0:03:16 > 0:03:18This programme contains some strong language
0:03:18 > 0:03:21and some scenes which some viewers may find upsetting.
0:03:21 > 0:03:24Good afternoon, ladies and gentlemen.
0:03:24 > 0:03:25We're here to review...
0:03:27 > 0:03:28..vacancies and retention.
0:03:32 > 0:03:33OK.
0:03:33 > 0:03:36How many vacancies have we got at the moment?
0:03:36 > 0:03:37699.
0:03:37 > 0:03:39699, OK.
0:03:40 > 0:03:42Throughout this year, we've run at anywhere between
0:03:42 > 0:03:4512% and 14% vacancy rates.
0:03:45 > 0:03:48OK. Draw our attention to the key points in the report.
0:03:48 > 0:03:53- So, one of the... We've obviously plugged in at the moment... - PHONE RINGS
0:03:53 > 0:03:57..the 20-odd Band 4s that we have joining us in April,
0:03:57 > 0:04:01- but it would be nice to see some of the hard-to-recruit people... - ANOTHER PHONE RINGS
0:04:01 > 0:04:03TEXT MESSAGE ALERT
0:04:08 > 0:04:11We are on stand-by for a major incident at Westminster Bridge?
0:04:11 > 0:04:13The Houses of Parliament?
0:04:13 > 0:04:15Have you got any more details?
0:04:24 > 0:04:26You on the news channel?
0:04:26 > 0:04:27Who's ringing?
0:04:27 > 0:04:30- BBC.- BBC News. - OK, we'd better adjourn.
0:04:30 > 0:04:34Go to your major incident positions and we'll await further information.
0:04:44 > 0:04:46We are on standby for a major incident.
0:04:46 > 0:04:49There's been some stabbing or shooting at Westminster.
0:04:52 > 0:04:55The Ambulance Service notified us
0:04:55 > 0:04:58that we're on standby for an incident in Westminster.
0:04:58 > 0:05:01So we've got a plan when this happens,
0:05:01 > 0:05:03and that's what we're now putting in place.
0:05:05 > 0:05:07So I'm going off to the site office,
0:05:07 > 0:05:08which will be the place
0:05:08 > 0:05:11where we will start to co-ordinate our response.
0:05:15 > 0:05:17- Any more detail? - So, 15 potential casualties.
0:05:17 > 0:05:20Potential? Do we know how many there are at this time?
0:05:20 > 0:05:24We've no idea. All we know is LAS have given us stand-by
0:05:24 > 0:05:26- with 15 excepting.- OK.
0:05:28 > 0:05:31Well, you can see on the TV there what's going on.
0:05:31 > 0:05:34- NEWSREADER:- We know that one police officer has been stabbed
0:05:34 > 0:05:37and that assailant has been shot.
0:05:37 > 0:05:41There is a major police operation now underway.
0:05:41 > 0:05:43Crikey.
0:05:43 > 0:05:46St Mary's Hospital in Paddington is one of four major trauma centres
0:05:46 > 0:05:49in London capable of dealing with mass casualties.
0:05:49 > 0:05:51Sarah, how many casualties?
0:05:51 > 0:05:52Three miles from Westminster,
0:05:52 > 0:05:56it's the nearest to the scene of a suspected terror attack.
0:05:56 > 0:05:58Everybody's phones are ringing like fury now as well.
0:05:58 > 0:05:59Hello, Lesley Powls?
0:05:59 > 0:06:03Lesley's taking Silver and Judy is taking Bronze.
0:06:03 > 0:06:05All right?
0:06:05 > 0:06:06During a major incident,
0:06:06 > 0:06:10the hospital follows a 194-page set of protocols.
0:06:10 > 0:06:13"Stand by" means prepare to receive casualties.
0:06:13 > 0:06:15Hello, Gold, this is Silver.
0:06:21 > 0:06:24The reason we have the command and control structure we do -
0:06:24 > 0:06:28which is Gold, who is strategic, Silver, which is what I'm doing,
0:06:28 > 0:06:30which runs the operational response,
0:06:30 > 0:06:33and Bronze, who runs the pure operational side of things.
0:06:33 > 0:06:36No, we can't give out any information.
0:06:36 > 0:06:40The reason we do that is so that you keep people in their own role.
0:06:40 > 0:06:41The word people are using at the moment
0:06:41 > 0:06:43is that this is a terrorist incident,
0:06:43 > 0:06:46so we need to be in a position to make sure that all of our
0:06:46 > 0:06:48decision-making is absolutely crystal clear.
0:06:48 > 0:06:53So anybody else who was elected for today who hasn't gone knife-to-skin,
0:06:53 > 0:06:56they need to be sent home.
0:06:56 > 0:06:58I'll tell them.
0:06:58 > 0:07:01We need a collation of A&E receiving spaces,
0:07:01 > 0:07:03trauma receiving spaces,
0:07:03 > 0:07:06and then a running collation of beds available now.
0:07:06 > 0:07:09What we'll do is we'll just go through each site quickly.
0:07:09 > 0:07:11I just have specific questions for each site.
0:07:11 > 0:07:13So, Hammersmith, have you got ICU beds?
0:07:16 > 0:07:18Can you go back to ICU and see if they can make as a bed,
0:07:18 > 0:07:20because we've been put on stand-by?
0:07:20 > 0:07:22How many spare beds do you have at the moment?
0:07:22 > 0:07:25ICU, they are full, is the simple answer.
0:07:25 > 0:07:27Major trauma have two spaces.
0:07:27 > 0:07:30So we're asking them to explore the capability -
0:07:30 > 0:07:32if they need to, can they go into major trauma?
0:07:32 > 0:07:35Or, by preference, are they going to go down to recovery?
0:07:35 > 0:07:38Guys, can we all please just make sure I know we've signed in?
0:07:38 > 0:07:42During a major incident, the entire resus area has to be cleared out.
0:07:45 > 0:07:48Because we are going to be getting lots of sick, sick people.
0:07:53 > 0:07:57It's 12 minutes since the hospital was put on standby.
0:07:57 > 0:08:01Off-duty medical and nursing staff arrive to assist in A&E.
0:08:05 > 0:08:08So each of the bays has got a team allocated
0:08:08 > 0:08:10of surgeons, anaesthetists,
0:08:10 > 0:08:12nursing staff, theatre staff.
0:08:12 > 0:08:15The bleep goes off, your phone goes off, and you come in.
0:08:19 > 0:08:22So we'll just make sure we're all organised.
0:08:22 > 0:08:25They look like they're getting some stretchers into ambulances.
0:08:33 > 0:08:35OK, so we need to make sure all your night shift
0:08:35 > 0:08:37can get in for duty tonight,
0:08:37 > 0:08:39because it looks like the whole of Westminster is shut.
0:08:39 > 0:08:40The only, obviously for labs,
0:08:40 > 0:08:44the big pressure will be we suddenly need a lot of blood.
0:08:44 > 0:08:46We would need surgical nurses from upstairs to come down
0:08:46 > 0:08:48and actually look after these patients as well.
0:08:48 > 0:08:51They can stay here and we'll bring the patient, yeah?
