoke-on-Trent, where a resident is having an epileptic fit.

OK, we've just got a call through.

We're on our way to a patient who's currently fitting

and we don't know much more about it.

We don't know if it's male or female.

Epileptic fits can be life-threatening.

They can last anywhere from seconds to minutes into hours.

The patient can stop breathing sometimes during a fit,

which is why it's important

we get there as quick as we can to treat them.

The patient was found having a fit

in the main reception area of the retirement village.

-Hi.

-Hi. Just down the end there.

-OK, thank you. Lovely, ta.

Hello, what's happened?

Has she? Are you relatives or were you just here? You're husband, OK.

Is she a known epileptic?

OK.

-OK, what's her name?

-Janet.

-Janet, okey doke.

Can I just have your arm, sweetheart? There you go.

I said, "I don't feel too good.

And she said, "Come and sit down",

and then I sat down and I can't remember anything after that.

She was lying in the chair.

She was twitching while she was in the fit.

She'd been in it over six, seven minutes

and it's never lasted that long before.

Then, when she come round and she didn't know me,

she didn't know where she was

and all she was saying was she wanted to go home.

So, that's when I knew that it was different

from all the other fits that she'd had.

When she started going, what did she start doing?

-Was she shaking?

-Shivering.

If a patient has a fit that's out of character

to how they may normally suffer a seizure,

it does make us worry is there something new that's happened

within the brain, is there something to do with the medication?

How long's she been on Tegretol for?

-A long time?

-Yeah.

-No changes in dose recently?

Not missed any dose that we know of?

-Has she?

-Yeah.

-Is that why...? Does she live here?

-And you live here with her?

-Yeah.

-Okey doke.

18 months ago, my wife was diagnosed with the first stage of dementia.

It's a big shock but she isn't too bad at the minute

because she's in the early stage of dementia.

It was a shock, but I try to carry on.

So, how bad's her dementia on a good day for her?

Would she talk and know where she is?

-So, she's just sometimes confused.

-Yeah.

-But 99% of the time, would be OK.

-Yes.

From the sounds of it, Janet's normally quite good.

She can normally communicate, leads a relatively normal life,

and can hold a conversation,

so we immediately know, by looking Janet

that, at the moment, something's not quite right,

as she's not talking to us at all.

If we were in a position where these were happening all the time,

and it was normal,

we'd leave you here and get hubby to keep an eye,

but being as they're not normal for you,

better to get you popped up, a couple of blood tests,

maybe a scan of the head and make sure everything's OK.

All her observations are stable.

She's much more awake and with us now,

but we're just going to pop up to A&E and get her checked over.

Hi, you all right?

This is Janet. Janet's a known epileptic.

Doesn't really tend to fit. She's on Tegretol.

But very early stages of dementia as well.

Spoke to one of the carers today, said she doesn't feel very well.

-Where's she then?

-Gone a bit shivery, shaky, gone very blank,

she doesn't really know where she is.

This isn't a regular occurrence for her,

-so thought probably up the road for assessment and go from there.

-OK.

Lovely. Thank you very much. Are you happy?

OK, thank you.

52-year-old Janet was examined in hospital,

where blood tests eventually revealed

why she'd suffered such an extreme fit.

-She'd had...

-I'd got a chest infection.

She'd got a chest infection and she was being given antibiotics.

The antibiotics had lowered the strength of the epilepsy treatment.

That's what caused this epileptic fit.

But now, she and husband Donald have other concerns.

We know the dementia's going to get worse.

There's no two ways about that.

We know what's coming, so we're prepared for it.

That's why we're here. Everything's in place, so...

She's more confident in herself now,

because she knows everything's in place, you know,

so she's quite happy.

I know I'm safe here. I think this is the place for me now, and just...

..try and lead a normal life as long as I can.

Before I became a paramedic, I used to work for Russells Hal Hospital.

I worked in the A&E department as a receptionist.

