0:00:03 > 0:00:08This programme contains scenes which some viewers may find upsetting
0:00:08 > 0:00:11'Emergency ambulance...'
0:00:11 > 0:00:14The moment an emergency call is made.
0:00:14 > 0:00:17A battle against time begins.
0:00:17 > 0:00:19- 'Is she awake?- No, she looks dead.'
0:00:19 > 0:00:22MOANING
0:00:22 > 0:00:25The decisions that are made in the first 60 minutes
0:00:25 > 0:00:28of major trauma patients will make the difference between life and death.
0:00:28 > 0:00:33If we can intervene within the first 60 minutes or so, the so-called golden hour,
0:00:33 > 0:00:37then we know we can positively affect your outcome.
0:00:37 > 0:00:39The sooner a doctor can reach their patient,
0:00:39 > 0:00:42the more likely they are to survive.
0:00:42 > 0:00:43We now have the ability to reverse
0:00:43 > 0:00:46the initial effects of the injury if we are given the chance
0:00:46 > 0:00:49and we are able to act quickly enough.
0:00:50 > 0:00:54In their race against the clock, doctors and paramedics are now
0:00:54 > 0:00:57taking the hospital to those at the very edge of life.
0:00:57 > 0:00:59We're getting close...
0:00:59 > 0:01:01SIRENS BLARE
0:01:01 > 0:01:02MOANING
0:01:02 > 0:01:05The more equipment and expertise and knowledge we can get
0:01:05 > 0:01:08out on to the street or the scene of the accident,
0:01:08 > 0:01:10then we will save more people's lives.
0:01:10 > 0:01:12Armed with new treatments and equipment...
0:01:12 > 0:01:14I'll get the auto pulse going.
0:01:14 > 0:01:18..They're performing surgery on the roadside.
0:01:18 > 0:01:20I could do the operation
0:01:20 > 0:01:22in the back of the ambulance if necessary.
0:01:22 > 0:01:24Administering powerful drugs.
0:01:24 > 0:01:26Draw us up two ampoules of tranexamic acid.
0:01:26 > 0:01:29Using innovative techniques...
0:01:29 > 0:01:32If you pull that one and I'll pull this one.
0:01:32 > 0:01:34And pushing the boundaries of science...
0:01:34 > 0:01:38Let's get cold fluids going and oxygenation.
0:01:38 > 0:01:40..To save time, and to save lives.
0:01:40 > 0:01:41We've got to go.
0:01:41 > 0:01:46This series will count down second by second, minute by minute,
0:01:46 > 0:01:51the crucial decisions made in the first 60 minutes of emergency care.
0:01:51 > 0:01:54One hour - the difference between life and death.
0:02:12 > 0:02:1562 million people live in Britain.
0:02:18 > 0:02:21Whether at home or at work,
0:02:21 > 0:02:25in the city or in the countryside,
0:02:25 > 0:02:31today over 900 of us will face a life-threatening emergency.
0:02:31 > 0:02:37This film will follow three patients through 60 minutes of care
0:02:37 > 0:02:40that will push the limits of scientific innovation.
0:02:43 > 0:02:47In central London 29-year-old Zoe collapses on Oxford Street.
0:02:47 > 0:02:50- 'Is she awake?- No. She looks dead.'
0:02:51 > 0:02:55A farming accident in rural Lincolnshire
0:02:55 > 0:02:59leaves 66-year-old Bill with life-threatening injuries.
0:02:59 > 0:03:03He's been crushed by a 650kg cow.
0:03:05 > 0:03:10And in north London, 30-year-old Rumen is hit by a car.
0:03:11 > 0:03:15From the moment each one of these emergency calls is made,
0:03:15 > 0:03:17the clock starts ticking.
0:03:24 > 0:03:27'Emergency ambulance, what's the address of the emergency?
0:03:27 > 0:03:28'It's a car accident.'
0:03:38 > 0:03:40In London, Ambulance Control
0:03:40 > 0:03:44receives a call about a serious road accident.
0:03:44 > 0:03:47A specialist paramedic scans the thousands of calls
0:03:47 > 0:03:51that come in each day looking for the most critical emergencies.
0:03:51 > 0:03:55If we're quick enough to listen to a call then we can dispatch
0:03:55 > 0:03:56the team in less than a minute.
0:03:56 > 0:03:59Mr Jeffers, we have a job for you,
0:03:59 > 0:04:05you're going to White Hart Lane, N22.
0:04:05 > 0:04:11A 31-year-old male - car versus pedestrian.
0:04:14 > 0:04:17Paramedic Steve tasks London's Air Ambulance.
0:04:17 > 0:04:22This elite medical service can get to any patient inside the M25 within 12 minutes.
0:04:25 > 0:04:28Our helicopter service is a dedicated trauma service.
0:04:28 > 0:04:32We only get sent to the most serious and severely injured patients.
0:04:35 > 0:04:37The co-pilot comes up, hands me piece of paper.
0:04:37 > 0:04:40It said pedestrian versus car.
0:04:40 > 0:04:44As soon as I hear that I immediately start thinking,
0:04:44 > 0:04:46what could the potential problems be?
0:05:11 > 0:05:14You're going to get hit by something that's pretty hard
0:05:14 > 0:05:19at speed potentially, you know, you will have some injuries.
0:05:19 > 0:05:23And my mind started going through what I could expect when I arrive.
0:05:29 > 0:05:34Police and a London Ambulance crew are already at the scene.
0:05:34 > 0:05:36Sorry, guys, give us space.
0:05:36 > 0:05:38Move back.
0:05:38 > 0:05:41OK, he looks pretty sick.
0:05:41 > 0:05:43You guys all right?
0:05:47 > 0:05:49Hi, I'm MJ and this is Graham.
0:05:49 > 0:05:50Rumen.
0:05:50 > 0:05:52This is Rumen. Hi, Rumen.
0:05:52 > 0:05:55HE GROANS
0:05:55 > 0:05:56Within seconds of arriving,
0:05:56 > 0:05:59MJ needs to assess Rumen for life-threatening injuries.
0:05:59 > 0:06:03Just going to have to do a quick primary survey.
0:06:03 > 0:06:04He's 30 years old.
0:06:04 > 0:06:07He's been bull's-eyed by that car over there.
0:06:07 > 0:06:09Just going to have a quick look at you, sir.
0:06:09 > 0:06:11Is it Rumen? Is that sore?
0:06:11 > 0:06:14- HE GROANS - OK.
0:06:14 > 0:06:18Rumen had lots of injuries to his face, and he was lying awkwardly,
0:06:18 > 0:06:21halfway on the road and halfway on the pavement.
0:06:21 > 0:06:25So all of these things are clues that already gets my mind going.
0:06:25 > 0:06:28Sorry, Rumen, say again?
0:06:28 > 0:06:29Your backside?
0:06:29 > 0:06:31Is your tummy sore,
0:06:31 > 0:06:35is that sore when I press?
0:06:35 > 0:06:38Is that painful?
0:06:42 > 0:06:46Yes, can you squeeze my hand, Rumen? Squeeze my hand.
0:06:46 > 0:06:49I'm going to have a quick look at your face.
0:06:53 > 0:06:56..And then bilateral ankles.
0:06:56 > 0:06:59It's mostly likely that Rumen's legs took the initial impact,
0:06:59 > 0:07:04right direct force that really broke the two legs.
0:07:04 > 0:07:08Then the next impact was on the bonnet where I think
0:07:08 > 0:07:10probably his ribs started hitting that,
0:07:10 > 0:07:15and then the windscreen, which was mostly his arms, possibly his head.
0:07:15 > 0:07:18I could see just by getting close to him that he had lots
0:07:18 > 0:07:21and lots of cuts on his arms and... and on his face.
0:07:21 > 0:07:23It was quite evident.
