Episode 3 Ambulance

This programme contains some strong language and scenes 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...'

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 are an atheist.

I am 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 that 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.

Kathleen?

From the moment a call comes in...

He's been stabbed in the stomach.

I'm looking for any 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 feel like hours when you're waiting for an ambulance.

My name is Peter. We're going to look after you.

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

We 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 1,000 people.

The NHS is under unprecedented pressure.

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

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 have overdosed, fella.

-Hey?

-You've overdosed.

..ambulances are struggling to keep up. The situation is now critical.

Someone has 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...

SCREAMING

..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.

..because there's somebody else that you can help.

-PHONE RINGS

-Oh, London has woken up. Here we go.

Now, listen carefully.

I'm going to tell you how to do resuscitation. OK?

Place you're the heel of your hand on the breastbone,

in the centre of the chest...

Would I still love you?

Frederick, that's not the point of the call.

I'm asking you a question, Frederick. Do you need an ambulance?

Shouting is not going to help the situation.

Tell everyone to calm down. This is important. We need to help her.

It's Friday night,

and the start of a long weekend in the control centre for A Watch.

I need to advise you that the 999 lines are very busy.

Just tell him to be still and wait for the help to arrive. OK?

Of the 2,500 calls for help they expect to hear tonight,

they know the number fuelled by drugs and alcohol will be

double the normal rate.

BEEPING

-Overdose.

-OD on cocaine and MDMA.

Oh, no.

OK, let's go.

The overdose call is in Brixton.

South London-based crew Dan and Donna are immediately dispatched.

If it's a weekend and it's a payday

and it's a full moon,

then you can be guaranteed to see absolute carnage.

Drunk, drug-fuelled problems.

But that can be quite interesting,

and I do quite enjoy that, to be honest.

Dan and Donna are a mile away from the patient.

With reports that his condition is worsening, an advance paramedic

who's specially trained to deal with overdoses is also sent.

Red base, Alpha Papa 6-1.

ETA is going to be about five minutes on this call.

'ETA is five minutes? Thanks.'

SIREN WAILS

He's reported to have a very fast pulse

and actually be quite hot as well.

Both of those conditions can cause problems with kidney damage,

muscle breakdown and can actually make you quite unwell.

Rich is on scene in six minutes.

Dan and Donna arrived in four minutes.

-Are they coming out now?

-They're coming out.

-OK.

-What do you know?

-21-year-old.

-He was shaking quite a lot when we first got in.

-Yeah.

-Possibly a small fit.

-Fine.

-We've packed him with some ice for now.

-Yeah.

-We brought his temperature down to 40.3.

You are in the back of an ambulance, buddy.

-You're OK, but we just need you on the bed.

-Why?

-DONNA:

-Look at me, OK? Nothing is going to happen to you, OK?

-We're trying to help you.

-Relax.

-Calm down.

Are you all right?

-We're not your mum.

-I'm not your mum. I'm trying to help you, OK?

HE SOBS

-PATIENT:

-You're trying to hit me.

Just peel it that way.

Just relax.

Take your hand off me, please.

Let go of him.

-All right, OK?

-Just relax.

Let go. Let go of my shirt.

You are going to get a little scratch, buddy.

It will take a little while to work.

-Relax.

-They're just trying to help you. All right?

The clubs are beginning to close but the Friday night party is

still in full swing.

First-response paramedic Andy is on his way to a call outside

a kebab shop in east London.

So, I've just been dispatched to a young lad who

has got facial injuries after being robbed.

Hello, mate. What is your name, fella?

-Ali. Ali, Ali.

-Ali? My name's Andy.

-Mate, I went to get a doner kebab and I got doner-ed.

-Oh, no.

I got doner-ed. Oh, shit.

-Do you live round here?

-No, I live in Essex.

I came here especially for that doner.

You came all the way here for a kebab?

For a kebab, and I got kebab-ed!

-Can I just have a little feel of your head?

-Yeah.

-Yeah?

-Oh, that's...

-Yeah.

Ali, it's going to be a trip to hospital, this one.

All right?

Andy operates alone as a first-response paramedic.

24-year-old Ali's condition needs to be closely monitored,

and this requires an ambulance.

Thank you. Could I arrange

some transport for this gentleman to hospital, please? Over.

Open your mouth for me.

-Have you broken your nose before?

-What?

Have you broken your nose before?

-So you had a bit of a wonky nose to begin with?

-Yeah.

-Yeah?

What actually happened?

They were yobs. Mostly they said, "Yo!"

I just knew what it is and I turned around and they said,

"What have you got for us?"

The guy came running and he just whacked me so hard.

It all fell out. My car keys fell out,

my glasses came off of me and my watch...

Everything came off...

HE MUMBLES

RADIO BEEPS

The truck's just round the corner, dude. All right?

We'll get you sorted.

Oh, yeah. What watch is it?

Oh, mate. How much is that?

Pfff! What do you do for a living?

Oh, right.

-So, you're an entrepreneur?

