Episode 2 Junior Paramedics

'Ambulance Service. Tell me exactly what's happened.'

'It's me husband. I can't wake him up.

-'Just confirm for me, is he awake?'

-'He's, like, comatose.

'I'm trying to feel a pulse, but I can't...'

'He's on the floor, he's unresponsive.'

RADIO: 'Er, cardiac arrest...'

A call to a cardiac arrest.

The paramedics have just eight minutes to get to the scene...

..and just 12 minutes to save the patient's life.

Do you want to do another pulse check just before we move him?

It's a scenario that can test the most experienced paramedic.

But what if you're a first-year student and you're new on the job?

Meet the Junior Paramedics.

Does this make me look vain?

'It is quite scary and daunting.'

I am only 19.

You got little ticklish feet?

When we go to a really serious job, like a cardiac arrest,

I will have to get involved.

You feel like you're doing something that means something,

and it's making a difference.

Flying around with the blue lights on, that'll be good.

I'm not going to lie!

MAN SPLUTTERS

Let's go do some shots.

The shifts are going to be hard to get used to.

I hate mornings, I'm not a morning person, at all.

All of the paramedics I've spoken to have said that there'll always be

one thing, when you get there,

you don't know why, but it affects you really badly.

You've got to be prepared to go into someone's house

and not be scared of the outcome.

I'm definitely quite worried dealing with my first fatal

or, you know, the first body that I come to.

Being a paramedic's my dream. It's something that I've always wanted.

Studying for a degree in paramedic science is tough.

Failure is not an option.

Six weeks of dealing with real people in real emergencies

is even tougher...

I'm yawning all the time and I'm shattered already.

..working gruelling shifts...

We're with you. Ambulance is here with you.

..and being put under immense pressure.

-Why am I doing this?

-There we go.

Why am I out in the cold at two o'clock in the morning?

They're young. They're inexperienced.

Oh, my God.

And every day is a matter of life or death.

I was like, a-a-agh! Adrenaline!

For these Junior Paramedics,

it's make or break on the emergency front line.

Do you know how to open it? Stop! SHE LAUGHS

Previously on Junior Paramedics...

Lots of drugs problems round here, so it could be an opiate overdose...

As they started their placements,

all nine Junior Paramedics were thrown in at the deep end,

experiencing real trauma for the first time.

-Take a deep breath.

-Yeah.

Steph was given a baptism of fire,

as she attended a suspected cardiac arrest...

I don't think I've ever had

an adrenaline rush like that in my life.

..before impressing during a major road-traffic incident.

-You haven't got any allergies at all?

-No.

-No.

She did really well, I'm really pleased with her.

Meanwhile, Lucy Mellor struggled with her bedside manner.

-Awkward silence.

-Are you busy?

..whilst Amy was left feeling emotional.

I feel really stupid for, like, getting teary about it,

but it, sort of, brings it home like that.

Although their first week might have been tough,

that was just the beginning.

With five weeks left on placement, and being constantly assessed

on their performance, this is the reality of life

when you're a Junior Paramedic.

'Hello, East Midlands Ambulance Service.'

'Tell me exactly what's happened.'

'Yeah, the wife has tumbled in the kitchen...'

'My husband's fell off a ladder outside.

'He's on the floor and he's struggling breathing.'

'OK, I'm organising help for you now. Stay on the line, OK?'

At the heart of England,

the East Midlands Ambulance Service provides

emergency medical assistance for 4.8 million residents,

receiving 2,000 999 calls every day.

BEEPING AND RADIO CHATTER

Across Northamptonshire and Leicestershire,

all nine Junior Paramedics

are starting their second week on placement.

And at Mereway Ambulance Station in Northampton, 19-year-old Bryn

and his mentor, Charlotte, are braced for their first call.

Bryn hasn't learnt the noises yet.

Every time it goes off he's like this.

BEEPING

-Enjoy.

-I'll see you in a bit.

In his first shifts, Bryn has been excelling in his new role.

It'll go on your toe like that.

-Oh...

-Oh! No, I didn't think so!

He's impressed his patients with his relaxed bedside manner...

-Can you say "British constitution" for me?

-British constitution.

-Good, and "Baby hippopotamus?"

-Baby hippopotamus.

Good, you can do it better than I can.

..has immediately bonded with his mentor, Charlotte...

One, two, boot!

..and he's a hit with the other students on the course.

Most of all, he's passionate about becoming a great paramedic.

'I want to be a paramedic

'because I've always been interested in emergency care.'

So, you know, when I was younger, when I first got my diabetes,

I was introduced to hospitals and the hospital environment,

so I was in there quite a lot.

If I don't take my insulin then my blood sugars will go up,

and then, if I left it for a long time

then I'd get diabetic ketoacidosis and die.

If I left it for a long time it could be quite bad, but, erm,

we won't be doing that, so...

If you're on two shifts in a row, you don't have time for a thing.