0:07:23 > 0:07:26And then also just being flung over the top of the car
0:07:26 > 0:07:29made me concerned about spinal injuries
0:07:29 > 0:07:33and further injuries to his ribs, rib cage and his abdomen.
0:07:35 > 0:07:39- Can you feel the doctor touching your foot?- OK, good.
0:07:39 > 0:07:42OK guys, what we have is someone with a minor head injury,
0:07:42 > 0:07:47possible fractured ribs, possible pelvis, possible abdomen,
0:07:47 > 0:07:50definite bilateral tib fib fractures.
0:07:50 > 0:07:51HE GROANS
0:07:51 > 0:07:53OK, Rumen. Good man.
0:07:54 > 0:07:57I was concerned that there was possible bleeding,
0:07:57 > 0:08:00possibly in his abdomen, possible in the pelvis
0:08:00 > 0:08:03so in my mind there's a good chance that he might deteriorate.
0:08:03 > 0:08:05Can you feel me touching?
0:08:05 > 0:08:11MJ must decide which of Rumen's injuries to treat first.
0:08:11 > 0:08:13The fact that Rumen can't feel his feet
0:08:13 > 0:08:16could show a potential spinal fracture,
0:08:16 > 0:08:22but it could also be lack of blood supply to his lower legs.
0:08:22 > 0:08:28If you leave it too long there's a risk that he could lose his legs.
0:08:29 > 0:08:31So we will to need to straighten these.
0:08:31 > 0:08:35It was clear that both his legs were badly, badly fractured.
0:08:36 > 0:08:40MJ is concerned about all of Rumen's injuries but decides
0:08:40 > 0:08:42to prioritise his legs.
0:08:42 > 0:08:45Just by putting it in the correct position
0:08:45 > 0:08:51you can improve the blood supply and prevent long term damage.
0:08:51 > 0:08:54We're going to have pull it slightly to get it back into line.
0:08:54 > 0:08:57The paramedic crew can administer painkillers
0:08:57 > 0:09:02like morphine and have already given Rumen 10 mg - but it's not enough.
0:09:02 > 0:09:05Any movement would cause absolute agony to him
0:09:05 > 0:09:11so he definitely needed good painkillers just to realign his feet.
0:09:14 > 0:09:17Because MJ is a doctor she can give pain relief such as ketamine,
0:09:17 > 0:09:19more powerful than morphine.
0:09:19 > 0:09:22Everything's fine. Sorry.
0:09:22 > 0:09:27I don't want to put someone in a helicopter
0:09:27 > 0:09:30if I'm not 100% sure they're stable
0:09:30 > 0:09:32and in the best possible condition.
0:09:34 > 0:09:36Is that his family over there?
0:09:36 > 0:09:38Are you family?
0:09:38 > 0:09:43- He's OK, is he your husband?- Yes.
0:09:43 > 0:09:47OK. He broke both his legs...
0:09:48 > 0:09:50We're going to do some medicine on him
0:09:50 > 0:09:55to make him nice and without pain. All right?
0:09:57 > 0:10:01Having straightened Rumen's legs, MJ turns her attention
0:10:01 > 0:10:04to his abdomen and the possibility of major internal bleeding.
0:10:04 > 0:10:08Just gently slide it in. Everyone ready?
0:10:08 > 0:10:10RUMEN CRIES OUT IN PAIN
0:10:13 > 0:10:14Rumen needs to get to hospital
0:10:14 > 0:10:17and we have to remember the clock is ticking.
0:10:27 > 0:10:28Eight minutes ago,
0:10:28 > 0:10:31another emergency call was made.
0:10:31 > 0:10:32On one of London's busiest streets
0:10:32 > 0:10:35a young woman called Zoe collapsed.
0:10:35 > 0:10:38'It's Oxford Street and we've got someone here having a fit.'
0:10:38 > 0:10:41Think she's had a heart attack, can you get here quick?
0:10:41 > 0:10:45- Is she awake?- No, she's unconscious. - Is she breathing?- No.
0:10:45 > 0:10:48I've got three units on the way to you now.
0:10:48 > 0:10:51Just stay out there and make sure there's someone there to flag them
0:10:51 > 0:10:54down when you see them, it might be one of our bicycle responders
0:10:54 > 0:10:56coming to you on a pedal bike.
0:10:56 > 0:10:59- Be really quick.- Yeah, they're not too far away.
0:10:59 > 0:11:02A cycle-mounted paramedic arrives on the scene.
0:11:02 > 0:11:05She was motionless,
0:11:05 > 0:11:10she was pale, her eyes were open,
0:11:10 > 0:11:16and she was receiving CPR
0:11:16 > 0:11:19with an absence of a pulse. I certainly yelled at people
0:11:19 > 0:11:23initially just to... Just to move on because, you know,
0:11:23 > 0:11:26this is a very undignified place to have a cardiac arrest.
0:11:26 > 0:11:28But is there any dignity in death?
0:11:35 > 0:11:38Roger, that's all copied.
0:11:40 > 0:11:42Across the city, the 999 call has also
0:11:42 > 0:11:47triggered London's only response car specialising in cardiac arrest.
0:11:47 > 0:11:51It delivers life-saving medical equipment, drugs and expertise.
0:11:54 > 0:11:57It is very rare, not just within the UK
0:11:57 > 0:12:02but around the world, to have a team that really is
0:12:02 > 0:12:04just focused on cardiac arrest.
0:12:04 > 0:12:08We should be...head on for Oxford Street.
0:12:11 > 0:12:14Basically, the heart has stopped functioning,
0:12:14 > 0:12:17for whatever reason, either it's not beating at all
0:12:17 > 0:12:19or it's trying to beat
0:12:19 > 0:12:23and can't eject the blood out of the ventricles.
0:12:23 > 0:12:26And of course, for the rest of the body that's a catastrophe
0:12:26 > 0:12:30because the rest of the body simply isn't getting the oxygen
0:12:30 > 0:12:33and glucose that it needs for life.
0:12:35 > 0:12:38Set of traffic lights at the bottom and straight across. OK?
0:12:40 > 0:12:43'Although we are going on blue lights and sirens - you know'
0:12:43 > 0:12:48for every minute or few seconds at a junction you're delayed
0:12:48 > 0:12:54there is literally brain tissue paying the price and a patient
0:12:54 > 0:12:58may either be severely disabled because of that or may not live.
0:12:58 > 0:13:04- We're estimating about two minutes now.- 'Roger that.'
0:13:04 > 0:13:06That's Oxford Street ahead of us.
0:13:06 > 0:13:11After battling through the traffic, Gareth arrives on scene.
0:13:11 > 0:13:15- Where's the patient?- Oh, just there.
0:13:24 > 0:13:28After CPR and an electric shock,
0:13:28 > 0:13:31paramedics have re-started Zoe's heart.
0:13:31 > 0:13:35But her pulse is weak and it could stop again at any moment.
0:13:36 > 0:13:38So just give me the history, she just collapsed?
0:13:38 > 0:13:40Probably had about ten minutes of CPR.
0:13:40 > 0:13:44- We checked the pulses after ten minutes.- OK.
0:13:44 > 0:13:45She had a pulse...
0:13:45 > 0:13:51They'd managed to restart the heart and there's some activity there.
0:13:51 > 0:13:58I was always worried that she would go into cardiac arrest again.
0:13:58 > 0:14:04Whatever precipitated it before we got there was an ever-present risk.
0:14:04 > 0:14:06She looks very young, doesn't she?
0:14:06 > 0:14:10I noticed that she had an engagement ring on and a wedding ring on
0:14:10 > 0:14:14and I think that's hard not to be at least a little bit
0:14:14 > 0:14:17emotional about that. You see that, you realise that someone's
0:14:17 > 0:14:19got a life, she's got a husband or recently married.
