Episode 2 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...

Statin 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 need to stop, please.

-Will you pull over, mate?

She's tiny. And then to actually end up over there for surgery now.

Is this the end for her? Is she going to pull through?

As the NHS concentrates specialist care for babies and children

in fewer and bigger hospitals...

I know, I know.

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

to undertake longer journeys to get expert care.

-Where's she going?

-They'll put her to sleep and hopefully fix her.

Sorry, Jake.

You are in so much distress. I just wanted somebody to help him.

I love you, baby.

SHE SOBS

24 hours a day, every day,

Embrace is on standby, tiny lives in its hands.

'Hello, Embrace. How can I help?'

Embrace Transport Service, Stacey speaking, how can I help?

What I'll do is I'll just take some details, Donna, if that's OK.

Every year, 3,500 calls come into

the Infant and Paediatric Transport Service Headquarters near Barnsley,

with requests to carry sick babies and children from local hospitals

to the specialist care they desperately need.

'Hello, Mandy speaking, how can I help?'

'Hi, I'm calling from Hull Royal Infirmary.'

-'Hello.'

-'And I'm calling regarding transfer of a baby.'

'Right. So, what's the problem at the moment? Is it a cardiac?'

-'Cardiac problem.'

-'You've got a cardiac problem. Right, OK.'

Baby Julia has almost died four times in the last week

because the oxygen levels in her blood dropped so low.

She has Down's syndrome, and like many children with this condition,

was also born with a defective heart.

Julia's parent are Polish.

-TRANSLATION:

-When I was pregnant,

we were aware of the fact that she was very unwell.

But we didn't realise that her condition was so serious,

that such a situation could happen.

So we were simply preparing ourselves for the worst.

Julia needs surgery, and the nearest children's heart unit to Hull

is 60 miles away in Leeds.

But there's been an unexpected development at the Leeds unit.

'Surgery at a children's heart unit in Leeds is suspended,

'because of concerns that the death rate is twice the national average.'

'Some parents, as we've just been hearing,

'and surgeons and clinicians based here, are absolutely devastated

'by last night's surprise news.'

The sudden closure of the surgical unit means Julia,

and all other heart patients like her,

will now have to be moved outside Yorkshire,

potentially doubling the amount of time each critically ill child

spends on the road.

One of the extra Embrace teams drafted in to cover the longer

journeys has arrived at Hull Royal Infirmary to collect Julia.

-Ooh! That's a bit abrupt.

-Exactly.

Nurse Jamie is an experienced critical care nurse

and Dr Sunny is a trainee specialist.

What I'm planning on doing is putting a small tube down

through her mouth, to basically help with her breathing.

So we're going to put her on a machine to take over the work of her breathing for her.

Julia's mum and dad moved to Hull from Poland

with their two older children four years ago.

Do you have any questions at the moment?

No. My husband speak English...

NURSE JAMIE: 'We want to tell parents as much as we can.

'We want them to know what we're doing, we want them to know why we're doing it,

'we want them to know the risks of us transferring their baby.'

'It's very hard and having been on the opposite side of it recently,

'where my little boy had to go to hospital in Spain,

'I understand how hard it is for the parents as well,

'not knowing what the staff are talking about'

whilst they're discussing your child.

As preparations are made to move Julia onto the trolley that will

take her to the specialist care she needs, something goes wrong.

The oxygen level in her blood is plummeting.

It should be 90% but it's now down to 40.

The saturation probe is OK and it's tracing OK.

Yup. We're on the same meds as we were on over here.

We're on less morphine than we were over there...

Nurse Jamie is checking there's nothing they've overlooked. There's no obvious cause.

'She wasn't responding to anything that we were doing and her oxygen levels weren't coming up.'

That's the IV fluids but I've not started them yet.

'It was quite a tense time, actually, on the ward when she became so sick,

'and it happened so suddenly.'

Apart from a cardiac problem, which we couldn't fix there and then,

there were no other explanation for why she did what she did.

Hi, Fatima, how are you?

Um, we were just about getting ready to move with this patient

but she just, about ten minutes ago,

started dropping her saturations.

Dr Sunny's now so concerned that she's getting advice

from a consultant at Embrace headquarters.

Julia's oxygen levels are still falling.

Now 28%.

On the bag in 15 litres of oxygen, she sounded like she had quite a lot of secretion,

so we've suctioned quite a bit off her chest,

which hasn't helped the situation.

If this continues, she will die.

Her brain is being starved of oxygen.

'On the inside, I was actually panicking.'

Yeah, equal air entry.

'But on the outside, you have to remain professional.'

OK, her sats are dropping, like, quite significantly.

If your saturations are that low for a prolonged period, you're going to arrest.

Right, so we've gone up on the background, we've given her a morphine bolus.

Um, we're going to give her a ten mil of fluid bolus

and I'm going to give her 0.1 milligrams per kilo of propranolol IV over ten minutes.

Julia is given a cocktail of drugs.

Her knees are raised to help her ailing heart.

To everyone's relief, the oxygen levels in her blood slowly

climb out of the danger zone. For now, at least.

-That's better.