-Yeah.

We'll see you on Dragons's Den in a few years

with piles of cash in front of you!

I think our transport has arrived, Ali.

-I got to go to the hospital?

-Yeah. All right, Ali.

I'm going to leave you in these guys' capable hands, mate.

-All the best, all right? Look after yourself.

-Cheers, guys.

-Right, how are you feeling there, Ali?

-So good(!)

THEY LAUGH

Never felt this good in my life(!)

Last year, the London Ambulance Service treated over 31,000

victims of violence and at the weekends, casualties rose by 50%.

I think we have a distorted view of London. We see the violence.

We see the result of it.

But I don't think London is more or less dangerous than any other

part of the country. It's just, as an ambulance service,

we know about it and we hear about it and we see it.

Can we put a little bit of oxygen on your face? Just a little mask?

Just to help? Yeah?

In Brixton, the MDMA overdose patient

has been successfully sedated,

but he still risks overheating,

so they must take him to hospital for further observation.

Red base, Alpha Papa 6-1. Can you do a move to King's College

-when you're ready?

-Yeah, go ahead, mate.

We have got a 20 - two-zero - year-old male.

He has a pulse of 160,

a temperature of 40.2,

ETA is only about five minutes.

Yeah, that's all being done for you now.

SIREN WAILS

You're in the back of an ambulance, yeah?

We going to take you up to the hospital

and we've let them know you're coming.

You're very hot, your heart's going very quick,

and you're having a reaction to the drugs.

He took a disliking to me, for some reason.

He's very, very paranoid.

I think that he thinks that we're his mother,

which isn't ideal.

You're not in trouble. You're fine. OK?

But you need to relax and trust us, yeah?

Can you do that for me?

-HE MUMBLES

-Good man.

-ETA 10 seconds.

-Thank you!

You're calming down a bit now, aren't you?

Yeah, that's good.

You'll feel a bit better in a minute.

You take drugs at your own risk.

You can't stop someone wanting to do that.

We will always be there if someone does overdose or take

something the wrong way, and it all goes horribly wrong,

but it shouldn't get to a point where it impacts on other

people's health because you overdosed and need an ambulance.

Oh, bit of...

MUSIC PLAYS

# When we erupt into the room

# And hear the sub go boom... #

'I look at my friends sometimes and what they get up to,

'and they're still out every week getting pissed,

'and I'm, on a Friday night, you know, in an ambulance going to them

'and people my age, and that can be a bit surreal sometimes.'

Oh, my God!

What a tune!

'So this job has definitely made me more mature.'

# ..Sweet sensation! #

As the shift draws on, the aftermath of Friday-night partying

shows little sign of letting up.

There are 19 crews currently treating drink and drug casualties,

but not all calls are the result of tonight's party.

WOMAN GROANS

I know that she's screaming, I know she's in pain, OK,

but she needs to try and stay calm, all right?

And take deep breaths in.

At this moment, there are three women in labour currently

on the line, and ambulances have been dispatched.

OK, I'm going to tell you how to deliver the baby just in case, OK?

Raise your head up with pillows but don't sit up

and do not go to the toilet.

Call-handlers are trained to deliver babies over the phone

in cases where it's clear the baby won't wait.

Listen to me, right?

The whole head is out, you're saying?

Is the whole head out?

Right, listen to me. Push hard now to get the baby out, please.

Right, as the baby delivers, it's going to be very slippery, OK?

So just be careful and support the baby's head and shoulders.

Right, is the whole baby out? Is the baby crying or breathing?

Right, OK. Sir, is the baby crying or breathing?

Yes?

All right. OK, congratulations. Is it a girl or boy?

I don't know, I don't know. I can't... I don't know.

-You don't know?

-I'm in shock.

-You're in shock?

Well, well done. The ambulance should be pulling up outside now.

-OK.

-OK, congratulations. I'll leave you with them.

-Thank you very much.

All right, thank you. Bye.

Is that the ambulance crew with you?

OK, I'll leave you with the ambulance crew. Thank you.

I'm going to leave you with them, OK? Good luck.

Lots of babies tonight.

A call has just come in from the police in east London for

a man who has been reported unconscious.

First-responder Andy is sent.

Hi, mate. Oh, has he?

Oh, OK. My name's Andy.

-What's happened tonight?

-Nothing.

-Nothing?

How come you're outside?

-I don't know.

-You don't know?

-No.

-It's very cold.

Do you feel cold?

-Very hot.

-Very hot?

-Very hot.

OK. How long have you been feeling hot for?

-1985.

-Sorry?

-Since 1985.

-What year are we in?

-I don't know.

You don't know. OK.

-How old are you?

-I don't know.

-All right.

-Can I do a couple of checks on you?

-No.

-No? Why not?

Don't touch me. Don't touch me.

-Can I take check your blood sugar?

-No.

-No?

-No.

Does he have any medical problems?

OK. Does he have any other medical problems?

OK. Unfortunately, I am very limited in what I can do right now.