So, what sort of thing do you eat in the middle of the night?

Oh, Super Noodles.

Something very unhealthy.

'My family are quite excited for me to go down the paramedic route,'

and hope that I can be the best that I can be, really.

It's a big leap into the unknown,

so I am a little bit nervous for him, but I'm very confident in him.

I think that he will be loving it, which makes me feel a little

bit better, because if he's happy then I will be happy as well.

'So I do a bit of a range of sports.

Coming to uni, I've picked up lacrosse.

It's quite a fast game.

You know, it's a contact sport as well,

so it's good to get a bit of aggression out.

You get tired out.

I feel ready to become a Junior Paramedic,

so, I feel prepared theoretically,

but it's another thing being mentally prepared and then actually

physically being in that situation and having to deal with it.

As temperatures plummet in Northampton,

Bryn's been attending a series of low-key jobs,

so he's desperate for some action.

RADIO BEEPS 534?

Not a problem. Thank you very much.

His moment has finally come,

but will he be able to cope under the pressure?

So, what's really important with an ankle injury?

What do we need to do to assess it?

Er, expose it first of all, so if he was, I don't know,

say, if he was playing football or something...

-So, expose and examine, yeah?

-Yeah.

-But what are we comparing it to?

-The other ankle.

-Yay.

After racing to the scene,

they discover that, to get to their patient,

they need to drive straight on to a busy football pitch.

Do you think I'm going to get through that?

I don't know. Yeah, you might do!

As they arrive, they discover

an amateur footballer lay on the ground,

who is remarkably calm,

considering his foot is pointing 90 degrees in the wrong direction.

How much pain out of ten?

If you could score it out of ten. A four.

Just get you on some gas and air for a minute.

Does it hurt at the moment? Maybe you've turned it a bit. No.

It's an horrific-looking injury,

which could distress any Junior Paramedic, yet Bryn is unfazed.

If you hold that to your mouth and just take some deep breaths in.

-Have you ever had this before, buddy?

-No.

-You haven't.

My gut feeling is that it is dislocated.

This doesn't look deformed in the fact that it's broken, and it looks

that your ankle's come out of place, so I'd say it's more dislocated.

The injury looks severe,

but Bryn and Charlotte still need to expose and examine the ankle,

to see the full extent of the damage.

Sorry, buddy, you are going to have to get some new shoes.

-Can you feel me touching your foot and everything?

-Yeah, I can, yeah.

If the dislocated bone stretches the flesh too far,

the patient could get critical skin,

where blood vessels are strained so much

the blood supply to both the skin and the limb could get cut off.

The critical skin is minimal,

but the patient will now need urgent medical attention at hospital,

since extreme cases can lead to amputation.

Yeah, 534, can you give me a heads-up

when the crew are about five minutes away,

so I can get someone to come and meet them?

Yeah, no worries, thank you.

The ambulance being delayed is a huge blow.

Bryn and Charlotte must now do all they can to keep the patient stable

in the rapidly-falling temperatures.

-Are you freezing cold?

-I'm getting pretty cold.

-Yeah?

I'm going to pop this here, cos that'll keep you warm,

I know you look a bit silly, but it'll keep your head warm.

As everyone starts to struggle with the cold, Bryn starts to realise how

the most simple of tasks can become difficult with freezing fingers.

My hands were so cold, I just, I couldn't get packets open

and things like that, so I couldn't really...

I should have been a bit quicker

just getting that pain relief as soon as possible.

I'm going to give you some morphine now, all right, mate?

'It makes it more difficult when you have to do things,

'and it was kind of fiddly things, like Charlotte put a cannula in.'

'For her doing that, it's quite a fine procedure,

'and when your hands are freezing cold that must have been really difficult.'

Luckily, I don't have to do that yet!

You're quite a fit guy, so it'll probably heal quicker.

LAUGHTER

Oh, brilliant(!)

As Charlotte squirms with embarrassment...

Brilliant. CHARLOTTE LAUGHS

..the ambulance finally arrives,

and since time is of the essence, Bryn takes charge of the situation.

We've got 29-year-old Ivor, he's, uh...

Looks like a dislocation to his ankle,

it's quite obviously deformed.

It's his first handover,

but with the patient's condition deteriorating,

there's no time for nerves.

OK, we're going to lift on "lift." Ready, brace, lift.

Having experienced his first dramatic incident,

Bryn now feels ready for anything.

He just needed pain relief, that's why I was going...

I know, I was taking for ever.

We need to get him some... No, don't worry.

My hands were so cold, I was like that, I can't actually get this out!

I felt so sorry for this guy

cos all he was doing was just training for a match, probably,

but he dislocated his ankle and then later we found out

he'd actually broken his tibia and fibula.

I think this chap actually was quite lucky in the fact that,

when he had got seen,

he had managed to just about get there in time to save the skin,

so he wouldn't have had to have a skin graft,

but it is an emergency situation if somebody has this critical skin

where it has gone really, really white.