-Yes!

Hello. Just an update. Saturations are now 95%.

Yes!

-TRANSLATION:

-'We actually talked about the fact that we needed to prepare ourselves

'for the worst. The situation was so critical.'

We just didn't think Julia would recover.

Thank you very much. Are you coming down to the ambulance with us

-to see us load up or...?

-No, we go car.

-You're going in the car. OK.

-Thank you very much.

-Thank you.

-Thank you.

-See you later. Thank you.

-Thank you very much.

If we'd not got the saturations up, eventually, she would've passed away.

The Embrace ambulance is a mobile intensive care unit.

But Nurse Jamie and Dr Sunny are still worried that Julia will have

another life-threatening episode before they reach the specialist hospital.

And, to make things worse, today the journey will be twice as long as usual.

Because Yorkshire's only children's heart unit is closed to surgical

patients, the Embrace team is taking Julia to another specialist centre.

It's 120 miles away, in Leicester.

'It was a long journey. We knew that we were going to be travelling

'for at least two to two and a half hours.

'And you know that she has a potential to do

'the same in the back of an ambulance,'

where you don't have the support of lots of people around you,

and, again, it's just yourself and a nurse and the driver with you.

'I've had some very difficult transfers while I've been at Embrace

'but she was very sick, and...

'..both myself and Sunny were concerned'

that we wouldn't make it to Glenfield Hospital.

For two hours, baby Julia's survival depends on Nurse Jamie

and Dr Sunny alone, with only the relatively limited resources

available in the back of an ambulance.

It's rare for a baby to lose the fight for life in the Embrace ambulance.

Only one patient has died en-route since the service was set up nearly four years ago.

Working in an intensive care environment,

eventually, you're going to have a patient pass away

that you're looking after.

I've lost a number of patients whilst working on the wards.

Thankfully, I've not lost any while I've been here at Embrace

but...but it does happen. And it's something that's...

It's never easy to cope with. Erm...

But as long as you know that you've done everything

you possibly could for the baby,

done everything you can for the family...

..then you can cope with it a lot better.

Against the odds, Julia makes it safely to the hospital

for the specialist care she needs.

Hello, Louise, it's Sunny. Just to let you know we've arrived at Leicester.

OK, thank you. Bye-bye.

After two hours on the road, Julia now has to have more tests.

'The first thing we're going to do is repeat the echocardiogram,

'which is the scan of the heart.

'So the cardiologists are on their way to do the scan now.'

So, in the next 15, 20 minutes, we will know what is the status of bloodflow into the lungs.

Julia has a complex heart condition.

Instead of having two valves connecting her heart and lungs,

she only has one. Her heart also has a hole in it.

I was very concerned for Julia, actually.

Even when we'd left her, I was concerned for parents

and I was a little worried about how she'd progress.

It's now nearly 11 pm.

If Julia needs an operation straightaway,

surgeons will work through the night to repair her heart.

PHONE RINGS

Good morning, Sheila speaking, how can I help?

'Oh, hello, it's Lucy Hind from the paediatric registrars in Barnsley.'

Embrace moves critically ill children in hospital

to specialist centres, so they can get the expert treatment they need.

OK, lovely.

We do have another transfer but it's completely up to you whether you want to do it.

The majority of their tiny patients are less than 28 days old.

I just wanted to speak about transferring a baby from special care

to NSU at the Children's Hopsital, please.

Today, a call has come in from Barnsley Hospital

about one-day-old baby Jake.

Jake has stopped breathing several times since he was born

and he can't feed.

Doctors suspect he needs urgent surgery.

An Embrace mobile intensive care unit is on its way,

to move him from Barnsley to a specialist centre in Sheffield,

15 miles away.

Hi, it's only me. So we've just set off...

Before joining Embrace, Nurse Jamie specialised in the critical care

of babies under 28 days old, or as medics call them, neonates.

Cheers, mate. See you later. Bye.

'I love working with the sickest babies, looking after the children'

who are really in need, and helping support the families.

It's likely that Jake has a rare

and potentially life-threatening condition called choanal atresia.

When the nurses here have tried to pass feeding tube down through the nostril,

it's come against some resistance. They've not been able to pass it.

Now, that generally indicates that there's a blockage at the back of the nostrils.

Infants are nasal breathers.

They don't use their mouths to breathe very much,

so...they need a clear nasal airway.

If it's bilateral and both nostrils are blocked,

it can be potentially life-threatening.

You are going to be loved...

Jake's mum has spent a harrowing first night with her newborn son.

'They were literally climbing up walls because he couldn't feed.

'That's, like, my main thing, not being able to feed him,'

either bottle or breastfeeding, cos that's your main bit

where you bond with your baby, when you feed them.

I'll go get our incubator in and just have a little bit of a desat now.

It isn't just feeding that's a problem.

Every so often, Jake's tongue falls to the back of his throat

and blocks his airway.

When that happens, nurses have seconds to save him.

JAKE CRIES

That's OK. Sorry, sorry!

Now you know his airway's open!

'That were probably the most heartbreaking thing.

'He were in so much distress and he was cross as well, like.'