I think, as you probably know anyway, the best course of action

would be to pop him back down to the hospital.

Just a little update for you on this very, very,

very much a mental health job.

He is going to need to go to hospital so we are going to need

a vehicle at some point.

There are currently no available ambulances in this area.

Andy's mental health patient must wait.

But he's starting to get restless.

You're going to have to stay here, I'm afraid.

-Nobody's looking...

-INDISTINCT

Nobody's looking to make you to go to jail.

What we're trying to do is get you somewhere safe and somewhere warm.

Oi.

If the patient continues behaving erratically,

he risks being detained by the police

to prevent him harming himself or anyone else.

He's not going to get the better of us.

-I'd rather not have him handcuffed.

-Calm down. Calm down.

INDISTINCT SPEECH

Finally, a private ambulance arrives,

one of 18 that have been specially contracted tonight

to ensure they can safely cover the whole of London.

-Hello, guys.

-Hello.

I think the police are going to do most of the work.

I think the more people around him...

the more difficult it's going to be to manage.

Over the last year,

there's been a 15% increase in the number of mental health calls

the London Ambulance Service attends.

It's desperately sad when people are in that situation.

We try our best to help them as much as we can, but...

..really, the only choice we have is to take them to hospital,

which isn't right, it isn't where they should be.

A&E is not a suitable place

for people who are having an acute mental health crisis.

But it's the only avenue open to us

at three o'clock on a Saturday morning.

It's...

Something's missing with our mental health care at the moment,

and I don't know what the answer is,

but what we're doing at the moment isn't working.

We'll put a plaster on it tonight,

and then next week, it'll be the same story again.

Why do you need an ambulance? He's drunk?

There's probably a very good reason

why they didn't prescribe dog worming tablets

to you as a human being as a type of medication.

Pete is in charge of the team dispatching ambulances

across west London this weekend.

He read on Google that these dog worming tablets

contain an active ingredient that helps people with anxiety issues.

Asked the doctor to prescribe them, the doctor said no,

so he went online and bought them online

and he's been chewing them for most of the day.

-Is he still anxious?

-Well, he's not so much anxious

as petrified now that he's done something to hurt himself

because of eating these tablets all day.

So his anxiety's gone through the roof now?

-It's gone through the roof!

-Oh, my God.

If you wrote a book, they would put it in the fiction section,

because they'd never believe that this stuff happened for real.

North London-based crew Abbey and Paul

head towards their second job of the night.

SIREN WAILS

'OK, how old's this person that's passed out?'

25? Is she awake now?

What's her name?

So, what do you reckon that Laura's been up to?

I don't know.

Passed out, unconscious, in and out of consciousness.

Unable to verbalise. Responding by moving fingers.

Could be...any number of things, couldn't it, I suppose?

They arrive four minutes later.

The woman has now regained consciousness.

-Right, Laura...

-Yeah?

-What we're going to do is we'll take you down to the ambulance.

-Yeah.

-Cos you've had a faint...

-Yeah.

..we'll want to do an ECG

to make sure it's not your heart that's causing any problems.

-Just, like...

-Just see how you are.

-I'll stand next to you.

Have a hold and we'll stand for a moment.

Oh, don't worry about that.

Don't worry about that.

-Oh, bless you!

-We've all done it.

I didn't know, and then I felt it between my legs, and I was like...

Oh, don't be silly.

Whilst you're on the stairs, Laura, if you feel unwell, just sit down.

Just sit back and sit down.

It was lucky I put my wash on, wasn't it, earlier?

-You're going to need some new trousers.

-Oh, Laura!

-Did I pee on you?

-You peed on everyone.

-We picked you up.

We just picked you up and you sprayed everywhere.

People thought it was part of the comedy routine.

Genuinely, he did have to say, "This isn't part of the routine."

-Did you have to say, "This isn't part of the routine"?

-The bloke did.

-Everyone was whooping and hollering.

-They thought you were a great act.

-Like one of those garden sprinklers!

-Yeah!

Laura has only had one bottle of cider tonight,

so Abbey and Paul need to explore other underlying causes

for her collapse.

Your underwear?

She's blaming her thong!

-You think that your thong...?

-My thong made me faint.

-Your thong made you faint?

-Yeah, genuinely.

I think this is the first time I've heard anyone suggest

that their wedgie has made them faint.

Yeah, genuinely, I think it was the wedgie.

Personally, I would have thought Spanx

-might have been more the kind of thing to make you pass out.

-Yeah.

Not that I have any...any knowledge about Spanx and stuff.

At hospital, it becomes clear

that it was a vitamin deficiency that caused Laura to faint.

..OK, and is she breathing?

She is?

Back in the control centre,

the Saturday night shift is getting busier.

'At the moment, we don't have enough resources available.'

She was in the bath?

OK, has she had a...? Listen. Has she had a fit?

'And there are some very, very difficult decisions to be made by the allocators.

'Which ones do I hold? Which ones do I send?'

We've got some help on the way to you, OK?