0:14:19 > 0:14:21- This is her blood pressure?- Yeah.
0:14:21 > 0:14:26When I saw she was so young, your mind goes into a bit of a spin,
0:14:26 > 0:14:28"What's actually caused this?"
0:14:28 > 0:14:32Most of the patients we go to in cardiac arrest
0:14:32 > 0:14:35are at least in middle ages or elderly.
0:14:41 > 0:14:44But Zoe is not responding in the way she should
0:14:44 > 0:14:46and is still in terrible danger.
0:14:46 > 0:14:49It'd be great if she'd just simply woken up
0:14:49 > 0:14:51the minute her heart started
0:14:51 > 0:14:55but we're in a different situation now, she wasn't waking up at all.
0:14:57 > 0:15:00Her pupils are big, aren't they?
0:15:02 > 0:15:07When I looked in her eyes her pupils were massively dilated
0:15:07 > 0:15:10and fixed, just like you see in dead people...
0:15:10 > 0:15:15It was obvious that she had sustained some brain damage.
0:15:15 > 0:15:19And that is the shock, that's what's worrying me at that point.
0:15:22 > 0:15:24Minutes after a cardiac arrest,
0:15:24 > 0:15:26brain cells begin to die from lack of oxygen.
0:15:26 > 0:15:31The sooner Gareth starts treating her the better.
0:15:31 > 0:15:36He must act now, or Zoe may suffer irreparable brain damage.
0:15:44 > 0:15:49Outside an urban centre like London, the challenges of
0:15:49 > 0:15:54delivering medical care in the first critical hour are even greater.
0:15:54 > 0:15:58150 miles away, a specialist trauma team are en route
0:15:58 > 0:16:00to a remote farm in Lincolnshire.
0:16:06 > 0:16:0833 minutes ago,
0:16:08 > 0:16:12a 999 call came in about an injured farmer fighting for his life.
0:16:13 > 0:16:17As the nearest major trauma centre is over an hour's drive away,
0:16:17 > 0:16:19the helicopter is his only hope.
0:16:24 > 0:16:26Hi, guys, it's Dr Topham...
0:16:26 > 0:16:28A local ambulance crew is already on scene
0:16:28 > 0:16:32but Bill now needs the interventions of a doctor.
0:16:32 > 0:16:37- Bill, 66-year-old male.- Yes.- Today Bill's been crushed against the
0:16:37 > 0:16:42- side of a wall by a cow.- Yeah.- He's not lost any consciousness at all.
0:16:42 > 0:16:44- OK.- He's made his way to here,
0:16:44 > 0:16:47he was crushed a bit further away, when we arrived
0:16:47 > 0:16:49he was conscious and breathing, we cannulated,
0:16:49 > 0:16:50he's got equal air entry.
0:16:50 > 0:16:53He's complaining of pain right-side abdomen,
0:16:53 > 0:16:57- and around the lower right of his chest.- OK.
0:16:57 > 0:16:59Hi, Bill, its Dr Topham here.
0:16:59 > 0:17:03I'm one of the doctors with the air ambulance, OK?
0:17:03 > 0:17:06Sounds like you're having an interesting day, doesn't it?
0:17:06 > 0:17:10I think there is, er, every chance that this could have proved
0:17:10 > 0:17:15a life-threatening injury, or at the very least, a life-changing injury.
0:17:15 > 0:17:19How you are feeling with your breathing just now?
0:17:19 > 0:17:21HE MUMBLES AND GROANS
0:17:21 > 0:17:25- There's no particular difficulty in breathing at the moment?- No.
0:17:25 > 0:17:28Bill's already had 10 mg of morphine
0:17:28 > 0:17:32but he's still in severe pain and Simon needs to work out why.
0:17:32 > 0:17:36Just going to feel around the tummy now, OK? Just let me know
0:17:36 > 0:17:38if it's too uncomfortable.
0:17:38 > 0:17:39GROANS
0:17:39 > 0:17:42Where's that? Where's it hurting...?
0:17:42 > 0:17:46How heavy was the cow - big one? Baby one?
0:17:48 > 0:17:49About 650 kg. Right.
0:17:49 > 0:17:51BILL GROANS
0:17:51 > 0:17:55This is a significant beast,
0:17:55 > 0:18:01650 kg - that's probably about seven or eight fairly standard humans
0:18:01 > 0:18:05squashing one person against a concrete wall.
0:18:05 > 0:18:08What does that feel like down there?
0:18:08 > 0:18:11But Bill's symptoms are causing Simon some confusion.
0:18:13 > 0:18:16Is it aorta, liver, spleen?
0:18:18 > 0:18:21My concern, given the mechanism of injury,
0:18:21 > 0:18:25was that he was going to have some internal organ damage
0:18:25 > 0:18:28in his abdomen. I expected to see that his blood pressure
0:18:28 > 0:18:31was dropping due to blood loss, and I expected to see that his...
0:18:31 > 0:18:34his heart rate was increasing as his heart tried
0:18:34 > 0:18:38to compensate for the, er, the loss of blood.
0:18:38 > 0:18:43But those things weren't there. But my gut feeling still was that
0:18:43 > 0:18:46there's something going on in the abdomen.
0:18:46 > 0:18:50Having had the morphine and this degree of pain,
0:18:50 > 0:18:54it didn't seem right to think there was nothing happening there.
0:18:54 > 0:18:57Simon doesn't know exactly how Bill was crushed by the cow,
0:18:57 > 0:18:59or which part of his body is injured.
0:18:59 > 0:19:01Where's that hurting you?
0:19:03 > 0:19:05What does that feel like down there?
0:19:05 > 0:19:07He could bleed to death.
0:19:07 > 0:19:11He might only have a small rupture to a liver or an internal organ
0:19:11 > 0:19:13but basically, you know, it might be a trickle,
0:19:13 > 0:19:15it could burst at any moment, you just don't know.
0:19:15 > 0:19:18You haven't got X-ray eyes.
0:19:18 > 0:19:22If Bill has internal bleeding they need to
0:19:22 > 0:19:25try and stem the blood loss before they put him on the helicopter.
0:19:27 > 0:19:29There was a degree of conflict at the scene,
0:19:29 > 0:19:33between a need to get him to the trauma centre and the need to
0:19:33 > 0:19:38ensure he wasn't going to deteriorate before he got there.
0:19:38 > 0:19:41GROANING
0:20:04 > 0:20:07..Just get him onto the scoop...
0:20:07 > 0:20:11In London, MJ and the paramedics have straightened
0:20:11 > 0:20:14Rumen's broken legs in the hope of restoring blood flow.
0:20:14 > 0:20:17She now has to think about getting him to hospital.
0:20:17 > 0:20:21But given the force of Rumen's impact with the car,
0:20:21 > 0:20:23she's worried about moving him.
0:20:23 > 0:20:26Everybody bleeds once they've been hit by something
0:20:26 > 0:20:29and the body starts forming clots to stop that bleeding.
0:20:29 > 0:20:33If I don't care for him in a careful way
0:20:33 > 0:20:36and I disturb his clots - we always say the first clot is
0:20:36 > 0:20:41the best clot - there's always a chance of him bleeding more.
0:20:41 > 0:20:44Three, four, five -
0:20:44 > 0:20:48just flush it for us.
0:20:49 > 0:20:51Squeeze that in, concentrate.
0:20:51 > 0:20:53Don't look anywhere else. Sorry, it's very important.
0:20:55 > 0:21:00Any sudden physical movement could dislodge Rumen's clots.
0:21:00 > 0:21:03MJ decides to give him a drug called Rocuronium.
0:21:03 > 0:21:06It will paralyse all the muscles in his body
0:21:06 > 0:21:08including those in his chest.
0:21:08 > 0:21:13The effect of a drug like Rocuronium is it stops the intercostal muscles
0:21:13 > 0:21:17working, stops diaphragm working, he will stop breathing.