0:08:53 > 0:08:54The first ambulance is on the ramp.
0:09:00 > 0:09:02SIRENS BLARE
0:09:09 > 0:09:11Everybody, just be quiet in resus for the moment.
0:09:11 > 0:09:13This is a gunshot wound.
0:09:17 > 0:09:20The first person to arrive in A&E is the alleged attacker.
0:09:30 > 0:09:32Non-open chest, we're going to transfer
0:09:32 > 0:09:35to a long-side and a right-side location, please.
0:09:38 > 0:09:39OK, so, right...
0:09:42 > 0:09:44Quiet for a second.
0:10:13 > 0:10:15The first casualty that's arrived has died,
0:10:15 > 0:10:17so we're going to set up a mortuary, he will go there
0:10:17 > 0:10:19and the police guard.
0:10:19 > 0:10:21So people are jumping in the river to escape,
0:10:21 > 0:10:25so this is what's come through from the antiterrorists.
0:10:25 > 0:10:28Right, Judy, get switchboard to stand us up formally now,
0:10:28 > 0:10:29put that call out.
0:10:31 > 0:10:32We're declaring.
0:10:33 > 0:10:37We're declaring a major incident at the St Mary's site only.
0:10:39 > 0:10:43So, NHS England have just come through to say, so,
0:10:43 > 0:10:46stood up or declared are ourselves, Chelsea and Westminster,
0:10:46 > 0:10:49- King's, Guy's and St Thomas' and UCLH.- Wow.
0:10:52 > 0:10:54St Mary's is now formally declared
0:10:54 > 0:10:57and the next phase of protocol can be implemented.
0:10:57 > 0:11:00London Ambulance Service will only bring
0:11:00 > 0:11:02critically-ill patients to A&E.
0:11:02 > 0:11:05We're now deploying the full lockdown policy
0:11:05 > 0:11:07and procedure for the St Mary's site.
0:11:07 > 0:11:10We'll make the site as secure as we possibly can be.
0:11:10 > 0:11:11'OK, that's very good, well done.'
0:11:12 > 0:11:14Simon, are we all right upstairs?
0:11:14 > 0:11:17We just need to start getting the beds actually liberated.
0:11:17 > 0:11:20Simon Ashworth is Head of Intensive Care.
0:11:20 > 0:11:22He needs to create capacity for casualties
0:11:22 > 0:11:24who have yet to arrive from the scene.
0:11:24 > 0:11:27This is the list of the people that we can move.
0:11:27 > 0:11:29It's the ambulances that are my issue.
0:11:29 > 0:11:31Our transport services are going to see if we can staff
0:11:31 > 0:11:33any more transfer ambulances.
0:11:33 > 0:11:34OK, right.
0:11:34 > 0:11:37You always worry about the situations arising
0:11:37 > 0:11:40when the system's already under strain.
0:11:41 > 0:11:44We're trying to arrange transfers across to other hospitals,
0:11:44 > 0:11:47but the problem is that
0:11:47 > 0:11:50we don't know if we're going to be able to get ambulances
0:11:50 > 0:11:52in the circumstances to be able to actually move them.
0:11:52 > 0:11:55Let's find out how we're getting on.
0:11:55 > 0:11:59We should be able to create up to 12.
0:11:59 > 0:12:01- OK.- But it's going to take time.
0:12:01 > 0:12:03OK.
0:12:03 > 0:12:06What we really don't want is a situation where the resus area
0:12:06 > 0:12:09can't function because they can't move people out.
0:12:09 > 0:12:12And that's what will cost people their lives.
0:12:12 > 0:12:15- Right.- Oh, my goodness, they're showing what happened.
0:12:15 > 0:12:19A man thought to be armed with a knife was shot by armed police.
0:12:19 > 0:12:21A number of others have been hurt,
0:12:21 > 0:12:24including some with catastrophic injuries...
0:12:25 > 0:12:29Our first casualty, who arrived to us as a code red,
0:12:29 > 0:12:35is believed to be the perpetrator of the incident.
0:12:35 > 0:12:37- 'OK.' - SIRENS BLARE
0:12:37 > 0:12:39So we're getting a fair bit of ambulance activity
0:12:39 > 0:12:42going on outside now, David, just to be aware.
0:12:51 > 0:12:54Paramedics have been treating victims at the scene.
0:12:55 > 0:12:58- NEWSREADER:- Mowed down on Westminster Bridge.
0:12:58 > 0:13:01Our colleague Nick Robinson saying a party of French schoolchildren
0:13:01 > 0:13:03were among those involved...
0:13:17 > 0:13:19Guys, this patient looks like they're arriving.
0:13:23 > 0:13:24Right, guys, patient's here.
0:13:26 > 0:13:27Over there, please. Thank you.
0:13:29 > 0:13:33The first victim to arrive at St Mary's is a French schoolboy.
0:13:34 > 0:13:36OK, on three, one, two, three.
0:13:38 > 0:13:41Right, guys, we'd better get a handle on our patient. Fire away.
0:13:47 > 0:13:49Today was the last day of a school trip to London.
0:13:49 > 0:13:51Right, we've got to finish the primary survey.
0:13:51 > 0:13:54We're going to get a collar on, we're going to log roll him,
0:13:54 > 0:13:56get him off the scoop, get him covered up warm,
0:13:56 > 0:13:59fast scan, set of bloods, then we're going to go to scanner, OK?
0:13:59 > 0:14:01Chest wall tender on the right-hand side.
0:14:03 > 0:14:05Victor, can you move your left leg for me?
0:14:05 > 0:14:06Lift your left leg straight up.
0:14:06 > 0:14:07Thank you. And your right leg?
0:14:11 > 0:14:12IN FRENCH:
0:14:19 > 0:14:21Sorry, he's 16. Does he know what's happening?
0:14:21 > 0:14:24So, can you explain to him that he was hit by a car?
0:14:25 > 0:14:27What's this one?
0:14:27 > 0:14:30Victor's school friend arrives in A&E.
0:14:39 > 0:14:4218-year-old Yann has lost a dangerous amount of blood
0:14:42 > 0:14:43from a severe scalp wound.
0:14:45 > 0:14:47We need quarters...
0:14:47 > 0:14:49I've got people who need to move.
0:14:49 > 0:14:52He's taken for immediate life-saving surgery.
0:14:55 > 0:14:56Are you free?
0:14:56 > 0:15:00As part of the major incident protocol,
0:15:00 > 0:15:02all nonemergency surgery has been cancelled
0:15:02 > 0:15:04and operating theatres cleared.
0:15:07 > 0:15:08Is this the scalp laceration?
0:15:10 > 0:15:11Theatre six, please.
0:15:12 > 0:15:17We have got one, two, three, four theatres available.
0:15:28 > 0:15:30OK, guys, resus, please, listen in.
0:15:33 > 0:15:37Resus one is unstable and they need to go to CT immediately.
0:15:37 > 0:15:39Resus two is going upstairs to the major trauma ward.
0:15:39 > 0:15:41Resus three is coming back from CT
0:15:41 > 0:15:43and resus four is just on their way to CT.
