Episode 1 Ambulance

This programme contains some strong language and some scenes which some viewers may find upsetting.

-Emergency ambulance...

-Tell me exactly what's happened.

When the most serious emergencies strike,

the ambulance has eight minutes to respond.

FRANTIC VOICE ON PHONE

I'm going to... Sir, I'm going to tell you what to do, right?

With 999 calls doubling in London over the past ten years...

I'm not asking if you're an atheist,

I'm asking, do you want an ambulance?

..in the control centre,

every single one needs a split-second decision.

Who needs an ambulance quickest?

It's so critical that we try and cut him down.

It's the only way we're going to be able to try and save his life.

And who must wait?

Kathleen, the ambulance will not be coming to you tonight.

Following calls from the moment they come in...

He's been stabbed in the stomach.

Looking for any ambulance for

a 16-year-old who's had her hands slashed by a machete.

Another stabbing?!

..as crews race to save lives.

Seconds feel like minutes, minutes feel like hours

when you're waiting for an ambulance.

My name's Peter, all right? We're going to look after you.

We're going to give you some very strong pain medicines.

Got a 94-year-old female who's fallen.

I need to know if he's breathing or not. It's really important.

He's as drunk as a thousand people.

With the NHS under unprecedented pressure...

There was a hanging, there was a four-year-old who's fallen 20 foot,

and now we've got another double stabbing.

You're the Queen of England? So why have you dialled 999?

..and with London growing by over 100,000 people a year...

-You've overdosed, fella.

-Eh?

-You've overdosed.

..ambulances are struggling to keep up.

The situation is now critical.

Someone's taken my Echo-231 for something else!

Another cardiac arrest, another deceased.

Please, God, be an ambulance. Be an ambulance.

This is the story behind the sirens...

FEEDBACK CRACKLES

..through the eyes of the London Ambulance Service.

Did you see what you were shot with? A shotgun?

I think essentially we should say that she's gone. It's time to stop.

Sometimes it's just not easy.

-But you go on to your next job...

-Marvellous!

..cos there's somebody else you can help.

Oh! London has woken up. Here we go.

SIREN WAILS

One, two, three, four.

One, two, three, four.

PERSON ON PHONE JOINS IN: One, two, three, four.

One, two, three, four.

OK, my love, I'm going to tell you how to give mouth-to-mouth, OK?

Just do two breaths, and then once you've done the breaths,

we're going to go back to the compressions, OK?

Wednesday morning in the London Ambulance Control Centre,

and today is a normal day.

I believe you were having some chest tightness and coughing

from inhaling bathroom bleach, is that correct?

The 75-strong team on shift have been at work for two hours.

Yeah, it's ticking over.

You know, we get very experienced very quickly in here,

of getting a rough gauge of

what sort of day you're going to have.

I need to know if he's breathing or not. It's really important.

Across London, there's probably 50 attempted suicides,

around 50 drug overdoses a day.

70 road traffic collisions.

Lots of elderly fallers.

Cardiac arrests, average in London is 28.

I'm organising help for you now, so just stay on the line

and I'll tell you exactly what to do next, OK?

Yeah. It's all...

It's reasonable so far.

5,000 calls will come in today.

But with only 386 crews at their disposal,

the split-second decisions they have to make

can have ongoing consequences across the city.

And for the patient, mean the difference between life and death.

BABY CRIES

THEY LAUGH

In the east, a Red 1, the most urgent of calls, is in progress.

Ambulance crew Scott and Andy are closest,

and they've just become free.

Right. Oh, Red 1.

Oh, Red 1. Cardiac arrest.

'999, road, activate.'

SIREN STARTS UP

Every second counts when you're dealing with a cardiac arrest.

They're not breathing, their heart's not beating.

Their tissue and organs are starting to die.

The quicker we start chest compressions

and we get that blood moving round the body,

the better chance we've got of saving his life.

-WOMAN SHOUTS:

-Wake up! Wake up!

DOG BARKS

Hello! Ambulance! In here?

When did you last see him, sweetheart?

Right.

Let's get those pads on.

The 62-year-old patient, Paul, lives with his sister Dawn.

Not seen since last night.

She found him when she came downstairs for breakfast.

-COMPUTER:

-If no signs of circulation, start CPR.

When we do CPR, it's brutal.

It is absolutely brutal.

We're putting airways in and we're doing chest compressions

and ribs are getting broke and...

for the family, it's just raw.

You know, the emotion that you get within a room.

And that can be really difficult.

28, 29, 30.

Yeah, adrenaline.

Ten mil, it's in date.

-COMPUTER:

-3, 2, 1, ventilate.

Ventilate.

Ventilate.

20 miles from Paul's house,

another man is suffering a cardiac arrest at his doctor's surgery.

Two ambulances are on scene,

and have requested urgent backup from an advanced paramedic.

The problem is the only one available

is stuck in heavy traffic in Central London -

13 miles away.

So 51-year-old male,

now confirmed with an ambulance on scene

saying the patient is in cardiac arrest

and has had one shock delivered.

Er...

Oh, nightmare.

There's no other way we can go at the moment.