-I embarrassed myself with that bunch of lads, as well.

-Why?

-Oh, when you called him fit.

-I didn't mean it like that.

I was like, "Oh, no, I'm blushing now."

"You just called me fit. Brilliant, thank you."

It's so embarrassing, I didn't mean it like that.

Over at Gorse Hill Ambulance Station, another Junior Paramedic

starting a nightshift is 19-year-old Lucy Wright.

-Hello!

-Hello, evening. All right?

-Yeah, you?

-Yes, fine, thank you.

Like Bryn, Lucy's proven to have a solid understanding of both

medical procedure and the technical aspects of the job.

-Well done.

-Brilliant.

However, Lucy has struggled to communicate with some patients,

often finding it difficult to reassure them

and make them feel at ease.

There we go.

But she knows that, if she can improve her bedside manner,

she'll be on course to become a success.

A lot of my friends were shocked when I said I was

going to be a paramedic, they thought I was a bit crazy.

"Why the hell would you want to do this for a living?"

My dad was quite poorly a while ago.

That was when I decided to get involved

with the care and stuff like that,

and it really made me want to, like, chase what I wanted to do.

I would describe myself as a geek, definitely.

Going out for me is not a big thing.

I really like gaming, so... Playing games like zombie games.

-I haven't been out with you yet.

-Yeah, we have.

-No, we haven't.

-You were begging me to get drunk.

-You weren't drunk, you stayed here.

The thing that I'm most dreading is having the awkwardness

of talking to a patient when I'm not really prepared to,

so I won't know what questions to ask and how sensitive to be.

I need to actually talk to patients more, which is

the thing I'm most dreading.

Certain things come natural and certain things don't.

'Ambulance, tell me exactly what's happened.'

'Hello, calling from LeicesterCare Lifeline,

'got a 67-year-old female with breathing difficulties.'

SIREN WAILS

On shift in Leicester, mentor Natalie is keen to see Lucy progress

if she's going to pass her placement,

so the time has come to push her harder.

We'll let you lead this one. See how you go.

Remember your questioning, A-B-Cs.

Natalie wants Lucy to deal with the patient directly,

ascertain her medical history, and assess her condition.

Hello? Hello, I'm Lucy, I'm a student paramedic. How are we feeling today?

However, once inside, they find the patient is gasping for air.

We're going to have a listen to your chest.

-Have you got asthma?

-COPD!

-COPD, right, OK.

Since the patient is in such a distressed state,

Natalie has no choice but to step in and take control.

Have you had a nebuliser before? Yeah.

PATIENT SPLUTTERS

Shall I put this on you?

The patient's breathing problems are

a symptom of chronic obstructive pulmonary disease - or COPD,

which is often caused by lung damage as a result of excessive smoking.

No, don't worry, you don't have to talk.

-You just concentrate on your breathing.

-It's 39.

-39.

-Yeah.

Right, Ann, we're going to be really mean,

cos you've got a really, really high temperature.

So I'm going to take this off, and just put your dressing gown on.

I know you're really cold,

but it's because you've got a really high temperature.

Whilst Natalie goes off to chat with the patient's husband...

So, these are all the ones that she takes?

That's the ones she starts the day with, yeah.

..Lucy begins to carry out general observations...

Try not to move them too much, you don't need to move too much.

..a series of tests monitoring blood pressure,

blood sugar level and pulse.

It's also Lucy's job to keep the patient calm and reassured

at all times.

But shyness has got the better of her.

As another ambulance arrives to take the patient to hospital,

Lucy has a chance to earn some brownie points,

if she can successfully perform a case handover to the new crew.

Do you want to tell Shab what's been going on, Luce?

Er, this is Ann, she's got COPD.

Erm, she's just struggling to breathe at the minute,

we've given her Salbutamol.

Erm...

Basically, she was feeling unwell earlier.

Erm, her husband wanted to ring her in...

Remembering every detail of a patient's medical history is tough,

so despite her best efforts,

Natalie has stepped in to help Lucy complete the handover.

-That's it, throw me your legs round.

-That's it, well done, Ann.

I know, you're all puffed out, aren't you?

As the patient is taken to the waiting ambulance,

Natalie takes the time to reassure her worried husband.

She's going to be fine, it's just taken hold of her a little bit,

-so we've obviously got the nebuliser going...

-Yeah.

..and that's helping her a little bit, she's calmed down a little bit.

For Lucy, it's the perfect demonstration

of good bedside manner.

We're going to get her on the ambulance and I'll come back

and let you know what hospital we're going to.

-Are you going to be all right?

-Yeah.

-All right. Just grab the stuff.

Back in the fast-response vehicle,

Lucy's mentor gives her some feedback.

You need a lot of pushing to approach the patient.