0:15:43 > 0:15:45If you're in the trauma team, stick with your team,
0:15:45 > 0:15:49if you're not in a red tabard I need more space in resus, please.
0:15:49 > 0:15:50Move out of the way, please.
0:15:50 > 0:15:5416-year-old Victor is being taken for a CT scan.
0:15:55 > 0:15:57Right, we are all connected, let's go.
0:15:59 > 0:16:01When people come in with major trauma
0:16:01 > 0:16:03and they've got multiple injuries,
0:16:03 > 0:16:05there may be stuff that we can't see,
0:16:05 > 0:16:08so the CT scan should be done as quickly as possible
0:16:08 > 0:16:12because given the amount of force, anything could be at risk here.
0:16:13 > 0:16:15Guys, can we slide him up, guys?
0:16:15 > 0:16:18- Are you all right translating for him as well?- Oui.
0:16:18 > 0:16:20The story is he's amnesic to events.
0:16:20 > 0:16:24He's complaining of right-sided shoulder, queried chest pain.
0:16:24 > 0:16:28So we're querying head, querying something in the torso as well.
0:16:34 > 0:16:38- His elbow...- Yeah, the elbow's dislocated, isn't it? Yeah.
0:16:38 > 0:16:40Guys, can we get hands in to get him off the trolley
0:16:40 > 0:16:42while we have a quick look at this?
0:16:43 > 0:16:48- So, fractures posterior from ten to about six...- Yeah.
0:16:48 > 0:16:51The scan reveals a fractured dislocation of the right elbow,
0:16:51 > 0:16:54multiple rib fractures and spinal damage.
0:16:54 > 0:16:57But most concerning is a collapsed lung.
0:16:57 > 0:16:58Guys, hang on, two seconds!
0:16:58 > 0:17:01So, with a collapsed lung, it can be life-threatening
0:17:01 > 0:17:03if it's what's called a tension pneumothorax,
0:17:03 > 0:17:05and that needs to be treated straight away.
0:17:05 > 0:17:07OK, resus two.
0:17:08 > 0:17:11We need to put what's called a chest drain in to let this air come out
0:17:11 > 0:17:13and let his lung re-inflate.
0:17:13 > 0:17:16We need to put a tube, do you understand?
0:17:16 > 0:17:18A tube on your chest.
0:17:18 > 0:17:19A small tube.
0:17:19 > 0:17:22- No fail-safe. - No fail-safe, it's just a two pint.
0:17:22 > 0:17:25So, he'll go into the invasive rib fracture...
0:17:25 > 0:17:27What I need to find out is whether we've got any beds available
0:17:27 > 0:17:29on the first floor.
0:17:29 > 0:17:31So as soon as that drain's in he could potentially come out.
0:17:31 > 0:17:34How are we doing, sedation-wise? What are we giving him?
0:17:34 > 0:17:3640 of ketamine.
0:17:36 > 0:17:3840 of ketamine, great.
0:17:38 > 0:17:41It's 45 minutes since Victor arrived in A&E.
0:17:41 > 0:17:45His condition is now stable and does not require immediate surgery.
0:17:47 > 0:17:49OK? There we go.
0:17:49 > 0:17:50There we go. OK?
0:17:50 > 0:17:51IN FRENCH:
0:17:53 > 0:17:55We'll get him upstairs.
0:17:58 > 0:18:00- VICTOR: Natalie. - Natalie?
0:18:00 > 0:18:02- Anthony.- Natalie, Anthony.
0:18:08 > 0:18:12The poor boy is here on a school trip and he's brought into a place
0:18:12 > 0:18:13where there was a lot going on.
0:18:13 > 0:18:16So for him, he's only 16, it's quite nerve-racking.
0:18:16 > 0:18:19So our main aim is to make sure the patients are treated properly,
0:18:19 > 0:18:21treated in a timely manner,
0:18:21 > 0:18:23hopefully comfortable up in the ward
0:18:23 > 0:18:25and that, actually, they are kept safe.
0:18:30 > 0:18:34Do you want to call his dad? We can get him to speak to his dad.
0:18:34 > 0:18:37IN FRENCH:
0:18:42 > 0:18:45You OK? Oui, ca va?
0:18:50 > 0:18:52HE GASPS
0:18:57 > 0:18:58This patient...
0:18:59 > 0:19:02..he was bleeding so much in A&E, he has had some blood,
0:19:02 > 0:19:04which has gone through.
0:19:04 > 0:19:07Victor's school friend, 18-year-old Yann,
0:19:07 > 0:19:10is undergoing surgery on his badly-lacerated scalp.
0:19:11 > 0:19:13So there are several layers to the scalp
0:19:13 > 0:19:15and he has gone through all of them right down to the skull.
0:19:15 > 0:19:17But, luckily, he hasn't got a skull fracture.
0:19:22 > 0:19:26The windscreen apparently had evidence of a bull's-eye hit
0:19:26 > 0:19:28and he was lying adjacent to the car,
0:19:28 > 0:19:32so we think perhaps the car hit him from behind,
0:19:32 > 0:19:34hence he has got an injury to the back of the scalp.
0:19:37 > 0:19:40Surgeons must sew each layer of Yann's scalp back together.
0:19:44 > 0:19:47He's also got a spinal injury,
0:19:47 > 0:19:50so we've had to be really careful about transferring him
0:19:50 > 0:19:52so that we don't move those injuries,
0:19:52 > 0:19:54so we're not making something that's stable at the moment
0:19:54 > 0:19:56into something unstable.
0:20:01 > 0:20:02Oh!
0:20:14 > 0:20:15- From the scene?- Yeah.
0:20:15 > 0:20:19OK. Well, we can put them in one of the bays down here.
0:20:19 > 0:20:22On an average day, St Mary's treats eight trauma patients.
0:20:24 > 0:20:28In the last hour and a half, six have arrived from Westminster.
0:20:43 > 0:20:46So, casualty update, then.
0:20:46 > 0:20:49So, we have the one RIP.
0:20:49 > 0:20:51Seven major trauma patients.
0:20:51 > 0:20:55We've also had three blue calls unrelated to the incident.
0:20:55 > 0:20:58So we are busy.
0:20:58 > 0:21:01I don't have much in the way of current capacity.
0:21:01 > 0:21:04It's all predicated on these moves happening.
0:21:05 > 0:21:08You know, we need the ICU capacity.
0:21:08 > 0:21:12It's still unclear how many patients will require intensive care beds.
0:21:14 > 0:21:17He's got pretty terrible injuries.
0:21:17 > 0:21:18I'm not very convinced he can go.
0:21:20 > 0:21:23To create capacity, Simon has to identify patients
0:21:23 > 0:21:26who can be transferred from St Mary's
0:21:26 > 0:21:29to another intensive care unit in the trust.
0:21:29 > 0:21:31One is nearing the end of an operation.
0:21:34 > 0:21:37I'm just going to talk to the vascular surgeons about...
0:21:39 > 0:21:43..what we do with their patient,
0:21:43 > 0:21:45whose surgery started at eight o'clock this morning.