I used to see the work that the paramedics used to do,

so it was something that I wanted to do.

I love the elderly patients that we deal with.

They're my favourite sort of patients.

I'll go to those all day long.

They've always got stories and they never want to bother you.

They're really grateful for your help

and sometimes, they're the ones that need it most

and they think that they don't deserve an ambulance.

It's 1am, and Tracey and her colleague, Dan Chapman,

have an urgent call.

We're going to a female who's fallen and injured her back.

We don't know where she's fallen. She pressed her lifeline button

which dispatches us, so we'll see what we find

when we get there. Presume it's this one with the lights on.

-I'm Dan, this is Tracey.

-Hello, Frieda.

-Hello.

We'll get you up. Have you hurt anywhere else, apart from your head?

-No.

-And she was like that when you got here, was she?

We got here a minute before you.

The phone went about 1.30

and they were saying, "You need to get up to your mum's straightaway

"because she's had a fall."

Where's hurting, Frieda?

Let's have a look at the back of your head.

-Has she got COPD or asthma?

-She's got lung cancer.

-Can you put me in a chair?

-Two seconds.

We need to have a look at the back of your head.

Pop that arm on there for me.

When she fell, Frieda hit her head on the cat flap.

Can you remember what happened? Can you remember what you were doing?

I was going to the toilet.

Did you feel dizzy or anything or did you trip over something?

You tumbled, so you over balanced. All right.

We're just going to put this on for a second

and then we'll get you up and get you cleaned up nicely, all right?

-Have you hurt your back?

-No.

We go to falls all day, every day.

Every shift, you can almost guarantee

that we'll go to somebody that's fallen over.

When the older patient gets out of bed

and they're still all stiff from their night's sleep

and they just don't have the mobility they used to have,

so they end up on the floor.

One, two and three. That's it.

-Now you're standing up, do you feel dizzy at all?

-Eh?

-Do you feel dizzy at all?

-No.

-No.

Shall we get you a frame and let's see how you get into the lounge.

All right.

-You're not!

-Mum is a lovable lady.

She is very independent.

Which chair is your chair? Is this your chair here?

She used to do all her own decorating in the house as well.

Past couple of years, though, gone downhill a little bit, hasn't she?

-So, we've done that for her.

-Yeah.

What we're going to do is tidy your head up, all right?

I think you've got a bit of a cut on there,

so we're going to clean it up a bit and get it dressed properly.

-I think so.

-Looks like it in your kitchen!

Frieda's obviously had a mechanical fall in the kitchen.

She's got quite a nasty laceration to the back of her head,

so we've dressed it. We'll do some obs on her,

make sure there's no reason why she fell,

then she's going to need to go up to A&E to get some stitches.

It looks a bit too deep to be glued.

-Can you feel me touching your arms?

-Yes.

-OK. There's no pins and needles in any of your arm?

-No.

-No strange sensations?

-No.

There was no other concern

but she'd sustained quite a full thickness wound, hadn't she?

-Yeah, it was deep.

-It had almost gone through bone.

-She's definitely a hospital candidate.

-Mm.

-You're going to need to go to hospital, OK?

-I don't!

I'm not going.

Frieda, you've got a nasty cut on the back of your head, OK?

You can't be left here with a cut like that, OK?

So, we're going to have to pop you up to A&E.

-I've just come out of the hospital.

-With a chest infection?

-Yes.

I know, I know. But it definitely, definitely needs looking at, OK?

-All right?

-Can I have a cup of tea?

Course you can, darling, course you can.

-I don't think Mum realised how serious her head injury was.

-No.

When the paramedic said, "Frieda, I'm sorry,

"you've got to go into hospital," I don't think she wanted the fuss.

She wanted to plod on in her little world in her own house, didn't she?

-Yeah, but unfortunately she weren't well enough.

-No.

-They convinced her to go, which was the right thing.

-Yeah.

There you go. Are you warm enough now or not?