In a two-year period since becoming an advanced paramedic,

I've done approaching 250 cardiac arrests.

The average paramedic in London

will attend between three to five in a year.

Dan is sent to the more complex cardiac arrests,

where his expertise can make the difference between life...and death.

Even if we get a pulse back...

that's actually the most difficult period

for cardiac arrest management.

And that's where my strengths certainly will come in.

Chelsea? Can you call Romeo-101 on their Bravo set

regarding that cardiac arrest, please?

Romeo-101, hello, it's Chelsea on the APP desk.

Chelsea is co-ordinating

the advanced paramedics across London today.

Give me a sec, I'll tell you exactly where he is.

So he's still a little bit to you, but he's making good progress.

Cheers, bye.

That's one of the ambulance crew that are on the scene

of this cardiac arrest that I've sent Dan to.

They've got a pulse back on this patient,

but they know that he's having an MI

and he's got a blocked artery in his heart.

Surviving a cardiac arrest is...

I think you've got a one in ten chance or something like that.

So the reality of running out,

jumping up and down on someone's chest and shocking them,

and everyone surviving like you see on TV,

is actually pretty rare.

It takes Dan 36 minutes to reach the scene.

'You are acutely aware that you've got someone's life in the balance.

'I think you have to have... kind of like tunnel vision.

'Without sounding too cold about it,

'you have to look at it as disease processes in front of you,

'and try to avoid thinking about an individual

'as a dad, as a son, as a member of someone's family.'

Have we got any family members here at all?

Yeah, yeah, yeah. They were made aware.

Earlier this morning, the patient, Saeed,

was walking his dog when he felt chest pains.

He went to his GP surgery, where he collapsed.

How we doing? Just the one shock?

-Yeah, just one shock...

-OK.

-And what's his name?

-Saeed.

-Saeed.

Obviously he's in a pretty fragile state

so we just aim to keep him as flat as we possibly can.

Minimal movement wherever we can,

and bear in mind that when we start to roll him around,

there's always the possibility he might re-arrest.

SAEED MOANS Dan must stabilise Saeed

before it is safe to transport him to a specialist heart attack centre.

His level of consciousness is starting to come up.

The problem with that is the whole time that happens,

he's going to start to put more and more pressure

on his fragile heart muscle.

OK, cool. Going to give him this and then we're going to get going, guys.

So can you just timestamp on this,

press the "event" button, then just press "morphine" for me?

SAEED GROANS

All right, Saeed.

I'm just going to go and have a quick word with his family.

Are you all right getting him out on to the trolley bed

-and just carrying on to the ambulance from now on?

-Yeah.

Hi, there, my name's Dan.

I've come to assist the guys here at the moment.

It all looks quite scary, but try to kind of reassure yourself

that we're on top of this at the moment.

Do one of you want to come in the ambulance,

or will you follow up separately, or...?

-If you can take her...

-Yeah, certainly.

All right, Saeed.

Just keep reassuring him at the top end, that's awesome.

SIREN WAILS

25, 26, 27, 28, 29, 30.

-COMPUTER:

-3, 2, 1, ventilate.

I mean, we've had nothing at all.

-Not a bleep, not even with adrenaline.

-Yeah.

What we have had so far, just...?

-Yeah.

-Yeah.

In East London, Scott and Andy have been trying to resuscitate

Dawn's brother Paul for 40 minutes.

For us, its someone we've never met, but for the family,

it's their loved one,

they're the most important person in their life...

MACHINE: Three, two, one...ventilate.

..and they think that we can perform miracles.

There comes a point where we can't do any more and we need to

let the person pass peacefully.

And he's not been seen since last night.

You know, no other reversibles.

Yeah, yeah, will do.

It is a really difficult decision because you know the impact

that it's going to have on people's lives, the family...

It doesn't look like we're going to have much success.

Hmm.

I just need to speak with our clinical people,

and talk about what's going to happen next, OK?

-Yeah.

-But erm, I should imagine we'll probably stop what we're doing.

We've done everything we can for him and at the moment...

He's passed away?

It does seem that way.

After 46 minutes,

they decide there's nothing more that can be done for Paul.

When we have to stop a resuscitation, sometimes the hardest

bit of the whole process is gathering the family together and

helping them to understand what's happened.

The ambulance driver said it was quick...

It was quick, you know.

It might be that we've not managed to save the patient,

but I think sometimes probably the most important thing we do is just

to show a little bit of humanity and a little bit of kindness to

the people that are left behind,

cos they're the people that have got to deal with what's left.

We're off now, sweetheart.

-Thank you so much.

-All right.

You've been so helpful. I really appreciate it.

-Thank you.

-You know if there's anything you need or anything,

you can always call, you know,

if you find yourself in a bit of a crisis.

-OK.

-All right?

-Thank you so much.

-All right? We're very sorry.

-Thank you.

Thank you. Thank you.

All right, Saeed?

We're at the hospital now, Saeed.

Do you want to follow us? Yeah, you follow us through, yeah, definitely.

Sorry, what was your name?

-Sufi.

-Sufi?