0:21:48 > 0:21:50Obviously the major incident has intervened,
0:21:50 > 0:21:53and we need to decide where we put them.
0:21:53 > 0:21:55And what I don't want to do is put someone in an ambulance
0:21:55 > 0:21:58and transfer them who is too sick to actually move.
0:22:00 > 0:22:02How sick is he going to be at the end?
0:22:02 > 0:22:05What is the right answer, Simon? How do I get a bed?
0:22:05 > 0:22:07THEY CHUCKLE
0:22:07 > 0:22:10I'm looking at needing to take seven patients today,
0:22:10 > 0:22:13but I'm looking at who's the least risky people to transfer.
0:22:14 > 0:22:18I don't like transferring hot vascular patients
0:22:18 > 0:22:20because the things that go wrong will then...
0:22:20 > 0:22:22He should definitely stay here.
0:22:23 > 0:22:25OK.
0:22:28 > 0:22:30Hi, there.
0:22:30 > 0:22:31So, this lady...
0:22:32 > 0:22:35It looks like a survivable injury, so...
0:22:35 > 0:22:37She is certainly fit for transfer
0:22:37 > 0:22:38and she's on the list to go.
0:22:41 > 0:22:42Just to make you a bit more comfortable,
0:22:42 > 0:22:44I'm going to lift your head up, OK?
0:22:44 > 0:22:47They'll give you some more painkillers in the ambulance, all right?
0:22:48 > 0:22:51The ambulances themselves don't really come with
0:22:51 > 0:22:52all the gear you need.
0:22:52 > 0:22:54Charing Cross, which is our sister hospital...
0:22:56 > 0:23:00..has sent doctors with assistants and all the equipment
0:23:00 > 0:23:02so that they can retrieve the patients to Charing Cross.
0:23:05 > 0:23:08And it's an absolute life-saver for us, you know?
0:23:08 > 0:23:09It's the reason we've capacity
0:23:09 > 0:23:12to take all of the patients who we need to take today.
0:23:14 > 0:23:15HE SIGHS
0:23:17 > 0:23:18So...
0:23:19 > 0:23:21This is where now we're sort of...
0:23:23 > 0:23:26..more or less ready to actually cope with the influx of patients.
0:23:28 > 0:23:29What about SIC?
0:23:29 > 0:23:32- SIC is free.- SIC is free,
0:23:32 > 0:23:36however, we would prefer to cope with all the major incident patients
0:23:36 > 0:23:37in main theatres.
0:23:37 > 0:23:39Helgi is now gone to resus.
0:23:39 > 0:23:42Are you happy to be the Bronze anaesthetist again?
0:23:42 > 0:23:47Do you want to send the open tibia guy up to theatre two now?
0:23:54 > 0:23:5640-year-old Stephen was on a day trip to London
0:23:56 > 0:24:00when he was caught up in the Westminster attack.
0:24:00 > 0:24:02He has multiple injuries that require surgery.
0:24:20 > 0:24:23Obviously it's a terrorist attack on your home city.
0:24:23 > 0:24:25For us, we have to push past that
0:24:25 > 0:24:27and just focus on doing the job on hand,
0:24:27 > 0:24:29which is patients come in that have injuries,
0:24:29 > 0:24:31we work out what's going on with them,
0:24:31 > 0:24:33we sort out a plan and we deal with it.
0:24:34 > 0:24:36Blood loss anticipated.
0:24:36 > 0:24:39Stephen's complex four-hour operation
0:24:39 > 0:24:41- is led by Shehan Hettiaratchy... - Blade, please.
0:24:41 > 0:24:44..who served as a military surgeon in Afghanistan.
0:24:44 > 0:24:46'He has got some quite serious injuries.
0:24:47 > 0:24:49'He had quite a serious chest injury,
0:24:49 > 0:24:50'quite a serious facial injury,
0:24:50 > 0:24:53'he has got quite a serious lower leg injury.
0:24:57 > 0:25:00'One of those injuries in isolation is not life-threatening
0:25:00 > 0:25:02'but when you put them all together in one person,
0:25:02 > 0:25:05'they have the potential to become life-threatening.'
0:25:05 > 0:25:06Blade, please.
0:25:08 > 0:25:11'The idea of a trauma centre is you get all the right experts
0:25:11 > 0:25:15'to look after that one individual patient in one place.'
0:25:15 > 0:25:16Can I get a curette?
0:25:16 > 0:25:19No, a bone nibbler, actually, let's have a bone nibbler.
0:25:19 > 0:25:20When you're ready.
0:25:20 > 0:25:23'If you look at what the trauma system has done,
0:25:23 > 0:25:27'you're twice as likely to survive major trauma now
0:25:27 > 0:25:29'than you were ten years ago.
0:25:31 > 0:25:34'This is a system that is saving lives.
0:25:34 > 0:25:36'I spent time working in Afghanistan -
0:25:36 > 0:25:38'you know, that was the most successful trauma system
0:25:38 > 0:25:40'the world has ever seen.
0:25:40 > 0:25:42'That happened because we were a single focused specialist
0:25:42 > 0:25:45'dealing with one thing, trauma,
0:25:45 > 0:25:48'and that's all we did and all we were there for,
0:25:48 > 0:25:50'and it shows actually what can be achieved.'
0:25:50 > 0:25:52Forceps.
0:25:55 > 0:25:59Stephen's wife, Cara, was next to him on the bridge when he was hit.
0:26:00 > 0:26:03She has sustained minor physical injuries.
0:26:03 > 0:26:05We're quite private people.
0:26:07 > 0:26:08We don't go out a lot.
0:26:10 > 0:26:11This was a special occasion.
0:26:13 > 0:26:18It's funny, because I don't like going on the Tube because I'm scared
0:26:18 > 0:26:20of something that might happen,
0:26:20 > 0:26:22and so we decided to get a taxi.
0:26:22 > 0:26:24Obviously we were going to flag a taxi down.
0:26:26 > 0:26:28What he looked like on the road...
0:26:29 > 0:26:31And he was just covered in blood.
0:26:31 > 0:26:33It was all over him.
0:26:38 > 0:26:41Everyone goes through shit, you know,
0:26:41 > 0:26:43but...not this.
0:26:46 > 0:26:47Not being ploughed down.
0:26:50 > 0:26:53SIRENS BLARE
0:26:57 > 0:27:00Can you stand us down at St Mary's for the major incident, please?
0:27:02 > 0:27:07Did you hear that? So, that is an LAS stand-down at 18.24 for us.
0:27:07 > 0:27:10- 'Have we had any more casualties come in?'- No.
0:27:12 > 0:27:16My suggestion is people reasonably have a think about
0:27:16 > 0:27:21what they need to do for us to get into business as usual,
0:27:21 > 0:27:23and just to check staffing tonight.
0:27:23 > 0:27:25All right, I've got people coming from
0:27:25 > 0:27:27all of the other hospitals to help.
0:27:28 > 0:27:30That's better.
0:27:30 > 0:27:34Stephen and two other victims of the attack remain in surgery.
0:27:34 > 0:27:37Do you want to take it up any higher? Happy with that?