-I'll put the fire on.

-All right.

SIREN WAILS

Here we are. Costa del Pensnett!

At hospital, Frieda was given seven stitches.

After that, they gave her a cup of tea and some biscuits

and then we were let to go home.

Unfortunately, two weeks later,

Elaine had to call the ambulance again.

She was saying she's got pains in her side,

so we sent for the paramedics again.

They listened to her chest and said,

"I think she's got fluid on her right lung."

She was blue-lighted in and taken into Resus.

Frieda was diagnosed with pneumonia and given intravenous antibiotics.

-Over the weekend, she got worse, didn't she?

-Just got worse, yeah.

About 12 o'clock, midnight, we had a phone call and they said,

"No need to come up, but just to let you know,

"Mum's breathing's changed." OK, thank you. Went off back to sleep.

Quarter to two, I think it was, the nurse said, "You ARE coming up now."

We got there about two o'clock,

-sat with her and she passed away at half past six.

-Six.

I will remember my mum as a very loving, funny human being.

-She was lovely, weren't she?

-Yeah.

-I loved her.

-She's in a better place now.

-Yeah.

-Not in pain.

It's lunchtime and paramedic Cameron McVittie is on his way

to a man who's fallen in the street.

So, I had a call from Control to respond to a 999 emergency

of a male who's been reported to be unconscious

with queried major blood loss.

My thinking at the moment is we establish an airway

as quickly as possible.

Depending on who's the fist person there, it could be me.

There's a crew on the way as well. It could be them.

-Hello. All right?

-I just found him, sweetheart.

-OK.

-Robert, isn't it?

-Robert? Who's Robert? Do you know him?

-Yeah, I know him. His name's Robert.

-Right, OK.

-He used to be a neighbour.

-Hello, Robert.

-Hello, mate. What's happened today? Did you fall over?

-Yeah.

He's a local drinker and he has been seen before.

-His first name he goes by is Robert. We don't know his surname.

-Yeah.

And that's all we know. Late 30s, early 40s, possibly.

And we don't know how this has happened to him today?

Well, the only story that we've got, he was coming up these steps,

suddenly tripped over.

Yes, so, at the moment, we've got a male who's quite intoxicated.

He is a known alcoholic in these areas.

The patient, Robert, is the same man

treated by Cameron's colleague Mike Duggan in Birmingham city centre,

just eight days previously.

He had an old injury that he kept on adding to and adding to

and it became quite clear, after speaking to some of my colleagues,

that he regularly falls forward onto his head.

But I'd never met him before.

I had never seen that he'd had that injury in the past,

so I have to treat that as a new injury.

At the moment, we need to get him in the back of the ambulance,

give him a good top to toe examination.

We're not quite sure what other injuries, if any, that he has.

-Hey, you!

-Where we going with the ambulance? We'll go to the hospital!

Just relax. We'll do our job properly, all right?

The road that we were on is one of the busy roads in that area of town.

-Keep moving, please.

-Guys, come on, please.

It can be quite daunting sometimes

when there's lots of people so close to you, watching,

all wanting to know what's going on.

-Ready, steady, roll.

-Come on, Robert. There we go, mate.

Robert, just relax, mate. Relax.

He wanted to touch his head, touch the injury that he had.

Obviously, we didn't want that

because we didn't want to make that injury any worse.

But again, it's difficult to ascertain.

Was he doing that because he was confused

because of his head injury

or was he confused because he was intoxicated? That's the difficulty.

Basically, we're assessing Robert from top to toe now

to see what kind of injuries he has.

As you can see, he's been immobilised,

but not with a traditional collar.

As he has a head injury, we need to assess him now

from top to toe for any other injuries.

Where are you hurting at the moment?

Are you in any pain?

What we can't see in the environment we're in is

is he bleeding inside his skull?

Has he suffered a skull fracture that can cause serious problems?