An hour and 20 minutes after going into cardiac arrest at his

doctor's surgery, Saeed's been brought five miles to one of

London's specialist heart attack centres.

Hang on, I'm just going to check the pulse.

Just check for a pulse a second, guys.

You got a pulse?

Have you got a pulse?

Hang on, let's get him out the lift.

Just into this area here for a second.

Just pop that down on the floor.

Hang on.

Yeah, he's got a good pulse.

So just get that back onto his face and just actually hold it

-like that, cos it's...

-Hold it just like that?

No, no, no, hold it like you had it before.

OK, cool. Ready, brace, lift.

Hang on, hang on.

Just one second, cos I need to get these straps off. OK, cool.

SAEED GROANS

Obviously the pressure's on to get this in and get... Here we go,

so the dye's going in now.

Over the next hour, the cardiac surgeon will remove the blockage

from Saeed's artery and insert a stent to keep it open.

I think luck does play a part in people's lives.

Having your cardiac arrest in a GP's surgery, where there's

a defibrillator and a trained medical professional is

probably the luckiest you're going to get.

In the city today, the ambulance service has dealt

with 26 cardiac arrests -

they've saved the lives of four of them.

Are you scared of dying?

It's not really something I've ever given really much thought about.

I wonder if this job changes... Because we do see

quite a lot of death.

I think it does.

I know this might sound really soft...but I think because

-I understand that, you know, life's quite fragile...

-Huh-uh.

-..and we could go at any time...

-Yeah.

-And because my boys are sort of spread...

-Uhmm.

-..a little bit and everything else...

-Yeah.

..every time I speak to them, I always make sure I tell 'em

-I love 'em.

-Yeah.

-And I think that has definitely changed...

-Uh-huh.

..since I've been doing this.

You know, with this job, at some point, you're going to see it.

You know, if you work in an office, you know, the biggest thing

-you've got to worry about is your pen running out.

-Yeah.

Well, I checked the ponds last night and there is not a tadpole in sight.

-Is there not?

-No, my fish have eaten them all.

Really?

I'm devastated. I'm not going to be a mum to frogs this year.

How many?

It looks like it's a care home.

A resident has assaulted a member of staff.

That member of staff has been stabbed and is in a bad way.

The police have reported that one of them may be in cardiac arrest.

They want two ambulances.

'When we get a major trauma job, they're always quite heavily

'resourced because we know we may have multiple patients and

'you can deplete your resources quite quickly.

'You suddenly find your stress level ramps up a gear.'

Two patients at the care home are suffering major trauma and

blood loss, and multiple crews are needed on scene.

All available ambulances in the area are dispatched.

Right, sorry, but I've got to cancel them.

There's quite a lot of crews at the moment, but there's

a larger incident, but obviously while that's going on,

calls are still incoming for the area.

Now I've got a red call...

12 miles from the stabbing at the care home,

another life-threatening emergency is in progress in East London.

Seen it.

Chelsea needs to quickly assesses

whether she has an advanced paramedic available.

HEMS as well, here we go - boom.

DIALLING

-AUTOMATED VOICE:

-Incident updated.

Three people have been shot, one in the leg, one in the back.

Dan, its Chelsea. Your next job is a shooting.

Two patients, HEMS are also attending.

I'll confirm the RVP with you shortly.

Yeah, roger, that's all received. It's right next to my flat.

Dan is 12 minutes away.

Two ambulances,

a first-response car and the air ambulance are also en route.

'If a bullet enters your leg, the difference between a couple

'of millimetres either side of one of the largest vessels in your body,

'is the difference between you living

'and potentially bleeding to death in the back of an ambulance or

'before an ambulance even gets to you.'

So the clock is ticking.

'The very nature of these calls is they tend to be pretty chaotic.

'There's always the possibility that there's someone still running

'around with a gun or a knife.

'The people that are involved in this incident were all running

'around and screaming and shouting,

'they're massively adrenalized and scared as well.'

Cool, how we doing?

'I may give off a certain air of calm, but, underneath, my heart's

'going as fast as everyone else's.'

While the air ambulance crew deal with the man shot in the back,

Dan, as the most senior paramedic on scene,

takes charge of the other victim.

How we doing?

This guy's got, erm, shot in the leg.

Was he shot in the car or... Do we know where it's all happened?

No, outside the car, he got put in the car.

-And it's...

-Single gunshot wound exactly there...

-OK.

-..and no exit wound.

-No exit wound, thank you.

Can you see the bullet anywhere near the surface, or anything like that, at all?

I'll find it in a second.

-And we've got no idea, at the moment, what he's been shot with?

-Er, no.

-OK, cool. Right...

-That's my brother!

-Yeah, well, let's get you... Listen,

-let's get you in the ambulance first.

-I want my brother!

I know, we'll get you in the ambulance first, mate, all right?

We've got one wound, erm, a single entry,

no exit wound on the back of his thigh.

No obvious underlying haematoma at all. Yeah.

I'm not going to undress it, but I want just

a quick look at your leg, mate.

Right.

I think we'll go and we'll do everything kind of en route.

Yeah.