They're going to be with you really, really soon.

'Sometimes you feel like you're playing God.

'You have to make that decision. Split second - send, don't send.

'And it's hard.'

Two hours in, and there's a queue of 53 patients who've been assessed

and are now waiting for an ambulance,

and more calls are coming in.

'Tell me exactly what's happened.'

'OK. Help has been organised for you.'

We are on our way to...

a young child, a girl, female, six years old,

and she's fallen from her bunk bed.

Head injury, it says.

SIREN WAILS

West London-based crew Ned and Nick

are on their second call of the night.

There are now no more ambulances available in this area.

And within a minute, a further four new calls come in.

'Can you tell me exactly what's happened?'

Jase, you seen this 4281?

-Yeah.

-Yeah, thank you.

Reports coming in of a patient that's been stabbed in the leg,

losing a lot of blood.

Within a mile of the stabbing, there are three ambulance crews.

But all are busy.

Ned and Nick are on their way to the six-year-old

who's fallen from her bunk bed.

This is a lower category call,

so they are diverted to the stabbing.

Cancelled.

One part of the job that's not always easy to do is juggling.

-So, we're going to a stabbing now.

-6.2 miles.

You know, you've got one ambulance, two patients,

both nasty ways of injuring yourself,

and we've got to make the decision who gets and who waits.

You know, I'm a dad of a six-year-old girl.

So if that was my six-year-old girl that's fallen off the bunk bed

and is waiting for an ambulance,

I don't care who else is hurt - it's my little girl.

I want her to get the ambulance.

Hopefully that little girl's not too badly hurt.

But if he's stabbed in the leg and there's a lot of blood loss,

that's going to kill him fairly quickly, so...

There's another ambulance on the way to her that came up green.

To the kid? Brilliant. Lovely.

It's in here somewhere, isn't it?

'I get worried, sometimes, going to these jobs,

'because the assailant is probably still around on scene,

'and it's your job to attend the patient,

'but also watch your back and your crewmates.'

And then it should be your first left.

'There have been a few occasions

'where I know that I've gone in on my own to go and help a patient

'full well knowing that there's someone there

'that could probably cause me harm.

'It is scary. Very, very scary sometimes.'

Hold back until police are on scene before making progress, over.

Yeah, all received now.

There they are. There's the police.

Do you guys have a bit of a story of what's gone on at all?

Not at the moment, no.

-Our colleagues are upstairs...

-OK.

-..dealing with him.

-OK.

-Is he inside?

-Apparently so. They're all upstairs.

The attacker has fled,

leaving the victim bleeding on his mother's doorstep.

He doesn't look very well, does he?

..OK, if that's all right.

I don't think you're very well at the moment, cos your pulse is...

Shall we get you in this chair?

We'll take you down to the ambulance and then we'll get you sorted out.

Just hold on for a minute.

One, two, three.

How long ago did it happen?

An hour ago? And has it been bleeding all that time?

Has it?

Stabbing someone in the wrong place will definitely kill them.

In my life, it's so unfathomable

that someone could do that to another person.

But it happens...often.

And I have to question whether these people understand

the consequences of their actions.

My name's Ned, by the way.

Nice to meet you, too.

I just need to put a really small needle in your arm.

We can give you something for the pain as well.

Just stay nice and still for me, mate. A quick scratch coming up.

I grew up in, like, a tiny, tiny village in West Dorset.

The worst thing you'd ever come across down there

is that a neighbour's had a fight, someone's been kicked by a cow,

someone's fallen into a slurry pit,

so the idea of going to a stabbing

where someone's actually been stabbed by someone

is completely removed from my normal life.

But now it's part of my everyday life, it seems.

Foxtrot 230, can you show us blue to St Mary's, please?

It's a major trauma.

He is saying that it happened an hour ago, from before we arrived,

so that could be, potentially, quite dangerous

if, you know, he's been bleeding all that time.

If you imagine pint glasses, all the blood that's been trickling out

over the last couple of hours,

how many pint glasses do you reckon it would have filled up?

Just a rough guess.

It's possible that it might have filled up about five pint glasses?

-HE GROANS

-Well, I'll listen to you.

Just coming up the ramp now, guys.

In London, 800 crimes are committed with knives every month,

injuring over 300 people.

It's becoming more common,

and certain elements of society have this habit

of stabbing people in the backside.

Which...

It's not so much to do with the injuries that it brings out,

the stabbing, but the victim will end up

having to wear a colostomy bag for the rest of their life.

Is it what they call bagging, innit, Michelle?

Bagging. They bagged someone.

Not nice.

Not nice at all.

In the first half of tonight's shift,

the Ambulance Service deals with 44 assaults across London.

They must balance coping with these

alongside every other emergency that comes in.

WOMAN GROANS

'Tell me exactly what's happened.'

-'Right, OK.'

-WOMAN GROANS

An ambulance has been requested in south-west London.

Dan and Donna are sent to help.

How have you ended up on the floor today, Margaret?

-I went out to go on the toilet.

