Episode 1 Children's Emergency Rescue

From Headquarters just outside Barnsley, in South Yorkshire,

a dedicated team of doctors and nurses fights

to keep some of Britain's sickest children alive

long enough to reach the specialist care they desperately need.

If a child needs a life-saving operation...

Down to ten, please.

..or a premature baby has to be moved to a neonatal unit,

it's the Embrace team's job to provide intensive care

in the back of a moving ambulance,

plane or helicopter.

We've got a really precious patient here.

He was just recently put on the transplant list.

It's all happened very quickly, really.

As the NHS concentrates specialist care

for babies and children in fewer and bigger hospitals...

Mick! Will you pull over, mate?

..some of the UK's most vulnerable patients will need

to undertake longer journeys to get expert care.

BABY GARGLES

You can hear him bubbling there.

The big worry is that saliva will spill into his lungs

and that's the most worrying thing for the journey.

I love you, baby.

24 hours a day, every day,

Embrace is on standby,

tiny lives in its hands.

'Hello, Embrace. How can I help?'

Good Evening, Embrace Transport Service. Stacey speaking.

How can I help?

The Embrace Transport Service for Yorkshire

moves critically ill children aged zero to 16,

but the majority are less than 28 days old.

'We've got a patient on Ward 12 of the LGI

'who's just gone onto the heart transplant list.

'At any point, it may be that we're calling on you

'to do an urgent transfer of him down to Great Ormond Street.'

At 14 years, Chance is a more unusual Embrace patient.

He has a rare condition which has badly damaged his heart.

It's feared that, without a transplant, he has weeks to live.

His heart had swollen so much, it wasn't beating.

It was really just shuddering in his chest, really, it wasn't pumping.

They did say, "We have to tell you that your son could die

"if he doesn't get a transplant."

Doctors at Leeds General Infirmary have contacted Embrace

with the news that a donor heart has become available.

But if Chance is to have this life-saving operation,

surgeons need him to be at a specialist hospital 200 miles away

within a five-hour window.

And they need the Embrace team to get him there.

'Just within the last half hour,

'I had a phone call from Great Ormond Street,

'from the transplant coordinator to say that, hopefully,'

a heart has become available for Chance.

Um... There's a very small window

in which you've got to get things moving and get things in motion.

It's 11.20 at night

and the Embrace team heads to Leeds General Infirmary

to meet up with Consultant Dr Hazel Talbot,

who's come straight from home.

-Hello!

-Hello, Hazel.

Hello! I didn't know who was coming.

'The worry for me...well,

'for everybody involved in Chance's care, was that'

he was on the super-urgent list for a heart transplant

and you don't go on the super-urgent list

unless you really need a heart transplant.

For Chance, that was his opportunity,

that was his one opportunity, this is the final point for him -

he needed a new heart.

I think we're hoping that we're going to fly down.

What's your time window that you're looking at, Karen?

So the earlier we can get him to you, the better.

The clock is ticking, so Embrace is drafting in an RAF helicopter,

but it means subjecting a sick teenager,

who's scarcely left his hospital bed in weeks,

to a long flight in a noisy military aircraft.

-'Hello.

-Hi, this is Tim phoning from the RAF Rescue Centre at Kinloss.

'They can be at Leeds Bradford for a pick-up at 0100.'

I woke Chance up, I said, "Chance," I said, "Come on, son."

And he says, "No, no, no, go back home, Dad.

"No, no, I'm going back to sleep."

I says, "No, Chance, come on." I say, "Trust me, son."

I said, "I always ask you to trust me, just trust me."

If there isn't enough room for you both to travel,

they'll send a car up for one of you.

Well, they'll organise a car locally

that will bring you down on blue lights.

-Tomorrow?

-Now.

'We did need to go and Mum and Dad remained

'really quite calm in the circumstances.'

And I think they projected that for Chance as well to make him feel

as comfortable as possible.

Have the doctors ever let you listen to your heart before?

-No.

-Do you want to listen?

Just stick those in your ears.

You want a hand?

-You got them in?

-May be a bit low, Chance.

-OK, can you hear that?

It's going bloop-too, bloop-too...

-Do you hear that, Chance?

-That's your heart...

beating away.

'Chance was the same weight as my own son.

'For me, that was quite nice,

'because I could really feel a connection.'

There's no pain in your tummy or anything?

'Just typical teenager, just wanted me to go away.'

I told you I talked a lot.

Just sit up this end and then just slide your feet round

and you'll have to tuck them under, can you manage to do that, Chance?

MACHINE BEEPS

Don't worry, that's just a noisy noise.

It's now 12.30am and the transplant team in London needs Chance

ready for his operation by four o'clock.

That's it, just shuffle your bottom to the middle now, sweetheart.

There you go.

It's up to the Embrace team

to not only get him there in time for the transplant,

but to ensure that his condition remains stable until then.

-Well done.

-Right, now, do you want to sit up a bit more?

BEEPING INTENSIFIES

You're all right, are you?

Don't worry, that's cos we've not got any monitoring going on it at the moment.

The plan is to meet the RAF at Leeds Bradford at one o'clock,

so we're going to have to get a move on.

