0:00:02 > 0:00:10This programme contains scenes which some viewers may find upsetting
0:00:11 > 0:00:16The moment an emergency call is made, a battle against time begins.
0:00:16 > 0:00:18'And is she awake?'
0:00:18 > 0:00:19'No, she looks dead.'
0:00:19 > 0:00:22GROANING
0:00:23 > 0:00:26The decisions that are made in the first 60 minutes of a major
0:00:26 > 0:00:29trauma patient will make the difference between life and death.
0:00:29 > 0:00:32If we can intervene within the first 60 minutes or so,
0:00:32 > 0:00:34the so-called Golden Hour,
0:00:34 > 0:00:37then we know we can positively affect your outcome.
0:00:37 > 0:00:40The sooner a doctor can reach their patient,
0:00:40 > 0:00:42the more likely they are to survive.
0:00:42 > 0:00:45We now have the ability to reverse the initial effects of the injury
0:00:45 > 0:00:50if we are given the chance and we are able to act quickly enough.
0:00:50 > 0:00:53In their race against the clock doctors and paramedics are now
0:00:53 > 0:00:57taking the hospital to those at the very edge of life.
0:00:57 > 0:00:59We're pretty close.
0:01:01 > 0:01:03MOANING
0:01:03 > 0:01:05The more equipment and expertise
0:01:05 > 0:01:07and knowledge we can get out on to the street or the scene
0:01:07 > 0:01:10of the accident then we will save more people's lives.
0:01:10 > 0:01:12Armed with new treatments and equipment..
0:01:12 > 0:01:15I'll get the auto pulse going and we'll get him on the auto pulse.
0:01:15 > 0:01:18..they're performing surgery on the roadside...
0:01:18 > 0:01:22I could do the operation in the back of the ambulance if necessary.
0:01:22 > 0:01:24..administering powerful drugs...
0:01:24 > 0:01:27Would you draw us up some Tranexamic acid?
0:01:27 > 0:01:29..using innovative techniques...
0:01:29 > 0:01:33If you pull that one and I'll put this one.
0:01:33 > 0:01:36..and pushing the boundaries of science...
0:01:36 > 0:01:39I'll let you know once the balloon is up.
0:01:39 > 0:01:42..to save time and to save lives.
0:01:42 > 0:01:44We've got to go!
0:01:44 > 0:01:48This series will count down second by second, minute by minute,
0:01:48 > 0:01:52the crucial decisions made in the first 60 minutes of emergency care.
0:01:54 > 0:01:58One hour, the difference between life and death.
0:02:17 > 0:02:2062 million people live in Britain.
0:02:22 > 0:02:28Whether at home or at work, in the city or in the countryside,
0:02:28 > 0:02:33every hour, over 35 of us will face a life threatening emergency.
0:02:33 > 0:02:38This film will follow three stories
0:02:38 > 0:02:41through 60 minutes of care
0:02:41 > 0:02:45that will push the limits of scientific innovation.
0:02:47 > 0:02:51In Birmingham, Gudrun collapses in a hotel room.
0:02:51 > 0:02:54'She's a 77-year-old woman, she's had a stroke.'
0:02:54 > 0:02:59In a leafy suburb of London, tree surgeon Ben falls 20 feet
0:02:59 > 0:03:00onto the pavement.
0:03:00 > 0:03:04- OK, so he's landed more on his side than his back?- More on his side.
0:03:04 > 0:03:05'Don't move him, don't move him.'
0:03:05 > 0:03:08'Do not move him unless he's in danger.'
0:03:08 > 0:03:12And in Shropshire, a road accident leaves 49-year-old Vincent with
0:03:12 > 0:03:14life threatening injuries.
0:03:14 > 0:03:16He's had a head-on collision.
0:03:16 > 0:03:19His motorbike is in the hedge there in numerous pieces.
0:03:19 > 0:03:23From the moment each one of these emergency calls is made
0:03:23 > 0:03:25the clock starts ticking.
0:03:29 > 0:03:34'We've got a motorcycle. The cyclist is not responding at the moment.'
0:03:34 > 0:03:37West Midlands Ambulance Control has just received an emergency
0:03:37 > 0:03:39call from the police.
0:03:39 > 0:03:42There's been a high speed collision between a motorbike
0:03:42 > 0:03:46and a car on a remote country lane in Shropshire.
0:03:46 > 0:03:49Its location and severity triggers an air ambulance,
0:03:49 > 0:03:51carrying a trauma team on board.
0:04:00 > 0:04:03You're always trying to imagine what the scene might be like.
0:04:03 > 0:04:06We knew it was a warm sunny day,
0:04:06 > 0:04:09so it might be quite a high speed impact.
0:04:09 > 0:04:12It makes you concerned that there may be major injuries
0:04:12 > 0:04:16that you'll be faced with when you arrive on scene.
0:04:16 > 0:04:19Local ambulance staff are already treating the patient.
0:04:22 > 0:04:26A motorcyclist. His motorbike is in the hedge there
0:04:26 > 0:04:30- in numerous pieces.- Oh, blimey.
0:04:30 > 0:04:31We can't even find the number plate.
0:04:31 > 0:04:34- Wow.- He's travelled an additional 20 yards up the road.
0:04:34 > 0:04:37He has travelled.
0:04:38 > 0:04:41'When we arrived on scene and looked at the severity and damage to the'
0:04:41 > 0:04:46bike it suggested that the mechanism of injury was quite significant.
0:04:46 > 0:04:49He'd also travelled a fair distance from his bike
0:04:52 > 0:04:56Hi, Vince, I'm Collette, one of the doctors here.
0:04:56 > 0:04:58He was quite sweaty, he was clammy,
0:04:58 > 0:05:03he looked very ashen in colour - all of which can suggest signs of shock.
0:05:03 > 0:05:06Collette is worried that Vincent is going into shock,
0:05:06 > 0:05:09meaning the organs and tissues in his body
0:05:09 > 0:05:12aren't receiving an adequate supply of blood.
0:05:12 > 0:05:16He had quite a weak pulse which suggested his blood pressure
0:05:16 > 0:05:20was on the low side and also his heart rate was fast as well,
0:05:20 > 0:05:24which made us concerned there may be an element of internal bleeding.
0:05:27 > 0:05:30Your main pain... You've got a funny sensation in your pelvis
0:05:30 > 0:05:33- and the leg. Is that the main issue? - My hips.- Your hips.
0:05:33 > 0:05:35- Is there any pain in your tummy at all?- I don't know.
0:05:35 > 0:05:39You don't know. If I have a quick feel there, is there anything?
0:05:39 > 0:05:42- I'm not sure, it just feels funny. - It just feels funny.
0:05:46 > 0:05:51When I assessed Vincent's leg, there was an obvious open fracture
0:05:51 > 0:05:54so I could see the bones exposed through the skin
0:05:54 > 0:05:55of Vincent's lower leg.
0:05:55 > 0:05:59However, there wasn't a huge amount of blood loss occurring
0:05:59 > 0:06:02from the wound and the bones didn't look overly deformed.
0:06:02 > 0:06:05Vince, I'm just having a feel of your feet, mate.
0:06:06 > 0:06:10- My boots feel ever so tight.- Vince, you haven't got your boots on,
0:06:10 > 0:06:14you've got some splints to hold it. We think you've broken your leg.
0:06:14 > 0:06:17But your foot is very, very pale.
0:06:17 > 0:06:19That's a mess, isn't it?
0:06:19 > 0:06:23They look a horrible colour. Really pale feet.
0:06:23 > 0:06:26One of our concerns was that maybe he wasn't getting blood
0:06:26 > 0:06:27supply to that right foot.
0:06:29 > 0:06:33Although concerned about Vincent's foot, Colette has to deal
0:06:33 > 0:06:36with any potentially life threatening injuries first.