So the kind of things we're kind of worrying about - where that

wound is, cos obviously you've got a big blood vessel that kind of runs up the inside of your thigh,

but it doesn't appear to be actively involved with that at the moment.

Right, cool.

No, no, no...

What's this scar from?

Did you?

So you just take it nice and easy mate, yeah?

6-2...

Yeah, Dan, go ahead with your report.

Yeah, can I put a blue call in to the Royal London when you're read details?

We've got a 22-year-old male, erm, with a single gunshot wound

at the back of his... ..And rear of his right thigh.

We've got an entry wound going in, with no exit wound seen.

I'm about to give him some morphine for analgesia,

but no further drugs administered... Understood?

And we've got an ETA of approximately 15 minutes,

this is going to be the second patient, following the HEMS patient

-that I believe is just ahead of us.

-Yeah, no worries.

This is just a bit of morphine. You might feel a bit of cold in your arm.

All right, I can give you more of this but obviously I can't take it away.

So I can always keep topping it up buddy, all right?

Listen, all your numbers that we're looking at are really good,

so there's nothing to suggest

you're bleeding heavily in your legs.

I know it hurts, all right, and I'm giving you stuff

and I can give you some more for that on the way, all right?

I know it's really... Huh?

I know, mate.

Mate, don't be brave about it.

I can give you plenty more, so that's not a problem, all right?

I know, I know, so to start off with,

you're going to have lots and lots of adrenaline running around you.

But that adrenalin's going to start to wear off.

Yeah, I know.

Did you see what you were shot with?

Was it a hand gun, was it?

-I think it was a shit gun.

-Right, a shotgun?

A shit.

Oh, shit gun, sorry, OK, yeah.

-Was it pretty close-range, then, was it?

-Yeah.

-Yeah, OK.

We're not far now, mate. Probably a couple of minutes.

-Is the pain still there at the moment?

-Yeah.

Yeah, let me give you a little bit more, mate,

cos obviously when that adrenaline starts to wear off...

'It's not my concern to think about what this person has done

'or not done to end up in the back of my ambulance.

'I don't want to know what's happened prior to me arriving

'and that way I can impartially treat everyone that's involved.

'I went to the Lee Rigby job and we didn't know what had happened.

'We thought it was just some gang thing, so we treated the two

'that killed him and it was only when we got back that someone went,

'"Put Sky News on," when we realised what had happened.

'I'm glad I didn't know.'

Lovely, all right, mate.

The East London shooting is just one of eight major trauma cases

currently in progress,

all requiring multiple crews on scene.

In the control centre, they're struggling to find ambulances

for the new high priority calls coming in.

If anybody can please assist us

with any of the following emergency calls -

chest pain in Thornton Heath,

a chest pain in Biggin Hill,

an unresponsive person in Croydon...

The allocators must appeal to crews to make themselves available

for the next patient as quickly as possible.

I was talking to 17, 18,

still looking for an ambulance, please, for a category four, SE1.

I'm afraid the cupboard is bare.

SHE EXHALES

'There can be times it makes you nervous.'

I was on duty on July 7th 2005 and there's always that thought

in the back of your mind,

"What is the next call going to be?"

What the flipping heck is going on today?

We've now got two people stabbed,

an 18-year-old male in the stomach and somebody else.

You're in your school uniform, stabbing other students, God.

Chelsea's coordinating three advanced paramedics across London.

Two are currently busy treating patients.

Dan is at the hospital with the shooting victim

and the other with a man who's in cardiac arrest

at King's Cross Station.

Chelsea must decide whether to commit the only other one available

to support the regular crews at the stabbing call that's just come in.

When you've got a limited number of vehicles

and plenty of calls coming in,

you have to decide, "Right, who's the sickest?

"Who am I hedging my bets with here?"

Tell me exactly what's happened there.

Oh, my God, there's another hanging.

I've just sent AP60.

Chelsea decides to dispatch her last available advanced paramedic

to the hanging, while an air ambulance crew

deal with the schoolboys who've been stabbed.

-'I'm worried as well.'

-OK.

Er...

At the moment, the best thing we can do for this patient

is to cut him down, because until he's cut down,

we can't start doing resuscitation on him.

'I can completely understand he wouldn't want to go back in.'

It's quite an ask for a member of the public

who's never seen anything like that before.

I understand, I do understand that you're worried, my love...

You do need to do this. You have to help us until we can get to him.

No, listen to me, sir,

it's so critical that we try and cut him down.

It's the only way that we're going to be able to try and save his life.

Is the ambulance with you?

-'Yeah, yeah.'

-Can you see them?

-'Yeah, yeah.'

-All right, my love.

I'll leave you with the paramedics. Thank you, bye-bye.

SHE EXHALES

It's gone crazy this afternoon.

Absolutely crazy.

-Chelsea?

-Got it.

Thank you.

A call has come in for a man

who's reported to have fallen from height.

At the Royal London Hospital,

advanced paramedic Dan has just finished handing over his patient

who had been shot.

Dan?

-AP62?

-Are you in a position at all to go green for a call?