You said at the very start of this placement that you do

struggle to speak to people, or some people.

That is evident, because obviously

one of the biggest things about this job is communication,

and it doesn't have to be on a clinical basis.

I'm just scared of offending people, mainly. Cos I'm so young,

especially, like, elderly, I don't want to say anything wrong,

and I just don't know how to chat as such, but I hope I'll get used to it.

It is only small talk.

Erm, it's not important when it comes to your university,

you know, doing your exams, doing your practical examinations,

things like that.

It's something that you need to master when you become a paramedic.

Although Lucy needs to concentrate on building her confidence,

she's not the only Junior Paramedic feeling out of their depth.

I'm going to pop this on your finger, is that all right?

In the first week, every little call that I got made my heart stop.

I was like, "What's happened?"

I'm doing the whole handover here.

There are times when they're like,

"Oh, do you want to do this handover in A & E?" And I'm like, "No way."

Because inside I'm just thinking, "I can't do that."

No, no, OK, just try to breathe normal.

I've learned, if a patient sees a panic on your face,

that must mean that it's gone really bad, and it's time for them

to be panicked, which isn't going to help them.

-Hello.

-Hello! My name's Amy and this is Shay. How can we help you today?

'Both my mentors now have started

'to let us take a bit of history from the patient.'

Is that all right to do some observations on you?

But I definitely wouldn't want to be in that situation on my own yet.

You've got to be able to hack it.

It's not just dealing with the patients, it's doing the long hours,

going into hospitals, doing the handovers,

and I think you need to be confident in everything.

Just push through it, really. Just man up.

Eat a Snickers. Drink some Red Bull.

-Oh, it's hurting again!

-You can lean on me, that's all right.

That's all right.

Confidence is key, and that's something Junior Paramedic Ashley

has never been short of.

And having previously worked in the Ambulance Service as a coordinator,

she has an idea of what the job entails.

My name's Ashley, I'm 27 years old.

I think I am really caring, erm,

but I am really ambitious and very competitive.

Hello, can you hear me? Can you open your eyes?

Yeah, there's a response, now I'm just going to listen for heartbeats.

I have a boyfriend, his name is Jamie, and he is a paramedic.

Do you think you could work with me?

-I don't think so.

-I don't think I could ever work with you,

because I think we're really similar characters, and I think I would

think I was right, and you would insist that you were right.

-OK, I'm going to go now.

-OK, darling.

The relationship with my grandparents is great.

I've always been really close with them.

I've grown up with them, and actually,

before coming to university, I've probably seen them every single day.

-Bye!

-All her life, she's always had loads of energy, hasn't she?

She's always full of enthusiasm.

-Nothing really fazes her, does it?

-No.

I think doing my previous job

and having friends and my partner in the industry, it definitely helps.

Would you have any advice for me for my first placement?

First placement?

Hmm, make sure you make a good cup of tea.

'I am highly driven,

'and I want to achieve something'

that I'm proud of, that isn't easy,

that is going to challenge me daily, that's going to have highs and lows.

I want to do something that means something

and I want to make a difference.

Since starting her placement in Northampton, Ashley's been eager

to roll up her sleeves, don the rubber gloves,

and get involved on every call.

THEY CHAT

So I need to change the green, cos that's compromised.

Good girl, well spotted. On the ball this morning.

Hello, it's the police.

But Ashley and her fellow Junior Paramedics have been shocked

by the level of social deprivation they've encountered

in the first days of their placement.

Why can't I just put them in order?

Many of their patients face day-to-day hardships

such as poverty, poor living conditions,

or ill health through substance addiction.

If Ashley is to succeed as a paramedic,

dealing with social deprivation

and learning to cope with such vulnerable patients is essential.

It's 1:30am, and Ashley and mentor Simon's next patient

is taking shelter in a local kebab shop.

-Hello, mate. Have a sit down, me old buddy.

-Thank you, thank you.

-How you doing?

-Not too good.

-Not too good.

-I met you the other night, didn't I?

-You did.

It's a homeless man known to many of the paramedics in Northampton.

So, what have we been called for tonight?

Right, how long's it been like this for?

A couple of days.

OK, did you see... Have you seen your doctor?

The patient's complaining of difficulty in breathing,

but when you talk to him, he's just so cold, he's so cold,

he doesn't know what to do, he has nowhere to go,

and he's just really hungry.

-Have you had any drink, any alcohol?

-No.

-No?

All right, buddy.

What are we going to do with you tonight, then?

A bit cold out there, innit?

I think really he just needs somewhere for the night,

and we have a duty of care, we can't just leave a vulnerable person

who's complaining of not feeling good.

Do you mind if I just check your pulse?

Just need to touch your wrist if that's OK.

Thank you, my love.

Although his situation is upsetting,

Ashley and Simon can only take a patient to hospital

if they are actually ill.

He's probably fought for his country

and he ends up sleeping on the streets.