0:21:19 > 0:21:2016.30.
0:21:20 > 0:21:22Over the next 60 seconds
0:21:22 > 0:21:26Rumen will become unable to breathe for himself.
0:21:26 > 0:21:28This makes the drugs kick in.
0:21:28 > 0:21:31It takes a bit of time to work - about 60 seconds.
0:21:31 > 0:21:34- Everything good, sats, pulse 99.- Excellent.
0:21:34 > 0:21:36You have to remember not to rush,
0:21:36 > 0:21:40I always tell paramedics it's medicine, not magic.
0:21:42 > 0:21:47That 60 seconds or 45 you have to wait can feel like an eternity
0:21:47 > 0:21:51when all you're thinking about is momentum, momentum, momentum.
0:21:56 > 0:21:58OK. See how his jaw feels.
0:22:00 > 0:22:01Feels good.
0:22:01 > 0:22:04MJ now only has seconds to act.
0:22:04 > 0:22:08Through a procedure called rapid sequence intubation
0:22:08 > 0:22:10she will insert a tube into Rumen's windpipe
0:22:10 > 0:22:12and start breathing for him.
0:22:12 > 0:22:17It's still quite a scary procedure to perform,
0:22:17 > 0:22:21especially by the roadside in someone who's bleeding, potentially
0:22:21 > 0:22:24has blood in their airway, who's got a high risk of vomiting.
0:22:24 > 0:22:28Yep... Put your hands over my hands, perfect.
0:22:28 > 0:22:33It is risky. Anything that can go wrong, has, at some point.
0:22:33 > 0:22:36Everybody concentrate here now.
0:22:36 > 0:22:39Anything as bad as death, brain damage,
0:22:39 > 0:22:42someone's blood pressure completely dropping.
0:22:42 > 0:22:46You've got your windpipe essentially running from your mouth,
0:22:46 > 0:22:51all the way to your lungs, right behind it is the food pipe,
0:22:51 > 0:22:54which goes from your mouth to your stomach.
0:22:54 > 0:22:57You don't want to put the breathing tube in that cos no air will go in
0:22:57 > 0:22:59to the lung.
0:23:06 > 0:23:08OK - tube's on.
0:23:08 > 0:23:12What we want to see is when we squeeze air into lung
0:23:12 > 0:23:20that the little monitor that we have turns from purple to yellow.
0:23:20 > 0:23:24That's an indication that carbon dioxide is coming out of the lungs
0:23:24 > 0:23:26and we are in the right place.
0:23:32 > 0:23:34- Yellow.- Perfect.
0:23:34 > 0:23:37OK, excellent job.
0:23:37 > 0:23:40Can I have one of the paramedics listening to chest?
0:23:40 > 0:23:41- Great job.- Air entry.
0:23:41 > 0:23:44Rumen is now intubated, paralysed and sedated.
0:23:44 > 0:23:48With suspected multiple internal injuries,
0:23:48 > 0:23:51MJ has done all she can for him at the roadside.
0:23:51 > 0:23:57Excellent job, guys. Next we put blocks on, tape, collar back on,
0:23:57 > 0:24:00and then trolley push to the aircraft.
0:24:10 > 0:24:14In the heart of London's West End,
0:24:14 > 0:24:1729-year-old Zoe is still unconscious.
0:24:17 > 0:24:21OK. Let's get cold fluids going and pre-oxygenate her as much as we can.
0:24:21 > 0:24:26Gareth is worried that Zoe's brain is suffering irreparable damage.
0:24:26 > 0:24:30I knew I needed to act and I needed to act fast by
0:24:30 > 0:24:35infusing some cold fluids to try and drop the brain temperature,
0:24:35 > 0:24:39which actually stops some of the really deleterious
0:24:39 > 0:24:41effects of oxygen starvation,
0:24:41 > 0:24:45which start to literally eat into the brain
0:24:45 > 0:24:48in the ensuing hours and days after a cardiac arrest,
0:24:48 > 0:24:53the cooling actually stops those processes and protects
0:24:53 > 0:24:58the brain from it literally sort of digesting itself from within.
0:24:58 > 0:25:00Evidence suggests,
0:25:00 > 0:25:04the sooner Zoe is cooled, the slower her brain cells will die
0:25:04 > 0:25:07and the less brain damage she will suffer.
0:25:07 > 0:25:09Gareth wants to bring her core body temperature down
0:25:09 > 0:25:13from a normal 37 degrees to 34 degrees,
0:25:13 > 0:25:16putting her into a state of hypothermia.
0:25:18 > 0:25:21Have we got the saturation on?
0:25:21 > 0:25:23So once that fluid gets into Zoe's body,
0:25:23 > 0:25:25eventually it gets to the brain,
0:25:25 > 0:25:28and it's the brain that's the most important bit.
0:25:28 > 0:25:32The cells of the brain start to lower their temperature,
0:25:32 > 0:25:37and as that temperature falls they need less oxygen,
0:25:37 > 0:25:39they need less glucose.
0:25:39 > 0:25:42Zoe's metabolism will slow down,
0:25:42 > 0:25:45reducing the speed at which her brain cells die.
0:25:45 > 0:25:49Pioneered in London, this pre-hospital cooling
0:25:49 > 0:25:52is only offered by a handful of services in Britain.
0:25:52 > 0:25:57Most patients in the world, most patients in the UK don't have
0:25:57 > 0:26:01that cooling process initiated in the pre-hospital phase.
0:26:01 > 0:26:04They have to wait until their heart is stable,
0:26:04 > 0:26:07they have to be transported to the hospital.
0:26:07 > 0:26:10So this is quite innovative to have that
0:26:10 > 0:26:17cooling process started as close to the cardiac arrest as Zoe's was.
0:26:19 > 0:26:22Every 1-degree drop in Zoe's temperature
0:26:22 > 0:26:25will slow the process of brain cells dying.
0:26:25 > 0:26:28But as her temperature drops, there's a risk that she will
0:26:28 > 0:26:30start to shiver.
0:26:30 > 0:26:32I knew I had to stop
0:26:32 > 0:26:38the patient's body from shivering because that muscle activity is
0:26:38 > 0:26:43what keeps the temperature up and we are trying to lower the temperature,
0:26:43 > 0:26:47so by giving her the drugs or the anaesthetic we stop her shivering
0:26:47 > 0:26:51and that means all our cold fluids will have a maximum effect.
0:26:53 > 0:26:56Whilst under anaesthetic, Zoe will be paralysed,
0:26:56 > 0:26:58blocking her shivering reflex.
0:26:59 > 0:27:02But this will also stop her breathing by herself.
0:27:02 > 0:27:07Gareth needs to insert a tube into her windpipe to breathe for her.
0:27:07 > 0:27:10It's a balance of risk,
0:27:10 > 0:27:13and I felt that doing this was far more in her interests,
0:27:13 > 0:27:16compared to the risks of her brain damage.
0:27:17 > 0:27:20If we can't pass that tube through her mouth
0:27:20 > 0:27:25and into her lungs that could ultimately be fatal for her.
0:27:25 > 0:27:28If you could just get ready with suction...
0:27:28 > 0:27:31OK, tube please.
0:27:31 > 0:27:34Right. Two seconds, mate.
0:27:34 > 0:27:36It's stuck there.
0:27:36 > 0:27:37Right.
0:27:59 > 0:28:02GROANING
0:28:02 > 0:28:04Bill?
0:28:04 > 0:28:07Bill? Bill?
0:28:10 > 0:28:11Bill. Hello.
0:28:11 > 0:28:15You were away there for a minute.
0:28:15 > 0:28:17In Lincolnshire, Simon is concerned
0:28:17 > 0:28:22that Bill could be harbouring life-threatening injuries.