Chance is very nervous about flying,

so his mum will travel in the helicopter with him.

Bye-bye, Chance.

'I sat down on the bed where he was laying.'

Everything just hit me.

To know that my son is going down to Great Ormond Street,

but then I think to myself,

"Am I going to see my son again?"

SIREN WAILS

'When they went, it was nothing but worries for me.'

I...I couldn't stop shaking.

It's unusual for the Embrace ambulance drivers

to use lights and sirens,

but Chance can't miss this flight from Leeds Bradford Airport.

Mind the bump!

It's fine. Please just let us in.

We've got a really precious patient here.

It's 1.15 in the morning.

Chance has just two hours and 45 minutes

to get to the heart waiting for him in London.

-We'll get the trolley wheeled up to the aircraft.

-Yeah.

-We'll head first towards the aircraft.

-Yeah.

And we'll probably lift him on, purely because if we winch him

we're likely to damage some of that kit.

You all right, sweetheart? It's pretty cold in there, OK,

so I'll wrap you up like a Christmas dinner!

And have you got some ear defender for Chance, cos he's very anxious?

The reason that Chance was going, was because he needed a heart that could pump harder.

Chance, you OK? Want to hold my hand?

AIR TRAFFIC CONTROL COMMUNICATION

If he was going to get anxious and his heart rate was going to

increase, that would put quite a strain on his heart.

If his heart had stopped during the transfer,

that's quite a tricky situation to be in, because the reason

he was being transferred was because his heart wasn't strong enough.

The only way we could get over that would be to have a heart transplant

and that was the reason for the transfer.

Chance has been relatively relaxed as you can be.

There's a text message from his dad.

I won't read it out, it's very, very sweet.

I was texting his mum and saying, "how is he? How is he? How is he?"

Tell him I love him and tell him just to be strong

and not to worry about nothing, he's in good hands.

I never thought about anything in terms of the transport, that he would die,

because she was a doctor. The other two were nurses.

After an hour and a quarter in the air, the Embrace team

is on its final approach to London's Regent's Park, Great Ormond Street's landing site.

Everyone involved in coordinating this transfer is aware

of the seriousness of his condition

but it's also vital to try to keep Chance feeling positive.

It was a very different environment for us to work in.

Even just talking to each other was quite difficult.

I think somebody must have given the RAF a heads up about me,

because my microphone didn't work

so I could hardly talk during the whole of the flight.

Which I think Anne and Jenny found amusing.

That looks good there, now.

Keep your cover back up, Chance, OK?

-You all right? Not too cold?

-No.

-What time did you need to be here by, four?

-Four-ish, yeah, what time is it? Just after three.

-3.10am.

-We'll give it a go.

You've been really good, haven't you?

Embrace has worked closely with the hospital transplant team

to ensure that Chance safely completes the final two-and-a-half miles of his life-changing journey.

SIRENS

I got a phone call about 1.30am asking me to go to Regents Park.

And then we go on to collecting the surgical team and taking them to the hospital.

It's just before 4.00am.

Chance has made it in time for his transplant.

He did say to me, "Mum, I don't want another person's heart."

But he said, "I know I need one, don't I?" I said, "Yes you do."

So he did know.

He knew he wouldn't be leaving hospital without it.

We just really had to worry about his comfort and his care.

We just had to make sure he was comfortable

and didn't get too anxious. And he coped with that very well.

He had a little bit of sleep during that. It was very quiet.

I think he's really tired now, he's probably very anxious.

It's six-and-a-half hours

since Chance left the Leeds General Infirmary in the Embrace ambulance.

Now, after a flight on an RAF Sea King helicopter,

he's lying in the operating theatre,

where surgeons are giving him a new heart.

I'm just wondering how big this baby is.

I'm wondering if she should just take this?

What makes Embrace different from the other patient transport services in England

is that it moves any critically ill child aged 16 or under,

including new-borns.

Hello, it's Hazel here, one of the Embrace Consultants.

Dr Hazel joined when it was first set up nearly four years ago.

When a call comes in from a hospital, she decides

if the patient needs to be moved to a specialist centre.

And if the child or baby is very sick, she will do the transfer herself.

You very quickly get used to the skill

of assessing someone over the telephone,

using another pair of eyes.

Right, Tracey, who's going on this job?

Is it Jamie and, um...Mick?

Yeah, it will be Jamie and Mick.

You get quite used to trying to work out what kind of equipment you might need,

who your team members are going to be, what's the safest way to do it.

70% of Embrace's patients are what doctors called neonates -

babies less than 28 days old.

And today staff at Scarborough Hospital have contacted Embrace

about a baby born just four hours ago who urgently needs surgery.

Right, so we need to come and collect your baby.

I'm not quite sure how we'll be getting to you.

But it's likely that we might fly up and fly him down to Hull.

It's a two-hour drive to Scarborough, so to save time,

Hazel drafts in The Children's Air Ambulance, a new helicopter charity

which serves the whole of England.

We're going to Scarborough, it's one of our furthest-away hospitals

and we're going to take the baby a was born at 5 o'clock this morning

who has oesophageal atresia.

Which means that his oesophagus,

that's your food pipe, isn't connected to his stomach,

which means his secretions that he'd like to swallow build up

and they spill over into the lungs and cause breathing problems.