We will take good care of him.

I just wanted somebody to help him, you know what I mean?

We were concerned about his airway because of the noises he was making.

While Jake's nose is blocked up with bone and tissue,

Jamie knows there's a risk he may stop breathing again,

and that could lead to brain damage or even death.

With this little one, because his airway's compromised, yeah,

it's a little bit more tense.

'If he had closed off his airway in any way,

'he would have suffocated.'

Erm, so, he's got IV fluids running,

because he's obviously not being fed.

He's got some little ear defenders on to keep his ears safe

while he's in the ambulance, cos it can get quite noisy.

When you're a new mum all you want to do is be with your baby

and obviously I couldn't be transported with him either

because I'd had C-sections.

Right, let's go, are you coming down with us? You're welcome to, if you...

Just gutting that I weren't able to be with him.

Obviously, because he were so distressed and everything.

See you later, thank you very much.

Dad is really feeling the pressure.

Very straight-talking guy.

Told us what he felt, told us how he were feeling.

We knew he was a bit on edge.

I think when people are used to being in control of their lives,

to have a baby with choanal atresia like Jake,

you'd feel completely lost.

It's only 15 miles to Sheffield from Barnsley,

but the team knows Jake's condition could deteriorate at any moment.

And it's not long till their fears are realised.

Jake's airway is blocked again.

Going to have to get Mick to pull over.

Mick, will you pull over, mate?

I'm thinking, "He's stopped breathing, he's stopped breathing."

Stopping on the hard shoulder of the motorway

is something Embrace only does in a life-and-death situation.

For us to safely give him some oxygen,

we need the ambulance to come to a complete stop.

You're fine there, you're fine there.

The oxygen saturation in Jake's bloodstream - his sats -

has dropped.

His tiny brain is being starved of oxygen.

We want to stop the ambulance as soon as it is safely possible.

Had we been somewhere safer to stop, I might have asked a bit quicker.

We were looking at the monitor, and we were looking at the baby

and we'd seen a clear dip in saturations

and a clear colour change in the patient.

There was definitely an occlusion of his airway.

He'd occluded his own airway by moving his head down.

We've had a little look at him. He's pink.

He doesn't seem to be having any problems at the moment, visually,

but the monitor is telling us

that his saturations are lower than we anticipated.

I've just re-sited his oxygen sats probe

and just giving him a little bit of oxygen.

He's going to be all right now.

Saturations are 94.

It's a moment of relief for Jamie and Dr Al.

Anything over 90 is a good saturation level.

The extra oxygen seems to have done the trick.

Jake's out of danger - for now.

Everything looks perfect again. He's fast asleep.

I panicked. It's just one of them things.

I had to sit back and watch it, you know what I mean?

You can't get involved.

I just let them get on with their job

and he were back to normal in no time.

-Hello, it's Embrace.

-Come through.

-Thank you.

The Jessop Wing Hospital

is one of the biggest neo-natal units in the North of England.

Specialists here will be able to confirm if Jake actually has

choanal atresia and if he needs surgery to unblock his nose.

I don't think he's very happy about me handling him right now.

However, I'm afraid needs must occasionally.

The ENT specialist uses an endoscope to look at the back of Jake's nose.

It were awful, because I didn't want to see him in that state.

Still not getting any progress there.

But then again, I also couldn't leave him.

Sorry, Jake.

Babies are little bit different to us

in as much as they are what's known as obligate nasal breathers.

They don't really breathe very well through their mouth

they prefer breathing through their nose.

So when there's a blockage of the back of the nose,

they get a bit stressed and they don't breathe very well

because they keep being forced to breathe through their mouth

because there's no airway through the nose.

Part of what is supposed to happen in the womb is

the back of the nose opens out so air can get in the front

and go down the back and down into the lungs.

But it's not happened in Jake's case.

It looks like the back is still closed up.

Our plan is, if my suspicions are right,

we will need to do an operation on him to try to open it up

and get him breathing through his nose again.

If he can breathe through his nose,

he'll be much happier feeding as well. That will be the plan.

-Is that OK? It all seems fairly logical?

-Yeah, yeah.

OK, that's the plan for now.

He went down for an X-ray on his nose and that confirmed it all.

They knew what it were then.

I think they knew before he'd had that X-ray what were wrong with him.

But that were just to confirm and they could see then

whether it were membrane or bone that they were actually dealing with.

In the next few days,

surgeons will try to clear the bone and membrane blocking Jake's nose.

Soon after that,

his mum and dad hope he'll be able to have his first proper feed.

but his outlook is still uncertain.

The last blast of winter has hit Yorkshire

and the effects of the cold weather

increase the Embrace medics' workload

as they transfer sick children and babies to specialist hospitals.

Chest infections

and conditions like meningitis are all more common in winter.

Premature babies -

those born at least three weeks before they were due -

are among the most vulnerable patients

the Embrace medics have to keep alive.

They can weigh as little as half a kilo.

The teams move 600 of these tiny babies each year,

whatever the weather.

We've got a baby... we've got a circuit. We're ready.