Just another side, how people do live,

is quite heartbreaking to see sometimes.

-Have you had anything to eat today?

-No.

-No? Are you hungry or thirsty?

-I am very hungry.

-You're very hungry.

-Yeah.

'This placement is an eye-opener for me,

'although I think I have got some good life experience.'

It's kind of been really shocking.

And it's kind of been more some of the social issues,

such as people who don't have any family, any friends,

any home, anything.

That's kind of hit home a little bit more.

Do you want a tissue? I'll get you a tissue if you like.

Ashley and Simon's examination

reveals the patient has developed a respiratory infection.

Since he has a genuine complaint,

he will spend the night in hospital after all.

There's a step. Yeah.

Don't you worry.

'They don't have anything and they probably never will.

'And there's just... There's nothing to support them.

'And that's a really sad prospect.'

Ashley's already learning that there's more to being a paramedic

than just tending to the sick and the injured.

It involves acting as a medic, a social worker and,

most importantly, a Good Samaritan.

It makes you realise how lucky you are, I suppose.

It's just sad that he doesn't have anyone, as well.

Let's see if you've remembered anything. What is this?

Oh, I can't say it.

The University of Northampton's Paramedic Science course

is incredibly tough to get on, and no-one is more aware of this

than 25-year-old Vicki.

She's desperate to become a paramedic,

but she failed to get on the course four times

before finally being accepted this year.

It's massively important to me.

I've never stopped trying to develop myself for it and be ready for it.

Finally this year, I managed to get my place at Northampton.

What's the problem? What have you called for?

Since starting her placement, Vicki has found the reality of the job

to be far more demanding than expected,

and at times has struggled to absorb essential information

provided by patients.

Should that fill up with blood? What should that fill up with?

-Faeces.

-Right, OK.

It's taken me a while to sink things in.

I know it's only my first shift,

but I don't want to just stand there and do nothing.

She's bonded well with her mentor George,

but Vicki is her own biggest critic,

piling the pressure on herself to make the grade on placement.

This is all the drugs. I'll test you now,

-see if you can remember where everything is.

-Oh, God!

SIREN WAILS

There you are. You've now got to go up the stairs with that.

Today Vicki and George are one of the teams

covering the Leicester area,

where they've been called to help a man

who seems to have fallen in his flat.

But when they arrive, getting access to treat the patient

is far from straightforward.

-Is he up again? Did they say...?

-Have you got a key to his house?

-No.

Has anybody?

-Just a minute.

-He has. Have they?

-Oh, here he is.

-Oh, brilliant..

-Hello.

-Have you got the key?

Do you have the key? The key?

-No.

-No?

-I show you the key.

-Oh, can you let us in?

-Yeah.

-Ambulance.

-All right.

-Out of breath.

Having no idea what condition the patient is in,

time is of the essence.

But getting the front door opened is proving to be a frustrating task.

Have you found it? Are you looking for it?

-Can't find it.

-He can't find it.

Have you got your key in there? Can you pass it to me?

Oh, that's not it.

-He's here on the floor.

-Behind the door?

-Yeah, well, he's trying...

He's making his way to try and pass me the key.

Just take your time. There's no rush.

-Is he crawling?

-He's scooting on his bum.

-Aw, that's all right.

We'll probably get the keys at the same time.

Have you got it? Thank you.

-Have you got it?

-Yeah.

Are you going to scoot back, so I don't open the door on you?

-Just pass it through the letter box.

-Take your time.

I've got it. Thank you.

Hello.

-I can't get up.

-It's OK. No worries. That's what we're here for. It's OK.

Since Vicki's already spoken to the patient, she continues to

take the lead, hoping to prove to George that she's up to the job.

-Are you hurt anywhere?

-Hit?

-Hurt. Are you sore? Aching?

Yeah.

Grab my elbow. There we go.

-That's OK.

-Are you up?

-OK.

-There you go.

-That's OK.

-Give us your hand.

There you go.

Just when everything seems to be under control, the situation

takes a sudden turn for the worse.

What happened then?

MAN GROANS

We're with you. We're with you.

The patient is having a seizure and although drugs can be

administered to ease the severity, it's often best

to make sufferers comfortable and reassure them until it's over.

We're with you. Ambulance is here with you.

Crew required, please. You come round here.

I'll go round there. He's stopped fitting now.

-But he's not come round any.

-'It's a little bit surreal,

'cos he literally was talking to us and then he just went

'and I just talked to him cos I know that they can panic'

when they come out of it and they are confused.

So I just thought talking to him might give him a bit of reassurance.

Relax, it's OK, we're the ambulance.

Although he's mid-seizure,

Vicki and George still have procedures to follow

and take all the patient's observations

before the ambulance arrives.

-Relax. It's OK. It's OK.

-Hello. Hello.

-It's OK.

-All right. All right.

Ambulance.

Hello. Hello.