If he starts to bleed inside his skull,

the pressure inside his head will get greater and greater,

can cause seizures, significant brain damage

and, essentially, that can kill someone.

Thankfully, though, Robert hadn't sustained any serious injuries.

He was discharged from hospital after having his head wound treated.

In the most serious cases, the West Midlands Ambulance Service

uses its mobile trauma unit, known as MERIT.

The main role of MERIT is to respond to major trauma cases

over and above what a normal ambulance crew could provide.

So, people with multiple injuries from various things,

like road traffic accidents,

stabbings, shootings.

It's an RTC, car versus seven-year-old.

Care team are on their way but they're going from QE,

so we're closer.

Rich and his colleague Matt Boylan have been called to a boy,

who's been hit by a car.

So, this job's come through

as a car versus pedestrian and it's come through, initially,

as a seven-year-old child that's been hit by a car.

There's ourselves and another ambulance resource

going to this incident at the moment

and we should get some more details en route.

SATNAV: Arriving at destination point on left.

-Looks like he's standing up.

-It does, doesn't it?

There's a large group of people on the traffic island

and it isn't immediately clear what's happened or who's hurt.

Hello. Hi, I'm one of the doctors with the Ambulance Service.

-What's happened?

-Car accident.

-OK. And it hit him, did it?

-Yeah.

And what happened to him?

-Did he fall onto the floor or did he get thrown?

-Flew.

Flew onto the floor, OK.

-And did he pass out at all?

-No.

To find the child standing up

when we arrive at an incident like that, obviously, is a big relief.

Fundamentally, if the child is standing up,

then there's far less chance

that they're going to have significant injuries.

OK, did you bang anything when you fell on the floor?

You banged your head or your neck?

Can you turn your head round to both sides?

And round this side. Good stuff.

Can I have a little look at your chest, is that all right?

So you didn't bang your chest at all?

That's all right, ma'am. Let's have a look. Any pain in your tummy? No?

OK, let's have a look at your legs. Any pain in your legs here?

No. Can you stand on one leg?

Can you stand on the other one? Better than me, aren't you?

Can you lift your hands up behind your head? And behind your back?

Good stuff. OK.

You can have injuries that aren't immediately apparent.

Again, that's part and parcel of why it's important

for us to assess the patient thoroughly.

In this instance, there didn't seem any significant injury.

That's not to say that there might not be something.

We're just going to have a look at the car

and have a chat with the driver,

just to establish exactly what speed people were doing when he got hit.

-Is that the driver?

-Yeah.

-Can we just get rough speed and things?

It's possibly the wing mirror that's he's hit.

Is it...? He just hit this? Yeah, OK.

There's a distinct difference between someone being hit

by the front of a car travelling at 40mph, for example,

to that of somebody that's been clipped by a wing mirror.

So, although he looked perfectly well,

if we'd found that he'd been thrown onto the bonnet,

and he'd hit the windscreen,

we'd have had a higher suspicion for some underlying injuries.

Probably not, no. He's not got any sign of any injury.

He's OK, all right?

If he starts developing any aches and pains

that aren't relieved by simple painkillers,

then he needs to go to the A&E, all right?

Cars, when they hit children, the car generally wins

and he was very lucky in this case,

that he just got clipped by the wing mirror

and not hit by the actual car itself.

9-8-2. Examined this little chap.

He's uninjured, so we're discharging him from the scene.

Be careful next time, OK?

I think anyone would be lying

to say that they weren't slightly anxious

when attending to a sick child or potentially sick child.

To arrive and see a child that's awake and talking

and confirming that they've got no injuries is a relief

and makes our life much easier.

I'm from South Wales.

I currently live in a village, Pontypool,

with my wife and children and the dogs

and, literally, ended up coming up to here for work.

I travel up. Takes me just over an hour every shift.

The best thing about being a paramedic is the feeling

when you know you're making a difference.

You are actually helping somebody.

That person is alive because of something you've done

or is getting better because of something you've done.