Today a call has come in from the Neo-natal Unit in Bradford

about a baby who was born 16 weeks early

and now has a life-threatening swelling in her bowel.

She urgently needs to be assessed by surgeons at Leeds General Infirmary.

Current weight is 1.944 kilograms. She's seven weeks old.

Baby Mia also has chronic lung disease and a bleed on the brain.

She's spent the first seven weeks of her life

in neo-natal intensive care.

The doctors have been to see us

and said, you know, a 50-50 chance that she could survive,

and she'd obviously have a lot of problems and they were going through

all the problems she could have and disabilities and things like that.

Even at seven weeks, nothing was for certain.

Mia's health and everything hadn't really moved forward in that

period of time.

So it was still the fight that we were both having

that she was still in intensive care.

These babies really have a rocky road

and we always tell the parents on the neo-natal units that you are going to

be here for a while and you're going to have quite a difficult journey.

Dr Mark is a specialist trainee

who's working for Embrace for six months.

This tummy really is quite big, actually.

It's probably compressing on her chest quite a bit.

And she's full of fluid. OK, sausage.

-I think we should increase morphine now.

-I'm sorry, I'm sorry.

Baby Mia is in a lot of pain.

We've just increased her morphine dose

which should increase her comfort.

We're going to give some muscle relaxant.

That should also mean that she'll be much more comfortable.

It made me feel guilty, thinking, why have I given birth so early?

So a lot of it was guilt

and then I think, I wish I could take her pain away.

But it's awful, you just don't know, you feel really bad.

Especially to see her in that much pain and things like that.

But no...

The bowel is a lot bigger than we would expect.

It's filled with a lot more gas.

That could mean that there is an obstruction at some point

or the bowel is sick and it's not functioning properly.

It's not squeezing along like it should do normally.

Doctors suspect that Mia may have

a bowel infection called necrotising enterocolitis or NEC,

but this needs to confirmed by specialists in Leeds.

Horrible, horrible condition.

If not treated quickly, it can get much worse and result

in the death of the bowel and possibly the death of the patient.

If she's asleep, she'll flicker her eyelids,

but normally she opens her eyes.

She had her eyes wide open for ages.

It was the fear of,

"Is this the end for her, is she going to pull through?"

She's tiny, so she's gone through all of this

and then to actually end up over there for surgery now,

you're on tenterhooks because you're hoping it's the best thing for her.

Hi, there, it's Mark, just letting you know we just left Bradford.

Right, speak to you soon. Bye.

Mia's parents are having an incredibly difficult time.

They're in the middle of moving house

and their 3-year-old son Ethan is also unwell.

It's horrible. I never want to go through it again in my life.

I think you must block it out. I think I did. I think I was scared.

You make jokes and things, don't you, when you're feeling scared

and things like that?

-Stress from all angles?

-You're telling me.

I think I'll be grey by the end of the year.

Mia was very settled throughout the journey.

She didn't require us to make any interventions en route.

Her observations were continually stable.

She's got a number of problems

including chronic lung disease for which she is ventilator dependent.

She's been very well sedated,

she is just starting to come round a little bit from the sedation now.

We've had an ongoing problem, really,

with not tolerating her feeds with intermittent abdominal distension.

She's never actually got to full feed.

We are obviously very worried about Mia

and about her abdomen in particular.

Our colleagues in Bradford can do most of the things we do here.

But what we've got here is our surgeons.

Over the next few hours, we'll get Mia seen by one of our surgeons.

I'll see her again with the neo-natal and medical team

and combine together with the team that we use to look after

babies that may have surgical problems.

The surgeon, he came up

and he had obviously seen a lot of the x-rays from what

they'd sent over from Bradford

and that's when he said she would be going to surgery first thing in the morning,

he needed to see what is going inside basically.

Mia's parents now face another agonising 24 hours.

Tomorrow morning, their tiny baby, who weighs just 2 kilos,

will have major surgery on her bowel.

At the Children's Heart Unit in Leicester,

baby Julia is still waiting to have an operation.

She was brought here from Hull by the Embrace team ten days ago,

because it was thought she needed emergency surgery.

She couldn't go to the Heart Unit in Leeds

as it wasn't accepting surgical patients

while an investigation was being carried out into mortality rates.

She is very stable on the medical treatment she is on at the moment.

But that can change very quickly.

Julia's mum is staying with her in hospital,

but her dad is 120 miles away at home in Hull

looking after her two brothers.

Dad, are you still with us?

Julia still desperately needs an operation

to repair her damaged heart.

There are ten specialist centres in England where this could be done,

although, in 2012,

a government review recommended this should be reduced to seven.

Under these plans,

both Leeds and Leicester would stop doing heart operations -

a decision being fiercely opposed by campaigners.

If they did close,

long journeys for patients like Julia would be the norm.

11 days ago,

children's heart surgery was temporarily suspended in Leeds.

Now, though, the unit has been given a reprieve.

TV: 'Heart surgery on children

'will resume at Leeds General Infirmary tomorrow

'after it was suspended over concerns about higher than usual death rates.

'Operations were stopped last month

'while investigations were carried out.