We're here to help you. Leave it in. Leave it in.

-Take the nasal thing out, or...?

-Yeah, probably just... He'll be all right.

He's not fitting, so we can take it out. Take it out. That's it.

-He's coming round.

-Just relax. Just relax.

At this stage, it's impossible to diagnose the reason for the seizure

since the symptoms could be indicative

of anything from epilepsy to a stroke.

20 minutes after collapsing, the patient already seems to be

regaining full awareness.

Minute by minute, Vicki's confidence also seems to growing.

Just stay there for now. Just relax there. OK.

-Hello.

-Are you all right?

-I'm all right, thank you.

The second paramedic team arrive to take over

and transport the patient to hospital,

leaving Vicki and George to reflect on

a job well done.

Vicki handled herself really well.

I did say, "Oh, he's fitting," but the dynamics changed

and she just went into, "Right, let's get on with it.

"Let's deal with it." That's what you need as a paramedic.

Things change all the time and you need to make plans,

new directions and think about what you're doing.

No rush. Take your time.

By using her initiative and getting us into the flat quicker,

it was really important

because that was the difference of us being with the patient

and managing his seizure, and managing his airway,

to him doing that without us

and, potentially, could have had life-changing effects for him.

Despite continuously putting herself under pressure to do better,

Vicki's starting to feel like she's making some real progress.

The more you go out, the more confident you get.

I definitely feel from day one of placement that I've grown

and developed, particularly confidence-wise, I've come on.

But there's a hell of a long way to go

and, particularly, not having a backup behind you of a mentor

is a scary thought.

SIREN WAILS

It's inevitable that every paramedic will face moments

where they question whether they're really cut out for the job.

After being shocked by the amount of social-deprivation cases

and the long working hours, Ashley is already wondering

if she was right to chase a new career.

Why am I doing this?

Why am I out in the cold at two o'clock in the morning?

This is potentially my life.

So she's off to see her nan,

a former ward clerk in a hospital emergency unit,

to ask for some advice.

-Hi, Nan.

-Hello.

-How are you?

-I'm fine. Lovely to see you.

-Yes.

-Lovely to see you.

-How long are you here for?

-Oh, not too long.

-Yeah?

So, how have your first few shifts been?

Are you getting really into it? Are you enjoying it?

It's been really good,

but I wobbled a lot sooner than expected.

With the big jobs I've been OK.

It's some of the other things that you think, "Oh,"

-cos it's sad to see how people live.

-Mm.

It's a very emotional job at times.

You will see awful things, but you're there to help.

Because without you, what would they have done?

I did go to one job. It was a patient with no home.

They were clearly homeless. And I found that it really got to me.

You're there to help and you think,

"I don't know how to help you. I don't know what I can do."

Because they're still suffering,

whereas a dead person is now at peace.

The person that you'd seen, who was cold and had nowhere,

he still had to go on that night.

There are lots of people

who I think lead really, really good lives

and people have real bad fortune.

When it's a social issue, it makes it much more complicated.

You have to think about all sorts of other dynamics.

What's the standard of living, you know?

Are you observing anything that's concerning, you know?

There's just all these other things. It's not straightforward.

It's compassion for people like that, and you have to keep that.

The more you get involved in your job,

the more you'll love it. You'll just come home and think, "Wow!

"that was a great job I've done today.

"I've helped somebody who needed my help."

Her nan might have offered some encouraging advice,

but will it be enough to lay Ashley's doubts to rest?

SIREN WAILS

-Hello.

-Evening. Are you all right?

-Yes, fine, thank you.

As Lucy starts her night shift in Leicester,

a call comes in to control.

SIREN WAILS

Lucy, mentor Natalie, and paramedic Naomi

are immediately dispatched to the scene.

We're going to a 28-year-old male.

It's come through as a male on the floor not responding.

-The patient is on the pavement. Querying maybe drink.

-Right. OK.

So this is going to be our first drunk young person, so...

Drunken patients can often be a struggle to deal with,

particularly when you're a 19-year-old junior

who's new to the job.

Some people can be so drunk that no matter what you do,

they just don't come round.

And it's strange because it is literally just drink-related.

A lot of them are absolutely fine,

but some people don't really want you to help.

They're very unpredictable. So we still have to be mindful.

Lucy's been making a more concerted effort to interact with her patients

but now she'll need to toughen up, take control

and be prepared for anything.

Oh, he's up. He's looking quite good for being unconscious. He's there.

-Is it this gent?

-This gentleman, yeah.

Medical conditions such as epilepsy or diabetes

can display symptoms that suggest a sufferer is drunk.

Shall we get you on the ambulance then?

So Lucy and Natalie can't make any assumptions

about the patient's state until they examine him.

Wait for us to get the ramp down.

Whoa, whoa, whoa. Wait a second.

HE MUMBLES

Yeah, well, you'll fall over, won't you?