Ta-da! Where's the wing mirror so I can check what I look like.

All right, pre-flight checks, please.

You've got a little message above your head that says, "Get well soon."

-OK, ladies, I shouldn't be any more than 20 minutes.

-Great.

A consultant is needed whenever the consultant decides the patient is sick enough.

So if we can predict that a patient is going to be really sick, then we'll go out.

Baby Gabor is just four hours old.

His parents are Hungarian, Mum doesn't speak much English

and Dad has had to go back to work straight after the birth.

When I first met baby Gabor's mum, she looked so frail and tired.

She'd just delivered a baby.

I could see the tears in her eyes.

And I thought, "Oh, you poor, poor lady."

And as soon as the midwives are happy with you,

then you can come to Hull too, not a problem.

But we'll take him in the helicopter to Hull

where they can have a look at him.

All right? I'm going to examine him now.

It's a very big stethoscope for a teeny baby, isn't it?

So, that was a nice glob.

I'm sure there's a technical term for a glob of mucus.

I'm just going to move you, Mum.

'The team in Scarborough had realised that there was a problem

'and that they needed to put the repogle tube in

'which is a tube that you can put into the pouch

'where the saliva builds up

'and you can suck that out and you can rinse that out as well.

'So, putting that in is a really positive step.'

Is Dad coming?

-Dad's gone to work.

-Dad's gone to work? Right.

You can hear him bubbling there.

GURGLING CRY

All right, poppet.

This is a potentially fatal condition.

Gabor urgently needs surgery

so he can swallow his own saliva instead of choking on it.

All right. I know.

OK. If you just put that down...

OK, sweetie pie. I know.

You're all bubbly, aren't you?

-Or do you want him up...? That's a bit better.

-Yes.

Oh, sweetheart.

HE CRIES

That is the secretions stuck in his throat,

so they're building up because he can't swallow them.

You'd be amazed how important being able to swallow your secretions is.

I know. I'm so sorry that we have to take him, but it's really important.

Always check in, yeah? Any time.

I will try and ring you to tell you that we have arrived.

The big worry for Gabor is that

his spit, his saliva,

will spill into his lungs.

'I had to just think, I'll just be as simple as I can

'and I'll just do the best that I can,'

but I'm not sure I'm going to be able to make her feel any better.

I love you, baby.

'You have to be able to understand what they're going through...

SHE SOBS

'..but our number-one priority is moving the child or a baby.

'You can't let your emotions interfere with that process.'

Just before take off, Baby Gabor starts choking again.

-Sats are 88 now. I'm not happy for you to start.

-OK.

If you wouldn't mind not starting?

Do you want to suction his mouth?

'When you're actually in the helicopter,

'you can't move around very much. You have to constantly watch them.

'You can't just ask the pilot to stop

'so that you can have a good look at the patient.

'So, there is that difference, you have to make sure

'that everything is tiptop before you get in.'

It's vital that Hazel keeps Gabor's windpipe clear,

otherwise he could suffocate.

During the flight, we did a few flushes

and he was just up and down a little bit.

Every now and again, it just gets blocked up.

Babies don't tell you, "I don't really feel very well.

"My tummy's upset and I've got some pain in my tummy."

They have no way of communicating with you, so it's about monitoring

the babies and treating them gently and watching them.

Unlike Scarborough, Hull Royal Infirmary

has a level-three neonatal intensive care unit.

That means the most critically-ill babies can be cared for here.

Some neonatal surgery can also be carried out at this hospital,

although more complex cases will be sent to Leeds or Sheffield,

60 miles away.

His heart looks a little bit globular, but good femorals,

no murmur. I think he'll need an echo.

Mr Fleet was a bit concerned he might be a little bit more complicated.

-GURGLING CRY

-Oh, hello!

-OK, sweet boy.

-Got him?

-Yep.

Have you got some suction handy? I just want to suction his mouth out.

Yep, got it.

Baby Gabor needs surgery straightaway

to connect his oesophagus to his stomach.

Sometimes they can't do it in one operation.

It depends how big the gap is

between the two ends of the oesophagus.

If the gap's too big, they can't stretch it to join,

so they will need further surgery.

The theatres are ready, the surgeons have been,

the anaesthetist has been,

bloods have been taken, so we're ready to go.

Every year, this NHS-funded mobile intensive care team

transports over 2,000 sick babies and children

to specialist centres in their adapted ambulances.

Critical care consultant Steve Hancock helped set the service up and now runs it.

From the outside, they look like a normal 999 ambulance.

But inside, they're a mobile intensive care unit

for premature babies and critically-ill children.

It's the medical air that's so important

because newborn babies are actually quite vulnerable to having

too much oxygen and if you give too much oxygen to a premature baby,

you can damage their eyes and their lungs.

As specialist paediatric services are concentrated in fewer hospitals,

these young patients are facing longer, more frequent journeys.

If we need to move a child to Newcastle or to London

or to Glasgow, then we can do that, and because this is our job,

this is what we do, it means that all the other doctors and nurses

in the referral unit or the receiving unit

can carry on looking after the other patients while we do the transfer.

That, I think, is a real benefit.