0:27:37 > 0:27:41- What happened?- A car mounted the pavement on Westminster Bridge.
0:27:41 > 0:27:44- OK.- Yeah. And then...
0:27:46 > 0:27:48..whether it was the driver or somebody else,
0:27:48 > 0:27:51they then got out with a big knife and stabbed a policeman,
0:27:51 > 0:27:52who was then shot.
0:28:03 > 0:28:05It does test your faith in humanity,
0:28:05 > 0:28:09seeing how horrible people can be to each other.
0:28:09 > 0:28:13But also, we see a lot of very uplifting things
0:28:13 > 0:28:16that make you think, "You know, actually, humanity is all right."
0:28:16 > 0:28:18On three, two...
0:28:20 > 0:28:22Yann, the French teenager,
0:28:22 > 0:28:25has had his scalp successfully repaired.
0:28:38 > 0:28:41IN FRENCH:
0:28:45 > 0:28:47Victor, the youngest one,
0:28:47 > 0:28:51has been asking about him and was worried about him,
0:28:51 > 0:28:52how he is doing.
0:28:52 > 0:28:54And he was also worried about his friend.
0:29:16 > 0:29:18We spoke to his family, his parents,
0:29:18 > 0:29:20and they are coming a bit later.
0:29:20 > 0:29:25I think a plane is being catered for the family in France
0:29:25 > 0:29:27to come over to London.
0:29:33 > 0:29:35Guys, let's stay focused, please.
0:29:36 > 0:29:39Stephen has been in surgery for two hours.
0:29:41 > 0:29:43It's quite a high-energy injury.
0:29:43 > 0:29:45Quite a lot of contamination,
0:29:45 > 0:29:49so we spent the last hour just getting that properly cleaned.
0:29:49 > 0:29:51If you get infection here, it could be a disaster.
0:29:51 > 0:29:53- Go for it.- Yeah?- Yeah.
0:29:55 > 0:29:59Yeah, the challenge is he's lost his soft tissues,
0:29:59 > 0:30:01where his broken bones are, and we've got to fix that,
0:30:01 > 0:30:02we've got to cover that.
0:30:02 > 0:30:07That's probably going to require quite a complex operation to do.
0:30:09 > 0:30:11So we are going to have to replace that tissue there.
0:30:13 > 0:30:16And the only way we can do that is to take tissue from somewhere else
0:30:16 > 0:30:19in his body and connect it up, which we'll get done hopefully...
0:30:21 > 0:30:23..next week, I guess.
0:30:23 > 0:30:26Basically, before orthopaedic and plastic surgery
0:30:26 > 0:30:29got to where it is now, this was an amputation-level injury.
0:30:29 > 0:30:33So this is now, we can salvage the limb.
0:30:34 > 0:30:35We hope.
0:30:49 > 0:30:51I don't even know actually what happened.
0:30:51 > 0:30:54It looks like it was a car that went onto the pavement.
0:30:56 > 0:30:58- NEWSREADER:- Four people are known to have died.
0:30:58 > 0:31:0020 people have been injured.
0:31:00 > 0:31:02- Four people have died?- Mm.
0:31:06 > 0:31:07HE SIGHS
0:31:07 > 0:31:10Yes. A busy day. Busy day.
0:31:10 > 0:31:13..there has been an attack on the seat of politics for the UK
0:31:13 > 0:31:15but they have lost one of their own officers.
0:31:22 > 0:31:23No, I doubt if we will either.
0:31:23 > 0:31:26I can guarantee you the minute I get on the Tube,
0:31:26 > 0:31:28the reality of this will start to hit home
0:31:28 > 0:31:31in that what we've got here are individuals whose lives
0:31:31 > 0:31:36have probably been massively altered by something totally unexpected.
0:31:36 > 0:31:39So as much of a shock that this was to us...
0:31:40 > 0:31:43..you can't even begin to imagine what it's like
0:31:43 > 0:31:47for these poor patients and their families.
0:31:47 > 0:31:51So, yeah, it will absolutely prey on my mind tonight.
0:31:51 > 0:31:52I guarantee it.
0:31:52 > 0:31:56I will look like a broken, sleepless woman tomorrow.
0:32:00 > 0:32:01Right, OK.
0:32:02 > 0:32:05OK, it was a challenging day, but actually, everything went to plan,
0:32:05 > 0:32:07everything went smoothly,
0:32:07 > 0:32:08we got all the work done.
0:32:09 > 0:32:11It's as good as it could be.
0:32:15 > 0:32:19It's actually, it's really easy when there's a little bit of heat on,
0:32:19 > 0:32:22when things are a little bit uncomfortable, to fall apart.
0:32:26 > 0:32:29So actually, I think what I was most pleased about today
0:32:29 > 0:32:30was our team worked
0:32:30 > 0:32:31and it worked well.
0:32:57 > 0:33:0030 people were treated in five London hospitals
0:33:00 > 0:33:03for injuries sustained during the Westminster attack.
0:33:07 > 0:33:09Five remain at St Mary's.
0:33:23 > 0:33:26OK. So, for this morning, then,
0:33:26 > 0:33:29we're going to try and get back to normal.
0:33:34 > 0:33:36You can feel it today. You can feel the atmosphere,
0:33:36 > 0:33:39everybody is a bit jittery. "Did you sleep?"
0:33:39 > 0:33:44Because people aren't quite sure how to process yesterday.
0:33:45 > 0:33:48So actually, what we've got to do today is just reset everybody
0:33:48 > 0:33:52to recognise that we're back into normal.
0:33:52 > 0:33:56So we'll step the site... With the agreement of the Met
0:33:56 > 0:33:58we're going to step off lockdown,
0:33:58 > 0:34:01but we will keep a police presence on the ninth floor.
0:34:01 > 0:34:04- Also, someone on the first floor. - Two on the first floor.
0:34:04 > 0:34:05Two on the first floor.
0:34:05 > 0:34:08And we'll keep someone at reception for the moment.
0:34:13 > 0:34:15Can I ask you, at least for the next 20 minutes,
0:34:15 > 0:34:19to put some of the emotion and some of the other thoughts in our heads
0:34:19 > 0:34:22around the incident to the back of your mind and let's focus on
0:34:22 > 0:34:25the clinical problems of the patients?
0:34:25 > 0:34:27Shall we start with the ITU ones?
0:34:27 > 0:34:29Yeah.
0:34:29 > 0:34:31Stephen has been intubated in ICU overnight.
0:34:33 > 0:34:36Major injuries of concern are an open tib-fib fracture...
0:34:37 > 0:34:39..which was operated on successfully.
0:34:40 > 0:34:42- Stage one.- Stage one.
0:34:42 > 0:34:48So, the plan with him, he will need a tibial nail next week.
0:34:50 > 0:34:53OK. The two French chaps on a tour from Brittany.
0:34:54 > 0:34:57I'll just check your temperature, yeah? Just under your tongue.
0:34:58 > 0:35:00OK. 18-year-old Yann?
0:35:01 > 0:35:04He had a large laceration on his scalp
0:35:04 > 0:35:07which was sutured by the plastic surgery service last night.