Right, up on there. Take a seat on the seat for us.

What's happened?

You've had an epileptic fit?

And you got scared.

Oh, the guy got scared.

You've got a sore head. Shall we have a look at it?

Do you want to take his hat off and have a look?

-MAN:

-It's nothing to do with it.

No. Sit up. Come on, sit up.

-Watch your language, one...

-Am I allowed to take your hat off?

We'll take your hat off and take a look at your head.

No neck pain?

No?

Around this side?

-Sit up. Come on, sit up.

-How much have you had to drink?

Two pints. How many...

No, you shouldn't. How many fits do you normally have?

About three a week. Watch yourself. Come on, sit up.

-You're not BLEEP...

-'Ey, 'ey, 'ey, calm down. Just watch him.

-Just calm down. What's up?

-It's all right.

Don't hit yourself in the head. Come on.

Suddenly Lucy and Natalie are in a potentially volatile situation.

They need to keep the patient calm

whilst making sure they don't put themselves in harm's way.

Come on.

Calm down. Come on, calm down.

Let's take this... Uh-uh, come on. Come on.

Well, we know you're not going to hurt us,

but we don't want you to hurt yourself.

Why wouldn't I like you?

You've not done anything to me.

Lucy still needs to carry out basic observations

but, on such an erratic patient,

she is going to have to communicate with him

and keep him reassured - the two skills she lacks confidence in.

Do you want to keep yourself sat up for me?

I don't want you to fall over.

-The green? Do you like it?

-Suits us.

-It does suit us.

As the patient continues to recover from his seizure,

he seems keen to prove that he's a lover and not a fighter.

You've got a fan, Luce.

Thank you.

Thank you.

-It comes natural.

-She's just got a pretty face, obviously.

She has got a pretty face.

-Um, no. Not right now.

-You can't stroke people.

No, no, no, no, no. I don't think Lucy wants you to stroke her.

-That's enough.

-There we go.

Lucy has successfully coped with an unpredictable patient

in a rapidly-changing situation

by being adaptable and able to communicate -

essential skills needed by every paramedic.

Finally her confidence is starting to grow.

I don't really feel vulnerable on my own, but I am wary.

But you've just got to handle it, be responsible,

and look out for yourself as well.

All across Leicester and Northampton,

there's an eerie chill in the air.

The junior paramedics are preparing for a truly gruesome event

that will leave some dazed and confused -

it's the Halloween fancy-dress party!

# What's that coming over the hill Is it a monster?

# Is it a monster... #

-Happy Halloween.

-Yay.

After working extreme hours and dealing with shocking situations,

it's inevitable the junior paramedics

will need to let their hair down.

ALL: Cheers!

# ..Is it a monster? #

All of us on the course, we do enjoy going out

and socialising with each other,

that's one of the great things about it, because you're so close -

there's such a small amount of people on the course.

-What are you today, Amy?

-I'm supposed to be Jigsaw, so...

-I get it.

-Can you not tell?

-Yes, I get it.

-I'm just missing the little tricycle.

It will definitely be nice, a bit of a release,

you know, to just go out with my friends maybe,

like, the day after I've had, like, quite a rough shift

and just so I can switch off and just forget about it.

You have to have that release, I think,

it's really important, otherwise you'll just go insane.

However, there is one student who is a little less excited

about a night on the blood-soaked tiles.

I don't mind having a good time and I'll do it once in a while,

but I prefer to go back and do work and that.

I know it comes across as a bit sad, but that's what I'm there for.

I'd be drunk off one vodka - a cheap night.

DISCO MUSIC

If I work hard, I can party hard later.

One junior paramedic who hasn't made the party is Ashley,

she's on a late shift and still having doubts

about whether she really wants to be a paramedic.

The downside in this job,

you can be pretty down,

so you have to be quite resilient

and not let that be a bit of a deadweight to you.

I think, otherwise, that can really affect you, not just in your job,

but you can really take this job home.

Although her nan provided some encouragement,

Ashley needs to regain her belief

that she can still make a positive impact

on a patient's life.

But while she contemplates where her future lies,

Ashley has to put any doubts behind her

as she and mentor Simon

go to an elderly lady who's apparently had a fall.

Oh, we are helping you. I just can't rush anything

because we want to make sure that you're OK before we move you.

On arrival, they find their patient, Gwen, on the floor

behind the bedroom door.

-Have you got any pain in your chest?

-No, I did have.

When? OK. But nothing at the moment?

All right.

I need to get you up onto your bed.

Then we can have a proper look at your heart.

Can you jump on the bed and get across to the lady's legs?

I just need to get an ECG on her.

Ashley heads into the bedroom to comfort Gwen

whilst the ECG monitors her heart.

But when Simon passes the results to Ashley to analyse,

she makes a vital discovery.

I spotted that she was having an MI, myocardial infarction,

looked like a heart attack.

That's like BAD.