-Yeah, yeah. Yeah, yeah.

-Great.

-I'm listening, yeah, go on.

A gentleman who's reported to have jumped

from the ninth floor of a hotel.

Great, and at the minute you're the only resource dispatched.

Yeah, no worries, yeah. Leaving.

The ninth floor, 600 foot.

OK, yeah, leave me on it, mate.

Yeah, will do. Cheers, bye-bye.

Bye-bye, bye-bye.

-INTERVIEWER:

-What's happened?

Er, so someone has jumped off a building from the ninth floor,

so they're sending me at the moment.

No other ambulances are available in the area,

so Dan takes the two at the hospital who are just finishing up

with the double shooting.

HEMS are currently not available.

He doesn't appear to be breathing, is what we've been told,

and he's not responding.

With a... With a head injury.

SIREN WAILS

'Even if something sounds hopeless, if we get there early enough,

'there is always a minute chance that we can do something about it.'

It's going to be down here somewhere, I'd imagine.

'I don't want to be the person that thinks "if only.

'"If only I'd tried, if only I'd checked for more injuries,"

'I don't want that "if only" sort of hanging over me.'

Is there any obvious kind of brain matter anywhere

-that you can see, or...?

-No.

-OK. Are you happy for me to move him?

-Yeah, yeah.

I'll just put the pads on him. I think realistically...

I mean, this is...

He's got massive chest injuries.

Pupils are fixed and dilated.

We've got blood coming out of there, we've got no pulse.

He is...he's deceased.

We'll get a time officially off this as well.

I take it this has literally just happened, hasn't it?

-We're declaring at 17...

-17:12, yeah.

Yeah, AP62, just a quick update when you're ready for details.

Yeah, I'm ready, Dan, go ahead.

Erm, he has got injuries incompatible with life

and we have recognised life extinct at 17:12.

Er, plenty of police officers on the scene.

Yeah, roger that.

Recognition of life extinct, 17:12.

Injuries incompatible with life. Thanks.

Thank you, mate, I'll call you shortly.

Blimey, OK.

'By the very nature of what I do,

'there is every chance that I'm going to pronounce someone dead

'at least once a shift.

'It has now become the norm for me.

'That's not to be confused with saying I'm used to it.

'I don't think you should ever become used to it,

'because then something's a bit broken inside you.

'But it's important to accept that it's part of the norm for my job,

'and you build up a level of resilience

'that you don't become too attached to that individual

'because the next call is inevitably going to be

'just as critical as the one I've just attended.'

WOMAN GROANS IN PAIN

INDISTINCT

It's all done.

Monday morning and across the city,

all 408 crews on shift are working at full capacity.

-You all right?

-Yeah.

We don't offer brandies, I'm afraid, otherwise I'd give you one.

He looks like he needs one, doesn't he?

SHE CHUCKLES

I understand that you've never done it before.

If the baby is ready to come,

we're going to have to help your wife.

In the control centre,

the past two hours have seen an unexpected spike

in life-threatening red calls.

Steph, can we have a report from the IRO

on that hanging one, please, love?

Stay on the line, I'll tell you exactly what to do next, OK?

We've also got another one there, 87-year-old not breathing.

You do think to yourself that absolutely every resident of London

has picked up the phone.

We have a whole department of people looking into trends

and sometimes it is just everybody gets sick.

With critical calls stacking up,

they're running out of ambulances.

You don't really want to see any yellow on the map.

We've got quite a big portion of London

that's not got any cover at the moment.

The patient has been on the floor for 50 minutes

waiting for an ambulance to become available.

We just don't have enough ambulances.

And there's still no let-up in new calls coming in.

CALLER SOBS

-Surge purple enhanced.

-Purple enhanced.

With a new emergency call now coming in every 12 seconds,

they're at risk of not reaching them all in time.

Senior clinicians decide they must escalate to a state

known as "surge purple enhanced".

We're struggling to provide a safe response to London.

We have to start making sure we're getting to the sickest quickest

and we have to say "no" or "not yet"

to those who aren't as seriously ill or injured.

OK, so based on the information that you've provided,

we have assessed that an emergency ambulance is not required

at this moment because you need a further assessment.

We have to start being a lot more ruthless

with the calls that we're holding.

We refer people to the 111 service,

we start advising people that they should be contacting their GP

or, if they're able to do so, make their own way to an A&E department.

..cos at the moment, we don't need to send you an emergency ambulance.

Once you ring 111, and you give them that information,

they will assess you and if they feel that they need

to provide transport, they'll automatically do that for you.

No, I understand that, OK, that's why I'm arranging this help for you

but at the moment,

an emergency ambulance is not required for yourself.

Well, give...

He's hung up on me.

It can be really difficult telling someone,

"No, sorry, we're not sending you an ambulance."

OK, who's in the house with you?

You can have people calling for help for their loved ones

or for themselves but we haven't got the vehicles or the staff

so that can be difficult and you do feel quite...heartless sometimes.

Only 15 ambulances are currently available

for the 8.5 million people of London.

And now a life-threatening call is coming in.

DEVICE BLARES

Oh, I know where we're going. Cool.