0:35:07 > 0:35:08Of all the patients from yesterday,
0:35:08 > 0:35:11he's probably the first one that can properly be discharged.
0:35:11 > 0:35:13- OK.- And ex-patted back to France.
0:35:13 > 0:35:16And we'll work out follow-up if he's going back to France.
0:35:19 > 0:35:22The second patient, Victor.
0:35:22 > 0:35:24Victor is 16.
0:35:24 > 0:35:29His main injuries are quite a number of right-sided rib fractures
0:35:29 > 0:35:31with a traumatic pneumothorax,
0:35:31 > 0:35:34which was treated with a chest drain insertion.
0:35:34 > 0:35:37So, reality, he'll be with us over the weekend at least.
0:35:37 > 0:35:38I think so, yeah.
0:35:38 > 0:35:40Anything else we need to be aware of with him?
0:35:42 > 0:35:43Everyone happy?
0:35:47 > 0:35:50IN FRENCH:
0:36:47 > 0:36:50Victor's parents arrived at the hospital just before midnight.
0:37:33 > 0:37:34C'est bien.
0:38:36 > 0:38:38HE IMITATES HER
0:38:47 > 0:38:49Stephen has spent the night in intensive care.
0:38:55 > 0:38:57He was celebrating his 40th birthday.
0:38:57 > 0:39:00So, I guess that illustrates the sort of...
0:39:02 > 0:39:06..the way these events just crash into people's lives.
0:39:09 > 0:39:12- You're going to keep him sleeping, I heard, until tomorrow.- Yeah.
0:39:12 > 0:39:14I think we need to know what you're going to do
0:39:14 > 0:39:16with the rib fractures.
0:39:16 > 0:39:20I mean, it's a borderline flail.
0:39:20 > 0:39:23I'm not really very convinced how well they do.
0:39:25 > 0:39:28Stephen we would describe as critically ill,
0:39:28 > 0:39:31in that he requires support on a breathing machine
0:39:31 > 0:39:34with a tube down his throat
0:39:34 > 0:39:38and he's requiring drugs to support his blood pressure.
0:39:39 > 0:39:44Now, I'm reasonably confident that he should make a good recovery...
0:39:45 > 0:39:48..but you can never be complacent about people in intensive care.
0:39:48 > 0:39:52There is always the potential for things to go wrong.
0:39:52 > 0:39:54Probably site a different epidural for the flap...
0:39:56 > 0:40:01..because obviously, hopefully, the chest pain will have receded.
0:40:01 > 0:40:04- We can minimise the risk.- Yeah. - We won't be able to eliminate it.
0:40:06 > 0:40:11Stephen requires another major operation to save his damaged leg.
0:40:11 > 0:40:16Until his condition stabilises, he is sedated and on life support.
0:40:17 > 0:40:18It's really hard when you spend
0:40:18 > 0:40:20so much time with somebody and then...
0:40:22 > 0:40:24..they're taken away from you
0:40:24 > 0:40:26and you're suddenly really, really alone.
0:40:31 > 0:40:34Because you just want to grab hold of him and...
0:40:34 > 0:40:37and just give him a cuddle and a squeeze and take care of him.
0:40:41 > 0:40:43But then he's so fragile you can't...
0:40:44 > 0:40:46..you just can't touch him.
0:40:58 > 0:41:01It's two days since the Westminster attack.
0:41:02 > 0:41:04The insurance company acting for Victor and Yann
0:41:04 > 0:41:06wants to fly them home together.
0:41:08 > 0:41:10PHONE RINGS
0:41:14 > 0:41:15Hello!
0:41:18 > 0:41:20Well, sure.
0:41:20 > 0:41:22Our first patient, Yann, is certainly fit for discharge today.
0:41:22 > 0:41:25The second patient, Victor...
0:41:25 > 0:41:28Victor's injuries are more severe in that I don't think
0:41:28 > 0:41:31he should be discharged or repatriated at the moment.
0:41:32 > 0:41:33OK. I understand,
0:41:33 > 0:41:38but it's not like we're signing off a mortgage contract here,
0:41:38 > 0:41:39we're dealing with a person,
0:41:39 > 0:41:42and as regards liability and responsibility,
0:41:42 > 0:41:43you know, it goes both ways.
0:41:45 > 0:41:48What's that? Monday or Tuesday, depending on how he looks.
0:41:48 > 0:41:50OK. Thanks for calling.
0:41:50 > 0:41:51OK. Bye.
0:41:53 > 0:41:56So, you know, they want to take the patient today.
0:41:58 > 0:42:01And I can understand emotionally it's probably the right thing to do
0:42:01 > 0:42:04but you have to remember these teams are making...
0:42:04 > 0:42:08are trying to make decisions with the best will in the world
0:42:08 > 0:42:12and, you know, very genuine decisions based on
0:42:12 > 0:42:15information over the phone, which isn't the same
0:42:15 > 0:42:17as actually standing at the end of the bed and seeing the patient.
0:42:17 > 0:42:20That's the real test of whether a patient looks
0:42:20 > 0:42:23fit to go or shouldn't go and I think right now
0:42:23 > 0:42:25the safest option - he's only 16 - is to wait.
0:42:30 > 0:42:32I think this doesn't make sense from our perspective
0:42:32 > 0:42:33but I don't know what you think, Morgan.
0:42:33 > 0:42:35No, I don't understand what the rush is.
0:42:35 > 0:42:37- And it's only to France. - We did say that.
0:42:37 > 0:42:39And we're still part of the EU!
0:42:40 > 0:42:41At least for a little bit.
0:42:48 > 0:42:52- Bonjour. Can you give me a cough? - MORGAN COUGHS
0:42:52 > 0:42:53- A big cough. - HE COUGHS
0:42:53 > 0:42:55- Encore. - HE COUGHS
0:42:55 > 0:42:56- A big breath. - MORGAN GASPS
0:42:59 > 0:43:02So, he has a lot of rib fractures.
0:43:03 > 0:43:05And his lung collapsed.
0:43:05 > 0:43:07And this drain treats that.
0:43:07 > 0:43:10Now, there was some talk about discharge today.
0:43:10 > 0:43:13Now, I know France is very close by but even so...
0:43:14 > 0:43:17..I wouldn't be in favour of him being transferred
0:43:17 > 0:43:20in a compressed aircraft because of the lung injury.
0:43:20 > 0:43:22WOMAN TRANSLATES
0:43:24 > 0:43:27I feel he should stay until after the weekend
0:43:27 > 0:43:30and I think the best thing is whatever the safest option is.
0:43:30 > 0:43:32WOMAN TRANSLATES
0:43:35 > 0:43:37OK. D'accord. OK.
0:43:42 > 0:43:45The boys have been in separate parts of the ward and haven't seen
0:43:45 > 0:43:48each other since the night of the attack.
0:43:48 > 0:43:49Great. Well done. Good.
0:43:49 > 0:43:52And we're just going to come round this side.
0:43:53 > 0:43:55OK. Well done.
0:43:55 > 0:43:56Good job.
0:43:56 > 0:43:58OK. Do you want some pain relief?