0:06:36 > 0:06:40'The problem that we faced is that you can't see what's going on'
0:06:40 > 0:06:41within Vincent's body.
0:06:41 > 0:06:45Although we could anticipate there was some internal bleeding.
0:06:45 > 0:06:47we had no idea where the source of the bleeding was.
0:06:51 > 0:06:54What we might try and do is just get a splint on his pelvis.
0:06:54 > 0:06:57Colette is worried that a fractured pelvis might be causing
0:06:57 > 0:07:00massive internal bleeding inside Vincent's body.
0:07:01 > 0:07:04If you pull that one and I'll pull this one.
0:07:04 > 0:07:07That's it, that's it.
0:07:07 > 0:07:09She hopes the splint will keep the pelvis stable,
0:07:09 > 0:07:13reducing any internal blood loss
0:07:13 > 0:07:17If you can't prevent bleeding or you can't keep up with the blood loss
0:07:17 > 0:07:20then, eventually, your patient will die.
0:07:23 > 0:07:26'I decided that we'd give him some Tranexamic acid,'
0:07:26 > 0:07:29and essentially that's a drug that encourages clot formation
0:07:29 > 0:07:34if there's a bleeding point that we can't see externally.
0:07:34 > 0:07:37Having taken steps to control Vincent's internal bleeding,
0:07:37 > 0:07:39Collette must now decide
0:07:39 > 0:07:42whether she has time at the roadside to treat his leg.
0:07:43 > 0:07:48Every minute is vital in deciding what interventions you do,
0:07:48 > 0:07:52how many interventions you do, and at what point you decide to
0:07:52 > 0:07:54package a patient for transfer to hospital.
0:08:01 > 0:08:03DIALLING TONES
0:08:03 > 0:08:06'Emergency ambulance, what's the address of the emergency
0:08:15 > 0:08:18Ten minutes ago, Ambulance Control in London received
0:08:18 > 0:08:22a call about a man who's fallen 20 feet from a tree.
0:08:22 > 0:08:24'Don't move him, don't move him.'
0:08:24 > 0:08:27'Do not move unless he's in danger.'
0:08:27 > 0:08:33I've got a job for you. Map reference is 32 November Bravo.
0:08:34 > 0:08:37Call connect is 13.45,
0:08:37 > 0:08:39and dispatched at 13.50.
0:08:42 > 0:08:46Falls from heights are the number one cause of death at work.
0:08:46 > 0:08:48In London, any fall over 20 feet triggers
0:08:48 > 0:08:50the dispatch of the air ambulance.
0:08:53 > 0:08:57Patients that fall from a height can do a myriad of injuries.
0:08:57 > 0:09:02If they land on their head, that can cause head injuries,
0:09:02 > 0:09:05they can damage their chest, they can break ribs,
0:09:05 > 0:09:08they can collapse lungs, they can damage their spine,
0:09:08 > 0:09:12and if they fall from a very high height they can damage the pelvis,
0:09:12 > 0:09:15one of the biggest bones in the body.
0:09:15 > 0:09:18We're going to be landing on a playing field,
0:09:18 > 0:09:21which is just to the south of the scene.
0:09:24 > 0:09:28Time is really important, not just in getting them to hospital,
0:09:28 > 0:09:32but getting to the scene, correcting as many of these
0:09:32 > 0:09:33issues as quickly as possible.
0:09:36 > 0:09:38Speed is part of the deal.
0:09:50 > 0:09:55I suppose the things I was worried about fall into two groups.
0:09:55 > 0:09:59One of which is very difficult - spinal injuries.
0:09:59 > 0:10:02- Left here.- Yes.
0:10:02 > 0:10:08But the others are injuries that may actually kill him,
0:10:08 > 0:10:11but we know that we can treat, we can save him from,
0:10:11 > 0:10:15we can repair him, we can get him back into a normal life.
0:10:16 > 0:10:19Just watch your safety here, mate.
0:10:19 > 0:10:2219 minutes after the 999 call, Gareth arrives
0:10:22 > 0:10:24in the leafy suburban street.
0:10:26 > 0:10:30London Ambulance Service are already treating the tree surgeon.
0:10:30 > 0:10:35He was in a position that he'd obviously fallen.
0:10:35 > 0:10:37That's never a good sign because
0:10:37 > 0:10:41the natural reaction, when you've fallen, is to get up,
0:10:41 > 0:10:45dust yourself down, and hobble away from the scene.
0:10:45 > 0:10:47Yeah.
0:10:47 > 0:10:50He's fallen from there, landed on his back.
0:10:50 > 0:10:53- He's been in this position since. - Yeah.
0:10:53 > 0:10:55OK, what's his name?
0:10:55 > 0:10:57What's your first name?
0:10:58 > 0:11:00- Hello, Ben. Ben, can you hear me?- Yes.
0:11:00 > 0:11:03My name's Dr Davies. Hi there, mate.
0:11:03 > 0:11:06I'm a consultant with the air ambulance, all right?
0:11:06 > 0:11:09- Air ambulance?- Yeah, the helicopter. All right?
0:11:09 > 0:11:10You're going to be fine,
0:11:10 > 0:11:15- I just need to find out what damage you've done on yourself, OK?- OK.
0:11:15 > 0:11:17He said the pain is right in his back
0:11:17 > 0:11:21- and he rates it at seven out of ten. - OK, all right.
0:11:21 > 0:11:26I was worried he might have broken his back and not been able to move.
0:11:26 > 0:11:31Now, can I ask you to move your legs?
0:11:31 > 0:11:35'I wanted to see that he wasn't paralysed.'
0:11:35 > 0:11:38Your arms and legs feel normal, do they?
0:11:38 > 0:11:40OK, fella.
0:11:40 > 0:11:43Ben can move his limbs, meaning there's no damage
0:11:43 > 0:11:47to his spinal cord, but Gareth thinks that some of Ben's vertebrae
0:11:47 > 0:11:51or bones, around his spinal cord, could be fractured.
0:11:51 > 0:11:55He may also have other injuries to his head and internal organs.
0:11:55 > 0:11:57Your pain, where is it?
0:12:06 > 0:12:10When I looked at Ben, he did look quite unwell.
0:12:10 > 0:12:13He looked very pale, he looked very sweaty.
0:12:13 > 0:12:18All of these are signs that he might be bleeding and in shock.
0:12:18 > 0:12:22- Can you describe how he landed?- He landed on his side, his right side.
0:12:22 > 0:12:24So, sort of his right arm, his hip,
0:12:24 > 0:12:28and he was sort of covering his head with this right arm.
0:12:28 > 0:12:30OK, so he landed more on his side than his back.
0:12:30 > 0:12:32More on his side, yes.
0:12:32 > 0:12:35The awkward thing is you can't see that bleeding.
0:12:35 > 0:12:39You have to predict it. You have to assess the fall,
0:12:39 > 0:12:40look how high he's come,
0:12:40 > 0:12:46try and examine his pelvis and look for other signs of bleeding.
0:12:46 > 0:12:50If Ben is bleeding internally, his life is at risk.
0:12:50 > 0:12:54But the full extent of his injuries can't be diagnosed at the roadside.
0:12:54 > 0:12:57Gareth needs to move him to a Major Trauma Centre as soon
0:12:57 > 0:13:02as possible, but any movement could make Ben's condition worse.
0:13:02 > 0:13:07- So where are we near? - Erm, N4, London.
0:13:07 > 0:13:08How long's the drive?
0:13:08 > 0:13:11I'd say 15 but...
0:13:11 > 0:13:13I was really concerned for Ben.
0:13:13 > 0:13:17He had symptoms that suggested a fracture of his lower back
0:13:17 > 0:13:22or his pelvis, which is often associated with bleeding,
0:13:22 > 0:13:24and has a very high mortality rate.
