Episode 2 Ambulance

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

'Tell me exactly what's happened.'

When the most serious emergencies strike,

the ambulance has eight minutes to respond.

-'What shall I do with...'

-Sir, I am 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'll be able to try and save his life.

..and who must wait?

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

-From the moment a call comes in...

-He's been stabbed in the stomach.

Looking for an ambulance for a 16-year-old who's had her hand slashed by a machete.

-Another stabbing?

-..crews race to save lives.

Seconds feel like minutes,

minutes feels 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. It's really important.'

'He's as drunk as 1,000 people.'

The NHS is under unprecedented pressure.

There was a hanging, there was a four-year-old

that had fallen 20 foot and now we've got another double stabbing.

You're the Queen of England?

So why have you dialled 999?

As London grows by over 100,000 people a year...

You've overdosed, fella. 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 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 not easy, but you go on to your next job.

There's somebody else you can help.

Oh! London has woken up. Here we go.

-Is she breathing?

-Nah.

-She's not breathing?

-Nah.

OK, sir, I need you to be really clear for me now.

Is she breathing or is she not breathing?

Cos if she's not breathing, you need to help her now.

It's a normal Tuesday night and D Watch is in the control centre.

Emergency ambulance. What's the address of the emergency?

In the first four hours of tonight's shift, they've already taken nearly 1,000 calls.

That's Bond Street underground station.

Yeah.

4405, another stabbing, but it's in the fingers. From the police.

At ten o'clock,

there are 24 patients waiting for an ambulance in north west London.

One has been waiting for four hours and 20 minutes.

I've got a patient over here who's been waiting an hour

and 20 minutes and every time we assign a truck, somebody else

has chest pains or gets stabbed or has a convulsion or something.

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

and a lot of very sick people tonight.

It's Francis's job as a dispatcher to make sure the most urgent calls

get assigned to the ambulance crews who are closest to them.

Once you think you've got everything sorted out, a new piece arrives

that doesn't fit and you have to rejig everything.

No problem. Thank you. Bye.

Echo 131 available.

A colleague of mine described it as playing

a nightmarish game of Tetris, so it never stops.

Francis allocates ambulances in the north west of London.

One patient waiting is elderly faller Eric.

Elderly fallers don't get put to the back of the queue

but unfortunately, if they're conscious and breathing and relatively alert,

it comes up as an amber call.

It's now been three hours this guy's been waiting.

He's 92 and has a back injury.

-Right. Ready?

-I'm good.

Shani and Dave have just come on shift.

They're the closest crew to Eric.

When you hit green, that means you're ready for your next call.

We call it greening up.

That makes the OC aware that you are ready to take your next call.

-We're going to...

-How old is this?

..Eric, who's fallen over,

he's got a back injury and he's slouched on the chair.

-Call come in at what time?

-Seven o'clock.

-Oh, man! It's ten o'clock.

-Three hours old.

-And he's 92. Bless him.

-Three hours ain't fair, is it?

-No.

-Poor old Eric. Let's go and see if he's all right.

Shani and Dave are a five-minute drive from Eric's house.

Two miles away, at Hampstead train station,

an emergency miscarriage call is in progress.

Just reassure her that she is doing very well, OK?

And help will be with her as soon as possible, OK?

Shani and Dave are now 300 metres from Eric's front door.

The miscarriage patient in Hampstead is a higher priority,

so the allocator desk must divert them to Hampstead.

-No, it's cancelled.

-Cancelled again.

This is upsetting, cos obviously now he's got to wait longer.

17 weeks and the patient's head is visible.

So potentially a premature labour for a 17-weeker.

-Oh, this is going to be hard.

-Hold on, guys.

SIREN WAILS

Baby's head is showing.

That's not nice. Non-viable, innit, 17 weeks?

She's still got to give birth to it, hasn't she?

'Is the baby completely out now?'

'OK. Have her push hard to get the baby out.'

'I'm going to stay on the line until they're right there by you, OK?'

'What then?'

Keep breathing the gas. Keep breathing the gas.

Just concentrate on the gas, my darling, all right?

Just relax.

WOMAN CRIES OUT

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

Are you feeling like you want to push?

You are beginning to open a little, darling, all right?

I'm not... Why are you panicked?

Does it make you feel better if I tell you I've delivered 17 babies?

Right. So don't worry.

You're in safe hands, all right?

When you feel the urge to push, just try and pant through it. Yeah.

With the gas and air, because the longer you leave it to push,

the easier it will be for you, all right?

That's all right.

-Shani, can you just give me... How old is she?

-26.

You've been told it's a miscarriage?

OK.

Echo 380, can you show us blue to the Royal Free?

This stuff's free. I'm saying it's free so have as much as you want.

We're fine, my darling.

Just relax.

-I can't do it.

-You can.

-I can't.

-You can and you will. Pant.

Pant through it. Pant through it. You're OK.