And the children arrive in better condition

than if it was a non-specialist team.

Long day, too.

We're planning on a transfer of a child

that Vikram and I transferred a few days ago...

The majority of the hundreds of road trips

Embrace makes every year are within Yorkshire.

But today a specialist team is driving 120 miles

from Barnsley to Newcastle

to collect a child who lives near Sheffield

but has become ill while on a family holiday.

Nine-year-old Katerina is in remission from leukaemia,

but a seizure she had on the first night of her trip

to the North-East indicates her cancer could be back.

They'd been concerned that the scan she had in Newcastle was abnormal,

but I think their overriding concern was whether or not

she'd had a recurrence of the leukaemia, which was why

it was paramount to get her back to Sheffield,

to the team that knew her best.

Doctors at the Childhood Cancer Centre

at Sheffield Children's Hospital have been treating Katerina

since she was first diagnosed nearly a year ago.

The family is now facing the possibility

that Katerina may never recover.

My hand started shaking and I thought, "That's not right."

Then it started doing that. Then my head started shaking.

I just knew immediately what was happening.

Called my brother-in-law

and my sister-in-law to call for an ambulance

and it just went really quickly from there.

Who's this?

Have you got names? You must have names!

I've got that many teddies, I haven't given him a name.

They're all lovely, aren't they? Can I have a look?

You obviously treat all children the same, but I think

some of them just make you smile that bit more.

All right. Well, if you hang on just a little bit

and then Kirsty will come back and sort this...

fluids out for you and then we'll get you onto the trolley, all right?

Over the last ten months of serious illness,

Katerina has had much to endure.

Tired and hungry, she now faces a long journey ahead.

-KATERINA SOBS

-I've had enough medicine now.

-It's awful.

-All right.

-I don't want to have this.

SHE SOBS

Listen, they're not starving you.

Listen... Sshhhh.

-Katerina...

-Darling, we just don't want you to be sick in the ambulance

-and feel poorly.

-I'm not going to be sick.

OK. But what we're going to do, we're going to carry them

and then you can suck on a sweetie...

'You feel really cruel and mean, denying them something

'that's going to keep them comfortable

'and they may not appreciate the reason for us doing that.

'Obviously, she's in the back of an ambulance'

which was going to be quite hot, she's travelling backwards

and we didn't know how well she was going to cope with that

and what we didn't want to do

was to make her feel worse during the transfer.

It's obviously quite a long journey from Newcastle down to Sheffield.

It's a gruelling three-hour trip

from Newcastle to the Children's Hospital in Sheffield

and it doesn't help that, for once, the country is experiencing

a summer heat wave. Temperatures are pushing 25 degrees Celsius.

Do you want to press the climate...? No, green one. Green one.

Yeah, you want that one as well. That's the one. That's it.

So, we won't be able to talk for a very much, I'm afraid.

It's a bit noisy in the ambulance.

But you'll be able to see each other and have a little chat.

She might actually sleep.

'I don't think it was a comfortable day for anybody in the ambulance.

'It was a particularly hot day and unfortunately, there's not a lot of ventilation

'in the back of an ambulance, so it does get quite hot

'and it's obviously quite a long journey.'

They took us aside and they did talk about the possibility of leukaemia

returning in the brain.

We had to go back to Sheffield immediately for more tests

and more recent scans

and that's where the Embrace team came to take us and save us.

It won't be long till we get there, pet.

KATERINA SOBS

We will give them to her before she gets there.

She can have them beforehand. Just a little bit longer,

and then we'll give them to you, all right, Katerina?

We will. We promise.

'We didn't tell her at the time that she may have leukaemia.

'She didn't ask.'

It just wasn't fair, we were starving her,

but she's all right now.

She's had a good sleep, actually.

'It must be difficult for all of them in their own ways,

'but I think it was lovely that the family were obviously a very close-knit family

'and very supportive of each other and they had'

a lovely relationship between all of them which was really lovely to see.

Close in, sweetheart. That's it. Excellent.

Over the next few days, the family is going to need all its strength.

Doctors are about to carry out a series of tests that will reveal

whether Katerina's cancer has returned.

At Great Ormond Street Hospital in London,

just ten hours after being flown in by the Embrace team

on an RAF helicopter, 14-year-old Chance has had

his heart transplant operation.

I think it went really well. We received the organ in good time

and critically, it was a good size match between the donor

and the recipient, so the new heart fits

very well into the chest. Then, once we managed to wean him

off the bypass machine, the new heart actually

took over very, very quickly and it had a very good blood pressure

to it, which is suggestive of its health

and I think it was as good as it could be.

I have a sister and she came to stay with me.

Lots of deep breaths, telling yourself to keep calm, calm down.

In a way, you just think, "Well...

"look what I'm going through, but I'm not going through

"what my son's going through."

That was the only way I could deal with it, really.

If Chance can deal with this, then I can.

I just came to the hospital after the operation and...

I see Lisa and her sister Deborah sat down there, beside my son.

I thought, "Is that my son on that table?"

It's something you can't describe, that pain, the feeling,

you know what I mean?

The first 30 days after a heart transplant are the riskiest.