The last remaining crews in the area are dispatched.

Is he breathing, Mo? Shall we get him down off the steps, mate?

Just start bagging him up first

and then we'll get him moving once the crew's here.

Cool. So, it looks to me, opiate overdose as given.

Yeah, we'll get him down and get him off the steps.

Careful, everyone. Careful, careful, careful.

OK, keep going, keep going, keep going, keep going.

OK, that'll do.

Mind his head, mind his head. Cool, OK, so we'll start bagging him.

We'll need some Narcan.

Just see what his veins are like first of all.

They're not horrendous.

No, they're not awful, so just be aware of sharps, guys.

I've got some Narcan here which I'll draw up for you.

-You happy at the top end still, guys?

-Yeah.

-Yeah.

Chest ain't moving...

Dan administers a drug, Narcan, that reverses the effects of the heroin.

So he's had 400, I'll give him another 400 in a minute.

I'm hearing his respiratory...

Yeah, we've got a pulse.

Open your eyes for us, fella. Hello, mate, how you doing?

-MAN GROANS

-Hello, mate. Just lie still for a minute, fella.

Just lie still for a minute. Shall we just get a 100% mask?

Just lie still for me, fella, lie still for me.

-You've overdosed, fella.

-Eh?

-You've overdosed.

Yeah?

Yeah.

Yeah? You're all right?

So, my name's Dan, I'm a paramedic

and these guys all around you are paramedics too as well, OK?

So just relax.

Just get them in as soon as we can, yeah?

Do it on that arm. All right, buddy? Do it on that arm.

Not sure. We found you up on the steps, mate,

so we're just going to give you a little bit of oxygen.

Just leave that one on cos that's just measuring it. All right, buddy?

What's your name?

OVERLAPPING CONVERSATIONS

Emergency ambulance, what's the address of the emergency?

We're going to be with you as soon as we can, OK?

I do need to advise you, though, it may take up to an hour

for an ambulance to be dispatched because we are very busy.

No, we haven't actually got any units at the moment to send to you.

Yeah, it may take up to an hour because we're very busy.

It will be as soon as we can, though. It will be...

I under...

I understand that it's an emergency

and we always get there as soon as we can,

it's just because we're very busy at the moment.

RADIO MESSAGE

Shaney and Gary have just finished treating a patient with a bad cut...

-SIRENS BLARE

-One in, one out.

..and already they've been dispatched to the home of

an 88-year-old man with dementia whose condition is deteriorating.

I think it's just right here.

-Royal Free's now getting busy.

-Is Royal Free busy as well?

Waiting times of up to 60 minutes.

DOGS BARK

-Hello.

-Hello.

Have we come for you?

We haven't done anything yet, don't be thanking us just yet.

And what's happened today? Why...?

He appears to be struggling a bit?

Sir? Hello.

-I'm fine, how are you?

-Thank you.

Your wife's very worried about you so what we're going to do is

we're going to pop you downstairs, get you on the ambulance,

all right, and take you to hospital, OK?

HE COUGHS WHEEZILY

-Oh, dear.

-WOMAN SOBBING:

-I don't want it...

Oh, darling, don't worry, it's all right.

SHE SOBS

-Sweetheart, listen, OK?

-Please...

Listen, if he's not very well, he's not very well, is he?

All right? You've done the right thing by calling us. OK?

Oh, whoa, there'll be no talk of that.

There'll be no talk of that, far too much paperwork to do.

-No talk of that. Let's get him back up the hospital.

-Yes.

That's a nice hat and scarf.

Is that all right?

Not at all, my lovely.

I know.

(Oh, gosh.)

He's not fat, but he's quite tall and heavy

and that's what I'm worried about.

-That lift's not big enough for a stretcher, is it?

-No.

..202, the patient is not weight-bearing at all.

And we're just getting him into the chair and then onto the bed

so it's going to be a difficult lift. Over.

-RADIO:

-Yeah, roger that. Absolutely. Don't be doing yourself an injury.

Could you get another crew running on this call,

preferably a double crew? Over.

-RADIO:

-Sorry, mate. Currently no.

In East London, three crews are still with their overdose patient...

Do you know where you are, buddy?

Tell me where you are.

..and Dan's drugs are working their magic.

OK, don't worry, it's just... That's all right, you can put it back in.

No, don't worry. We've had to give you a little bit of that already.

You've already had some cos that's what's woken you.

You weren't really breathing properly.

Well, you were barely breathing at all...

so we've got some oxygen on at the moment

and we've obviously had to give you some of the naloxone.

You are at the moment but obviously you know probably full well

that the drug we've given you wears off a lot quicker.

We're going to get you up onto our trolley bed in a minute.

Listen, we just need to get you on the ambulance

so we can do some checks on you.

Yeah, well, you are at the moment but because of what we've given you,

you know full well that wears off quicker

than the heroin that you've taken.

'There's always the chance that if he wanders off without our help,

'he could go back into respiratory depression and respiratory arrest

'so he could overdose again.'

Let's just put some oxygen on you, buddy.

Just sit yourself up, fella.

There we go.