Another cardiac arrest, another deceased.

We're holding 13 at the moment on the north west, and our

oldest call now is three hours and one minute that we've been holding.

That's a three-year-old with a high temperature.

Like to be not holding any at all.

-Um... That's the aim, but...

-Does that ever happen?

It's not happened for a long time.

There have been 350 999 calls in the past two hours,

and in north west London there are currently

no ambulances available for the 1.2 million people who live there.

It's impossible for me to say.

This is really an emergency ambulance line.

Yeah, you said that before.

Tell me exactly what's happened.

Is she still on the floor?

And what's her name, please?

Sorted!

BEEPING

-Er, Swallow House. Really? We were there the other day.

-It's Peggy.

Ambulance crew Andy and Dean

have just accepted their fourth call of the night.

It's to another elderly faller - Peggy.

She has a heart condition and they travel on blue lights for

the 2.1 mile journey to her flat.

-Peggy, what happened?

-You tell me.

-Can you not remember falling?

Did you fall from sitting or standing?

Can you point your toes to the ceiling?

Move your legs, Peggy.

-There you go, marvellous.

-Perfect!

-Right, I'll have a little look...

Elderly patients like Peggy account for two thirds

of all ambulance callouts in London.

What time did you fall, Peggy?

-How long ago?

-Well, quite a while,

because I couldn't remember where I'd left my pendant.

-Oh, dear.

-Oh, no. Where was it?

-On the kitchen table.

-Right, shall we get you up?

-But I had to get to it, you see.

-Did you? Shall we sit you up?

Bend your legs, Peggy.

How's that?

-OK?

-Yes.

-I think I might have felt a little bit dizzy.

-OK.

-Well, what...?

-But I'm not certain.

-OK.

Look, first things first, shall we get you up, get you into a chair?

And then we can do some checks, eh?

Ready? One, two, three...

-Marvellous.

-There you go.

-Marvellous indeed!

-So we're going to...

-Let's feel your wrists, quickly.

-Where do you sit, on the wheelie one?

-Yeah.

Yeah, I've got you. You're not going anywhere. Just pop yourself down.

Whee!

SHE COUGHS

Do you want me to make you another cup of tea?

-Ooh, I'd love a cup!

-I know. Cos your one was on the floor.

How do you like your tea? Do you have sugar?

-Three sweeteners.

-Three sweeteners?!

Peggy is visited by a carer two times a week.

Public spending on elderly care services

has dropped 9% in the last five years.

So you felt a bit short of breath?

Stood with your back to the seat?

And how long has that been going on for?

Have you seen your doctor about it?

OK.

I can tell, I can tell. It's probably cos you're talking a lot.

It might be an idea to pop you to hospital.

You might have a bit of a chest infection,

then we can have a listen to your chest.

How many smokes do you have a day?

I've been to you before!

Cos you told me that you started smoking when you were 80.

Was it because you started putting weight on?

That's it. I do, I remember coming to you before.

-Started when she was 80 years old.

-That's brilliant.

Have you? Are you cutting down?

Do you not? But it keeps you slim.

I need to borrow a finger to do your blood sugar.

You're a diabetic, in't ya?

THEY LAUGH

I need to come up under your jumper to have a listen to your chest.

-Is that OK?

-Of course.

Ha-ha.

What are you calling him(?)

-You said it, not me.

-He's been called worse tonight.

-Yeah.

SHE WHEEZES

Crackles, upper right.

Reduced air entry.

-Have you been able to sleep all right?

-I'm not a good sleeper.

-No?

-Right, you might need a chest X-ray.

Is it all right with you if we pop you in? You can finish your tea.

They probably will, cos look at the time it is.

-Yeah, I think...

-She's tachy now. She wasn't tachy before.

-Hmm.

They're a bit tight, in't they?

Peggy's heart rate is getting dangerously high.

Worried that her condition is deteriorating,

Andy and Dean decide to take her into hospital.

-That's it. It's on.

-OK.

36... Right, Peggy...

Time to get you in our chair, young lady.

-Just stay there a minute, Peggy.

-Wait there, Peggy.

-OK.

I'm just setting things up, all right?

-Grab my elbows.

-Give Dean a bit of a hug.

-Grab my elbows...

'Nobody has any time for anybody in London any more.

'But if you're elderly, they can be quite isolated.

'You have to assume that, in calling 999 and asking for an ambulance,

'they're kind of at their wits' end.'

What did you say?

-Arms in the air.

-I've got me arms in the air...

-There you go.

-But you just don't care.

'You're the only people in the world who can help them

'and that's a huge responsibility.'

-A what? Really?

-ANDY LAUGHS

-On our chair?!

-LAUGHTER CONTINUES

You have made our day.

-I can't believe it.

-She was very good.

-I honestly cannot believe it.

-That was moving down there, weren't it?

-Bold.

-Yeah!