0:13:43 > 0:13:46Having treated Vincent for suspected internal bleeding.
0:13:46 > 0:13:52Colette turns her attention to the open wound on his leg.
0:13:52 > 0:13:55It's very common that an open fracture can cause
0:13:55 > 0:13:59compression of the blood vessels and prevent blood flow to the lower leg.
0:13:59 > 0:14:01I was quite confident that that could be a possible
0:14:01 > 0:14:06source for the paleness and mottled colour of his foot.
0:14:06 > 0:14:09If left for too long without blood, the muscles will die
0:14:09 > 0:14:11and the limb may not survive.
0:14:11 > 0:14:14Before treating his leg, Colette decides to give Vincent
0:14:14 > 0:14:17an analgesic - or pain killer.
0:14:17 > 0:14:20Vin, one of your foot has gone a funny colour
0:14:20 > 0:14:23so we're going to give you something to relax you a little bit...
0:14:23 > 0:14:24Yeah, do it.
0:14:24 > 0:14:26..and then we're going to have to pull it.
0:14:26 > 0:14:27One of the things you can do is try
0:14:27 > 0:14:32and straighten the bones which not only helps with analgesia, it helps
0:14:32 > 0:14:37with blood loss, but would also regain blood flow to the lower limb.
0:14:37 > 0:14:40It can be a very painful procedure so I administered
0:14:40 > 0:14:44some ketamine which is not only an analgesic in its own right,
0:14:44 > 0:14:46it's also a sedative medication.
0:14:46 > 0:14:49You might have to give me a heave-ho.
0:14:49 > 0:14:52Vince, just some pulling, mate.
0:14:55 > 0:14:57I don't think it's going to do anything.
0:15:01 > 0:15:04'Unfortunately, it didn't have the desired effect
0:15:04 > 0:15:08'and there wasn't much dislocation of the fractured bones.'
0:15:08 > 0:15:10SHE WHISPERS Yeah.
0:15:12 > 0:15:16I think that's as good as you're going to get.
0:15:16 > 0:15:17It's just the oozing.
0:15:18 > 0:15:21'So again, it makes you think, "Is there something going
0:15:21 > 0:15:23'"on within his body that's preventing
0:15:23 > 0:15:26'"blood flow to his lower limbs?"'
0:15:26 > 0:15:30- How you doing there, Vince? - Just... My legs...
0:15:30 > 0:15:33Yeah, we're going to sort that out, sweetheart.
0:15:33 > 0:15:36There's nothing more Colette can do for Vincent at the scene.
0:15:38 > 0:15:41'I think the most difficult decision was deciding
0:15:41 > 0:15:44'when to stop performing any interventions at the roadside
0:15:44 > 0:15:48'because delaying time on scene would delay any further
0:15:48 > 0:15:50'interventions that he could receive in hospital.'
0:15:51 > 0:15:54ALL TALK OVER EACH OTHER
0:15:55 > 0:15:56PHONE DIALS
0:15:56 > 0:15:58- OPERATOR:- Emergency. Which service?
0:15:58 > 0:16:02She's a 77-year-old woman and she's had a stroke.
0:16:02 > 0:16:05- Is she conscious and breathing? - I don't know.
0:16:06 > 0:16:1133 minutes ago, a 999 call was made when Gudrun, a holiday
0:16:11 > 0:16:13maker from Germany, collapsed in her hotel room.
0:16:16 > 0:16:19She's lost all feeling down the left-hand side of her body
0:16:19 > 0:16:22and is having trouble speaking.
0:16:22 > 0:16:25She's rushed into the Queen Elizabeth Hospital in Birmingham.
0:16:25 > 0:16:28So, tell me, how were you feeling when you first woke up this morning?
0:16:40 > 0:16:42I want to run through an assessment with you.
0:16:42 > 0:16:45It allows me to see how your brain is working at the moment.
0:16:45 > 0:16:49- Is that all right? Can I get you to shut your eyes tightly for me?- What?
0:16:49 > 0:16:51Shut your eyes really tightly.
0:16:51 > 0:16:55Open them wide. Give me a really big smile.
0:16:55 > 0:16:57Show me your teeth. Lovely.
0:16:57 > 0:17:00'It's really clear to me that she's got a facial droop
0:17:00 > 0:17:02'and that she's not moving the left side of her body,
0:17:02 > 0:17:06'which is a really good indication that it's probably a stroke.'
0:17:06 > 0:17:09A stroke is caused by a lack of oxygen to the brain
0:17:09 > 0:17:11due to a bleed or blockage in the blood vessels.
0:17:13 > 0:17:16Rachel begins by assessing Gudrun's reactions.
0:17:19 > 0:17:21Look that way for me.
0:17:21 > 0:17:24The assessment was really important because it showed me
0:17:24 > 0:17:27Gudrun could follow basic commands, and that she did understand
0:17:27 > 0:17:30what I was saying because it allowed me to see that her cognition was
0:17:30 > 0:17:32not damaged. So she understood what was going on,
0:17:32 > 0:17:34and it was likely that that part of the brain
0:17:34 > 0:17:36wasn't affected from the stroke.
0:17:36 > 0:17:40Can you lift this leg up in the air? Hold it there.
0:17:40 > 0:17:42'When someone's experiencing a stroke,
0:17:42 > 0:17:44'it's really vital that we get someone to scan
0:17:44 > 0:17:46'so that we know what's happening so we can give that treatment,
0:17:46 > 0:17:49'and potentially save the brain cells from dying.'
0:17:51 > 0:17:55During a stroke, almost two million brain cells can die every
0:17:55 > 0:17:58minute, so Rachel needs to establish quickly
0:17:58 > 0:18:01exactly what kind of stroke Gudrun is having.
0:18:01 > 0:18:03There are two types of stroke.
0:18:03 > 0:18:06There's ischemic stroke, which is basically a clot which
0:18:06 > 0:18:07forms in a blood vessel in the brain.
0:18:07 > 0:18:09And then there's also a hemorrhagic stroke,
0:18:09 > 0:18:11which is when bleeding occurs in the brain.
0:18:11 > 0:18:13And they're both treated very differently.
0:18:13 > 0:18:14There we go.
0:18:14 > 0:18:19Gudrun needs to have a CT scan as fast as possible
0:18:19 > 0:18:21so the team can see what's going on inside her brain.
0:18:23 > 0:18:28I'm just going to wheel you round for a scan now, OK?
0:18:28 > 0:18:31- Could someone be able to give me a hand?- Yeah, sure.
0:18:36 > 0:18:39Complaining of low back pain and right shoulder pain.
0:18:43 > 0:18:47INDISTINCT CHATTER
0:18:47 > 0:18:50On a quiet residential street in North London,
0:18:50 > 0:18:52Gareth and the paramedics are treating Ben,
0:18:52 > 0:18:55who has fallen 20 feet from a tree.
0:18:55 > 0:19:01Possible spinal fractures and rib fractures on the left side.
0:19:03 > 0:19:04Ben.
0:19:04 > 0:19:07We're going to roll you on to a stretcher now.
0:19:07 > 0:19:10It's going to be a bit cold. We're going to give you some morphine
0:19:10 > 0:19:11to help you with this roll. OK?
0:19:13 > 0:19:15We need to get Ben moved to hospital,
0:19:15 > 0:19:21and we're not going to do that if every time we move him he cries out.
0:19:21 > 0:19:24That will delay his transport from the scene.
0:19:28 > 0:19:31OK. All the way. All the way.
0:19:31 > 0:19:34That's the worst bit over with, mate.
0:19:34 > 0:19:38As well as back and head injuries, Gareth also suspects Ben may
0:19:38 > 0:19:41be bleeding internally from a broken pelvis.
0:19:41 > 0:19:43Ready, brace, lift.
0:19:46 > 0:19:49Just going to get you off the road and into the ambulance.