Today, Mike's been called to a woman who's experiencing extreme pain.

We've just been assigned to attend a female

who's had a three-day history of back pains.

It doesn't say whether she's injured herself

or whether they've just come on. So, got to make an assessment.

For all we know, it could be a long, ongoing chronic condition

and the lady just can't get a doctor's appointment with her GP.

MIKE KNOCKS ON DOOR

Right, what's your name then?

-Susan.

-It's what, sorry?

-Susan.

-Susan. What's happened today?

-Er, my back.

-Three days ago, I got up and I couldn't straighten up.

-Right.

It eased off yesterday for a bit

and this morning, I just can't straighten up at all.

-The pain is literally killing me.

-OK.

It became quite apparent early on

that that lady was in quite severe pain. She was really upset.

If you had to score the pain,

zero is nothing and ten's like the worst pain you've ever felt...

-100.

-It's that bad?

-That bad.

-OK.

I think she was quite depressed by it.

It had been something that had been getting her for quite a while,

just getting gradually, gradually worse.

-And you haven't had any pain relief at all?

-No, not today.

-VOICEOVER:

-I just wanted to die.

I just wanted the Lord to take me that morning because of the pain.

I've never felt pain like it

in my life. Never.

Going to be a trip to hospital then.

That morning, I was furious,

because I've been that many times with it and got nowhere,

just to be told that it's sciatica,

it's this, it's that, it's the other, and sent home.

Normally, I refuse point blank to get in an ambulance.

I will not get in it.

But today, the pain is so extreme, Susan's decided to go in to A&E.

-A crew just arriving.

-Hello.

-Hello. Come on in, come on in.

This young lady is Susan. Three days ago, she felt her back go.

It eased, but today, same again.

She now feels like she can't straighten at all.

27 years ago, they diagnosed me

with a crumbled split disc at the bottom of my spine.

Then I was diagnosed later on, when the pain was getting worse,

it was sciatica.

Then, later on, a couple of years ago,

they diagnosed me with crumbling of the spine.

The pain is getting worser but I've got nowhere near why.

After 15 minutes,

the pain relief begins to work and Susan is finally able to move.

Now, we'll help you whatever way you want us to, all right,

but we won't be lifting you, just in case it causes you any more pain.

Do you understand that?

Mike, the paramedic, assured me that they are going to get

to the bottom of it and get me the help.

Right, if we come out.

And I think that's why I actually got in the ambulance in the end.

Right, little bit of a push. Oh, sorry, was that your hand?

-Try and pull yourself in the middle, my love.

-Ow...

-There we go.

The lady was in a lot of pain.

She's got an ongoing lower back problem anyway,

where she suffers from a crumbling disc.

So, she does need to be transported off to hospital

and get that surgical assessment

as to whether she's going to need further treatment.

Hopefully, it's all early enough that she'll make a full recovery.

Susan was given treatment in hospital to stabilise the pain,

but her long-term diagnosis isn't good.

The doctors have said that there's nothing they can do for my spine.

It's getting that bad that it will just get worse.

When I heard that, I just wanted to give up now,

but then I think about my grandchildren. I can't give up.

I've just got to carry on trying to manage it myself.

So, I am coping the best I can.

As a paramedic,

you see all sorts of jobs

from something so minor that isn't an emergency,

but that person that you're dealing with, it's THEIR emergency,

to life-threatening conditions

and you just work to your full ability to each job.

It's Thursday afternoon

and paramedic Kathryn Davies is responding

to a call from a care worker in Stourbridge.

We're going to a gentleman, who's had a fit within the last 12 hours

sand he is diabetic, so he's bumped his head while he had a fit.

That's as much info as what we've got at the moment.

-Where am I going?

-Down here.

-Right, what's happened then?

-Yeah.

-He's had a seizure, fallen, cracked his head.

-Does he have many seizures?

-No, they're very well controlled.

-Once a month, maybe.