At the Royal Free Hospital, Shani and Dave's miscarriage patient

turns out not to be pregnant at all and has run off.

-What can you do?

-Nothing.

-I can't believe I was so badly had!

Oh, well.

Fucking hell!

I can't believe it! I've never been had like that, ever!

PHONE RINGS

-Hello, Echo 380?

-I'm just calling for an update on this young lady.

It seems that she hasn't...

This hasn't been her first visit today.

I swear to God, everything down there was bulging

as if something was going to come out of it.

We obviously blued her into, um, the Royal Free,

cos we was concerned and wanted her to be seen straightaway,

cos she'd been told that she's going to miscarry and it's a stillborn

and, obviously, when we got there, the Royal Free recognised

that she'd been in four times already that day by ambulance.

-And was it her fourth visit to the Royal Free today?

-Yeah.

So she is known to you guys.

I'm not sure, to be honest.

I don't know if there's underlying mental health issues

or if she just enjoys hoaxing the emergency services.

Nice one. Thank you, my friend. Take care, bye-bye.

It's an abuse of the service and whether the abuse of the service

can be excused or not - that's the only question.

If the person has no mental health issues, and just likes

the colour of ambulances, then it's extremely irritating.

-She's on the phone again.

-She's on the phone AGAIN?!

-Yeah.

Via buses.

Area controller Anne-Marie listens to the second call from the woman

claiming to be having a miscarriage to assess the situation.

-'Are you the patient?

-Yeah, I collapsed...

'I've collapsed on the floor and I've blacked out

'and I've knocked my tooth out and I've just been vomiting and, like,

-'I've got pancreatitis.

-Sure, and how many weeks pregnant are you?

-'I'm five.

-Five weeks, OK.'

Yeah, she's saying she's knocked her tooth out now as well.

It's rather annoying, if she's...

She's obviously wasting everybody's time.

Really?

All right, I'll pass that on.

Thanks for that, mate. Cheers, bye-bye.

Tony said he had her a couple of months ago, identical situations -

giving, er, birth on a bus with some visible bulge and screaming

like a banshee and they sent two crews down for the same thing.

So this is...this is months this has been going on.

'People take it for granted.

'If people in London had to pay £500 every time they phoned an ambulance,

'we wouldn't get half the calls we get.

'If they knew what it would be like to pay, they wouldn't do it.

'They wouldn't abuse the service the way they do.'

Hello, 380, it's Anne-Marie. You all right?

Hello, Anne-Marie, you all right?

-She's called again.

-Oh, she's called AGAIN?!

She's really convincing, because I've listened to the tape

and she's saying that she fell, hit her head, blacked out

and had loss of consciousness, she doesn't know for how long,

and she's knocked her tooth out.

Oh, she said that she'd knocked her tooth out to me as well.

-Yeah.

-So that's not a new thing.

-Does she want us to run on it again?

-Do you want us to run on it again?

-Would you mind?

-No, no, we'll run on it again.

-Yeah, we'll run on it again, send it down.

-Yeah?

-Yeah.

We can't say, "Oh, it's her again!" and not send an ambulance.

Because that may be the one time that there is actually

a person there with that description of diagnosis, who is in labour,

and it would be a death sentence if we didn't send an ambulance,

but it's maddening, unfortunately.

So we think this is her again.

FOUR months pregnant.

It's mad that she's phoned in again, it's absolutely crazy.

She's changed her story, hasn't she? It's different, isn't it?

Yeah, I'm intrigued to know what she's going to say

when she sees us, though, cos we've now seen her once before.

Her face might be a bit of a picture.

But I can't believe that she keeps phoning in.

Surely she'll realises that we know...

Well, she must know that, in a small area, we...

there's a possibility she might get the same ambulance crew, surely.

Yeah, you'd expect, wouldn't you?

'I've had miscarries myself.

'Quite a horrific thing to go through.

'As you miscarry, you feel so empty inside

'and you have a sense of loss

'and you're grieving over something that you haven't got.'

ELECTRONIC VOICE: 'Cancelling all functions.'

'So you do quite often relate

'what you've been through in life to calls.'

All right, why don't we get in the back of the ambulance

and we can have a proper chat there, yeah?

But alcohol's a condition, isn't it?

Look, you follow Dave.

-I'm not going to tell you off.

-I should've told you the truth.

What I'm going to say to you is what you've got to understand...

-Yeah.

-The ambulance crew...

-And you've had a lot of ambulances out.

-I'll be honest with you, when you called...

-Yeah?

..we was going to a 95-year-old

who'd been on the floor for three hours and we was round the corner

from his address and we got cancelled to come to you.

-I'm not saying it to make you feel bad.

-No, no.

I'm being honest with you.

I myself... I've had a couple of miscarriages,

-so it's very close to home, the subject.

-Yeah.

So is it... Is it like an attention thing?