0:19:49 > 0:19:54In my mind's eye, I'm inside his pelvis and inside his pelvis
0:19:54 > 0:19:59are lots of broken bones, and around those bones are blood clots.
0:20:00 > 0:20:06And I know that every time I move him or roll him, those bones pull apart
0:20:06 > 0:20:13and those clots disappear. And when they disappear, bleeding ensues.
0:20:15 > 0:20:17HE GROANS
0:20:17 > 0:20:19CHATTER
0:20:21 > 0:20:24He's still in a lot of pain. He's asking for some more analgesia.
0:20:24 > 0:20:27- What do you want to give?- Just give him a little bit of medaz and ket.
0:20:27 > 0:20:29Yeah, that's what I was going to say.
0:20:29 > 0:20:32- Do you want to go up to ketamine? - Yeah. All right, mate.
0:20:32 > 0:20:33I'm just a little bit worried
0:20:33 > 0:20:35that you might have broken your back there.
0:20:35 > 0:20:38We may have a couple of fractured ribs.
0:20:39 > 0:20:42I'm going to give you some pain relief.
0:20:44 > 0:20:47Just give him ten of ketamine to begin with.
0:20:47 > 0:20:49SIREN BLARES
0:21:08 > 0:21:11In Birmingham, Gudrun started suffering from a stroke
0:21:11 > 0:21:16around 45 minutes ago and is about to have a CT scan.
0:21:16 > 0:21:20Stroke consultant Don Sims needs to decide whether her stroke is being
0:21:20 > 0:21:24caused by a clot or a bleed inside her brain.
0:21:24 > 0:21:28The time pressure in stroke is much more acute than in many other
0:21:28 > 0:21:31conditions, even a heart attack.
0:21:31 > 0:21:34We know brain tissue is exquisitely sensitive to losing its blood
0:21:34 > 0:21:38supply and the damage is happening right from the start.
0:21:39 > 0:21:42A stroke caused by a clot can be treated
0:21:42 > 0:21:45effectively by administering a blood-thinning drug.
0:21:45 > 0:21:48But if Gudrun's stroke is being caused by a haemorrhage,
0:21:48 > 0:21:52then the drug will intensify the bleeding, which could kill her.
0:21:53 > 0:21:56Brain scans really don't diagnose blood clot type of strokes.
0:21:56 > 0:22:00The brain scans are really there only to rule out the bleeding type
0:22:00 > 0:22:05of stroke, so the diagnosis is based on my assessment of the patient.
0:22:05 > 0:22:08If Gudrun's stroke is being caused by a clot then the affected
0:22:08 > 0:22:12area of her brain may not appear on the CT scan
0:22:12 > 0:22:15until several hours after the onset of her stroke.
0:22:16 > 0:22:20But if she has a bleed on her brain, it will show up straightaway.
0:22:22 > 0:22:26There's absolutely no blood in it at all...so it has to be a clot.
0:22:28 > 0:22:31That's fine. We can get her off.
0:22:32 > 0:22:35Once I'm happy that there's no bleeding on the brain scan,
0:22:35 > 0:22:38the priority is to get her straight back to the emergency department and
0:22:38 > 0:22:42deliver the clot-busting treatment without any further hesitation.
0:22:42 > 0:22:45We target ourselves giving the treatment within half
0:22:45 > 0:22:48an hour of their arrival to the emergency department.
0:22:53 > 0:22:56Gundrun, hello. My name is Don Sims. I am one of the stroke doctors.
0:22:56 > 0:22:59Nice to see you. Can you squeeze my hand for me?
0:22:59 > 0:23:00Can you shut your eyes?
0:23:00 > 0:23:01Can you show me all your teeth?
0:23:01 > 0:23:05Hold that one up for me. Just keep it up.
0:23:06 > 0:23:08Can you do this one at all for me?
0:23:11 > 0:23:15That's more difficult, isn't it?
0:23:15 > 0:23:19Gudrun...we think that you're having a Stroke.
0:23:19 > 0:23:21The brain scan didn't show any bleeding,
0:23:21 > 0:23:24so it's a small blood clot that's caused the stroke.
0:23:24 > 0:23:25Because you're here quickly enough,
0:23:25 > 0:23:28we would like to give you the clot busting treatment,
0:23:28 > 0:23:30which breaks down the clot.
0:23:30 > 0:23:32Don has decided to treat Gudrun
0:23:32 > 0:23:35using a process called thrombolysis.
0:23:35 > 0:23:36Through an injection,
0:23:36 > 0:23:40the treatment dissolves blood clots using a powerful drug.
0:23:40 > 0:23:43Suddenly there was a clot busting drug treatment that seemed to
0:23:43 > 0:23:44be really very effective.
0:23:44 > 0:23:47Before thrombolysis, there was really no acute stroke treatment,
0:23:47 > 0:23:49so this is all quite new and novel.
0:23:51 > 0:23:55But to stop the clot doing permanent damage to Gudrun's brain,
0:23:55 > 0:23:57it must be given within four and half hours
0:23:57 > 0:23:59of the onset of her symptoms.
0:24:00 > 0:24:02All right?
0:24:02 > 0:24:06There is a small risk with it. About two to 3% of people
0:24:06 > 0:24:09we give it too have a significant bleeding,
0:24:09 > 0:24:12that can be in the brain.
0:24:12 > 0:24:16And then the outcomes is obviously much worse for them.
0:24:16 > 0:24:19But the majority of people - the overwhelming majority people -
0:24:19 > 0:24:22either get better or it doesn't affect them
0:24:22 > 0:24:24in any way for good or bad.
0:24:24 > 0:24:27They just have the same symptoms that they were going to have anyway.
0:24:30 > 0:24:32- Is that OK?- Yes.
0:24:32 > 0:24:33Yeah?
0:24:38 > 0:24:41OK.
0:24:41 > 0:24:44Brilliant. Thank you. OK. Yeah, just got for it.
0:24:46 > 0:24:51'The clot-busting treatment dissolves the protein strands,'
0:24:51 > 0:24:53'it breaks down the mesh of the blood clot,
0:24:53 > 0:24:57and then your body helps to clear the rest of it.
0:24:57 > 0:24:5810:04.
0:24:58 > 0:25:00And then, hopefully, blood flow
0:25:00 > 0:25:03continues through where the blood clot was.
0:25:06 > 0:25:08It's one injection,
0:25:08 > 0:25:12and then we give you continuously over 60 minutes, then it is all done.
0:25:12 > 0:25:15Because we're going to be giving you some medication,
0:25:15 > 0:25:18we have to make sure we've got lots of access to your vein. OK?
0:25:41 > 0:25:43SIREN BLARES
0:25:46 > 0:25:49In Shropshire, the team are preparing
0:25:49 > 0:25:51to fly motorcyclist Vincent to hospital.
0:25:53 > 0:25:56'We've tried to re-align his lower leg
0:25:56 > 0:25:59'and his foot was exceptionally pale.'
0:25:59 > 0:26:03He ten of morphine, 40 of ket.
0:26:04 > 0:26:07Right is open tib fib, left is the ankle.
0:26:10 > 0:26:11- ETA is still the same. - Say half past.
0:26:11 > 0:26:15That's great. Thank you very much. See you soon. Bye.
0:26:20 > 0:26:23All right, Vince, I think we're ready to go, mate.
0:26:23 > 0:26:26CHATTER
0:26:40 > 0:26:43Over the last hour, emergency doctors have battled to keep three
0:26:43 > 0:26:45critically ill patients alive.
0:26:45 > 0:26:49RADIO CHATTER
0:26:49 > 0:26:52For Ben, Vincent and Gudrun, the crucial decisions
0:26:52 > 0:26:55made by the front line medics in the first hour have given them
0:26:55 > 0:26:57a greater chance of survival.
0:26:59 > 0:27:02But the fight is not over.