0:28:22 > 0:28:26I'm just a bit worried you've crushed one of your internal organs
0:28:26 > 0:28:30and may be bleeding a bit, so I'll try and give you some medication
0:28:30 > 0:28:32that will try and protect that.
0:28:32 > 0:28:35Bill could bleed to death before he gets to hospital,
0:28:35 > 0:28:38so Simon decides to give him a clotting drug.
0:28:38 > 0:28:43Draw us up to 2 ampoules of tranexamic in a 20ml syringe.
0:28:43 > 0:28:47We did give him a drug called TXA or tranexamic acid.
0:28:47 > 0:28:53It was used for heavy menstrual bleeding initially, and childbirth.
0:28:53 > 0:28:56It's a drug that binds the clots together.
0:28:56 > 0:28:58OK, Bill, this is the painkiller going in now,
0:28:58 > 0:29:00you might feel a bit strange.
0:29:02 > 0:29:06So when someone stops bleeding from a clot, the tranexamic acid
0:29:06 > 0:29:10actually stops that clot breaking down, so hopefully reducing bleeding
0:29:10 > 0:29:13and making the patient stabilise prior to getting to A&E.
0:29:13 > 0:29:1539.
0:29:15 > 0:29:17Since 2013,
0:29:17 > 0:29:21this drug is being introduced to all Britain's roadside trauma teams.
0:29:23 > 0:29:27Simon now hopes it will buy him enough time to get Bill to hospital.
0:29:27 > 0:29:31Going to have a little feel around here.
0:29:31 > 0:29:34Can you give me a score for your pain out of ten?
0:29:34 > 0:29:38If ten's the worst you've ever known.
0:29:38 > 0:29:39- 9 or 10.- 9 or 10, OK.
0:29:39 > 0:29:42I think we're going to have to give you something
0:29:42 > 0:29:45a bit stronger for the pain to try and help with that.
0:29:45 > 0:29:49When I arrived he'd already had 10mg of morphine,
0:29:49 > 0:29:51which for most people of his age
0:29:51 > 0:29:57and size should give very good pain control, yet he was still in pain.
0:29:57 > 0:30:01BILL GROANS
0:30:01 > 0:30:03OK, 15 minutes and still 9 out 10.
0:30:03 > 0:30:06No, we're going to give him some ketamine.
0:30:06 > 0:30:09Bill's pain levels are still worryingly high
0:30:09 > 0:30:12and might cause him to struggle when they try to move him.
0:30:12 > 0:30:15GROANING
0:30:16 > 0:30:20Pre-hospital trauma teams now have access to ketamine,
0:30:20 > 0:30:24a drug that until a few years ago, outside London,
0:30:24 > 0:30:27was only given on arrival at hospital.
0:30:27 > 0:30:31- Check that for me - 4 ml.- Yes.
0:30:31 > 0:30:34It's a horse tranquiliser.
0:30:34 > 0:30:38It's a very strong drug. It's been used by vets for many years.
0:30:38 > 0:30:42It's quite strong stuff but his pain scale's 9 or 10. He's had morphine
0:30:42 > 0:30:44but it's not subsiding, so he may...
0:30:44 > 0:30:47Simon hopes the ketamine
0:30:47 > 0:30:51will sedate Bill enough to keep him still on the journey to hospital,
0:30:51 > 0:30:55reducing the risk that he will disturb vital clots inside his body.
0:30:55 > 0:30:59I'll start with 10 milligrams...
0:30:59 > 0:31:02Just keep giving a little bit more at a time.
0:31:02 > 0:31:05We'll give you 10 ml. Start you now.
0:31:10 > 0:31:14The medicine we're going to give can you feel strange,
0:31:14 > 0:31:15it can make you see things...
0:31:15 > 0:31:19OK. Bill, can you hear me?
0:31:21 > 0:31:24Bill, what is it that's bothering you?
0:31:24 > 0:31:26BILL CONTINUES TO GROAN
0:31:31 > 0:31:35I don't know whether that's the emergence of the ketamine
0:31:35 > 0:31:37or he's actually in pain.
0:31:37 > 0:31:41It's really a great drug for what we need it to do,
0:31:41 > 0:31:44but it dissociates the patient from their environment
0:31:44 > 0:31:49and frequently you see people having hallucinations.
0:31:49 > 0:31:52They can also still appear to be in pain -
0:31:52 > 0:31:57probably because of that dissociation.
0:31:57 > 0:32:00Give more TXA and then get him on the...
0:32:00 > 0:32:04It's whether he's going to be adequately analgaesed for shifting,
0:32:04 > 0:32:05but we need to get him moved.
0:32:07 > 0:32:09Simon can't tell whether Bill's reaction
0:32:09 > 0:32:13is just the effect of the ketamine or due to organ damage.
0:32:13 > 0:32:17He decides to take one last precaution.
0:32:17 > 0:32:20Try not to move your head, Bill...
0:32:20 > 0:32:23GROANING
0:32:23 > 0:32:24What we're going to do
0:32:24 > 0:32:28is we're also going to put a splint round your pelvis -
0:32:28 > 0:32:32it's like a wide band to support your pelvis
0:32:32 > 0:32:35in case there's any bleeding around there.
0:32:43 > 0:32:47All right, Bill, you'll feel this get tight round your pelvis.
0:32:47 > 0:32:51'The whole point of putting on a pelvic binder is to
0:32:51 > 0:32:54'stabilise the pelvis if there is a fracture within it,'
0:32:54 > 0:32:59and by stabilising it reduce blood loss further. But also so that
0:32:59 > 0:33:02we know he's going to be physically stable through the journey.
0:33:02 > 0:33:059.45.
0:33:05 > 0:33:09Out here, there's nothing more Simon can do. Only a CT scan
0:33:09 > 0:33:12will reveal the full extent of Bill's injuries.
0:33:29 > 0:33:34Back in north London, MJ has fully anaesthetized Rumen.
0:33:34 > 0:33:36Only now does she decide he's stable enough
0:33:36 > 0:33:39to be transferred to a major trauma centre.
0:33:39 > 0:33:41PHONE RINGS
0:33:41 > 0:33:43When you stand in Resus, there is a moment
0:33:43 > 0:33:47when that phone rings - it makes a very distinctive noise.
0:33:47 > 0:33:52PHONE RINGS
0:33:52 > 0:33:55- Hello.- Hello. We are bringing in an adult male patient.
0:33:55 > 0:33:57Pedestrian versus car.
0:33:57 > 0:34:01It just goes a bit quieter for a few seconds
0:34:01 > 0:34:05and people tend to look to the phone and person writing down notes.
0:34:05 > 0:34:10He has been RSI'ed, he's potential poly trauma,
0:34:10 > 0:34:13and our ETA with you guys is about 15 minutes.
0:34:15 > 0:34:17Good to go.
0:34:18 > 0:34:23It was obvious from MJ's call that Rumen was badly injured
0:34:23 > 0:34:25and this could still get worse.
0:34:35 > 0:34:38On Oxford Street, Gareth is taking over Zoe's breathing.
0:34:38 > 0:34:41That's good, so yes, for yellow.
0:34:41 > 0:34:43In the trachea, that's fine.
0:34:43 > 0:34:46- Happy. Feels good your side?- Yep.
0:34:46 > 0:34:50OK, let's just... Two seconds, slowly, slowly.
0:34:50 > 0:34:52Well done. Are you OK to do that tie?
0:34:52 > 0:34:55- Yeah.- You're a star.
0:34:56 > 0:34:59OK, that's great, so we can control her ventilation.
0:34:59 > 0:35:03It's in normal parameters now. She's well and truly oxygenated.
0:35:18 > 0:35:20MACHINE IS SWITCHED OFF Let's do it again.
0:35:24 > 0:35:28- OK, that's good air into both sides. - You can slow that down a bit.- Right.