Yeah. All I can stress to you is there's a question of whether

-the police might arrest you for nuisance calling.

-No, I understand.

You've got to consider that as well, because there are people out there

-who need our help, that really need help.

-Yeah.

-But you've got to understand...

-I totally understand.

..the concept of, when you call an ambulance,

you've now seen for yourself what happens.

'When it turns out it's all fake,

'you have to look at the bigger picture. What is she going through?

'What makes someone want to fake something as big as that?

'I do feel very sorry for her,

'because she's obviously in a bad place herself to do that.'

Well, I'm...

I'm being honest with you, just so you know.

You know, you only needed one ambulance today, didn't you?

-I did and they couldn't help...

-But you needed five...

Shani and Dave have now spent nearly three hours dealing

with this patient and they still need to take her to hospital...

..leaving other crews to deal with the incoming 999 calls.

Tell me exactly what's happened.

You can't shout and scream at me like that, my love, OK?

Yeah, we'll get you some help, OK?

Is the baby completely out now?

Is the baby completely out?

Is the baby crying?

It's just gone 2.30am and Andy and Dean have been treating Peggy

for the last hour and a quarter.

-Aw!

-No, don't say that!

Throw you away? I'm not going to do that!

You can call me a gentleman, but not an officer.

What's that?

HE LAUGHS

Oh, dear!

You've had... You've had what?

Yeah?

Yeah?

Were they?

-Mm-hm.

-Oh, no! I don't know what to say, Peggy.

I should do another one.

-She looks worse now, though, now we've moved her.

-She does, yeah.

-Let's just blue her in anyway.

-Yeah.

SIREN WAILS

You all right, Peggy?

Peggy?

How are you feeling? You tired?

-Have a little bit of sleep, if you need to.

-I need to.

-Yeah?

Is it well past your bedtime, is it?

Yeah?

Here you are, Peggy. I'll pull up this...

I'll pop the blanket further up around your neck.

Lift your chin up.

There you go.

-Thank you, darling.

-OK? All right?

'It's very, very important to treat people like Peggy

'with the respect and the dignity that you'd hope to be treated with,

'when your final days eventually come.'

You all right, Peggy?

Thank you, yes.

You're welcome.

You feel like the Queen?

-Has my driving woken her up?

-No, she says she feels like the Queen.

-Oh, does she?

-I think that's testament to your driving.

-Ah!

It's like Driving Miss Daisy.

'You might be the last person

'with whom they have any kind of relationship with, really.'

-I'm just pulling up, Dean.

-Eh?

-Just pulling up.

-All right, mate.

'If you can just give them a little bit of happiness,

'a little bit of joy, a little bit of sense that...that they're not

'all alone in the world, necessarily, for however long

'they've got left, then, yeah, very, very important.

'It's one of the most important jobs in the world, I think.'

Right, then, young lady, let's get you seen to, eh?

We can't do that!

You've just got the oxygen going up into your nostrils.

Just watch we don't catch on that wire, mate.

You know, I was thinking...

-"Are you just going to go?"

-And then she was just fine.

-Yeah.

It was weird. Cos when she started going,

-"I just want to die," and I'm thinking...

-Yeah, I know.

-.."Uh-oh!"

-They don't make 'em like that any more.

-No, no.

-They're a dying breed.

-Yeah, absolutely.

Tell me exactly what's happened.

Where has he been stabbed?

12 hours later and D Watch is back at work

for the Wednesday night shift.

I feel like I'm ever so low down.

THEY GIGGLE

I'm having a hot flush.

Londoners call for an ambulance more than any other region,

logging 1.9 million emergency calls a year.

Busy. Very busy. People are staying out longer, because the sun's out.

Instead of heading home an hour ago, they're still out and having fun

and drinking and crashing cars and falling over

and punching each other. All the usual stuff!

Since the start of tonight's shift,

the call takers have received nearly 200 calls from across London.

Tell me exactly what's happened.

You can't get in your house?

Hold on. Sorry, can I stop you there?

You've called for an emergency ambulance.

We deal with cardiac arrests,

bleeding, stuff like that, taking people to hospital.

So, is anybody injured or hurt or...?

Then why have you asked for the ambulance?

That's all we deal with.

We cannot deal with people getting into their homes.

She's taken an overdose, OK.

All right, darling, you need to take a deep breath for me.

We're going to get her some help, OK?

Is she breathing?

You don't know? OK, darling, listen to me.

I need you to get right next to her, OK?

OK.

Can you pass your phone to your mum, please?

OK, we need to check her breathing now.

Because she's not breathing, we need to start CPR.

Is she breathing?

OK, darling, we need to start CPR, OK?

Speed is of the essence in cardiac arrest cases and,

for the best chance of survival,

chest compressions need to start as soon as possible.

Right, I'm going to give you some instructions. Place the heel of your hand on her breast bone

in the centre of her chest right between her nipples, OK?

And put your other hand on top.