0:27:02 > 0:27:06As the race continues, hospital clinicians will build on these
0:27:06 > 0:27:09decisions and uncover the full extent of their injuries.
0:27:09 > 0:27:13The discoveries they make will determine what type of recovery,
0:27:13 > 0:27:16if any, they will make.
0:27:16 > 0:27:18Some oxygen. OK.
0:27:18 > 0:27:20- You all right?- Good?- Yeah, I'm good.
0:27:20 > 0:27:22At the Royal London Hospital,
0:27:22 > 0:27:26Gareth is about to hand over Ben to the waiting trauma team leader.
0:27:30 > 0:27:33The information we had prehospitally,
0:27:33 > 0:27:36I was concerned that he had an unstable spinal injury,
0:27:36 > 0:27:39so we had to make sure we didn't allow his spine to move at all.
0:27:43 > 0:27:49This is Ben brown, a gentleman that works as a tree surgeon,
0:27:49 > 0:27:55and has been working on a tree today and has fallen 20 feet onto concrete.
0:27:55 > 0:27:58Witnessed by a colleague. No loss of consciousness.
0:27:58 > 0:28:00Has been GCS 15 throughout.
0:28:00 > 0:28:02Has moving all four limbs.
0:28:02 > 0:28:09He's had 10mg of morphine, 50mg of ketamine and 2mg of medaz.
0:28:10 > 0:28:12No further interventions.
0:28:12 > 0:28:15- Did he fall on his back? - He landed on his left side.
0:28:15 > 0:28:17OK, thank you.
0:28:17 > 0:28:22So can you start the primary survey and find out where it's hurting him?
0:28:22 > 0:28:24Very few patients come in with a big thing
0:28:24 > 0:28:27stamped on their forehead saying what's wrong with them.
0:28:27 > 0:28:35What I was trying to do with Ben is make the invisible visible.
0:28:35 > 0:28:38I'm just going to have a quick listen to your breathing.
0:28:38 > 0:28:40- Which side is hurting the most? - Left side.
0:28:40 > 0:28:42Deep breaths for me now.
0:28:42 > 0:28:47OK. Chest x-ray in three, two, one...
0:28:47 > 0:28:49An x-ray machine above the bed allows Helen to
0:28:49 > 0:28:51check for fractures immediately.
0:28:52 > 0:28:55It's painful on the left side, is it?
0:28:55 > 0:28:57Any pain when I press here?
0:28:57 > 0:29:01'The other really serious injury people who have fallen
0:29:01 > 0:29:04from a height can sustain from a height is a pelvis fracture,
0:29:04 > 0:29:07which can be associated with massive bleeding.
0:29:07 > 0:29:12Pelvis x-ray in three, two, one...
0:29:13 > 0:29:15I'm just looking at the chest x-ray.
0:29:15 > 0:29:18The chest x-ray and pelvic x-ray are important things to do because
0:29:18 > 0:29:23if they are abnormal, they tell us what we're dealing with early on.
0:29:25 > 0:29:26Yeah, and the chest.
0:29:31 > 0:29:34Chest and pelvic x-rays look pretty normal.
0:29:37 > 0:29:40'I was surprised about that because he was complaining of pain'
0:29:40 > 0:29:43in his lower back when he took a deep breath in.
0:29:43 > 0:29:48If they're normal, it doesn't rule out a serious underlying injury.
0:29:48 > 0:29:51Hello. My name's Helen. I'm another one of the doctors.
0:29:51 > 0:29:52Hiya.
0:29:52 > 0:29:54Is your pain getting better?
0:29:59 > 0:30:01The X-ray won't give a complete picture of Ben's
0:30:01 > 0:30:05injuries as it may not pick up enough fine detail.
0:30:08 > 0:30:13Plain x-rays are not very good at showing soft tissue injuries.
0:30:13 > 0:30:17They're good at showing bone injuries, but not internal bleeding.
0:30:17 > 0:30:19Whereabouts in your back, Ben?
0:30:23 > 0:30:25At this level? Where my hand is?
0:30:25 > 0:30:26A bit lower?
0:30:28 > 0:30:30Down here?
0:30:30 > 0:30:32Yeah, right in there.
0:30:32 > 0:30:35So you've got pain in your back, about there.
0:30:37 > 0:30:39Further behind there. OK.
0:30:39 > 0:30:41Can you feel me touching your feet?
0:30:41 > 0:30:44- Yeah.- And this side?- Yeah.
0:30:52 > 0:30:55Your toes are wiggling.
0:30:55 > 0:30:57That's a good sign.
0:31:00 > 0:31:04We'll go through to CT, so can you request
0:31:04 > 0:31:08head, neck and whole spine?
0:31:14 > 0:31:17'There is a sense that you need to think quickly'
0:31:17 > 0:31:20and things need to happen quickly.
0:31:44 > 0:31:4681 minutes after his 999 call,
0:31:46 > 0:31:49Vincent arrives at the Queen Elizabeth Hospital.
0:31:56 > 0:31:58This is Vince. He's 49.
0:31:58 > 0:32:01He's been involved in a motorcycle accident. Tummy's tender.
0:32:01 > 0:32:04Pelvis was tender. He's got an open tib fib on the right.
0:32:04 > 0:32:07I've tried to reduce it cos it's looking very pale but...
0:32:07 > 0:32:10It looked quite straight and I just couldn't do anything with it.
0:32:10 > 0:32:12He's been GCS 15 on arrival
0:32:12 > 0:32:20- BP?- BP is being.... Last one was 143/63.
0:32:20 > 0:32:22So, treatment wise, he's had 60 of ketamine...
0:32:22 > 0:32:26He's had 60 of ketamine. Ten of morphine with the crew.
0:32:26 > 0:32:27He's had a gram of transanic acid
0:32:27 > 0:32:30100mls of normal saline and four of...
0:32:30 > 0:32:32Crack on with primary survey.
0:32:32 > 0:32:35Vincent is suffering from internal bleeding
0:32:35 > 0:32:36and a severe leg injury.
0:32:36 > 0:32:40Trauma lead Jitender must decide which to treat first.
0:32:42 > 0:32:45He was driving the bike at a very high speed,
0:32:45 > 0:32:48and in a big crash. And the pre-hospital team did tell us
0:32:48 > 0:32:51that there was a major damage to the car and Vincent's bike,
0:32:51 > 0:32:56so you do start to imagine that he must have multi system injuries.
0:32:56 > 0:32:59- What's your first name, sir? - Vincent.
0:32:59 > 0:33:02- Do you prefer to be called Vincent or Vince?- Vince.
0:33:02 > 0:33:03'When you see his observations,'
0:33:03 > 0:33:06you look at his colour and you think,
0:33:06 > 0:33:09"There is some serious blood loss going on inside his body."
0:33:11 > 0:33:12We've got fluids going in.
0:33:12 > 0:33:15If he's got a decent blood pressure, this is the time to go
0:33:15 > 0:33:17quickly to CT and come back
0:33:21 > 0:33:23You can do it fast, if needed...
0:33:33 > 0:33:36Jitender urgently needs to find the source
0:33:36 > 0:33:38of Vincent's internal bleeding,
0:33:38 > 0:33:41but he also wants to do everything he can to try
0:33:41 > 0:33:42and save Vincent's leg.
0:33:57 > 0:34:00We were suspecting that he may have an injury to one of the major
0:34:00 > 0:34:02arteries of his leg because we couldn't feel
0:34:02 > 0:34:04the pulses in his foot.
0:34:05 > 0:34:08Jitender is worried that the damaged arteries in Vincent's
0:34:08 > 0:34:11pelvis could be stopping the blood flow to his leg.
0:34:13 > 0:34:16Time is an important factor in management of any
0:34:16 > 0:34:19poly trauma patient, especially patients like Vincent who
0:34:19 > 0:34:21have multiple systems involvements.