Chance spends the next three weeks in Great Ormond Street

being closely monitored for any indication

that his body may be rejecting his new heart.

You just hope that the heart that he's got is going to settle

and is going to be OK with him.

Is he going to accept this heart?

Is he going to reject it?

Is it going to be OK?

To see my little boy pull through

and to the family who's giving him this heart,

it's the greatest gift they've ever given to my son

because they've given my son back to me and that's the best.

The worst bit was kind of like...

..the first part after the operation.

Now things are getting better and I go home soon.

When a critically ill child or baby in Yorkshire

needs to be moved to a specialist hospital,

the call comes in here to Embrace headquarters near Barnsley.

Good morning, it's Rebecca at Embrace.

-I'm good, thanks, how are you?

-Fine, thank you.

-Good.

What are you like bed-wise today?

One Intensive and six Special. Yeah, that's great.

All the ambulances are checked every day before we go out.

We are like coiled springs should an emergency occur.

It's like origami for the bewildered!

All 40 doctors and nurses here

are trained in critical care paediatric and neonatal patients.

My name's Ann Jackson,

I'm one of the senior transport nurses here at Embrace.

Most of my nursing career has been with paediatrics,

and prior to coming to Embrace I worked on IC

at Sheffield's Children's Hospital for about 17 years.

We are just putting Embrace 2 in there to restock it

cos it's back and is better.

When you've just got one child to look after

you can give them absolutely 100%.

They cope remarkably well with illnesses,

much better than we do as adults.

Oh, look at this. It's just like packing to go on holiday now.

Right...

How fast can we do this, then, Clive?

But there will be no time for Ann and the team to do the housekeeping,

as a call comes in from Barnsley Hospital.

Doctors there are very concerned

about a two-day-old baby who's having seizures.

In a child this young, frequent fits can indicate brain damage.

MAN. 'He kept on having these frequent episodes,

'like every half an hour or so he had an episode of this

'although the heart rate remained stable.'

This is a little baby boy that was born two days ago at Barnsley,

who's been having some problems with seizures, fits.

He's deteriorated from a respiratory point of view,

so he's ended up on a ventilator.

Nurse Ann and her colleague Ann Kelly,

who is an advanced nurse practitioner, will take the baby

to one of the biggest neonatal units in the North,

at the Jessop Wing Hospital in Sheffield.

Barnsley have done some investigations

and are waiting for results, but Jessops need to do further

investigations and ongoing management.

So we're going down to Barnsley and make sure he's stable

and then transfer him across.

Barnsley Hospital is a ten-minute drive from Embrace,

and the Jessop Wing Hospital is only 15 miles down the motorway.

But moving a baby can take several hours.

We are very keen on safety,

so we have an attitude of it takes as long as it takes.

-Did they say what fluids he was on in terms of mils per kilo?

-No.

We want to move these children as swiftly as we can,

but if it takes an hour or six hours, then that's what it takes,

because they don't want to move them until they are absolutely ready.

So...unplugged.

Brakes off. Happy at your side?

Since he was born, 48 hours ago, baby Jackson has had several fits

which have caused him to stop breathing.

He's also holding his thumbs in an unusual way.

It's very well tucked in, that thumb, isn't it?

Is it tucked in on the other side as well?

The concern with baby Jackson was that there was

some degree of brain damage somewhere,

either caused by the birth process or infection

or some undiagnosed neurological condition that needed investigating.

Because certainly some of the symptoms he was displaying,

particularly with his tucked-in thumbs, it's a very abnormal sign.

Oooh!

I like the Batman look. He's been under the lights, hasn't he?

Taking your temperature, sweetie pie.

As the team swaps baby Jackson from the hospital breathing machine,

or ventilator, onto the Embrace ventilator, there's a crisis.

RAPID BEEPING

Heart rate is 78.

-Yeah, I think this tube is out. Have you got his mask?

-OK.

Maybe Jackson isn't getting any air at all into his lungs.

He's coughed at the breathing tube that connects him to the ventilator.

You've got to keep one step ahead with the little ones

because anything can happen at any time.

Are you happy with the ambi bag?

The adrenaline and your heart rate goes up and you think,

"Oh, gosh," but it's controlled. It's scary, but it's controlled,

because you've got everything there you need to deal with it.

Back to 98. Heart rate's fine at 158.

His tube had come out,

but we managed to control his breathing just by bagging him

by hand until we got the equipment ready to put another tube down.

The numbers and everything are fine

and the situation is under control, but we've asked for

some assistance now because we need to put a new tube down.

He's fine. It just delays us a little bit longer,

but he's OK and that's all that matters.

The doctor on the neonatal unit puts another tube

down Jackson's windpipe and now he's almost ready to move.

Just have a quick word with Mum and tell her what happening,

because she's sat out there wondering why the door is closed.

When we're working with babies or children,

time goes very quickly for us, particularly when there is a lot to do,

but for parents that clock ticks very slowly.

For baby Jackson they've been called in from home,

so they were very stressed when they arrived on the unit anyway.

And as a parent - and I'm sure I'd be the same -

if the door is closed, I think you always assume

that there's something wrong, something seriously wrong.

So what he's done is he's coughed his tube out.

He'll get his bottom slapped. It's not a problem, right?