The average 999 call lasts just over five minutes.

Across the desk, Emma has been on the line to a man threatening to

take his own life for half an hour.

We're trying to help you. Whereabouts are you?

31 bus stop.

What are you outside of? What shops can you see?

Because I want to help you.

No, why are you going to do that?

Don't start smashing things up.

Why do you feel like you want to do that?

Count out loud for me.

Three, four, one, two, three, four.

-No, they're doing it now.

-They're doing it now. OK, I'm going to leave you with the paramedics, OK?

You're not a bad person.

You're just somebody going through a bad time.

I'm here with you

So you can talk to me.

So don't focus on smashing things up around you.

With psychiatric patients, especially suicidal patients,

you never know when they're going to put that phone down and then you

may lose contact with them,

you know, for good.

It's so important to make sure that the beginning of the call that

you try and get as much information as possible.

But I don't... I don't want you to jump off any bridge.

Please don't do that, David.

All right? We've got an ambulance out so that we can help you.

Why? Why will you go?

Please don't go.

Stay on the phone with me.

We're going to get some help for you. You'll feel better.

Going to a male

stating he wants to die and that he wants to jump in the river.

I've never done anyone jumped in the river. Have you?

-Yeah.

-You have?

-Twice.

-Twice.

I had one that jumped in at Camden Lock and we retrieved him.

He was fine, though. He was just extremely cold.

-And another one, I went along in Embankment and...

-Embankment?

Yeah. There was a body floating.

-Oh, no.

-So it wasn't really a...

-So he was dead?

-Yeah.

Can you see any ambulances anywhere?

What are you going to run away from?

They're coming there to help you.

But they would...

There's no reason for them to put you in a cell.

OK, 380.

Roger that. Cheers, mate. Thanks for the update.

What do you want me to do, David?

David, David, it's OK.

It's all right.

They're there to help you.

Please don't run away.

Don't put the phone down.

-Hello.

-Hi.

Well, this is a David but it's not the David.

OK, so we don't know where he's gone.

What's going on with him that he feels like

he's going to kill himself?

How did you happen to meet with him today?

You just bumped into each other on the street?

So how are we going to find him, then?

What way did he go?

So did he have the station on his left?

So he's gone towards Camden Lock?

Straight up the high road.

All right, then.

Just got an update actually. Let's have a look. Here we go.

Caller states, "Can see ambulance crews outside McDonald's."

There's more updates. Caller states, "Wants to run away."

Do you want to go back round? If we go back round,

we go back to McDonald's. That's all we can do really.

The London Ambulance Service now treats nearly 2,700 patients

every week with mental health problems.

It's one of two things.

He might be doing it for the attention.

Of course he's loving all this if he is.

But then it's probably mental health and he might be having

a real crisis and might just be scared to approach us.

It's a difficult one to say.

Yep.

But we don't want you to do that, David.

Why don't you speak to someone today so that you don't feel that way?

Please let us help you, David.

That's what we're here for.

We can do something to help you.

It's a scary thing, yeah.

It is a scary thing but I'm here.

I'm here to help you.

There are people that do want to help you.

David.

Is that him there on the phone?

Yes, hopefully it is.

-I think we've found him.

-Ready?

We've been to him before.

Can you see the ambulance?

Hello, mate.

-You all right?

-You can.

They're going to help you, all right?

Can you hear me still?

You don't need to be upset. We've met you before. We know.

-Don't be scared. We're here to help you, mate.

-Just relax, my darling.

-Come on.

I'm going to leave you with ambulance crew, all right, David?

-Don't be scared. We're here to help you, mate.

-Just relax, my darling.

Call handler Emma has spent an hour on the phone to the suicidal patient.

Sometimes you come off the phone and you think, "Have I done a good enough job?"

Sometimes you just want to get in your car and just go round there

and tell him everything's going to be all right but, you know,

that's not a possibility, unfortunately.

It's very difficult to be there saying, "I can't do any more than this.

"I'm doing as much as I can."

OK, have you called us before?

OK, is this Kathleen?

Listen, listen, bear with me one second.

Over the past four weeks, frequent caller Kathleen

has clocked up 87 calls to the ambulance service.

She's already been visited by an ambulance crew and

a district nurse today.

The paramedics have all assessed that she doesn't need an emergency ambulance.

And we're struggling a bit tonight.

There is nothing we can do for her.

She's just going to keep calling and keep calling.

And she said, "I'm going to keep calling till I get one."

And I said, "It don't work like that, Kathleen!"

We're not social services.

You know, we can't take an ambulance off the road,

potentially taking it away from someone in cardiac arrest for someone

who's been deemed by paramedics as not requiring an ambulance.

Frequent callers cost the NHS almost £19 million a year.

A team of clinicians working in control room must assess if

the most prolific 999 callers really need an ambulance.

There are a couple of different ways that frequent callers are defined.