'That decision was criticised by some

'who said the figures the concerns were based on were incomplete.

'NHS England has said it will continue to explore the issues

'raised about the unit.'

Despite the fact that Leeds has re-opened,

doctors decide to go ahead with Julia's operation in Leicester.

They think it's too risky for her to make another hundred mile journey.

TRANSLATION: Because we had already spent one month in Leicester,

it was a period during which she recovered

and was being prepared for the surgery and that took quite a while.

I thought she was feeling safe there

and I was happy with the way the doctors were looking after Julia.

I thought the medical attention she was getting was the best.

Julia has a complex heart condition,

which means the surgery is intricate and takes several hours.

She's got two conditions combined, which we see sometimes.

One of which is called Tetralogy of Fallot,

and the other one is called complete AVSD,

so what that means is that the middle of the heart didn't form properly

and there's a big hole where it should be,

and it also means that the lung artery is narrow,

so what they are doing at the moment is patching that defect,

constructing two valves in the middle of the heart

where there's currently one,

and enlarging the way out for blood to go to the arteries,

to the lungs, so she can be pink again.

At the moment what you can see is the hole in the middle of the heart,

the complete AVSD.

Mr Lotto's feeling underneath the valve

to see where he's going to put his stitches.

Without the surgery, her life would be very limited

because the amount of blood flowing around the lungs is not really enough

and the heart would be damaged by the amount of blood

flowing across the hole in the heart, so for her,

this kind of surgery is her only chance of a relatively normal life.

The complex operation is a success,

but the next few days are critical.

For the next steps, she will stay here overnight to make sure

that everything is really OK.

HE TRANSLATES INTO POLISH

This is a safe place for her to be now.

The first post-operative period is very encouraging.

She's just been extubated,

which means that now

she's breathing on her own,

she is fully awake, so that is a good first step.

The important thing, you need to see how the heart beats

and how the left-side valve that we created works,

which is the major question mark that we have about the outcome.

I haven't got the crystal ball, so we don't know yet.

We need to follow her, Julia, up.

120 miles away from Leicester,

in Hull, it's four months since Julia's heart operation.

Two weeks after surgeons repaired the hole in her heart,

she was allowed to go home.

TRANSLATION: She's a very cheerful and polite child.

She sleeps throughout the night.

She likes playing and she plays with us a lot

because we live far away from my parents.

She likes to attract everyone's attention and she's a bit bossy.

Like mama.

-TRANSLATION:

-Just like her mum.

Everything's OK. We really love her

and we're really happy the whole story ended the way it did.

Meanwhile, in Sheffield at the Children's Hospital,

another Embrace patient is waiting to have major surgery.

Baby Jake is having difficulty breathing

because his nose is blocked with bone and tissue.

They're going to basically use a telescope to look through his mouth,

so they can see the back of his nose,

and then they're going to make an opening in the back of his nose

so that he's able to breathe through it.

I'm Neil, the ENT consultant.

Jake will be in the operating theatre for just over an hour.

Good. Shall we send? Fantastic.

JAKE CRIES

Aw!

What we're going to do today is unblock the back of Jake's nose

with a combination of some dilators and a drill, just to remove

some of the bone that's blocking the back of the nose there.

I just couldn't wait for the day they operated on him,

because it were awful, you know, having to see him

struggle to breathe and watching his chest go up and down.

It were awful, really.

It were kind of relief that he were going into the theatre

and getting it sorted, really.

-See you shortly.

-See you later, bye.

-See you later.

We will put the endoscope into his mouth and look back

at the back of his nose, and then pass our instruments down

through his nose to widen the passages at the back there.

And then at the end of the operation

I'm going to put a couple of soft plastic tubes into his nose

which are going to sit there for a few weeks or so

to allow him a breathing passage

and allow everything to heal up, hopefully without closing up again.

This is a perilously delicate operation.

We are very close to the base of the skull

and we are very close to the base of the brain and the brainstem.

That's at the top of where we are operating.

At the side of where we're operating there are lots of big veins.

If we go too far to the side,

we run in the problem of getting troublesome bleeding.

And obviously we don't want to go too far up and damage the base

of his skull because that would lead to very significant problems.

One baby in 10,000 is born with the condition choanal atresia.

Good, so now we've got everything in position,

I can see the back of the nose.

Have you got a damp cloth there?

Instead of nice holes there, we've got some membrane covering them.

So what I'm going to do first up

is pass a little dilator through the nose...

..to just perforate that.

There we go. The dilator is just coming through there now

and I can see just by feeling it

that it's mostly membrane causing that.

We'll do a little bit more when we are...

when we've done a bit of drilling.

So now you can see I've established some airways there

and I'm just going to use my little drill

just to widen those a little bit.

I'm just going to start to drill away some of that bone.

DRILL BUZZES

Perfect. That's great.

We're going to put our stents in,

our splints in just to keep things open.

So I've put the splints in here

and we can see them just sitting in the back

and I'm now going to just secure them in place

and make a little airway...

..for Jake to breathe through.

He's now got some tubes in there which should enable him to breathe.

The operation went really fantastically well.

I'm very pleased with the way it went.