We've just popped another tube back down.

He's giving me his wild look. He's got one eye open and one eye shut.

Finally, after three-and-a-half hours,

they are ready to take Jackson to the Jessop Wing hospital in Sheffield.

One, two, three.

Come on, then.

In you go.

Good lad.

We'll turn your head, mister, and then we'll get this door shut.

Once the Embrace medics are on the road,

they operate as a mobile Intensive Care Unit,

but with a fraction of the resources of the hospital.

Thank you very much.

-I don't think we've left too much of a mess, have we?

-No, it's fine.

Thank you. Cheers, bye.

Only one patient has died en route

since the service was set up nearly four years ago.

Ann Jackson remembers it well.

It's horrible. It's horrible, because it's not what should happen.

I think with that particular child we knew the risks were high.

The family knew the risks were high.

But it was the baby's only chance of surviving, so it was with

the family's consent, in fact their wishes, that we moved the baby.

It doesn't make it any easier when you lose them.

We cried with the parents.

And I'm not ashamed to say that

because I think that makes them really realise that you do care.

That is not just another baby.

But you have to be careful

because they're the ones that have lost the baby. It's their child.

We are the transport team.

So it's getting that balance between sympathising, holding,

saying the right things, but then drawing back a little bit

and recognising their grief.

But it affects the team hugely.

Ray, hi, it's Ann. We've arrived at Jessop's.

Thankfully, like most of the specialist team's patients,

baby Jackson has had an uneventful journey.

Right, this is Jackson. Mum and Dad are on the way.

We've told them he's been moved because of his abnormal murmurs.

I don't think they really understand

the significance at the moment.

Dad picked up on his thumbs being tucked in and said,

"Is that normal?" and we said it wasn't

and that's partly why he needs further investigation.

But he's their first child.

So they are on their way across.

As the transport team hands over to staff on the hospital's

neonatal unit, baby Jackson's parents still don't really know

how sick their child might really be.

In you go. Good lad.

Doctors will carry out more tests,

hoping they can at least rule out permanent brain damage.

Saturations are rising. Good lad.

Baby Gabor's parents are Hungarian and speak little English.

Just hours after he was born, their baby had to be whisked away

for an urgent operation to connect his oesophagus to his stomach.

I love you, baby...

They arrived here at Hull Royal Infirmary just as their new baby

was coming out of the operating theatre.

The operation involved opening the chest, finding this blind,

and...his oesophagus

and finding the connection between the oesophagus and the trachea.

Tied that what we call fistula to prevent any further air

going into the stomach and then bringing those two ends together,

to do continuity, and allow the baby to be fed in future.

Everything went all right. We haven't had any surprises.

Gabor, I would say,

is lucky that he doesn't have any other abnormalities so far detected.

And he is growing and we do hope that in future

he will not have any further problem.

MOTHER SPEAKS HUNGARIAN

-TRANSLATOR.

-I was very anxious on the journey to hospital,

and when we arrived there we saw the little one was unwell.

But I was also pleased because there he was in front of me.

The operation had been successful.

The doctors told us right away

everything that had happened,

what could happen

and what to expect throughout the following couple of days.

Finally, after two weeks in hospital, Gabor's happy

and relieved parents can take their first-born home.

It was difficult.

I was a bit afraid whether I could look after him

because I had to get to know the baby.

There really was just two of us and there was no-one else.

There was no doctor to ask if I didn't know something.

She said everywhere is good, but the best at home.

Every year, the Embrace teams make over 2,000 journeys moving

critically ill babies and children to and from hospitals in Yorkshire.

You should maybe have led the way.

In the biggest centres, like Leeds General Infirmary,

even experienced Embrace nurses like Suzanne can lose their way.

It took me a little while to get used to the hospital,

but now, after three years, you do get used to it.

This is a new unit, though, so it's the first time I've been here.

Hello!

I'm going to take you over in the ambulance.

Is this your nice blanket?

Kyreece is six years old.

He was starved of oxygen at birth and suffered brain damage.

'When he was born, he had a flappy larynx,'

which is too much skin over the windpipe.

And he just got quite poorly after that operation

and he ended up losing his eyesight and most of his mobility.

The nurse is just going to tell me a nice long story

and then we'll come and get you over.

-OK?

-Yeah.

-Yeah?

You're a clever boy.

A week ago, Kyreece developed an infection and almost died.

He was quite swollen from his neck upwards and he was quite grey

and there was just no breath there.

I rang the ambulance and they said I had to give him CPR.

And as he kind of... not woke up, but came round,

he went straight into a fit.

And things went quite downhill from there and he ended up

on life support.

Over the next few days

Kyreece recovered from the infection and now he's well enough to be

moved to Martin House, a children's hospice 15 miles outside Leeds.

Ohhh... There's a nice bed.

This is a different bed for you, Kyreece.

'I don't have any children of my own but I enjoy the company of children.

'I do have nieces and a nephew that I spend a lot of time with,'

so that's helped as well, so I know what children of Kyreece's age

are like and what's interesting to them.

Are you going in the big special car?

Mum will see you in a minute. 30 minutes, OK?

-Yeah.

-Love you.