-Right.

-Even less than that.

-Hello.

-Hello.

-How you doing?

Let's have a look at this. What's your name?

-Can you remember falling over?

-No.

-You can't, OK.

52, thank you. I'm going to need a crew.

I'm going to ask for an amber response.

This gentleman's on the floor, unable to get up. Over.

OK, no problem.

Melvin and his friend, Eric, share a flat

and are looked after by support worker Sam.

I was cooking the tea for Mel and I was in the kitchen

and I heard him have a fall.

I went to see him and he was suffering from a seizure.

He's had seizures before but he hasn't really bumped his head

or had cuts on his head, so when I saw he had a cut on his head,

I had to phone the ambulance.

-You got no pain anywhere?

-No.

-No? No pain round here?

-Anything down here?

-No.

-No?

-No.

That's only a little scratch on your head. We can deal with that.

He had got a superficial wound to the top of his head.

It was only a small cut but, as an advanced paramedic,

that is something that I could deal with.

But I decided to wait till the ambulance crew got there

because I wanted to do his basic observations first of all.

Just going to have to wait for an ambulance crew to come now, OK?

They'll help you get up off the floor.

In the meantime, I'm going to sit by you,

-so I can be your cushion, all right?

-Yeah.

You're leaning on me, yeah.

Hey, I'm not a recliner!

Don't make yourself TOO comfortable!

Bless him.

52, thank you. Do we have an ETA of the crew,

only the patient's using me as a recliner at the moment?

Yeah, that's lovely, thank you. They're only five minutes away, Mel.

Come on, we've got Melvin. He's had a fit today.

We have just got a tiny little graze to the head,

but I can deal with that in a minute.

He says he's got no pain anywhere and his numbers are fine.

But he just needs that bit of a...

You know, he is quite a big lad,

so I think we're going to need the Mangar Elk to get him up.

The Mangar Elk is a lifting cushion.

It's got four compartments and it is initially very flat

which, if a patient is on the floor, we can get underneath them.

It's dangerous for both the patient and the operator

to try and get somebody up off the floor without this cushion.

It could end up with more injury to the patient

and injury to the paramedic as well.

Can you shuffle a little bit backwards?

-No, not lie backwards, no.

-Keep shuffling.

-That's it.

Bend your knees again.

You can even hold my hands, all right?

-God!

-SHE LAUGHS

He's a monkey! He's a monkey!

-He's off the floor. That's it.

-That's it.

-Hello!

-Hello!

-You're taller standing up.

-Yeah!

Are we going to go on your recliner? Come on, mate.

All right, sit yourself up, my darling.

Let me have a look at this head.

Once we got Melvin up and sitting in the chair,

I'd got a better vision of his head wound.

I cleaned it up and realised that it was only a superficial wound.

It did need closure and I'm looking at it.

Tissue glue would have dealt with this wound perfectly.

-This is just going to sting a bit, matey.

-Yeah.

-But it'll do the job.

-Melvin?

-Yeah.

Shall we just get you up and have a little walk around,

-make sure you're back to your normal self?

-Yeah.

-Yeah?

-Yeah.

-Go on.

Let's see you stand up, Melvin, and take a few steps.

I'll move out your way.

Show us how you do it.

Easy.

This normal for him?

Go on, hold his hands then. OK.

-Oh, ay-up, there you go. Hey!

-SHE LAUGHS

All right, I think we know that you're all right.

He's in good spirits. In fact, I'd go as far as saying he's feisty.

All his observations are fine

and he's walked quite happily to the chair.

I've just cleaned his head up

and it just needed a little bit of tissue glue.

That's going to keep him out of hospital, which is always a plus,

so we've got a happy ending all round, haven't we, Melvin?

-Yeah.

-All right then, Melvin.

It's been a pleasure meeting you, all right.

-Yeah, and you.

-Behave yourself.

-Yeah.

-Bye-bye. Bye-bye.