0:34:21 > 0:34:24What we are historically told that what kills first,
0:34:24 > 0:34:27what kills second, what kills third.
0:34:27 > 0:34:30The first clinical decision was to see if we can get him
0:34:30 > 0:34:31to CT as soon as possible.
0:34:34 > 0:34:37His breathing pattern is slightly altered.
0:34:37 > 0:34:41It's just becoming slightly altered, where he's doing very deep...
0:34:41 > 0:34:43HE GROANS
0:34:43 > 0:34:47But just before they can move him, Vincent crashes.
0:34:47 > 0:34:49His blood pressure drops dangerously low.
0:34:49 > 0:34:52BEEPING
0:34:54 > 0:34:56Vincent is bleeding to death
0:34:56 > 0:34:59and the team only have minutes to try keep him alive.
0:35:04 > 0:35:06At the moment, we need to get his BP stabilised.
0:35:06 > 0:35:10Can we put the rapid infuser on to the grey canula?
0:35:10 > 0:35:12It's quite high potential,
0:35:12 > 0:35:14so we have to get him stabilised before we go anywhere.
0:35:22 > 0:35:2577-year-old Gudrun is in the midst of a stroke.
0:35:29 > 0:35:31But she's been given a groundbreaking emergency
0:35:31 > 0:35:34procedure, which doctors hope will stop
0:35:34 > 0:35:37the stroke by breaking down the blood clot in her brain.
0:35:41 > 0:35:42How are you feeling now?
0:35:44 > 0:35:45Good.
0:35:45 > 0:35:49Can I get you to lift both your arms up for me now?
0:35:50 > 0:35:52- This is all...- That's wonderful.
0:35:52 > 0:35:54Oh, look at that.
0:35:54 > 0:35:56Fantastic. Brilliant.
0:35:56 > 0:35:59And if I get you just to bring your hands back to me.
0:35:59 > 0:36:00Can you squeeze my hands?
0:36:00 > 0:36:03- Yeah, I can squeeze them. - SHE LAUGHS
0:36:06 > 0:36:07It's working.
0:36:09 > 0:36:11Oh, my word.
0:36:15 > 0:36:16You want to try and walk.
0:36:16 > 0:36:18Not yet. Not yet.
0:36:18 > 0:36:21We have to keep you on the bed for just a little bit because the drug
0:36:21 > 0:36:24we're giving...we want to make sure you have all of it first.
0:36:25 > 0:36:28But that's pretty impressive. That's brilliant. Well done.
0:36:34 > 0:36:36I'm happy.
0:36:41 > 0:36:44'The type of stroke that Gudrun's having is where
0:36:44 > 0:36:45'she is quite fluctuant.'
0:36:45 > 0:36:47And even though she's got slightly better,
0:36:47 > 0:36:50when I'm seeing her, I know that she could easily slip all the way
0:36:50 > 0:36:52back again without much warning.
0:36:52 > 0:36:56If... If she gets worse, give me a call.
0:36:56 > 0:36:57Good. Thank you.
0:36:58 > 0:37:01The way that she's fluctuating is the likely
0:37:01 > 0:37:03location of where the stroke is.
0:37:03 > 0:37:06It's likely to be in a particularly part of the brain
0:37:06 > 0:37:09where we commonly see paralysis
0:37:09 > 0:37:12of one side of the body, and people do often have these fluctuations.
0:37:12 > 0:37:15Perhaps we've dissolved the clot partially
0:37:15 > 0:37:18and there's still some clot there, or it's moved slightly downstream,
0:37:18 > 0:37:21allowing a little bit of blood flow but still causing problems.
0:37:41 > 0:37:43Motorcyclist Vincent has suffered
0:37:43 > 0:37:46a sudden catastrophic haemorrhage.
0:37:46 > 0:37:49The team still don't know exactly where his internal
0:37:49 > 0:37:50bleeding is coming from and
0:37:50 > 0:37:52they haven't been able to find a pulse in his leg.
0:37:54 > 0:37:56They are now fighting to keep him alive.
0:37:57 > 0:37:59The head of trauma medicine
0:37:59 > 0:38:01Professor Porter is called down to resus.
0:38:03 > 0:38:07As you continue to lose blood, your blood pressure falls.
0:38:07 > 0:38:12You don't deliver effectively oxygen to the vital organs,
0:38:12 > 0:38:15including the brain, so you will lose consciousness.
0:38:15 > 0:38:17Your heart can't pump effectively
0:38:17 > 0:38:20because there's no blood left in the circulation.
0:38:20 > 0:38:23Your kidneys can't make urine, and it very much
0:38:23 > 0:38:26is a short pause before that patient is going to die.
0:38:27 > 0:38:29You OK there, sir?
0:38:34 > 0:38:38Vincent did actually say, "I feel like I'm bleeding inside."
0:38:38 > 0:38:40That's something I've heard before.
0:38:40 > 0:38:43And I've also heard patients say, "I feel I'm dying."
0:38:43 > 0:38:47And again, that's quite often seen in someone who's actually
0:38:47 > 0:38:50very actively bleeding and getting progressively shocked.
0:38:50 > 0:38:54It's almost a feeling of, you know, impending death or impending doom.
0:38:55 > 0:38:58- What's GCS...? - GCS has been 15.
0:38:58 > 0:39:01The only time it went to 14 was because he had some ketamine.
0:39:05 > 0:39:09Vincent needs to be stabilised before he can be moved.
0:39:09 > 0:39:12The team begin a rapid blood transfusion to try and control
0:39:12 > 0:39:15the haemorrhage before the source of the bleeding
0:39:15 > 0:39:16can be fixed in surgery.
0:39:34 > 0:39:38The blood transfusion has improved Vincent's blood pressure,
0:39:38 > 0:39:41but Professor Porter is now worried about his breathing.
0:39:41 > 0:39:43As the patient deteriorates,
0:39:43 > 0:39:47his level of consciousness will become compromised.
0:39:47 > 0:39:50He's then at risk of obstructive his airway or,
0:39:50 > 0:39:53indeed, of potentially vomiting, and there's no protection to stop
0:39:53 > 0:39:55the vomit going in to his lungs.
0:39:55 > 0:39:58And therefore one has to do a sort of risk benefit
0:39:58 > 0:40:02analysis between continuing to managing without intubation
0:40:02 > 0:40:06or to actually intubate him and secure his airway.
0:40:07 > 0:40:09We need to get you to the ct scanner,
0:40:09 > 0:40:12- so that we can scan all your injuries that are going on. OK?- OK.
0:40:12 > 0:40:17The safest way for us to do this is we have to put you off to sleep.
0:40:34 > 0:40:37Doctors are now controlling Vincent's breathing to ensure
0:40:37 > 0:40:39he gets a steady supply of oxygen.
0:40:41 > 0:40:44The team have bought just enough time to get Vincent
0:40:44 > 0:40:46scanned and rushed into surgery.
0:41:04 > 0:41:06At the Royal London hospital,
0:41:06 > 0:41:08Helen is looking at the results of Ben's CT scan.
0:41:13 > 0:41:18He did have four consecutive vertebral fractures
0:41:18 > 0:41:19in his lower back.
0:41:19 > 0:41:25They weren't unstable, so he wasn't in danger of damaging his chord,
0:41:25 > 0:41:27but really painful.
0:41:29 > 0:41:32Ben has multiple fractures of his vertebrae, ribs and pelvis,
0:41:32 > 0:41:35and severely bruised lungs...
0:41:36 > 0:41:40..but Helen suspects there may be other hidden injuries.
0:41:40 > 0:41:41Something wasn't quite right.
0:41:41 > 0:41:44I couldn't quite believe that this could have happened
0:41:44 > 0:41:46without any damage to the head.