But while the stents are in his nose,

Jake will still have difficulty feeding.

It could be many weeks before he has his first proper bottle.

35 miles away, at Leeds General Infirmary,

two months after a major operation,

baby Mia is just starting to breath on her own.

-OK, sausage.

-I'll just increase that morphine now.

The Embrace team brought Mia to Leeds from Bradford Royal Infirmary

when her stomach became dangerously swollen.

Thanks a lot, cheers. See you later.

So how is Mia today? How's she doing?

She seems to be doing really well this morning.

Mia had suffered a chronic infection

and a specialist surgeon had to remove a section of her bowel.

You don't know if she's going to survive the surgery,

so you're panicking about all that,

and then when he came up and he said, you know, it went really well,

and obviously this is what he'd found

and the bowel had been perforated

and he had to remove, was it 10cm?

-10cm, I think he said.

-..of basically dead bowel.

Mia has a temporary colostomy bag so that her bowel can recover.

But the surgeon now wants to join her intestines up again.

Food that she eats obviously

comes out through these,

drops into the bag from there, such as you would, pooing as normally.

That's all just her bowel, so that will be all reconnected,

and then everything will work as normal.

Mia was born 16 weeks prematurely

and as well as her bowel problems,

she is also being treated for lung disease and a bleed on her brain.

Are you ready for surgery?

Are you? Are you?

-When she gets home.

-What's he doing?

Mia's mum and dad want her older brother Ethan to stay with her

right up until she goes into the operating theatre.

'He's understanding as best a three-year-old can

'what we're doing and why we are in hospital, not him thinking'

"Why is Mummy and Daddy not with me? What's happening to me?

"Why am I with Grandma again?" And stuff like that.

So he was always a part of it

and we always tried to explain to him what you can.

-ETHAN:

-Where's she going?

She's got to go to surgery, where they will put her to sleep

and hopefully fix her.

I'm a bit apprehensive, scared

cos obviously she's going into surgery, you know, things can happen

'but also happy that she's getting it done.

'She's a step closer to going home.'

This is a critical time for Mia.

Surgeons are not sure if her bowel is ready to be reconnected, but

she's had the colostomy bag for over two months and it's started leaking.

They just had to do it because I think it was making her worse,

so they reconnected her up, hoping for the best.

If this delicate operation isn't successful,

then on top of her other medical conditions,

Mia may also have to use a colostomy bag for the rest of her life.

At Embrace Headquarters near Barnsley, details are coming in

from Doncaster Royal Infirmary

about a child with long-standing health problems

who's stopped breathing after having a fit.

'Four-year-old girl with thermal palsy.

'She had chronic lung disease and severe tracheobronchial malacia

'and had a tracheostomy, but she also has hearing impairment,

'requiring hearing aids, and visual impairment.

'I think she's blind in her left eye.'

Millie was born 12 weeks prematurely

and spent the first 18 months of her life in intensive care.

For the last two years,

Millie has been well enough to be cared for at home, until today.

She's had a fit at home.

I think she's had a couple of fits before

but they've been fairly short acting.

The paramedics have obviously attended at home

and given her some diazepam and it stopped her breathing, basically.

You want to sit in the front? Yeah, that's fine.

Ann is one of Embrace's most experienced critical care nurses

and has seen the problems

that premature babies like Millie can have later in life.

It's almost impossible to know how many are going to be left with

what degree of severity of problems.

You get some that are born really early that do really well,

and some that are born a little bit later on, that you think

are sort of over that bit of a cusp that then go on to have problems.

It should take 40 minutes to get to Doncaster Royal Infirmary

from Embrace Headquarters, but a traffic jam has impeded progress.

OK. That's fine. Paul!

Lights and sirens to get through traffic, please.

SIREN WAILS

Ann and the team will move Millie from Doncaster

to Sheffield Children's Hospital.

Oh, bless. Hello, Millie.

Fast asleep? OK.

She's been completely well in herself,

and then at about 12 o'clock her family said she started fitting,

symmetrical jerking movements of her arms and legs,

and she also desaturated and became tachycardic.

Hello, sweetheart.

'I think when you've got a little child like Millie who's

'been through such a lot, the parents are fantastic advocates for them.'

-Just have a listen to her chest.

-I'll let you have a look at her.

I'll have a quick word with mum. Yeah, OK.

'They've battled, probably, since she was born.'

Yeah, that's fine. All right.

Right, so, have we moved her before, as an Embrace team?

-Yes.

-We have? Yes?

-Some years ago.

So we're just going to have a good look at her, OK?

Her temperature has gone up

more than it was, so we'll give her something to bring that down.

She's already had some antibiotic cover.

We've had us ups and downs.

We've been sometimes well, sometimes not,

but for the last two years,

she's been well in herself in every way.

Can I just have a listen to the chest, please?

It's the mum and dad that know the nitty-gritty,

and they know their child better than anybody.

She has got problems, so trying to decide what is normal for her

and what we were dealing with at the time was very important,

so it's good to get that conversation going with Mum and Dad quite early

to say, "Is this normal for Millie or is this something we need to be worried about?"