One, is that they will call five times or more in a month.

Or, 12 times or more in three months

from a residential address.

We do have a list of known frequent callers.

At the moment, it's around about the 160 that we've got files on

that we can access.

Is your breathing normal?

Are you there by yourself or is someone there with you?

All right, I'm organising the help for you so stay on the line.

We'll be there as soon as we can but it can take up to an hour.

It can be a little bit longer depending on how busy we are.

Obviously, we'll be there as soon as possible.

It will be there as soon as we can, madam, OK?

In north London, Shani and Dave are taking the patient who is

threatening suicide to A&E.

I know for a fact from his history, cos I've picked him up before,

that he had a lot of heartbreak when he was a child. Um...

and I've heard his stories before - absolutely horrific,

you wouldn't wish it on anyone.

And there's nothing we can do, other than listen to him,

because I can't make it better, I can't take that pain away for him,

and he will use alcohol to take the pain away.

Every year, it's estimated over a million people are admitted

to A&E for mental health problems.

Is this Kathleen?

I think you just called.

Over the next two hours, Kathleen, who has dementia,

calls a further five times.

Emergency ambulance. What's the address of the emergency?

You've been waiting 20 minutes?

Tonight we're on about 15 calls now,

in the space of about five and half, six hours,

so, she's in pretty...

And some of those were while the ambulance crew

and the district nurse were in the house with her,

telling her, "You don't need to go to hospital."

We have to do something, we've got to break this cycle,

because if we don't, it'll impact on the area and the people around her -

and, you know, it's not their fault, either.

After consultation with the senior clinician,

the decision is taken only to send an ambulance to Kathleen

this evening if her daughter, who is travelling to check on her,

believes it is absolutely necessary.

Hello?

Hello!

Kathleen?

Hello, Kathleen, it's Liam from the ambulance again.

Kathleen, an ambulance will not come now.

Kathleen...

We've been to you already tonight,

you've had the district nurse out tonight.

Yes, yes.

Yes, but she knows you well.

-No, I want... I can't sleep...

-I know.

I know.

Nothing's come for me.

Kathleen...

Kathleen, no.

The ambulance will not be coming to you tonight.

Kathleen, I also need to tell you, if you do keep phoning and phoning,

the ambulance will still not come,

we'll ring you back every now and again, one of my colleagues...

OK, Kathleen, I'm going to go now.

Kathleen...

I'm now going to speak to your daughter,

before it gets too late, OK?

No, you're not, love.

I'm going to speak with your daughter.

It's been nice talking to you, Kathleen.

Speak to you soon, Kathleen. Bye-bye.

So, I've actually muted Kathleen, now.

I just want to hear what she's doing,

while she's in the background.

OK, she's put the phone down.

-Oh, she's picked it up again...

-RECEIVER RATTLES

..and she's put it back down again.

-KEYPAD BEEPS

-Nine, nine, nine.

Kathleen?

We'll always...

We'll always answer the phone to you, Kathleen, all right?

-I'm going to ring your daughter now. Bye-bye.

-No...

I know, darling.

Kathleen, you only need to ring us...

You only need to ring us if something changes.

All right? I'll speak to you later, Kathleen.

-Bye-bye for now.

-No.

So, again, I'm going to mute, and I will probably not wait much longer.

She's phoned.

-KEYPAD BEEPS

-Nine, nine, nine.

She's straight back on the phone, so I'm going to hang up now.

I'll ring her daughter.

It's always distressing, cos she's absolutely adamant

and convinced that she must have an ambulance. Nothing else will do.

Nobody believes her, she wants to go to hospital.

It's now 10.45 at night,

they're not going to be doing anything for her at the hospital.

This is an ongoing problem for one to two years.

You know, conscious of her age, but, to her, it's real.

And she's entitled to courtesy, she's entitled to respect,

but what we have to do is just manage her demands -

there you go, she's straight back on the phone again.

Kathleen, listen, I need to hang up,

because I need to take other emergency calls.

OK?

Cricklewood.

Fell onto the track?

Four hours into their shift,

Andy and Dean are on their third patient of the night.

You're definitely liking the old "de-dar", ain't you?

Feeling a kid again.

-I do like that siren.

-All you need is a bell, as well.

-Ding, ding, ding, ding, ding!

-Yeah!

It's very easy to roll your eyes, sometimes,

at the kind of thing that you're being sent to.

-It's just here, isn't it?

-Yep.

-Is it?

-Yeah.

-Yeah.

What, did he fall from this height?

I know.

-Thanks, mate.

-Cheers, dude.

You all right, mate?

Fella?

'I'd never have, in a million years,

'wouldn't believe the kind of things that people phone an ambulance for.'

How you doing, mate?

It's the ambulance. You hurt yourself on the train?

'It's people who shouldn't be calling for an ambulance -

'or not even not calling for an ambulance,

'but shouldn't even be seeking medical attention at all, really.'