-Yeah?

-I didn't reach the toilet. I reached the door here.

-OK.

I think I had some kind of fit or something.

What makes you think that, Margaret?

I was just totally out.

OK. OK, how much have you had to drink today?

-Not a lot.

-Not a lot?

-No.

-OK.

All right, let's sit you up and get you on the bed, then, OK? Three.

-MARGARET YELLS

-Well done.

Stand up, Margaret, well done.

-OK?

-OK, there we go.

-OK, have you had this pain in your side before?

-No.

-No?

So if you had to give it a number out of ten,

if ten was really bad and zero was no pain...

-About a nine.

-A nine.

So really, like, crippling?

OK.

-Can I get you a tissue? Your nose is running.

-There?

-Ah!

-Where I'm pressing there?

-It's there.

-Your rib.

-No, here.

-Here.

-Where I'm pressing. Yeah.

-There.

See, if it's causing you that much pain,

we should really pop you up to hospital, really.

Come on, then.

The London Ambulance Service receives nearly 100

alcohol-related call-outs every shift.

On a Saturday night, that number doubles.

Margaret, do you drink half a bottle of vodka every day?

No.

-No? Is it just...?

-I've recently come out of rehab.

-OK.

And, basically, I drink about twice a week.

A lot of the stuff we do is routine, mundane stuff, and you think,

"Why are we doing this again?

"Why are you going to this person who's fallen over?"

But what's the alternative?

We can't just turn around and tell people who've been drinking

they can't have an ambulance, partly because we'd be out of jobs.

There'd only be about four of us sitting here every weekend.

But also partly because people who do drink become vulnerable.

Oh, good. I like you because you're helping me.

Well, of course. It's why I'm in this job, to help people, Margaret.

OK, let's play another game. How old do you think I look?

Show me your teeth.

-Is that an important part, is it?

-Yeah.

-How about my teeth, then?

-What about Donna?

How old do you think Donna, our Care Bear in the front, is?

25.

23.

-Oh, bang on for me...

-You took eight years...

..and pretty close to Donna as well.

-Yeah, you took a few years off my life.

-Just a decade!

-Well, there you go.

-Dan!

When I put my glad rags on and I've got my face on...

-I bet you look lovely.

-I don't look 50-odd.

I bet you do.

So, we'll go this way.

Halfway through the Saturday night shift and the control centre

is taking calls at a rate of 250 an hour.

-Right, so he's been assaulted?

-Yeah.

-And was there any weapons involved?

OK. And is he awake?

Ambulance crews are currently dealing with nine people

who have been assaulted, including two stabbings.

-So, we've had a stabbed in the leg.

-Yeah.

We've had a bottled, or slashed across the face,

-a stabbed in the back.

-Yeah.

Tonight has been a bit of a stab-a-thon.

Yeah, there's another one just come in now, actually. Where's that one?

What's the address of the emergency?

A first response paramedic is already on scene

and an air ambulance team has been dispatched, but they'll need backup.

Half a mile away,

ambulance crew Ned and Nick have just become available.

ALARM BLARES

-Another stabbing?

-We've got another stabbing.

It says central stab wounds in Soho.

-They're still there.

-They're still there. Yeah.

I don't even know if I fit in mine.

I think I'm probably too fat to get in my stab vest now.

It's a four-minute journey to the crime scene.

The police have moved in to cordon it off.

I've been dealing with him.

The patient has already has his wound dressed by Stuart,

the first paramedic on scene.

-It was a knife.

-I'm going to peel it back and...

It was a knife. Yeah. Let me see it, OK?

There is a fairly significant amount of blood.

-Ned.

-Ned, hello, Ned. Is this the only one?

That's the only wound that I found, yeah. That's it.

So it's already been packaged up by the paramedic

he's seen previously. But I'd say there's got to be

more than 500ml in his trousers at the moment.

In fact, every time he sits down, there's more and more and more.

And that's just come down from there?

It appears to have just dribbled down, yeah.

It was all quite manic when we got here. Like, I'd literally got...

-Oh, really?

-Yeah.

I know.

Aye?

The patient's injury is potentially critical,

so he's taken to a major trauma unit on blue lights.

He is the fifth stab victim of the night.

I can remember when if you got the call for a stabbing,

-it was a performance.

-Yeah.

Now if we do a shift and we haven't had one, it's a comment of note.

Right, so I'm holding one, two, three, four,

five Category A calls all needing ambulances.

Going to have to take Alpha 230 off that to go on the As.

Calls are still coming in at over 200 an hour,

and in the west of London, there are currently no ambulances

available to deal with them.

I am dragging Charlie 450 from the other side of London

to try and help a poorly man,

and I'm also holding an uncalled Category A call

and there's no-one anywhere who can help.

That's it.

It's busy in Dan and Donna's area, too.

But they can't help clear the backlog because they are tied up

with a patient who is homeless

and has discharged himself from hospital.

We can't take this out of you.

We've got to take you up to hospital to have that done, OK?