0:41:47 > 0:41:49I think what's crucial is that
0:41:49 > 0:41:52if something doesn't fit, you need to have the courage
0:41:52 > 0:41:57and the confidence and the back up to look into it,
0:41:57 > 0:42:00and not be rushed on to the next thing.
0:42:00 > 0:42:03If something doesn't fit, there's a reason it doesn't fit.
0:42:05 > 0:42:09I kept asking Ben whether he could remember what had happened
0:42:09 > 0:42:14because I wanted to get some idea whether he had a head injury.
0:42:14 > 0:42:15How far did you fall?
0:42:23 > 0:42:26'Falling from 20 feet onto concrete,
0:42:26 > 0:42:31if you've hit your head, you'd expect there to be some sign,
0:42:31 > 0:42:35either a bruise or some bleeding, but we couldn't see any.
0:42:37 > 0:42:42So I wasn't quite certain of the story, not certain enough to take
0:42:42 > 0:42:47the decision not to do a CT of his head, which I'm glad I did.
0:42:48 > 0:42:50HE MUMBLES
0:42:50 > 0:42:52HE COUGHS
0:43:01 > 0:43:04It's been 15 minutes since Rachel checked how Gudrun's stroke
0:43:04 > 0:43:08is responding to the thrombolysis treatment.
0:43:08 > 0:43:10You all right there, my darling?
0:43:10 > 0:43:12How are you feeling now?
0:43:19 > 0:43:23It's not your fault it's not quite working again.
0:43:23 > 0:43:25This sometimes happens.
0:43:25 > 0:43:28So...shall we have a look? Can we lift this arm again now?
0:43:28 > 0:43:30Do you think we can try?
0:43:32 > 0:43:35- So the movement's gone again, hasn't it?- Yes.
0:43:35 > 0:43:37We were starting to see fluctuations in her symptoms,
0:43:37 > 0:43:39in her stroke symptoms.
0:43:39 > 0:43:41Unfortunately, this is quite common.
0:43:41 > 0:43:42Can you squeeze my hand?
0:43:44 > 0:43:45No. OK.
0:43:45 > 0:43:47Don't worry. Don't worry.
0:43:47 > 0:43:50Yeah, it's a bit frustrating, isn't it?
0:43:51 > 0:43:52All right, my darling.
0:43:52 > 0:43:55It's got worse and then it started improving a little bit again,
0:43:55 > 0:43:56so there's a lot of fluctuation.
0:43:56 > 0:44:00There are two main reasons why a clot-busting drug may not work
0:44:00 > 0:44:03One is it does dissolve the clot, but the brain has
0:44:03 > 0:44:08already suffered enough damage that the stroke still occurs.
0:44:08 > 0:44:10The other reason is that the clot may be just too
0:44:10 > 0:44:13big for the clot-busting treatment to dissolve.
0:44:15 > 0:44:17CT are free and ready, and they're getting drugs
0:44:17 > 0:44:19ready for a CTA. I've already spoke to them.
0:44:21 > 0:44:24All right, Gudrun, we're just going to take you for a scan.
0:44:24 > 0:44:28Don decides to order a more sophisticated CTA scan,
0:44:28 > 0:44:32which combines the CT scan image with a contrast dye,
0:44:32 > 0:44:36to try and highlight the actual clot in Gudrun's brain.
0:44:37 > 0:44:40What we're looking for is are the blood vessels all filling with
0:44:40 > 0:44:45dye, apart from in one area where the blood clot is stopping the dye?
0:44:45 > 0:44:48In theory, we could have done the scan with dye at the first
0:44:48 > 0:44:51stage, but that would have probably added ten or 20 minutes to her
0:44:51 > 0:44:54scan time and we didn't want to take that long.
0:44:56 > 0:44:59If the dye can reveal the location of the clot,
0:44:59 > 0:45:03there's one last emergency surgical procedure Don can try.
0:45:03 > 0:45:06It's actually about going in and physically removing
0:45:06 > 0:45:07the clot that's causing the stroke,
0:45:07 > 0:45:10and that's done through a small cut at the top of the leg and
0:45:10 > 0:45:14feeding a catheter up to the brain to try and snag it and take it out.
0:45:15 > 0:45:18But the results are inconclusive.
0:45:18 > 0:45:20Don still can't see the clot.
0:45:22 > 0:45:27Nothing big and obvious clot-wise, even in any of small vessels.
0:45:27 > 0:45:29'There isn't a clot visible any longer,'
0:45:29 > 0:45:32which means that it's probably dissolved by the clot-busting
0:45:32 > 0:45:35treatment or it might just be too small to see.
0:45:39 > 0:45:43Nothing retrievable on the CTA, nothing you can pull out.
0:45:43 > 0:45:45Complete the lysis, as we have done,
0:45:45 > 0:45:47then she can go up to the stroke ward
0:45:47 > 0:45:49and we will continue conventional stroke care.
0:45:52 > 0:45:55There's nothing more Don can do.
0:45:55 > 0:45:57Gudrun is admitted to the stroke ward whilst
0:45:57 > 0:46:00they wait to see what kind of recovery she will make.
0:46:04 > 0:46:08- Get some rest, OK? All right.- Thank you.
0:46:08 > 0:46:10Pleasure. Pleasure.
0:46:10 > 0:46:13Just get some rest, sweetie.
0:46:22 > 0:46:23At the Royal London Hospital,
0:46:23 > 0:46:26Helen and her team are waiting for the radiologists report
0:46:26 > 0:46:28of Ben's CT scan.
0:46:36 > 0:46:40'Injuries to the brain itself, I would say, are the most'
0:46:40 > 0:46:43dangerous and they have long term consequences.
0:46:43 > 0:46:48Although they're less likely to kill you very quickly than a burst
0:46:48 > 0:46:53lung or severe haemorrhage, it's possible to live
0:46:53 > 0:47:00for a very long time, but that life may not be worth living.
0:47:00 > 0:47:03We've got some unexpected findings.
0:47:04 > 0:47:06- Here.- Look at that.
0:47:11 > 0:47:15- So they're talking about this, aren't they?- They're talking about that.
0:47:15 > 0:47:22The CT's reported showing fractures through petrus temporal bone.
0:47:26 > 0:47:30The fracture line through the base of the skull ran very close
0:47:30 > 0:47:35to one of the holes in the skull where some quite important
0:47:35 > 0:47:37blood vessels travel.
0:47:38 > 0:47:41Ben has fractured his skull.
0:47:41 > 0:47:44The question now is whether this has caused any damage
0:47:44 > 0:47:46to the nerves in his brain.
0:47:46 > 0:47:48Yeah. Yeah, exactly.
0:47:53 > 0:47:56Have you looked in his left ear?
0:48:02 > 0:48:05Ben, can you hear me?
0:48:05 > 0:48:07We've got the results of the scan back.
0:48:07 > 0:48:15They think you might have a fracture of your skull, just down here.
0:48:15 > 0:48:17Is it sore when I touch there?
0:48:20 > 0:48:23- Yeah.- There. It is painful.- Yeah.
0:48:25 > 0:48:26OK. We won't push too hard then.
0:48:26 > 0:48:29I think we're going to have to look in your ear.
0:48:32 > 0:48:36- Since the accident?- Yeah.- OK.
0:48:36 > 0:48:39'It started to ring alarm bells for me'
0:48:39 > 0:48:44because it could indicate that there was damage
0:48:44 > 0:48:46to one of the nerves leading to the brain
0:48:46 > 0:48:48that's responsible for hearing.
0:48:48 > 0:48:53And there are other nerves that supply our other senses -
0:48:53 > 0:48:56sight, smell and taste.
0:48:56 > 0:48:59Can you screw your eyes up tightly for me?
0:48:59 > 0:49:00Stop me opening them.
0:49:00 > 0:49:03Good. Does anything smell funny?