0:35:28 > 0:35:30Paralysed and unable to shiver,
0:35:30 > 0:35:33Zoe's body temperature finally drops.
0:35:35 > 0:35:40Bless here. Right, OK, we've got her controlled.
0:35:40 > 0:35:43Her brain is protected and she's getting enough oxygen.
0:35:43 > 0:35:47After 51 minutes of roadside treatment, Gareth decides Zoe
0:35:47 > 0:35:49is stable enough to travel to hospital.
0:35:49 > 0:35:54- How long do you reckon it will take us from here?- About six.- Brilliant.
0:35:55 > 0:35:56Brilliant. Six minutes.
0:35:58 > 0:36:01It's a lady approximately 20-30 years of age,
0:36:01 > 0:36:04who has had a sudden collapse on Oxford Street.
0:36:06 > 0:36:13- The bottom line is she looks pretty pink.- She does, doesn't she?
0:36:14 > 0:36:17'I felt that the next pressure was really to
0:36:17 > 0:36:21'take Zoe to the most appropriate hospital.'
0:36:21 > 0:36:24Zoe is en route to St Mary's Hospital where she will be kept
0:36:24 > 0:36:29in an induced coma to try and let her body and brain recuperate.
0:36:29 > 0:36:34Only time will tell what kind of recovery, if any, she will make.
0:36:35 > 0:36:39I can't do any more. This is all medicine can do now for Zoe.
0:36:40 > 0:36:42Mother Nature needs to do the rest.
0:36:45 > 0:36:47SIREN WAILS
0:36:50 > 0:36:52INAUDIBLE
0:36:52 > 0:36:54PERSON GROANS
0:36:57 > 0:37:00- One, two, three, lift. - MAN GROANS
0:37:00 > 0:37:03- All right, sweetheart. - MAN GROANS
0:37:07 > 0:37:09MAN CONTINUES GROANING
0:37:09 > 0:37:11We're on our way with a patient if the aircraft's
0:37:11 > 0:37:14prepared for us, buddy. Be with you within a couple of minutes.
0:37:19 > 0:37:20Straight in, mate. Ta. Yeah.
0:37:20 > 0:37:23MAN CRIES OUT IN PAIN
0:37:23 > 0:37:26One, two, three, lift.
0:37:26 > 0:37:27TELEPHONE RINGS
0:37:35 > 0:37:36He's a 65-year-old gentleman
0:37:36 > 0:37:38who's been crushed by 650kg cow,
0:37:38 > 0:37:41between cow and a concrete wall.
0:37:41 > 0:37:44He's sustained blunt abdominal trauma.
0:37:44 > 0:37:48- Can you ring us when you've landed? Is that all right?- OK, thank you.
0:37:48 > 0:37:49See you shortly. Bye.
0:37:49 > 0:37:51OK, cheers. Bye-bye.
0:37:54 > 0:37:55Crushed by a cow!
0:38:00 > 0:38:02SIREN WAILS
0:38:06 > 0:38:09For the last 60 minutes, doctors and paramedics have fought to keep
0:38:09 > 0:38:11three critically injured patients alive.
0:38:11 > 0:38:13'Airborne with the patient.'
0:38:15 > 0:38:18For Zoe, Rumen and Bill, the decisions made in
0:38:18 > 0:38:22this first hour of care have given them a greater chance of survival.
0:38:24 > 0:38:26But the fight is not over.
0:38:29 > 0:38:32Now new hospital teams will race against the clock to uncover
0:38:32 > 0:38:34the full extent of their injuries.
0:38:37 > 0:38:40The discoveries they make - and decisions they take -
0:38:40 > 0:38:43will determine whether each of them lives or dies.
0:38:48 > 0:38:51HELICOPTER COMMS CRACKLE
0:38:54 > 0:38:56HE GROANS IN CONTINUAL PAIN
0:39:02 > 0:39:06In Nottingham, trauma surgeon Adam Brookes is standing by to try
0:39:06 > 0:39:08and find the cause of Bill's extreme pain.
0:39:08 > 0:39:12This is Bill, he's a 66-year-old gentleman
0:39:12 > 0:39:16who was crushed by a 650kg cow between the cow and a concrete wall.
0:39:18 > 0:39:21'When Bill came in he had a significant amount
0:39:21 > 0:39:23'of pain in his abdomen predominantly,
0:39:23 > 0:39:25'especially as he'd had quite a lot of pain relief,'
0:39:25 > 0:39:28morphine and ketamine, so two very powerful drugs
0:39:28 > 0:39:29to help him with his pain.
0:39:31 > 0:39:33What it suggested to me was there was some pathology,
0:39:33 > 0:39:37some issue going on, there was an injury in his abdomen.
0:39:37 > 0:39:39Starting with 5mg of morphine by the crew,
0:39:39 > 0:39:43which didn't give him relief, still 10 out of 10
0:39:43 > 0:39:46so we've given him ketamine, titrating 10mg.
0:39:46 > 0:39:48- So he's had a total of 50.- 50.
0:39:50 > 0:39:51Isabel?
0:39:53 > 0:39:54Open your eyes for me, Bill.
0:39:54 > 0:39:58Very early on, I make the call that he needs to go to the CT scan.'
0:39:58 > 0:40:02In Nottingham, the trauma team aims to get patients scanned within
0:40:02 > 0:40:0715 minutes of arrival, to diagnose injuries as quickly as possible.
0:40:07 > 0:40:10Should we do a quick check-up before we leave for CT?
0:40:11 > 0:40:15- So, anaesthetist, you are happy with airway, need any drugs?- Yes.
0:40:29 > 0:40:31HE GROANS
0:40:42 > 0:40:43OK, injection starting.
0:40:46 > 0:40:49CT scanning does give us the opportunity within minutes
0:40:49 > 0:40:51of getting a complete picture of the injuries.
0:40:56 > 0:40:59Adam is looking for signs of internal bleeding,
0:40:59 > 0:41:02but the answers aren't immediately apparent on the CT scan.
0:41:05 > 0:41:09It's always a concern when the investigations we have
0:41:09 > 0:41:12and the clinical picture don't marry up,
0:41:12 > 0:41:15as they just don't seem to fit together.
0:41:15 > 0:41:17And that sets us out on more of a detective story -
0:41:17 > 0:41:20what is the issue here? What are we missing?
0:41:32 > 0:41:36ARRIVAL UPDATE FROM PILOT ON COMMS SYSTEM
0:41:49 > 0:41:52MJ is preparing to hand over severely injured Rumen
0:41:52 > 0:41:55to the trauma team at the Royal London Hospital.
0:41:56 > 0:42:01There was a chance he could still die in our department seconds after arriving.
0:42:04 > 0:42:07So there's a degree of anticipation.
0:42:11 > 0:42:14And you think anything could still happen.
0:42:17 > 0:42:18Patient's here.
0:42:22 > 0:42:23Everybody keep quiet.
0:42:26 > 0:42:29Hand over the airway and then get the handover.
0:42:29 > 0:42:33OK, guys. This is Rumen, we think in his 30s,
0:42:33 > 0:42:35he was a pedestrian hit by a car,
0:42:35 > 0:42:39bull's-eyed the windscreen, completely cracked it,
0:42:39 > 0:42:41was found on opposite side of car,
0:42:41 > 0:42:44halfway on the pavement, half on road.
0:42:44 > 0:42:47They didn't see scene, they didn't see the car,
0:42:47 > 0:42:50they didn't see the windscreen, they didn't see the bump,
0:42:50 > 0:42:54they didn't see how Rumen looked when I arrived.
0:42:54 > 0:42:59Injuries top to toe, multiple facial lacerations, no body swelling,
0:42:59 > 0:43:01pupils equal and reactive.
0:43:01 > 0:43:04The handover from MJ is crucial.