When she's well, in terms of movement, how much does she do?

-She's very active.

-She's very active, OK.

-She's always moving.

-On the go?

-The arms and legs.

-Yes, fine.

Her numbers on the monitor are OK.

I'm concerned that she's not breathing for herself

and she's not woken up, but the other numbers are looking better.

I'd just like to see her a little more lively.

She was kind of moving her arms and legs a little bit

when we were doing things to her,

but you know she's quite an active child.

So, she's not your Millie, is she? At the moment. OK.

The team is using suction to clear the mucus from Millie's lungs.

Good girl. All right. Good girl. Good girl.

The staff here were saying they've not had much secretions,

but the chest X-ray looks a bit patchy, particularly on the left.

So sometimes, with Jenny doing the bagging, you can

just loosen stuff that's there,

and I'm just trying to get it up basically.

INDISTINGUISHABLE SPEECH

Yeah, she'll be wanting a drink.

She'll be like, "Is it dinner time yet?"

If you want a bottle then you have to wake up cos your bottle's there.

Isn't it? Yeah.

She is proud deaf as well as, like, she can only see through one eye.

And... Yeah, she's a little fater.

Come on.

You can have one of those really big cuddles.

Millie's dad spends all his time with her.

You know I'll take good care of her, don't you?

I know. I know.

HE SOBS

Yeah. She's toughie though. Think what she's been through before.

-It's knowing, isn't it? Really.

-Hmm.

But he numbers are good.

You never know, she might be awake in a couple of hours' time.

They've done a good job with her here,

but she's going to a unit that they know her well.

-It's just that she's not herself.

-I know.

I know.

I'm used to her fit and well all the time.

-So, to see her like this.

-Flat on her back.

But you know what kids are like. You've seen it, haven't you?

They go downhill really quickly

and then they come back up really quickly...

and that's what they do, isn't it?

It'll take 45 minutes to get to the team

at Sheffield Children's Hospital.

It's been treating Millie since she was tiny for the complications

that have arisen due to her premature birth.

I've been a nurse for many years, but I'm a mum.

I think to see your child go through that,

my heart absolutely goes out to them.

And sometimes I do stop and think, "If it was mine",

and I kind of have to stop myself from doing that till later on

because I have to focus on the job.

But as a parent, it's hard to see them go through it.

Sheffield has the only dedicated stand alone children's

hospital in Yorkshire.

Every year, the specialist doctors

and nurses here treat over 100,000 children.

Hello. Who's that?

Hello.

Millie.

Millie has already spent 18 months of her young life here,

and her family are keen that this time her stay will be short.

Got Jordan who's 18, got Courtney who's 15,

and Alicia's who's 11.

And Jordan's girlfriend always comes with us as well, Amy,

and they all stand by Millie 100%...

and her dad Steve.

You all right, missy?

Eh? Yeah.

She's been in overnight and she's slept for 18 hours solid.

She woke up this morning a bit grumpy, a bit not herself,

but she's on the mend now and she's doing well.

So, hopefully, by tomorrow we'll have her home.

The whole family is supposed to go on holiday at the end of the week.

It looks like Millie may be well enough for it still to go ahead.

Meanwhile, there's good news for another Embrace patient

at Sheffield Children's Hospital.

Baby Jake is about to have the plastic stents taken

out of his nose so he will be able to have his first proper feed.

-Hi.

-Come on in. Have a seat.

-So, how is he?

-He's been spot on.

-Good. Good.

-He's feeding OK?

-Yeah.

He just gargles a lot.

So, what I want to do today is take the tubes out. OK.

See how he gets on with no tubes in.

Fingers crossed we've left it in long enough for it all to

heal up, so it doesn't immediately scar.

Four weeks ago, Jake had an operation to remove the bone

and tissue that was blocking the back of his nose.

BABY CRIES

I don't want to pull the tubes out without the stitch cos

then that will leave the stitch in the back of his nose.

Come on, mister.

Come on.

LAUGHTER

-Come on, little man.

-Come on.

There we go.

-All done.

-There we go. Sorry about that.

-Come on.

-Oh. Do you want to give him a bottle?

His nostrils will not always be that big.

SHE LAUGHS

He's feeding really nicely,

he's breathing beautifully through his nose.

That's really pleasing. He's fantastic.

You're bonding with your baby,

getting to feed him for the first time,

and obviously we had a lot of trouble when he were first born.

Chris did his first feed, that's when we found out his nose were blocked.

The main reason to do this is so that he can be feeding

and thriving, and put some weight on and grow nicely.

SHE LAUGHS Thank you very much.

Not at all. Nice to see you again.

There's a chance that Jake's nose will become blocked up again,

in which case, he'll need ore surgery.

Back at Embrace Headquarters near Barnsley,

a team has been dispatched to collect a premature baby

who's been critically ill for most of her short life.

Embrace first moved baby Mia when she was seven weeks old

and needed lifesaving bowel surgery at Leeds General Infirmary.

Now, nearly three months later,

Mia's finally well enough to be transferred to her local hospital

20 miles away in Harrogate.

Cos we've been here quite a while now, it's like, "Ooh...