Right.

'They never thank you for saving their lives.

'As soon as you start waving syringes around,

'they know what you've done

'and they don't want you to give them any more.'

However they've paid for it, they got their hit

and if you turn up and ruin it by administering the drug,

they don't particularly like it, so...

You understand the potential of you walking away here is that

you could overdose again and stop breathing, you understand that?

Yeah, I know you've no intention but you have to understand

and you need to repeat it back to me.

Yeah?

Fantastic, right.

Well, sorry, mate,

cos we thought you were in cardiac arrest at the time.

-I'm sorry about that.

-Can you sign there?

Cos you weren't breathing and you were blue.

To all intents and purposes, you were dead.

'You can become very angry and very disillusioned doing this job

'if you got judgmental with every single patient.

'My job is to treat what's put in front of me.

'If I suddenly got to the point where I'm judging and deciding

'who gets my assistance and who doesn't get my assistance,

'you're getting into the realms of playing God a little bit there.'

Come on, pop your jacket on.

If you want to leave, feel free to leave now,

otherwise stay with us and we'll take you to hospital.

Right.

'People aren't born onto the streets.

'They all have a story.

'In the time that I've been with the ambulance service,

'homelessness has definitely gone up.

'I've been to homeless people who went to public schools,

'who had good jobs,

'who were married and had children and are now living homeless.'

Your mates are all up the top.

With your dog.

All right?

OK, well, the dog that was with you, then.

'People who are kind of living on the streets have no-one.

'It... It's sad.'

Yeah, well, because he's at an angle, if I hold it like this,

it'll be...

Cyrus's carer has arrived

and offered to help Shaney and Gary move him down to the ambulance.

Does he normally go to hospital with you?

-It's not on properly, no?

-No, it needs to come up.

One, two, three...

-Is that OK?

-Yes, fine.

Thank you so much for your help.

No, you've saved another ambulance coming.

-I'll give them a call.

-Did you cancel it?

Yeah, it's Echo 202. You can cancel.

We've worked around it with the help of the carer, over.

Of course, of course, are you ready to go?

I'm going to get this up.

Sweetheart, just give us a second.

We're just going to get your husband on the bed

and then we'll get you in, all right?

All right, you ready?

One, two, three...

Perfect.

You should get a job in the ambulance service.

-I just said that to him.

-Did you?

THEY LAUGH

Erm... Four.

Not yet. Not yet!

Where are you from?

Oh, really?

When did you come over here?

Really?

Oh, I see.

36 years!

Oh, honey. I know, it must have been horrific.

How was...?

Wow.

Well, that's pretty horrific.

This is your ex-husband?

Do you still live together though?

Wow!

It's a good job you do love him, isn't it?

Sorry, darling?

Yeah, we're here.

You all right, darling?

Yes, of course.

Don't rush!

By five o'clock,

call volume across London has fallen and normal service has resumed.

Is there a person there that needs an ambulance?

You don't need...

Tell me exactly what's happened.

Right.

OK.

Ambulance emergency, what is the address you need the ambulance?

Sorry, you're the Queen?

You're the Queen of England?

All right. So why have you dialled 999?

Emergency ambulance, what's the address of the emergency?

Sir, sir, I'm going to tell you what to do, right.

OK, is everyone safe and out of danger?

You think he's dead?

Right, so you...

Yeah, OK, listen to me.

Help is on the way. We're getting the fire brigade.

How many now?

Three now?

So you've just got a third person out, yeah?

And they're burnt as well, are they?

IP62.

Pete is the nearest advanced paramedic.

Stoke Newington area, there's a fire call.

There's lots and lots of people at the scene.

I think there's a lot of smoke. Involving a flat.

Some people are reporting an explosion.

But there's one person trapped inside and there's one person

outside that was either on fire or something to that effect.

We had multiple calls and by multiple I mean in excess of ten.

I will go. Be green in two seconds.

All right, bye.

'Multiple calls normally triggers alarm bells

'that what you're responding to is going to be big.

'It does make you step up a gear and focus.'

Four ambulances, five first response cars, advanced paramedic Pete,

the air ambulance team and the fire brigade are all en route.

Yeah, so you've got everybody coming down there as fast as they can.

Well, they're all on the way.

Ambulance, police and the fire brigade. Everyone's on the way.

They are coming as fast as they can.

Seconds feel like minutes, minutes feel like hours,

when you're waiting for an ambulance, don't they?

You're doing really well though. Just keep flushing out with water.

Yes?

I can't talk to you at the moment.

OK, I can't talk to you.

The air ambulance team will deal with the patient feared dead

inside the flat.

Pete is responsible for the other three patients

who are scattered across the site.

Hello, mate.

Yeah.

Yeah.

Yeah.

Yeah.

-OK.

-OK?

-Do we know the cause of the explosion?

-We don't yet...

All right, no worries, I'll go and start triaging.

Yeah, hello, mate, you all right?

-OK, so, open your mouth, stick your tongue out and say, "Ah".

-Ahhh...

And does your... Does your throat feel burnt at all?

I'm just going to look up your nose.