This call was not exactly as it was given.

Andy and Dean have spent 40 minutes with this patient.

Meanwhile, there are 17 callers in the west of London

still waiting for an ambulance.

Tell me exactly what's happened.

What's happened?

Yep.

OK, Kathleen, I'm going to have to clear the line now,

so I can answer emergency calls.

If there's any change, call us back, but otherwise...

Please don't keep calling.

We've spoken at length about your mum Kathleen tonight,

and my clinical advisor on call, the senior,

has agreed with me that we will put this "No Send" in for tonight.

-Right, OK.

-Your mum has been told.

-Yeah.

-To be perfectly blunt, she didn't take a blind bit of notice.

-Right.

So, I had five phone calls on 999 whilst I was on the phone to her.

Oh, God.

Now, something Mum did put to me

when I was near the end of the call with her, which...

I've never spoken to Mum much before,

so I don't know if it's normal -

does she threaten to do away with herself?

-Yes, I've had that, as well.

-OK, so...

I used to get really upset with it. I'm hearing it so frequent now...

-So, that's normal and frequent from her?

-Yes, it is.

Does she have any record

-of having attempted to do away with herself?

-No, she hasn't, no.

Does she have any means of doing it?

Erm...she's only got paracetamol.

-And does she use them?

-Erm...

Well, I think half the time she forgets to take them, anyway.

OK, all right.

So, she's unlikely to do it because she forgets to take them anyway. OK.

-We are not going to send, unless out-of-hours doctor...

-Right.

-..someone else, or you...

-Yes.

-..tell us to,

but we will collect all Mum's calls,

they will be reviewed by one of my clinicians in the clinical hub,

so it'll be a paramedic with experience in this.

-Every now and again, periodically, we may try to ring her...

-Yes.

..but once Mum stops ringing, I don't plan to wake her up

by phoning her to see if she's all right.

-No.

-Does that make sense?

-Yes, it does.

-All right, Linda, all the best. I hope Mum feels better.

-Yes, so do I.

But I don't know that tonight's going to make any impact on her,

-to be perfectly honest.

-Probably not.

-All right?

Cos I think it's a mental stage now that she's reached, actually.

-Possible.

-Yeah. OK.

-All right, lovey.

-Thank you very much.

-All the best. Bye-bye, now.

-Thank you.

-Bye-bye.

-Bye-bye.

I've got to be honest - she's somebody's mum,

and, in a few years' time, that could be you, me, or anybody else,

and I would want them to be treated with the utmost care, decency...

but it's got to be appropriate.

She's on the phone again.

Oh, Kathleen, for crying out loud.

Anyway, there you go. Some you win.

-I'm in terrible agony.

-OK. And I'm sorry for that, I really am.

I'm sorry for that - but I am going to clear the line, now,

to take another emergency call.

General broadcast, general broadcast, all mobiles,

looking for any ambulance or FRU at the moment for an emergency call.

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

'London can seem quite cold and lonely sometimes.

'If nobody knows who you are, nobody's going to talk to you.

'When I first arrived, I used to say "hi" to people I passed on the street.'

Because that's what we do back in my hometown.

I stopped that fairly quickly.

It's not so much that London destroys my faith in humanity

but it does test it.

DIALLING TONE

-'Hello?'

-CAD 85? All right, thank you, bye.

It looks like it's a hostage-taking.

In the north-west of London,

a serious category A call has just come in.

But none of the 28 crews covering this area are currently available.

Within a mile of the suspected hostage-taking,

one crew is on a mental-health call,

another crew is treating a patient with septicaemia,

and Shani and Dave are helping an elderly faller up off the ground.

And then what we'll do is we'll all go together.

We'll pull up and you'll push up with your legs. One, two, three...

-Push, push, push, push, push.

-Blimey, that was good!

-Push.

-Just try and stand up for us.

-It's all right, we're here, we're here.

-FRANCIS:

-Let me just GB this.

General broadcast to mobiles, general broadcast to mobiles -

looking for an ambulance, please, for a police call.

50-year-old male has locked himself in the property,

'saying he's harmed someone inside and is armed with a knife

'and it's turning into a hostage-taking.

'That's any ambulance available, please.

'Any ambulance able to assist, if you could, please go green or make yourself known.'

General broadcast at 38. Foxtrot, Bravo, red base, out.

'General broadcasts are used when we're holding calls'

and don't have trucks available for them immediately.

We just put out the general broadcast so they can hear it and respond if they can.

'Here's Echo 380.'

Do you want to just hold that call for a couple of seconds while

we can get out to the vehicle and take that one over?

'Roger, 380. As quickly as you can.'

Thank you for coming up, I appreciate that.

It's only going to take them... six, seven minutes to get there.

North West 5. This is around the corner from the station.

It's not far, is it?

'999 mode.'

We'll need to get our stab jackets on.