I can't do that in this ambulance for you today.

His cannula needs to be removed.

Definitely doesn't want to go back to Mary, then.

-That's fine, we'll go to George's.

-Do you drink alcohol, Wayne?

-Yes.

Have you had any alcohol today?

No?

General broadcast to all mobiles PDO2.

Currently holding an uncalled Category A call in Uxbridge.

Also holding Category A calls in Hayes, Heathrow, West Drayton

and another one in Hayes.

If we literally have nothing available at all, no cars,

no ambulances, no motorbikes, no volunteer responders,

we'll just put a general broadcast - anybody available, please,

to assist with an emergency call, and hope,

sometimes pray, that somebody offers up.

General broadcast to all mobiles, general broadcast to all mobiles,

currently holding a Category A call.

What's this you're drinking?

-Coca-Cola.

-That's not Coca-Cola. That's something else.

You've diluted that with something. What's in there?

You can't be having a party on the ambulance, drinking...

-I'm not, it's orange juice in there.

-OK.

-If I was...

-Right, are you ready to go?

-We're going to head off to the hospital.

-Yeah.

Just because he's pleasant and nice with being drunk and whatever,

there is a fine line between that and actually taking away from

the jobs we should be going to.

He needs to get his cannula removed, that needs to be done in hospital,

really, but it doesn't need an emergency ambulance.

And while we're on the scene there,

there were two general broadcasts over the radio.

So you do then think sometimes,

as nice as it is to sit with him chatting, actually,

there are sick people out there that need us more than him.

Right, step this way.

That's it.

-Well done.

-That's it.

That's it, this way.

I think the government's out of order at the moment.

They've cut back on the ambulance crew.

And they've cut back...

..on the police force.

Now, don't get me wrong,

I'm not a big lover of the police force, but...

..they are a necessary evil.

And we need them.

We need... We do need them.

This chap here is going to assess you and then he'll sort out

taking this out for you and getting something to eat for you, OK?

I want something to eat now.

I'm going to go and look now to find out what they've got, OK?

Do you have any sandwiches for patients?

-There's not been anything since 8.30.

-No?

-Bread and jam.

-Yeah?

They have no sandwiches, but they've got bread and jam.

Would that be OK? No? You don't like bread and jam?

He doesn't want bread and jam, but he's quite content now.

I think he's sleeping.

He could have been delivered here by other means, maybe,

but he needs the cannula removed and it's a place of safety for him,

so we've done the best we can.

He's here, and if he's hungry and they can offer him some food,

then what's a sandwich?

It's nice, isn't it?

It's just nice to be able to help, do something, at least.

I can't offer him somewhere to live or change his life,

but a sandwich is a sandwich, so...

That guy is taking the piss well and truly.

He has refused to let them take out his cannula because he knows,

he's not an idiot, that he'll get found,

he'll have to get to hospital to get his cannula taken out.

So we've now taken him to St George's

at a cost of £450, thereabouts, to the taxpayer.

So that's a very expensive sandwich, isn't it?

-He didn't get a sandwich.

-Well, whatever.

But I don't necessarily...

Yeah, I'm not saying it's right, I'm just saying I understand.

-So why do you feel sorry for him, then?

-Because I do.

He's homeless, he's hungry and he feels that's his only way

to get himself something to eat.

I'm going to go and take the crutch back.

I'll tell you want. When you go take that crutch back,

why don't you go and give him a big hug and a pat on the back

and tell him well done and give him the receipt,

or actually an invoice for the costs to us when we could have gone

to that 19-year-old having a fit or the 20-year-old unconscious.

-You're not upset with me, are you?

-No, of course not.

I still disagree with you

and I think you shouldn't feel sorry for him.

You should feel sorry for the people that we've let down,

that we haven't been able to get to

because we've been tied up with Mr I Want A Sandwich.

-Erm, Dan...

-Do you feel sorry for them?

I didn't say that what he did was right

or that he should be treated over anybody else.

I just said I understand...

And you feel sorry for him.

-I feel sorry for his circumstance.

-OK.

Circumstances are unpleasant, aren't they? But, you know.

Could be worse.

-It could be a whole lot worse, yes.

-What is a whole lot worse? Tell me.

-Working with you for a night shift.

-That's not funny.

SHE LAUGHS

It's Sunday night, the final shift of the weekend.

Is that that toaster one? Oh, leave off!

Man, how do you even get your finger trapped in a toaster?

She must have giant hands.

# Do you know why you've got feelings in your heart? #

It's like a game of roulette.

You know there will be all these jobs waiting for you

and it's just luck of the draw to which one you're going to get.

After a run of mundane jobs, it's nice when you push that button

and you get someone that does seriously need an ambulance.

# Do you know that

# Tonight the streets are ours?

# Tonight the streets are ours

# These lights in our street are ours... #

I'm trying to assist you. Do you need assistance?

-Do you need assistance? Do you need assistance?

-No!

Right, come out of the way.

Dan and Donna have been sent to treat a taxi driver

who has been involved in a fracas.