-It does feel burnt.

-OK, so he's got singeing to his nose hair.

-What happened?

-I don't know, mate.

OK, all right.

Let's leave these on here for another ten minutes

so the burns gels have been on for 15 minutes.

-You're going to stay with this guy, OK, all right?

-OK.

And you guys are going to transport him.

-Is this patient number three?

-No, it's only patient number four.

Injuries, quickly?

-He's got quite a lot of singeing.

-Got you.

-Dude, open up your mouth and say, "Ah."

-Ahhh...

OK, so there's no soot in the airway.

-I couldn't see anything.

-No singeing.

OK, cool. I'm happy to leave you with him.

-OK? All right.

-Yeah, no worries.

-Hello.

-Are you the LAS paramedic?

-Yes, yeah.

-We're about ready to go, he wants you to come with him.

The explosion's happened in the middle of an Orthodox Jewish area

and the community Hatzola ambulance has come to lend a hand.

-GROANING MAN:

-All right, all right.

Hello, man, how are you? I'm Pete, you all right?

How you doing? Nice to meet you, mate.

-Injuries?

-There's burns on his face.

-His neck... His neck. His two hands, both have deformed.

-OK.

And he's got the both legs and his buttocks.

How long have these burns gels been on?

Have they been on for more than 15 minutes?

-Um... Just about, yes...

-OK, right. So, guys, all burns gels off.

I want clingfilm on the burns you can see,

don't wrap them all the way around his arms.

Once the clingfilm's on,

I want him completely covered to stop him getting cold.

Sir, my name's Peter, all right? We're going to look after you.

We're going to give you some very, very strong pain medicines.

Does your airway, does your throat feel burnt at all or sore?

-MAN:

-Yeah.

-OK. OK, right, this guy needs to go.

OK, I'm worried about his airway.

Just going to give you some strong painkillers, OK?

Some really, really strong painkillers.

Yeah, Papa 6-2, can you show me blue with Hatzola

to the Royal London Major Trauma Centre, please?

-OVER RADIO:

-'Blue for the London with Hatzola.'

He has partial and full thickness burns.

I haven't worked out a percentage yet. He does have airway burns.

He's currently GCS 15 and talking.

He's been given IV ketamine and our ETA to the Royal London

is going to be 15, 1-5 minutes, over.

'Pete, I got all of that loud and clear.'

Thanks, I'm going to pass for you now.

How's that pain? I gave you a really strong painkiller. How's the pain?

Is it a little bit better? OK, cool. Right, let's go, please.

Thanks very much. All right, all right, it's OK, it's OK.

He's got full thickness burns to his face, hands, buttocks and both

lower limbs, and confirmed to have airway burns, which presents a huge

problem because it isn't long before the airways start swelling.

Hence the need to go very, very swiftly to hospital

with this gentleman.

And I'm sure Pete will be watching him like a hawk the whole way there.

Yeah, of course, yeah. No, it's fine.

Each day can be...

mentally, emotionally and quite physically draining.

It takes its toll, that's for sure.

-PHONE RINGS

-'Hi!'

Oh, hello.

-'Hello, how are you?'

-Yeah. More importantly, how are you?

'Ah, yeah, good, good. I'm tired now.'

'I bet you are.'

I'd love to talk to you for longer but I want to go home.

-SHE LAUGHS

-'I'll speak to you tonight.'

-All right. Take care, sleep well.

-'Bye!'

-Bye-bye!

-'Bye.'

He sounds fine, you know.

To be fair, we're all pretty resilient.

You've got to be, otherwise, after years of doing this I think...

-I'd probably be a jibbering wreck!

-SHE LAUGHS

# Oh, my

# I didn't know what it means to believe

# Mmm

# Oh, my

# I didn't know what it means to believe... #

With the greatest of respect, the governing party of the UK

isn't really relevant as to whether you need an ambulance at the moment.

Frederick, Frederick?

OK, Frederick, I don't think God is going to punch me on the nose today.

Frederick, you're going to need to listen to me.

# Oh, Lord

# I'mma getting ready

# To believe

# Oh, my... #

My sister asked me not that long ago about how many dead people

I reckon I'd seen and I genuinely have long ago lost count.

It's only when you talk about it or chat to relatives or friends

who aren't involved in this,

you realise that what we do is not entirely normal.

HE CHUCKLES

# But if I hold on tight is it true?

# Would you take care of all that I do?

# Oh, Lord... #

-SHE GROANS

-I'm pleased that day's over!

Yeah, I bet.

SHE LAUGHS

It was a nice way to finish, though.

# Then we'll be waving hands singing freely

# Singing standing tall It's now coming easy

# Mmm

# No more looking down, honey Can't you see? #

-Home, James.

-Yep.

I'm done.

-London's had it all.

-JAMES CHUCKLES

# I'mma getting ready

# Oh, Lord

# I'mma getting ready

# To believe. #

Next time, it's the night shift.

I need you to keep calm, keep taking the gas and air, darling.

FEMALE WHINES WITH PAIN

Unfortunately, we've got too many calls and not enough trucks

and a lot of very sick people tonight.