He should be all right. As long as he's got them, he should be fine.

If he likes music, we might sing to him.

-Yeah, he...

-Does he like songs?

-He does.

-He likes Happy Birthday and Jingle Bells.

-All right.

-They're his favourites at the moment.

-We'll try them if we need them.

-If he starts getting cross just don't sing owt.

-Just leave him be.

And he likes it if you tell him what different animal noises do.

-Oh, that's a good one.

-All right.

She was really quite reluctant to leave him

and it's obvious that he is the apple of her eye,

that her whole life revolves around him.

And I can understand why. He's a very charming boy.

She has dedicated her life to Kyreece.

And it came across in the way they interacted

and it was just beautiful to see them as a family unit.

ELECTRONIC VOICE

-Are you pressing the buttons?

-Yes.

-Yes?

-MUM.

-You're scared because they are

with someone they've never met before.

-Are you OK?

-Yes.

Yes. Oh, that's a good boy.

You've got to have that faith.

You have to have that belief of he will be OK

and I'm not far behind him.

Kyreece had been very unwell, so he could become unwell again quickly,

so it's better to have the specialist team involved.

KYREECE CRIES

Ohhh...

Are you OK, Kyreece?

We carry a full Intensive Care in the back of the ambulance.

If we have a clinical incident and the patient needs some kind

of intervention or treatment, we have to stop and pull over.

She promised she'd call if there was a problem, and my phone didn't ring

and I'm sure if there was a problem she would have called me.

It's sunny. Can you feel the sun?

Yes, it's beautiful.

That's us.

We'll probably get round OK.

I think it's really important that Kyreece has the same

quality of life that any of us can expect.

To do that we have to make sure that he doesn't become hospitalised

or institutionalised.

And places like Martin House are so important

to just make things as normal as possible for Kyreece.

Are we getting any more of your smiles?

-Yeah.

-Yes?

-Have you got lots of big smiles for us at Martin House?

-Yes!

-Yes!

Excellent.

You've been so good, haven't you?

Ready? Wheeee!

Well done!

-Is it a nice hotel?

-That was a big smile.

I think that helps, don't you?

-MUM.

-Kyreece is happy now, being there.

When we first started going, it was a new place to him

and it was the people, and in Martin House there is a lot of people.

Go on the swings? You like the swings, don't you? Yeah?

They are like family to you.

Nothing is too much and they are happy and they are just

so understanding, and that's what you need, somebody who understands.

Whooo!

After his sudden and life-threatening illness,

Kyreece is starting to build up strength again.

His mum is confident that in a few weeks' time

he'll be well enough to go back to school.

That's good, innit?

Do you like it?

Do you like it?

Back at Embrace headquarters near Barnsley,

and the search is on to find a spare cot for baby Jackson, who is

being treated on the specialist neonatal unit in Sheffield.

I just wondered if there's been any changes

and whether or not we could send Jackson to you.

After six. Right, OK.

I'll pass that on to our coordinator and we'll see what they can do.

At two days old, Jackson was having unexplained fits

and breathing problems, so Embrace moved him

from Barnsley Hospital to the Jessop Wing Hospital.

Jackson was also showing signs that he might have brain damage,

particularly the way he held his thumbs.

He didn't move.

He was quite lifeless and his thumbs were just tucked in.

That was the main thing we noticed, really. And he just...

We were asking if it was normal and none of them could give us

an answer straightaway, but we noticed quite soon.

Tests revealed that although, thankfully, he didn't have serious

lasting neurological problems, baby Jackson did have meningitis.

Fortunately it was a strain that could be treated

with an intensive course of antibiotics.

That word, meningitis, you think the worst straightaway.

But they reassured us that it wasn't

as bad with younger babies as it would be with a toddler.

-DAD:

-Every day we were going to Jessop's

and he was on these antibiotics for two weeks

and for the first few days he would pick up

and then after about three or four days, he started...

His hands started moving, didn't they? We were like,

"Oh, look, his hands are moving!" He started coming on, didn't he?

After two weeks, baby Jackson is well enough for the Embrace team

to move him back to Barnsley Hospital.

He looks quite chilled out, doesn't he?

He's wriggling a little bit, but he looks all right.

I had to make sure it doesn't upset my monitor, because

if he kicks around a bit, it upsets my monitor and I don't like that.

In the local hospital it's easier for Mum and Dad to visit

and it also frees up a cot on the neonatal unit

in Sheffield for a baby who is more acutely ill.

From Barnsley.

After three more weeks on the ward,

Mum and Dad are finally able to bring Jackson home.

He's watching! What are you watching?

He's quite a funny, cheeky little baby.

He laughs a lot he's always got to be awake and one eye open.

JACKSON CRIES

Oh, dear!

Oh, no. He likes attention all the time.

You've got to give him attention.

But, yeah, he's a little monkey, isn't he? Cheeky.

It's good to have him home, yeah. He's boss of the house.

Yeah, it's nice to have him home

and it's nice to be the parents,

-isn't it?

-Yeah.

Doing things for him and looking after him.

We had to have fertility medication to get pregnant,

so we feel quite lucky that we've managed to...

We've gone through it all, but he's come out.

-We didn't think we'd have any, did we?

-No.