"I wish they were coming for me."

I've been saying that for weeks now.

I wish they were coming for me.

I've seen them coming in loads of times and...

now it's our turn.

Like many premature babies, Mia has several health problems,

the most critical being her damaged bowel.

There were fears that she might need a colostomy bag,

but surgeons have successfully reconnected her intestine.

Five months on Thursday, aren't we, madam?

You're one of the old lasses now...

aren't you? Eh?

It went well and she started to feed.

It was amazing for us, changing her dirty nappy.

It was just one of them things that, for her,

we didn't know if she'd ever get to that stage.

AMBULANCE BEEPS

She's never seen the bright light outside.

Erm...

She's only been in a pram once.

She's probably thinking, "Where's my dinner?"

'She's a fighter.

'That's all she's done, basically, since she's been born.'

She's fought from day one and carried on fighting,

and I think she's going to be fighting for a long period of time

cos everything that there is with the chronic lung disease

and everything such as that,

they're not going to cure her overnight. It's going to be years.

-You feel better now you're on home ground?

-Oh, yeah.

Mia has made amazing progress.

She's still being fed by tube, but once she learns to take

a bottle, Mum and Dad will finally be able to take her home.

Is that better now?

Are you starving?

I'm still in shock, really, that it's happened so quick.

I'm so happy.

You're just, you know, trying to get a normal life back,

that's all, so I am so happy.

We've got three acutes on the go at the moment.

We're just chatting to our coordinator about it.

Just wait a minute. I'll see what we can do.

Two teams arrived at Doncaster at the same time, so it will be quite manic.

Every year, Embrace makes over 2,000 journeys moving sick babies

and children from local hospitals to get specialist

treatment in bigger centres.

Some of these tiny patients are transferred more than once.

Today a specialist team has been called out to collect baby

Jake again - he's had a serious setback.

He's having breathing difficulties,

despite recently having an operation to unblock his nose.

HE GASPS

It seems like it's probably closing off,

so we are taking the baby from Barnsley Hospital to

Sheffield Hospital, where the surgery was done, for the ENT team

to have a look again and whether they need to place back the stents,

which we have taken out.

He hasn't been too bad, has he?

He's been fine until last night.

It's just been a bit gradual.

When we've been feeding him it's been getting a bit more sputtering because

he's been struggling with trying to breath while taking his bottle.

We've just given him a feed when we got in about tea time

and he spat most of that out,

so he's trying to breath through his mouth

and drink his milk at the same time.

But we know he's still breathing through his nose,

but he's struggling a bit cos it's got smaller.

Has he been having that noise since the tube came out?

-No.

-No? Nothing.

He was breathing completely fine, so the noises only started last night.

-The first few days, he were fine.

-Gradually it's...

-Yeah.

'It's a big thing, I think, as parents,

'to take a baby on that's got that kind of condition

'that's kind of life-threatening if it's not dealt with.'

-We probably did panic, didn't we?

-Yeah.

Seeing his baby brother rushed back into hospital has also been

alarming for ten-year-old Josh.

My mum and dad are away again, aren't they, Josh?

You just get passed from everybody.

Right then.

'The main thing to worry is

'whether he blocks off his nose again completely.'

And that will be more difficult to manage in terms of him

we might have to try more manoeuvres,

probably open his mouth,

keep a tube in his mouth just to keep his mouth open

so that he can breathe more easily.

This is the second time in his short life that Jake has made the 50-mile

trip from Barnsley to Sheffield in the back of an Embrace ambulance.

Last time he made this journey, the team had to pull

over on the hard shoulder of the M1 to give Jake extra oxygen.

BABY CRIES

I'm not glad that I've had to bring him in,

but I just want him sorted out and get him better now.

So...that's all we wanted all along.

We never expected at all for it to close back up as quickly as it

did do, did we? Never, ever, not within a matter of days.

I were thinking, "Maybe when he's about one-year-old, it might

"start or he might need a little bit more surgery, but not within days."

Doctors are Sheffield Children's Hospital decide Jake needs

a minor operation to stretch his nostrils,

but within days he's back again.

All in all, he has to have four minor operations

and two major surgeries before his nose is fully cleared.

It's rewarding to hear that the patients that we

transfer are doing well.

We're very happy with the outcome and it's very rewarding.

It's three months since Embrace first moved Jake from

Barnsley Hospital to get specialist treatment for choanal atresia,

a potentially life-threatening condition where the

back of the nose is blocked by bone and tissue.

He's gone two weeks now and we haven't had to go back with him.

I don't think they'll do anything with him

unless he shows signs of deteriorating.

I know one of the last times they did some drilling on a little

bit of bone that's got.

They did say that he'd probably need it doing again when he gets older.

You can't believe the journey that he's come through in 11 weeks,

and how much he's just thrived as a baby.

Nothing's stopped him developing in any other way at all.

-And he's just brilliant, isn't he?

-Yeah.

He wakes up in the morning and he's laughing and talking to us,

and smiling and kicking your arms and your legs in your cot, aren't you?

Eh? Going crazy.

So...

BABY COOS