0:43:58 > 0:44:01- Yes.- I'll go ask the nurse for you to get some pain relief.
0:45:36 > 0:45:38IN FRENCH:
0:46:16 > 0:46:19You know, it's a horrible situation for Victor
0:46:19 > 0:46:21because he wants to go home.
0:46:30 > 0:46:33We always try and do what our patients would wish us to do
0:46:33 > 0:46:36but there are times where we just can't do that.
0:46:36 > 0:46:41We've got to wait until we're comfortable and confident
0:46:41 > 0:46:45that he will be able to breathe without the chest drain in
0:46:45 > 0:46:47before we can let him fly.
0:47:05 > 0:47:09Stephen is no longer sedated and has been moved out of intensive care.
0:47:11 > 0:47:13And were you just in London for the day?
0:47:13 > 0:47:15- It was my birthday. - Oh, was it your birthday
0:47:15 > 0:47:17on the day? Oh, Stephen.
0:47:17 > 0:47:21I remember making the decision, "Let's cross the bridge,
0:47:21 > 0:47:24"get a taxi on the other side." That's pretty much it.
0:47:24 > 0:47:26My wife was there as well.
0:47:26 > 0:47:30- Oh, is she OK? - She has minimal physical injuries.
0:47:30 > 0:47:34I think she has a twisted ankle and a few bruises.
0:47:34 > 0:47:36- Right.- But...
0:47:36 > 0:47:38she remembers it and I don't.
0:47:38 > 0:47:40You don't remember it.
0:47:40 > 0:47:42So, I've got the broken body, she's got the broken...
0:47:42 > 0:47:44The broken mind, I know.
0:47:47 > 0:47:49I'm really worried about her.
0:47:52 > 0:47:55You know, it was horrendous.
0:47:57 > 0:47:59Cara told me there was an image online of us
0:47:59 > 0:48:01so I went looking for it.
0:48:01 > 0:48:02This is it, really.
0:48:02 > 0:48:05This is me laying in the road
0:48:05 > 0:48:08and Cara is just on her knees crouched over me,
0:48:08 > 0:48:12telling me to be OK and it's all right.
0:48:12 > 0:48:16I just see love in it, really, cos all that chaos and hatred,
0:48:16 > 0:48:18all I can just see is my wife looking after me.
0:48:20 > 0:48:22But we're going to deal with it together.
0:48:22 > 0:48:24So... That's what we've kind of...
0:48:24 > 0:48:27HE SIGHS
0:48:27 > 0:48:31That's our plan, you know, we'll both do it together.
0:48:31 > 0:48:32And so, like I say,
0:48:32 > 0:48:35we've got different experiences of the situation.
0:48:44 > 0:48:45OK if we come in?
0:48:46 > 0:48:48Do you remember me?
0:48:48 > 0:48:51So, I was going to chat to you a little about the leg.
0:48:51 > 0:48:53You know, getting the operation done
0:48:53 > 0:48:57to fix both the bone and the soft tissue.
0:48:57 > 0:48:59So, the whole aim of this is trying to get rid of
0:48:59 > 0:49:01any chance of infection which could...
0:49:01 > 0:49:03Do it once and do it well once and that's it.
0:49:03 > 0:49:05That's exactly right.
0:49:05 > 0:49:07OK, the other thing I always ask people is,
0:49:07 > 0:49:09are you having any problems sleeping, flashbacks,
0:49:09 > 0:49:10anything like that?
0:49:10 > 0:49:12Erm...
0:49:12 > 0:49:14- Let's get this sorted.- Yeah.
0:49:14 > 0:49:17Then we can cross that bridge when we come to it.
0:49:17 > 0:49:20Just so you're aware, if you do start getting those kind of things,
0:49:20 > 0:49:21it's completely normal.
0:49:24 > 0:49:26I just want it over and done with.
0:49:27 > 0:49:30If you want someone to talk to, we've always got people around.
0:49:30 > 0:49:33Our aim is to get you back to where you were, OK?
0:49:35 > 0:49:38'We've got to get it into his head that actually it's not going to be
0:49:38 > 0:49:41'a smooth journey. He's going to have rough days, bad days,
0:49:41 > 0:49:43'he's going to go up and down.
0:49:44 > 0:49:47'He might be walking down the road in six months' time
0:49:47 > 0:49:50'and hear a car revving and it may just somehow
0:49:50 > 0:49:53'subconsciously flick him back into where he was
0:49:53 > 0:49:55'on the day of the accident,
0:49:55 > 0:49:58'and I think it's important to warn people that can happen.'
0:49:58 > 0:50:03Every one of us has a limit to how much mental resilience we have
0:50:03 > 0:50:07and you've just got to be conscious of that.
0:50:07 > 0:50:10SPEECH INAUDIBLE
0:50:26 > 0:50:27Bonjour.
0:50:29 > 0:50:30Ca va?
0:50:30 > 0:50:33- Can you give me a big cough? - VICTOR COUGHS
0:50:33 > 0:50:35- Big breath in. - THEY INHALE
0:50:35 > 0:50:38That was good. I think we can take that out.
0:50:38 > 0:50:40We're going to remove the drain.
0:50:40 > 0:50:43Whilst the lung re-inflates and expands,
0:50:43 > 0:50:46it sticks to the inside of the chest wall.
0:50:46 > 0:50:47And that keeps it up.
0:50:49 > 0:50:50Just taking out a stitch.
0:50:54 > 0:50:56OK, and again.
0:50:57 > 0:50:58And blow hard.
0:50:58 > 0:51:00THEY EXHALE
0:51:01 > 0:51:02OK. Done.
0:51:02 > 0:51:04Done. Breathe normal.
0:51:07 > 0:51:08OK?
0:51:08 > 0:51:10Tres bien?
0:51:11 > 0:51:13Good. Do it again.
0:51:13 > 0:51:15Non.
0:51:19 > 0:51:22OK, we're going to take a quick picture of your chest, yeah?
0:51:22 > 0:51:24Good. Get your shoulders very close for me.
0:51:24 > 0:51:27OK. Big breath in for me, please.
0:51:27 > 0:51:29And breathe normally.
0:51:29 > 0:51:32IN FRENCH:
0:51:38 > 0:51:40Yeah. His lung is nicely expanded,
0:51:40 > 0:51:45his collapsed lung is nicely sealed, so he could be discharged today.
0:51:47 > 0:51:50IN FRENCH:
0:51:56 > 0:51:59- Bonjour.- Bonjour.
0:51:59 > 0:52:01Paramedics from the French insurance company
0:52:01 > 0:52:03arrive to collect Victor.
0:52:04 > 0:52:06IN FRENCH:
0:52:40 > 0:52:43Victor, all the best, man. OK?
0:53:17 > 0:53:22I walked across Westminster Bridge yesterday and it's just so mundane.
0:53:25 > 0:53:29I know exactly where our patients were injured.
0:53:29 > 0:53:33Sometimes, it's almost surreal to think that actually, a week ago,
0:53:33 > 0:53:35it was a very different scene.
0:53:37 > 0:53:39It's the day of Stephen's leg operation.