We never thought we'd be able to have any.

We've come through it quite hard, but we are grateful for him now.

Meanwhile, at Sheffield Children's Hospital,

another Embrace patient, nine-year-old Katarina,

is about to find out if her leukaemia has returned.

She's been treated at this cancer unit

since she was diagnosed in August 2012.

When I was first diagnosed, Mum and Dad sat me down and said,

"Do you know all those other little girls on the ward with no hair?"

He said, "You're going to lose your hair." I said "Why?"

And he said, "Because you've got ALL." I said, "what's that?"

He said, "That's Acute Lympho...blastic Leukemia."

-MUM:

-From the day she was diagnosed, she has changed...a lot.

Sometimes you to forget what they used to look like.

I'll never feel what she felt.

I'll probably never experience what she has experienced...

..but it gets me to appreciate more

that she's here and fighting and alive.

-You're pulling stupid faces now.

-No, I'm not.

She wasn't responding to treatment.

She had some new drugs which she has responded to,

but then had complications with infection in the sinus and brain.

And it took her a long time to recover from that.

Subsequently, in February this year she was fit for a transplant

and received an unrelated transplant.

Katerina had her bone marrow transplant in February,

and until last week she'd been in remission for five months.

Then, on the first day of a family holiday in the North-East,

she had a seizure, triggering fears that her leukaemia had come back.

The Embrace team was mobilised and brought her to Sheffield

from Newcastle, so the doctors who knew her best could carry out tests.

It...

It feels like you're dying,

cos you struggle to breathe and you're like...

SHE GASPS FOR BREATH

I think what most parents who've been through this would probably say

is that after a while it does actually become normal.

You don't think that when it starts off.

You think, "How on earth am I going to cope with this?"

But actually, after a while, it becomes your way of life.

So I've just had a word with the pathologist

who looked at the biopsy that she had last Wednesday with a microscope,

and that was the final result we were waiting for.

And the good news is that they see no traces of either leukaemia

or infection in the brain.

What that means is that the fit that Katerina had a week ago

were due to the high level of tacrolimus

that they had documented in Newcastle.

And with now reducing the dose

and keeping her at the lower level,

she shouldn't be at risk of having more fits.

Fantastic. Thank you very much.

The result on the brain, what they had to take for a biopsy,

it's all negative.

It's all good. We could go home tonight.

No.

SHE GIGGLES

-Why not?

-Now that I've been in a hospital, I like it here.

I like it. I don't want to go home.

It has a playroom and keeps you occupied.

Whenever you finish work, I'll give you a shout to come and pick us up.

Are you all right with all that?

OK. All right, then. See you later. Love you, bye.

We're going home!

SHE LAUGHS

We constantly check her, that she's OK,

but seeing her, what she has gone through, you've just got to say

to yourself to keep going, because you've got to keep going.

She is strong, and seeing her smile after all...

..the hurdles just keeps me going.

But Katerina's reprieve was not to last.

Although she'd managed to beat the leukaemia,

her immune system had been badly damaged.

A few weeks after we finished filming,

another infection spread through her body.

On November 30, 2013,

Katerina died in Sheffield Children's Hospital

with her family around her.

At Leeds General Infirmary, 14-year-old Chance is about to visit

the nurses who kept him alive before his heart transplant.

The last time he was here,

Chance was setting off on a life-changing journey

to Great Ormond Street Hospital,

with Embrace consultant Hazel and her team.

The Embrace team was so good.

The way they went about it, it was fantastic.

But I just wanted that night to be over so quick.

Dozens of people have been involved in Chance's remarkable recovery,

but staff at the children's heart unit in Leeds looked after him

for five months.

-Hello, nice to see you.

-Nice to see you. Hello, sweetheart.

-Are you feeling good?

-Yeah.

-Looking fab.

-I know, he looks brill.

-He's doing really well.

-Glad to have him home?

-Oh, absolutely. Absolutely.

-How long were you in altogether?

About five...

It's rare for Embrace medics to see their patients again,

but Dr Hazel, who was key in getting Chance

to his heart transplant in time, happens to be in the building.

She takes the opportunity to check up on her former patient.

Hello, Chance, do you remember me?

Can you remember my name? I don't expect you to. It's Hazel.

Wow, you look amazing.

Wow.

You look like you've grown a bit as well,

but I've never seen you standing up properly either.

-He has grown a bit, yeah.

-Have you got a big appetite?

-Yeah.

-It was very scary, but...

-Did you feel quite frightened?

-Well, not the actual journey.

-The journey was good.

-That's what I like to hear.

-Yeah.

-Were you quite scared? It's all right to be afraid.

-Yeah.

-Yeah.

What was the worst thing about the journey for you?

-Was it the thought of getting there, or was it...?

-Yeah.

It just seemed to be so quick, do you know what I mean?

One minute he's there, the next minute he's got the heart and...

I think we are going to have to unblock the corridor

and I'm going to have to get on my way. It's really nice to see you.

-Thank you very much.

-And I hope you never have to use Embrace ever again.

LAUGHTER

-Thank you.

-Thank you.

-It's all right, you're done, don't worry.

-Thank you, bye.

-See you, bye-bye.

Bye.