-The quick story is, guys, that...

-Was he knocked out, was he?

No, no, no, what's happened is, he's assaulted the taxi driver.

Can we leave it with you?

I have requested police, because he was getting a bit...

-Sure, sure.

-Yeah.

I think that might just need some glue on there,

or maybe a stitch, all right?

-I'd rather have glue.

-Sorry?

-I'd rather have the glue.

Terry would rather drive himself up to hospital, which I said is fine.

-Are you sure?

-Yeah, yeah.

-OK, Terry.

-His numbers are getting better.

-OK.

Because he's got all his stuff in his cab,

-he doesn't really want to...

-Leave it, OK.

-Yeah.

Oh!

-That was a bit chaotic, wasn't it?

-I know.

But that is what I love about this job.

When you get on the scene, it's just all chaos has broken loose,

-isn't it? You never know what you're going to be faced with.

-No.

And that's exactly that, and I love it. Absolutely love it.

OK, no, OK, I know you've fought with the Germans, OK?

I'm not disputing that.

OK, no, OK, I don't think some of these people are Germans, sir, OK?

So... What I'm asking you, sir,

is what is exactly wrong that you need an ambulance?

In the control centre,

a call is in progress from an elderly patient who lives alone.

No, no, sir, you can't wait until they come

because you haven't told me...

LINE BEEPS, HE GROANS

He's already been visited once by an ambulance tonight.

The crew decided that he didn't need a trip to hospital.

Hello, sir. This is the London Ambulance Service.

You can't just hang the phone up, OK?

OK, you're saying you need some help,

so I need to know what is wrong with you to send you the help.

OK, your heart is hurting. Thank you very much.

OK, could I confirm your address once more?

BEEPING

He just hung up again.

Why does he keep hanging up?

Because the man claims he's experiencing heart pain,

an ambulance is dispatched.

Dan and Donna leave the scene of the taxi driver assault

in central London to attend.

OK, so the help is on its way to you now, sir, all right?

OK, thank you very much.

You're not going to die, all right?

You just need to take your tablets in the morning,

in three hours' time.

Why do you call ambulances?

Cos you call us a lot, don't you?

I call a lot because I have pain. I've got pain in my heart.

OK.

You were here about half an hour ago.

We weren't here half an hour ago.

You had a different crew here before, didn't you?

Another ambulance crew, yeah.

At seven o'clock this evening they were here to see you, weren't they?

You were in hospital yesterday.

-Was it an ambulance that took you there?

-Yeah.

-Yeah.

OK, I've got to pop these on across your chest, OK?

Just looking through this gentleman's patient care planner

we've got here.

He is a frequent caller to us with chest pain,

non-traumatic chest pain

and medication queries or catheter problems.

He used to be an artist, so that's a self-portrait of him, yeah.

The patient is visited by a carer three times a day.

Can I just have a listen to your chest? Is that OK?

Have you had a cough recently at all?

-Yeah.

-You have.

Just one more thing I want to do, if that's OK - just say "99".

-Say "99".

-99.

Just clear your throat. Just go "hem-hem", like that.

-Yeah.

-Say "99".

-99.

-OK.

We've checked you over, and from what you've told me

and the way you've described things, OK,

I'm not worried that it's your heart.

It is my heart.

It is my problem, my heart.

-You are leaving me alone.

-Hmm.

-I can die and...

We can't sit here with you all night, can we?

You see enough of us, you shouldn't worry too much.

-I want you to take me to hospital.

-Why did you want to go to hospital?

To be sure that I'm... I will be all right when I...

-But I'm telling you it's not your heart.

-It is my heart.

I think we'll have to agree to disagree on that one, won't we?

If there was anything wrong,

we wouldn't be discharging you here, we'd be taking you to hospital.

Everything's fine. Try not to worry, all right?

If we go, are you going to call another ambulance?

-You are leaving me here?

-Hmm.

-Yeah.

-I don't know what to do.

'His situation is sad.'

Bye-bye.

He's got no friends, he's got no family, he lives on his own.

There should be another system in place that he can call

for when he gets anxious.

What system's that?

There isn't. That's the problem.

London is very demanding. It's a demanding place to work.

11 o'clock on a Sunday night,

you're not getting hold of social services,

you're not getting hold of the ongoing care teams.

These people that have got ongoing medical problems

can't contact their social workers, they can't contact Meals On Wheels,

they can't get hold of district nurses, and that's where...

that's where we, the NHS, is failing.

When I started 15 years ago,

I thought I was coming here to make a difference, to save lives

and, you know, deliver babies and do CPR over the telephone.

The reality, unfortunately, sometimes is starkly different.

But then every so often, something will come in.

A call will come in and you'll end up thinking to yourself,

"Yes, this is it.

"This is what we came here to do. This is why I do what I do."

-WOMAN ON PHONE:

-Tell me exactly what's happened.

She's bleeding?

And how many weeks or months pregnant is she?

21 weeks?