0:43:04 > 0:43:09In those few seconds she gives us a picture,
0:43:09 > 0:43:13a little snapshot of the preceding hour.
0:43:13 > 0:43:15He's not had any fluid with us
0:43:15 > 0:43:19- and he's got bilateral cannulas. - Brilliant. Thank you very much.
0:43:19 > 0:43:23That handover defines what we do in the next few minutes.
0:43:24 > 0:43:28- Steven, on your count we'll move him. - Yep, OK.
0:43:28 > 0:43:30Having just flown in a chopper, the paramedics
0:43:30 > 0:43:35and the doctors have just had a very emotional
0:43:35 > 0:43:41involved experience, and it's good then for a second person to come back
0:43:41 > 0:43:44and look at everything they've done.
0:43:44 > 0:43:48And sometimes a fresh pair of eyes can see smaller things now
0:43:48 > 0:43:50in the brighter lights of Resus
0:43:50 > 0:43:53that they may have not picked up pre-hospitally.
0:43:53 > 0:43:55Five, four, three, two, one.
0:43:56 > 0:43:59Because Rumen was anaesthetised at the roadside
0:43:59 > 0:44:02and delivered in a stable condition he's ready for any operational
0:44:02 > 0:44:05intervention that Johann thinks he needs.
0:44:06 > 0:44:09Can we have three people on each side? We're going to
0:44:09 > 0:44:12move him across on to the centre of the trolley
0:44:12 > 0:44:14and then take the scoop out.
0:44:14 > 0:44:19Three people on the patient's right. Scoop on the left to come out first.
0:44:19 > 0:44:21I was primarily concerned that he may still be
0:44:21 > 0:44:22bleeding from somewhere.
0:44:22 > 0:44:26He had bad injuries to his legs and possibly
0:44:26 > 0:44:29to his pelvis and his abdomen, so we were worried that there may
0:44:29 > 0:44:32be something going on inside him that we haven't discovered yet.
0:44:33 > 0:44:35We wanted to make sure he was stable
0:44:35 > 0:44:38and to get him into the CT scanner as soon as possible
0:44:38 > 0:44:40to see if there's anything else going on inside
0:44:40 > 0:44:42that we can't see from the outside.
0:44:43 > 0:44:46OK, pupils are 2mm equal and non-reactive.
0:44:46 > 0:44:49But before they can get him to the CT scan,
0:44:49 > 0:44:52Johann is concerned about Rumen's legs.
0:44:54 > 0:44:56He'd obviously fractured both his lower legs
0:44:56 > 0:45:00and we were worried that the blood was not getting into his feet.
0:45:01 > 0:45:05If the pulses were not there, that means that he may lose his feet.
0:45:07 > 0:45:12No surgical emphysema. Equal chest movement bilaterally.
0:45:19 > 0:45:22- Anything? - He's got a pulse on the left.
0:45:22 > 0:45:25So he's got pulses on his left ankle.
0:45:27 > 0:45:31- He's got bilateral pulses present. - After a worrying few seconds,
0:45:31 > 0:45:34the team find a stable pulse in both of Rumen's legs
0:45:34 > 0:45:38and can now focus on his suspected pelvic injuries.
0:45:38 > 0:45:42All right, folks listen up. As a summary, our primary survey is OK.
0:45:42 > 0:45:44He's obviously badly injured.
0:45:44 > 0:45:47We're going to take him now for a CT head down to pelvis.
0:46:02 > 0:46:05The whole hospital has been designed around
0:46:05 > 0:46:08the Emergency Department and around Resus.
0:46:08 > 0:46:11The CT scanner is right next to him.
0:46:11 > 0:46:16All the equipment that we need has been designed to be right there,
0:46:16 > 0:46:20right next to him, available whenever necessary.
0:46:20 > 0:46:23The team itself, they all know where they need to go.
0:46:25 > 0:46:26All right.
0:46:36 > 0:46:39His pelvis looks OK. All right, let's get him off.
0:46:45 > 0:46:48His injuries, especially the ones
0:46:48 > 0:46:51we were worried about, are not there,
0:46:51 > 0:46:55especially the life-threatening ones are not there.
0:46:55 > 0:46:59I think Rumen can consider himself lucky to be alive.
0:46:59 > 0:47:02After Rumen left the Emergency Department he went
0:47:02 > 0:47:07to Intensive Care and the primary concern then was with his legs, to
0:47:07 > 0:47:11make sure that they can repair them to a point where he can walk again.
0:47:13 > 0:47:17If MJ hadn't put his feet back into a straight position
0:47:17 > 0:47:23pre-hospitally, they would have been without blood or nerve supply
0:47:23 > 0:47:25for a prolonged period of time.
0:47:25 > 0:47:29I think it would have definitely made his chance of walking a lot less.
0:47:42 > 0:47:48In Nottingham, Adam is still trying to work out the root cause of Bill's pain.
0:47:53 > 0:47:55You always look at the patient,
0:47:55 > 0:47:57listen to the patient, examine the patient, and that really has
0:47:57 > 0:48:00got to have primacy in your decision-making.
0:48:00 > 0:48:02So his pain was out of proportion
0:48:02 > 0:48:06and then we had nothing on the scan. That didn't sit comfortably.
0:48:06 > 0:48:10HE GROANS
0:48:12 > 0:48:15All right. Let me have another look at your scan.
0:48:15 > 0:48:17I think for anyone involved in medicine
0:48:17 > 0:48:21and certainly major trauma, to get balance between new technology
0:48:21 > 0:48:24and instinct, experience is actually quite difficult.
0:48:24 > 0:48:27Basically suspicious that there's something happening
0:48:27 > 0:48:30but we haven't yet spotted it on the CT scan.
0:48:30 > 0:48:34The new scanners are very accurate, but we still miss things on them
0:48:34 > 0:48:37such as injuries to the small bowel,
0:48:37 > 0:48:40you don't see free air all the time, injuries to the pancreas,
0:48:40 > 0:48:44even on the new scanners you don't necessarily pick that up early.
0:48:46 > 0:48:49So nothing's definitive. Nothing in medicine is 100%.
0:48:57 > 0:48:59I think there's something going on here.
0:48:59 > 0:49:01I think there's some fluid here.
0:49:01 > 0:49:05After radiologists examine the scan in more detail,
0:49:05 > 0:49:07they alert Adam to a potential injury.
0:49:07 > 0:49:11When I went back and looked at the scan I saw a bit of subtle fluid
0:49:11 > 0:49:14underneath the liver, and that's fluid that shouldn't be there
0:49:14 > 0:49:17and also where he was markedly tender.
0:49:20 > 0:49:24Adam thinks he's finally detected the cause of Bill's extreme pain.
0:49:27 > 0:49:30If he's been trapped there's two things that could happen,
0:49:30 > 0:49:33one of which is he's going to squash an organ against the bones,
0:49:33 > 0:49:37split it, and make it bleed, the other is can increase
0:49:37 > 0:49:40pressure in the bowel where the air is
0:49:40 > 0:49:43and you'll get a blowout somewhere.
0:49:43 > 0:49:46And at the moment my money's on the latter,
0:49:46 > 0:49:50that we'll find that he's got a small bowel or duodenal perforation.
0:49:50 > 0:49:53A ruptured bowel can lead to blood poisoning.
0:49:55 > 0:50:01Hey. You OK? How's your pain?
0:50:02 > 0:50:04Still got a lot of pain in your tummy?
0:50:06 > 0:50:07Yeah?
0:50:10 > 0:50:11Not too bad?
0:50:13 > 0:50:15I think you've got a little bit of fluid in your tummy
0:50:15 > 0:50:20and maybe a loop of bowel has popped and leaked some fluid out
0:50:20 > 0:50:23and that's why you've quite so much pain there.