'When you get situations that involve violence, stabbings, guns,

'we will drive to the call, they'll keep us updated and they kind of

'keep you back until the police are definitely on scene.

'You kind of have to suss it out en route.

'Control are in touch with you,

'you'll get little snippets of, "There's lots of shouting going on."

'Our safety comes first, cos we're no good to a patient if we're not safe.'

When Shani and Dave arrive,

police are already on scene and have arrested the man.

He's hurt himself with a knife of some sort.

But the problem is, is he's saying that he's murdered other people.

He's suggesting that one's in the bin or someone's in his flat,

and they've been through his flat, they've been through the bins.

They cannot find any evidence of someone being murdered.

Let's get you in the warm, all right? Get you out of this cold.

MAN SOBS

It's just here, yeah? Any drugs?

Yeah? What have you had?

Cocaine and heroin tonight? How did you take the heroin?

You smoked the heroin. And how did you take the cocaine?

Snorted the cocaine. OK. How much did you have?

Not a lot. How much is not a lot, mate?

Not enough!

Let's just get a bit of a what's happened so I understand better what's happened.

So you've had an argument with your girlfriend and then who's done these injuries?

Did you do them yourself or has someone done them to you?

You were fighting with someone?

And you put them in the bin.

OK, OK.

Are you hearing any voices at the moment? You are, yeah?

What are the voices saying in your head?

There's no-one been hurt by you, mate.

I've been through your flat, friend, and there's nothing...

There's no-one in there and there's no signs of you've hurt anyone.

You know, what's happening is, what you took earlier is making

you think that something's happened, and it clearly hasn't.

OK? So, just relax. You're not going to prison for a long time.

He's calming down,

and I think Dave and the policeman at the moment are building up

quite a good rapport with him

cos he was quite emotionally upset earlier.

And it's hard to get the full history.

But he's only got a few cuts on his hand. Nothing life-threatening.

'The police are going to take him to the police station.'

They're going to get him to see his FME, and then they'll talk

to him about the mental health side of things and take it from there.

'380, good morning. I just wondered,'

what was the actual outcome in the end? Over.

This gentleman had locked himself in his flat.

'His girlfriend had got in touch with the police.

'The police had gone round.'

He then self-harmed to his hands.

'We've assessed him but we're not taking him to hospital.'

Roger, 380. Thanks for the update.

Glad everything worked out and you guys are OK. Over.

MUSIC: Coles Corner by Richard Hawley

I wonder how may people have seen the sunrise over London

-as many times as we have, hey?

-It's lovely, isn't it?

-Yeah, it is nice.

-No-one around.

-I'd rather be on that plane that's flying over.

-That's very true. Where do you want it to be going?

-Ibiza.

-Ibiza!

-Cyprus.

-Cyprus?

-I'd go to the Bahamas.

-Really?

-Yeah.

-I want to be on it, never mind where's it going.

-That is true.

That is beautiful, isn't it?

# Hold back the night from us... #

There's always a sense of relief that we got through it

when we finish. We all walk out of there at the end of the day

knowing we've done the best job to the best of our abilities.

I can't believe I used to hate this job. And now I love it.

A lot of the time, it's kind of nonsense that we go to anyway.

-But when it's genuine...

-You get a buzz out of it.

People call us when it's literally the most desperate they could

ever be. And who do they call? 999 ambulance.

-It's not the Ghostbusters, is it?

-No.

# Out over the rivers and on into dark... #

'Everyone's a little bit broken in some way. Everyone.

'Some of us have hit rock-bottom and been depressed, you know?

'So, we can use that to our advantage to make us understand

'what people need, how to help people better.'

-All the weirdness is over for tonight.

-Really?

I like a little bit of weirdness in the morning.

-We just had a cardiac arrest in a brothel.

-Lovely.

I mean, if you're going to arrest, that's the way you want to go,

-isn't it?

-Well... That's it, my friend.

I'm going to go home and get some sleep.

# Going down town where there's people

# The loneliness... #

'What's the address of the emergency?'

-WOMAN:

-'It's...Baker Street.

-MAN:

-'It's on the junction with Dorset Street.

'Just on the crossroads.

'It looks like a baby swan here. But...

'Sorry, there's a baby swan?

'This lady's just phoned you and her English isn't very good.

'And you're saying there's a baby swan?

'It's by a tree, looks like it's been hit by a car.

'It's a swan, as in, like, a duck?

'Yeah. You just can't contact the RSPCA at this hour in the morning.

'I thought you might be able to help.'

This is the ambulance service and we won't be able to help you

-with a swan that's been hit by a car.

-'All right, Cheers, mate.'

All right, take care. Bye-bye.

# Cold city lights glowing

# The traffic of life is flowing

# Out over the rivers and on into dark

# Hold back the night. #

Next time, it's the weekend shift.

OD on cocaine and MDMA.

-Red 1.

-Red 1. Oh, no.