Received, premature, 21 weeks and crowning.

Thanks, I'll get there as soon as I can, thank you.

A crew is already attending what could be a premature birth

and they've requested extra support from advanced paramedic Rich.

550, good evening. This is the APP desk here.

Just to let you know, AP61 is ten minutes away.

Initially with this, I just need to be really calm.

Mum will pick up on any anxieties or any worries that I have.

Obviously I am going to be concerned about her,

I'm concerned about the baby as well,

but mum has to be confident that we can help her,

that she's safe with us.

Overall, it'll just be very calm.

First response paramedic Kelly has been treating the patient

before Rich arrives.

This is her fourth pregnancy.

When I got to her, she was in quite a lot of discomfort.

I had her on Entonox.

-Then, all of a sudden, waters broke.

-Right, OK.

-As well as blood, and I could see baby's head.

-Right, OK.

But since the waters have broken, she's in no pain.

Yeah, I think let's just go now and then we'll do everything else...

What's the ETA to Queen's?

About 10 to 12 minutes.

All right, a little scratch.

Can you just let him know I'm going to cannulate?

Just ask him to slow down a little bit and warn me if there's a corner.

We're going to cannulate, mate. Just slow down a bit.

It's fine, just done it.

Thank you. So there is a little bit of bleeding.

Not sure yet what's going on.

It might be an early labour, it might be something else.

What we can't do in the back in here is monitor the baby,

cos we don't have the equipment,

so I want to get you up to the hospital as quickly as possible.

The maternity unit have been pre-alerted,

so they know we're coming in.

A potentially difficult case for them, so we've made them aware.

From the arrival of my colleague, a large amount of amniotic fluid

or water, PV bleeding and what looked like crowning.

All right?

-Good luck.

-All the best, OK? All the best.

The mother's condition stabilises over the next hour,

but doctors find major complications with a tumour in the placenta.

Her baby cannot be saved.

Pete...

-It's not a good outcome.

-No.

-So baby's... Baby's died.

No-one turns up for their day at work

wanting the outcome to be the worst outcome for the patient.

You're always fighting for the best outcome.

When it doesn't happen, despite your best efforts, that...

It's deflating.

It does happen, it's part of the job and it takes a little bit of time

to process that and then to move on with the rest of the shift.

We've all got to go back to work, despite what happens.

The APP said they're OK, but...

people say they're OK when they're not.

As I left her, her parting words to me were, "Thank you.

"I hope my baby lives."

And then to be told by the nurses that it hasn't...

What I'm going through pales in comparison

to what they're going through.

I can't even imagine what they're going through.

But...you kind of brush yourself off and come in again the next day

or go on to your next job

because there's somebody else that you can help.

That help... That helps spur you on,

but sometimes it's just not easy.

It's not easy.

I'm going to pop out,

cos my twins were 21 weeks, and it's actually hit me a little bit.

My wife and I lost twins at 21 weeks last year,

our son and our daughter, Lily and Max.

Yeah, it's upsetting.

'You don't let a lot get to you doing this job, cos you can't,

'but there will be maybe one a week that does stick with you

'and that you do think about.

'Sometimes it makes you realise why you do the job,

'but then other times it just makes you want to go home and give

'your loved ones a cuddle and just sort of remind yourselves

'that there's things away from the job.

'More important things.'

A salt beef bagel from Brick Lane.

Just what's needed at five o'clock in the morning.

It's amazing.

# Steel yourself

# May your wheels run true

# I just want... #

It should be a nice day, I think.

-A nice day. In bed.

-What size of bed...?

Have you got a double bed

or have you got a super king-sized bed like me?

Why do you keep going on about this king-sized bed?

-Do you like quite a firm bed?

-Yeah.

-Do you? Really?

-Why wouldn't I like that?

Uh, that's weird.

-You're weird.

-It's not weird, man.

# Don't let the grass grow

# Don't let the wheels... #

No, I think I'll get home, I'll get into bed and I'll sleep,

then I'll get up and do it all again tonight.

What, are you going to do more?

-Yeah.

-That's why you're doing so much overtime, is it?

Yeah, I sleep, breathe it.

You need to get a life.

I think being a paramedic is an important job,

but it's a job that's changing.

It's no longer just going out to genuine emergencies any more,

you know?

You are almost a social worker, a mental health practitioner,

a district nurse, a GP, a policeman.

Yeah, honestly, at what point do we stop? At what point do we say,

"No, we can't do any more. That's out of our scope of practice"?

# I told myself

# No good feeling blue... #

This old girl came on the phone one night.

She said, "I just want to say thank you to you for coming round

"earlier and picking me up off the floor. You really done me a treat."

I was gobsmacked. All it takes is one person saying thank you.

Making a difference to that one person will set you up

for a night full of nonsense.

# The way I'm feeling too

# Don't let the grass grow

# Don't let the wheels make you slow

# Your hat is on

# You're on your way now

# Don't let the grass grow

# Just let the wheels bring you home

# Your hat is on... #