0:50:23 > 0:50:25It looks like it's squashed against lower ribs
0:50:25 > 0:50:27and the upper part of your tummy
0:50:27 > 0:50:31and there's little bit fluid where it shouldn't be on CT scan
0:50:31 > 0:50:33and that's probably what's causing all that pain,
0:50:33 > 0:50:35because it's sore in your tummy, isn't it?
0:50:37 > 0:50:39I think what we need to do is
0:50:39 > 0:50:42we need to pop up to the operating room and look inside, OK?
0:50:43 > 0:50:45My wife. My wife.
0:50:45 > 0:50:48Don't worry, we'll let your wife know. OK, mate.
0:50:49 > 0:50:51OK, don't worry.
0:50:51 > 0:50:53We were best off doing an operation and having a look inside
0:50:53 > 0:50:57and look at the injuries, as the ultimate investigation,
0:50:57 > 0:51:02but also it gives us the opportunity to treat any injuries that we find.
0:51:02 > 0:51:04- Can we start?- Yes, please do.
0:51:08 > 0:51:11Bill is taken to the operating theatre for surgery.
0:51:13 > 0:51:17What we do is look around the whole of the abdomen, we look at all
0:51:17 > 0:51:21the organs internally, in sequential fashion, looking for injuries.
0:51:23 > 0:51:27Can't see anything at the moment. Have you spotted anything yet?
0:51:28 > 0:51:30Good, small bowel, lots of it.
0:51:31 > 0:51:35His bowel was all fine, which was good, that was a relief.
0:51:35 > 0:51:39If it had been the bowel leaking then that would need more
0:51:39 > 0:51:43extensive work to make sure it was repaired and didn't leak again.
0:51:43 > 0:51:44But he had some ongoing bleeding.
0:51:44 > 0:51:47It's around his liver, we'll have a look at that,
0:51:47 > 0:51:49it's not bleeding very much by our standards.
0:51:49 > 0:51:51A look at the colon, a bit of fluid.
0:51:51 > 0:51:53Having discounted a bowel injury
0:51:53 > 0:51:57Adam continues to check all Bill's major organs for bleeding.
0:51:59 > 0:52:01Ooh, look, here's his liver injury.
0:52:01 > 0:52:04So he's got a little liver injury which is bleeding.
0:52:06 > 0:52:11There's a little bridge there that he's torn. That'll stop.
0:52:11 > 0:52:15He had some ongoing bleeding from a fairly subtle liver injury right at
0:52:15 > 0:52:20the back of his liver, tucked away near one of the big blood vessels.
0:52:20 > 0:52:23So although this is a pretty small liver injury, by scale of things,
0:52:23 > 0:52:27it's actively bleeding, it's under my finger there.
0:52:27 > 0:52:31So that's exactly what he's done, he's been squashed at the front
0:52:31 > 0:52:34and where his liver overlies his spinal column
0:52:34 > 0:52:36he's got a couple of little tears in his liver.
0:52:36 > 0:52:38They've caused his pain.
0:52:38 > 0:52:40So Mark, I'm going to put a couple of stitches
0:52:40 > 0:52:42and a couple of things around the liver.
0:52:42 > 0:52:44Good. OK, we're going to close and get out of here.
0:52:44 > 0:52:48- Mark, are you happy?- Yeah.- The team are just going to close. OK?
0:53:13 > 0:53:15'I kept going through my mind,
0:53:15 > 0:53:18' "Am I dead, is this... is this the end, like?" '
0:53:18 > 0:53:20I wouldn't wish it on no-one.
0:53:20 > 0:53:25But they did good, marvellous what they did for me.
0:53:25 > 0:53:26Else I shouldn't be here today.
0:53:31 > 0:53:34- Do you want the rest of the morphine? - No, we'll give him some ketamine.
0:53:34 > 0:53:37Bill did very well. He's made a full recovery.
0:53:37 > 0:53:38Er, and I think a lot of that is
0:53:38 > 0:53:41because we made the right decisions at the right time.
0:53:41 > 0:53:42In that first "golden hour",
0:53:42 > 0:53:45in the first 60 minutes of his care we made the right decisions.
0:53:45 > 0:53:48BILL GROANS All right, Bill. Bill?
0:53:48 > 0:53:50HE CONTINUES GROANING IN AGONY
0:53:59 > 0:54:05Yeah, I thought I was dying, to be honest.
0:54:07 > 0:54:11I didn't want to leave anybody behind. Just not easy.
0:54:24 > 0:54:25Is it Rumen? Hi, Rumen.
0:54:28 > 0:54:31Rumen's injuries to his legs were quite devastating.
0:54:31 > 0:54:37It's going to take months, if not years of intensive physiotherapy,
0:54:37 > 0:54:42learning how to walk again, learning how to live with his injuries.
0:55:28 > 0:55:32The simple fact is that most patients don't survive
0:55:32 > 0:55:36a cardiac arrest, perhaps less than 10%,
0:55:36 > 0:55:40and some of those that do survive are blighted by brain damage.
0:55:44 > 0:55:46So what I'm going to do is pop a few stickers on,
0:55:46 > 0:55:49just to monitor your heart while I'm checking.
0:55:49 > 0:55:52My husband told me that he was holding my hand
0:55:52 > 0:55:54and as I started to come round,
0:55:54 > 0:56:01he said, "If you love me squeeze my hand." And I squeezed his hand.
0:56:01 > 0:56:03Sorry.
0:56:03 > 0:56:08He said, "Squeeze it tighter, if you love me...
0:56:08 > 0:56:13"squeeze my hand really tight," and so I squeezed it really tight.
0:56:13 > 0:56:16And they knew then that I was in there.
0:56:17 > 0:56:21Zoe's cardiac arrest was caused by a rare heart condition.
0:56:21 > 0:56:23Doctors hope they can prevent another.
0:56:23 > 0:56:28- NURSE:- And the good thing is your device is wireless, so...- Yes.
0:56:28 > 0:56:30I've had an ICD fitted -
0:56:30 > 0:56:34an Implantable Cardiovascular Defibrillator,
0:56:34 > 0:56:37so if my heart needs to be paced it will kick
0:56:37 > 0:56:41in and try and pace it out of a rhythm, an arrhythmia,
0:56:41 > 0:56:46and if it needs to try and give me a shock, to get my heart
0:56:46 > 0:56:50working properly, then it will be able to administer a shock as well.
0:56:50 > 0:56:53I don't know if I expected it to be really heavy or not.
0:56:53 > 0:56:55It feels quite light.
0:56:55 > 0:57:00It's the ultimate, it's taking someone whose life has just gone,
0:57:00 > 0:57:02literally stopped,
0:57:02 > 0:57:07and rekindling it through some very complex diseases to a point
0:57:07 > 0:57:12where she's not just alive, but she's alive like she was.
0:57:12 > 0:57:16She hasn't got any disabilities,
0:57:16 > 0:57:21she can go on and lead a completely normal family life.
0:57:21 > 0:57:24That's one thing I really want to know.
0:57:24 > 0:57:26Can you skydive if you have an ICD?
0:57:26 > 0:57:28NURSE CHUCKLES
0:57:42 > 0:57:45EMERGENCY CALL COMES IN
0:57:49 > 0:57:53Next time, a high-speed road accident critically injures Michael.
0:57:53 > 0:57:55- Is blood running?- Yep.- OK.
0:57:58 > 0:58:01And in North London, 68-year-old Mick collapses.
0:58:01 > 0:58:04I must admit, I can't feel a cardiac output in this chap.
0:58:05 > 0:58:08You can find out more about Trauma and Emergency Care
0:58:08 > 0:58:11with The Open University's free booklet.
0:58:11 > 0:58:18Call 0845 030 3043 or go to the bbc.co.uk/anhourtosaveyourlife
0:58:18 > 0:58:20and follow the links to the Open University.