0:49:05 > 0:49:07No, I don't think so.
0:49:07 > 0:49:09- We've given you water, haven't we? - A little bit.
0:49:09 > 0:49:13Did it...? I know this sounds like a really stupid question,
0:49:13 > 0:49:14but did it taste like water?
0:49:15 > 0:49:18- It didn't have any funny...- I didn't notice any...
0:49:18 > 0:49:19Not weird. OK, good.
0:49:21 > 0:49:25I'm just going to have a quick look in your ear.
0:49:29 > 0:49:31Don't move your head.
0:49:31 > 0:49:35I just want to make sure there was no blood behind your eardrum.
0:49:37 > 0:49:39No, that's fine.
0:49:42 > 0:49:48The hearing may not be great because nerves that supply your ear,
0:49:48 > 0:49:52help you to hear, are running near to where this fracture is.
0:49:52 > 0:49:56It explains why your hearing is a bit disturbed.
0:49:56 > 0:49:58It doesn't mean it's always going to be.
0:50:01 > 0:50:03It's unclear what long-term effects
0:50:03 > 0:50:06the damage to Ben's head will have on his hearing.
0:50:21 > 0:50:25After a CT scan has revealed multiple fractures,
0:50:25 > 0:50:29Vincent is about to undergo surgery to fix the bleed in his pelvis.
0:50:31 > 0:50:36An injured patient lying on a trolley with drips going in.
0:50:37 > 0:50:40The smell of the road and the smell of blood...
0:50:40 > 0:50:43it's never very...
0:50:43 > 0:50:47It's never a very uplifting scenario.
0:50:47 > 0:50:50Your heart goes out to the poor chap who's injured
0:50:50 > 0:50:52because they're in for a hard time.
0:50:57 > 0:51:00OK. Right, there you go.
0:51:06 > 0:51:10Right. Could we have the fence, please?
0:51:12 > 0:51:14'You always know, in a trauma situation,
0:51:14 > 0:51:18'that your access to the vessels is going to be more difficult.'
0:51:18 > 0:51:20It's like going into a dark room...
0:51:20 > 0:51:22and you can get nasty surprises.
0:51:24 > 0:51:27Malcolm is exploring the blood vessels in Vincent's abdomen
0:51:27 > 0:51:31to find the precise location of the bleed in his pelvis.
0:51:31 > 0:51:34We need more room down below, don't we?
0:51:34 > 0:51:39'You've got to rapidly find a bit of normal vessel you can recognise,'
0:51:39 > 0:51:43and then go along the vessel and find the point of injury.
0:51:43 > 0:51:46Can I have a long clamp and a tie?
0:51:48 > 0:51:49That's fine.
0:51:51 > 0:51:55HE MUMBLES
0:51:58 > 0:52:01Oh, there it is. There it is. Got it.
0:52:01 > 0:52:03Whey!
0:52:06 > 0:52:09Malcolm's found the source of Vincent's bleeding.
0:52:09 > 0:52:13We've got a vein hole, which I'm trying to define so I can repair it.
0:52:13 > 0:52:17It is controlled. There is some ongoing bleeding from internal iliac,
0:52:17 > 0:52:20which is not so bad.
0:52:22 > 0:52:24Actually, give me the scissors again for a minute.
0:52:24 > 0:52:27I just want to try and get this fluff off and define that hole.
0:52:28 > 0:52:30For the first time since his accident,
0:52:30 > 0:52:33Vincent's internal bleeding is finally under control.
0:52:36 > 0:52:39Malcolm must now see if anything can be done about Vincent's leg,
0:52:39 > 0:52:42which has been without a pulse for over four hours.
0:52:46 > 0:52:51I'm going open his groin and get some blood flow back to the leg.
0:52:51 > 0:52:52Forceps, please.
0:52:52 > 0:52:57He starts to explore the main artery that supplies blood to the leg.
0:52:57 > 0:53:00HE MUMBLES
0:53:00 > 0:53:02But he quickly makes a discovery.
0:53:04 > 0:53:05What have we got there?
0:53:08 > 0:53:12We found unexpectedly severe arterial disease.
0:53:13 > 0:53:17Vincent's artery is blocked by fatty deposits.
0:53:27 > 0:53:29'When you have an accident'
0:53:29 > 0:53:32and have a severe blunt injury to an artery,
0:53:32 > 0:53:37a young elastic injury will just recoil and survive,
0:53:37 > 0:53:38and nothing much will happen.
0:53:38 > 0:53:41But if you've got arterial disease,
0:53:41 > 0:53:43then the arterial lining is detachable.
0:53:47 > 0:53:51We found that the internal lining of the artery had come
0:53:51 > 0:53:56adrift and so it had caused blockage down towards the groin.
0:53:57 > 0:53:59The impact of Vincent's crash
0:53:59 > 0:54:02on his arteries has dislodged the fatty material.
0:54:03 > 0:54:06Flush, please. I think we've got it
0:54:10 > 0:54:14We had to take out the dissected fatty material from the
0:54:14 > 0:54:18inside of the artery to make sure we had flow going down to the leg.
0:54:25 > 0:54:28The leg's flowing again now, we think.
0:54:30 > 0:54:32Ooh!
0:54:38 > 0:54:40The leg's flowing now.
0:54:40 > 0:54:44It may not be flowing that well, but there's a pulse in his artery anyway.
0:54:47 > 0:54:50Time will tell if Vincent's leg will survive being starved of blood
0:54:50 > 0:54:52and oxygen for so long.
0:55:15 > 0:55:19SHE SPEAKS GERMAN
0:55:20 > 0:55:23At the moment I'm not cured.
0:55:23 > 0:55:27I still have a lot of problems, physically.
0:55:27 > 0:55:34My left side, my arm and my leg are lame and...
0:55:34 > 0:55:36they don't work.
0:55:36 > 0:55:41But all the other parts of my body are still normal.
0:55:45 > 0:55:49Gudrun will recover by effectively relearning how to do
0:55:49 > 0:55:52the tasks that that part of the brain used to do.
0:55:52 > 0:55:54So the damaged tissue has gone,
0:55:54 > 0:55:57but that doesn't mean your recovery can't continue.
0:55:58 > 0:56:02Inside I'm still the person I was.
0:56:02 > 0:56:08Life is really a gift and you have to be careful with it.
0:56:08 > 0:56:10Life is still worth living.
0:56:25 > 0:56:28The muscles had swollen up and gone rock hard,
0:56:28 > 0:56:31and it was obvious that the muscles had gone beyond
0:56:31 > 0:56:32the point of no return.
0:56:35 > 0:56:38You have to take some difficult decisions.
0:56:40 > 0:56:43Saving life comes first. Saving limb comes second.
0:56:47 > 0:56:51Things had deteriorated much more rapidly than I'd expected.
0:56:51 > 0:56:55We thought we were going as fast as we could, but it wasn't fast enough.
0:57:19 > 0:57:21To have fallen from that height
0:57:21 > 0:57:23and not to have sustained life-changing injuries
0:57:23 > 0:57:27was...almost not possible.
0:57:29 > 0:57:33The scariest bit being told about my ear, actually.
0:57:33 > 0:57:37That it was... The deafness in my ear was permanent fixture.
0:57:39 > 0:57:45He did have some potentially nasty injuries that some people wouldn't
0:57:45 > 0:57:47have been able to cope with as well as he has.
0:57:47 > 0:57:50I mean, the fact he's back in a harness swinging out of trees
0:57:50 > 0:57:52is pretty remarkable, really.
0:58:02 > 0:58:06Being deaf in one ear compared to being wheelchair bound or
0:58:06 > 0:58:08having brain damage is...
0:58:08 > 0:58:11I think I got off pretty lightly.
0:58:13 > 0:58:15You can find out more about trauma
0:58:15 > 0:58:18and emergency care with The Open University's free booklet.