0:53:44 > 0:53:47About six, eight months ago we got married.
0:53:47 > 0:53:49And that's it.
0:53:49 > 0:53:52We're just a happy little unit, really.
0:53:54 > 0:53:56We live our lives like anybody else.
0:53:56 > 0:53:59We go to work, go home, watch a bit of TV,
0:53:59 > 0:54:00have a bit of dinner and go to bed.
0:54:01 > 0:54:02This will change us.
0:54:04 > 0:54:07We're going to appreciate each other more.
0:54:07 > 0:54:09You know, and for both of us to survive....
0:54:11 > 0:54:12You know, that's just...
0:54:12 > 0:54:15You take it for granted, you step out of the door every morning
0:54:15 > 0:54:16and on your merry way you go.
0:54:24 > 0:54:28The operation is the start of his rehabilitation
0:54:28 > 0:54:32and the start of his journey back towards getting to being
0:54:32 > 0:54:34that person he was before he got hit.
0:54:35 > 0:54:38If we can now say to you, "Right, Stephen, you're fixed..."
0:54:40 > 0:54:43..your next focus is walking out of the hospital, that's a big deal.
0:54:48 > 0:54:50- Are you ready, Stephen?- I am.
0:54:53 > 0:54:55I don't know if that's going to be the last of it.
0:54:55 > 0:54:57I'm not expecting it to be the last of it.
0:55:00 > 0:55:01I want him back home.
0:55:03 > 0:55:05I want to have a Friday night
0:55:05 > 0:55:07on the sofa with a pizza and a beer, you know?
0:55:09 > 0:55:10I want that back.
0:55:15 > 0:55:17Right. There we go.
0:55:17 > 0:55:22This is our titanium nail that's going to stabilise the fracture.
0:55:22 > 0:55:24The operation will last nine hours.
0:55:25 > 0:55:29First, an orthopaedic team inserts a 390mm rod
0:55:29 > 0:55:32into Stephen's shin to stabilise the fracture.
0:55:34 > 0:55:36OK. X-ray, please.
0:55:36 > 0:55:40Then, Shehan attempts to repair the large open wound.
0:55:40 > 0:55:43'You see, the leg break itself's relatively straightforward.
0:55:43 > 0:55:48'The problem for him is that it's happened in the context
0:55:48 > 0:55:51'of losing lots of skin around the leg break.
0:55:54 > 0:55:57'So we need to replace the skin that's been lost
0:55:57 > 0:55:59'using tissue from his other leg.
0:55:59 > 0:56:02'The way we do that is we take a block of tissue
0:56:02 > 0:56:03'on its blood vessels.
0:56:07 > 0:56:09'We then move it to where that skin is missing.
0:56:11 > 0:56:13'So, slightly robbing Peter to pay Paul,
0:56:13 > 0:56:17'but we're hoping the robbery's worth the outcome.
0:56:20 > 0:56:23'And then we reconnect that blood vessel
0:56:23 > 0:56:24'to blood vessels in his legs...
0:56:25 > 0:56:28'..using microsurgery, so it's quite delicate stuff.
0:56:30 > 0:56:32'If we can't get that connection to work...
0:56:34 > 0:56:36'..then we've got a problem.'
0:56:41 > 0:56:43Yes, that's all now hooked up.
0:56:45 > 0:56:47So, you can see this tissue's now bleeding,
0:56:47 > 0:56:50and ideally you want it bleeding exactly the same as it was
0:56:50 > 0:56:52when it was in the thigh.
0:56:55 > 0:56:58So hopefully, after today, he's going to be...
0:57:00 > 0:57:02..on the road to recovery and walking
0:57:02 > 0:57:05and getting back on with his life,
0:57:05 > 0:57:07at least from the physical side.
0:57:08 > 0:57:11I'm sure that other things take a bit longer.
0:57:15 > 0:57:17- All right?- Good.
0:57:27 > 0:57:29- How are you?- How are you? - I'm all right.
0:57:31 > 0:57:32It went really well.
0:57:34 > 0:57:35Probably 12.
0:57:35 > 0:57:38That's basically... That's as good as it could be.
0:57:42 > 0:57:44Cara, hi, Shehan Hettiaratchy,
0:57:44 > 0:57:46I'm the surgeon looking after Stephen.
0:57:46 > 0:57:49He is awake, comfortable...
0:57:50 > 0:57:54..and he wants to go dancing, so I think that's probably a good sign.
0:57:55 > 0:57:58No, it's a pleasure. Take care. All right.
0:57:58 > 0:57:59Bye-bye.
0:58:01 > 0:58:04'Our job here within our trauma centre
0:58:04 > 0:58:08'is to deal with victims of trauma no matter how they suffered that.'
0:58:12 > 0:58:13It's important to reflect,
0:58:13 > 0:58:16but it's also important to realise we all have jobs to do
0:58:16 > 0:58:19and we have to move on from this and we have to keep going.
0:58:25 > 0:58:27I want to do this as a log roll.
0:58:29 > 0:58:30I'll come down.
0:58:31 > 0:58:34Where are you? You're in resus? Yep, coming down.
0:58:34 > 0:58:36- What's happening?- I don't know,
0:58:36 > 0:58:39but I know there's a bad stabbing down there.
0:59:08 > 0:59:09Salut!
0:59:09 > 0:59:12IN FRENCH:
0:59:26 > 0:59:29I can't wait to have that first kind of beer in the garden.
0:59:29 > 0:59:31I think, Cara, I feel like...
0:59:33 > 0:59:36..I'm allowed to say we've won.
0:59:39 > 0:59:41We survived and we're safe.
0:59:49 > 0:59:50My heart...
0:59:52 > 0:59:54..hopes that you only ever have one day like that.
0:59:55 > 1:00:01My head tells me that I'll be putting on that tabard again.
1:00:02 > 1:00:06And that sense of almost inevitability
1:00:06 > 1:00:10is something that you just have to get used to.
1:00:13 > 1:00:16So, let's move on to the income report.
1:00:16 > 1:00:19With the NHS under mounting financial pressure...
1:00:19 > 1:00:22We have a financial deficit of 41 million.
1:00:22 > 1:00:25..the trust treats private patients to boost income.
1:00:25 > 1:00:28It's better that we address our deficit that way
1:00:28 > 1:00:31than that we have to cut back on NHS services.
1:00:31 > 1:00:35And with patient demands for new, expensive cancer drugs rising...
1:00:35 > 1:00:40We are in a golden era of more and more drugs available.
1:00:40 > 1:00:42How do you cost life?
1:00:42 > 1:00:43It is very, very difficult.
1:00:43 > 1:00:46..an increasing number are self-funding
1:00:46 > 1:00:48experimental treatments.
1:00:48 > 1:00:51If it even gives Glenn something to live for now...
1:00:53 > 1:00:54..it's serving a purpose.
1:01:01 > 1:01:03What choices would you make when faced with
1:01:03 > 1:01:05complex health care decisions?
1:01:05 > 1:01:09Visit our interactive pages to find out how you would respond.
1:01:09 > 1:01:10Go to...
1:01:12 > 1:01:15..and follow the links to the Open University.