Need to get a line in ASAP.

Can you get me an IV kit?

A myocardial infarction, or heart attack as it's more commonly known,

is often the first stage of a cardiac arrest.

Ashley and Simon now fight to keep Gwen alive.

Stay with us, sweetheart, OK? I'm going to have to cut this nightie off you.

The job changed very quickly.

We need to get the de-fib pads on because she could go,

so, yeah, like, adrenaline.

Suddenly, Gwen starts to lose consciousness.

Staying with us? Gwen?

Gwen, your heart's not working properly at the moment.

All right?

I know you do, sweetheart. Your heart's not pumping properly

and you've got a blockage in one of your coronary arteries.

Not while you're with me, darling.

How long have you had chest pains for?

All right, sweetheart.

I don't know if this is the sickest patient I've seen,

but we're catching this patient in the process

and that, kind of, makes the process completely different.

Gwen? Excuse me. Gwen.

Come round the back of me. Gwen? Stay awake. Stay awake.

If you go to someone and they're dying

or they're in cardiac arrest, or something,

that process has happened and you're just intervening and you've missed that.

When you go in and see someone have that deterioration

and then suddenly you kind of see that process,

it's completely different.

The feelings, the anxiety, the pressure -

"Oh, my God, this is really serious."

Are you all right, Gwen?

Gwen needs to get to hospital urgently

and when more paramedics arrive, she is soon on the move.

How are we doing? Stay with us. Keep talking to me.

But her condition continues to deteriorate rapidly.

We've got the patent on the ambulance. We're just trying to stabilise

and she's going to be taken to hospital as quickly as possible

because she's having a heart attack.

It's very serious

and she's very on the brink of having a cardiac arrest.

Gwen is rushed to Kettering General Hospital

where she is diagnosed with having two blocked arteries

but is now on the mend.

By noticing the irregularity on the ECG,

Ashley's attention to detail helped save Gwen's life.

I was really chuffed that I was able to interpret that

and be, like, really confident in interpreting that,

that was a real turning point for me, that was a real positive.

Gwen's close call has reminded Ashley

exactly why she wanted to be a paramedic in the first place.

And I got to stay to see her into hospital

and see her perk up and start being the person she was

before she was suddenly in this really horrendous place.

One of those jobs you'll remember - "My first MI, I'll remember that."

It seems Ashley's "wobble" is over,

but not all patients are as lucky as Gwen.

# Even though the dancing's done

# The night is young

# Who cares where we go We're ready for the afterglow... #

It's been a long and eye-opening week for Lucy

as she's finally started gaining some much-needed confidence.

# ..Afterglow We're ready for the afterglow. #

From being held back by her own shyness

to successfully dealing with potentially volatile patients,

Lucy's growing into her new role.

If it's a cardiac arrest,

I'll start compressions and you can manage the airway.

So check the airway,

make sure it's not obstructed or anything like that.

It's got no saliva or blood in...

However, she's about to face the biggest challenge of her life

as she and her mentor Natalie race to help a man

suffering a suspected cardiac arrest.

Does he suffer with anything that's been causing him to be unwell?

-No.

-OK. Do you want to just stop for a second?

Inside the house, the patient's son has been carrying out CPR

but without success.

OK, you need to step back,

because I need to shock him. OK, Lucy, he's in VF.

All right. I'm just going to charge. Keep everything away.

OK, I'm going to shock.

Nothing. Right, back on the chest.

-Lucy, do you want to take over and let me do it?

-Yes.

It's a critical situation and the man's life is now in Lucy's hands.

She must continue to pump the man's heart

and keep blood moving around his body

to have any chance of reviving him.

-Do you want me to take over and you do some bagging?

-Yes.

Obviously keep his airway nice and... Pull his airway up.

Stop.

As more paramedics arrive,

every effort is made to restart the patient's heart.

He was in VF so I shocked him once.

-Quite a bit of saliva.

-We'll do a bit of suctioning.

-Do a suction?

-Yes. Put your finger over. That's it.

Suction what you can see.

Not long ago, Lucy was studying for her A-levels,

now she's experiencing the most dramatic situation of her life.

How's it looking for cannula?

It's mad to be doing this at such a young age, 19,

but you've got to be a certain type of person to do it.

Lucy, we're looking at reversible causes,

so what do we need to be looking at?

Um...

Hypoxia.

Even in tense situations such as this,

mentors keep pushing the junior paramedics

to test their medical knowledge.

But Lucy's proving to be capable and in full control.

-Hypoglycaemia.

-Yes.

-Hypovolaemic. Toxicity.

Fantastic.

Suddenly there's a sign of life.

-Has he got a pulse?

-Yes.

-OK, right.

-Charge up.

-Charge it up.

-Just take the oxygen away.

-Just pull that off.

-That?

-Just pull it up and then don't touch him, Lucy.

Stand clear.

As his wife watches on,

the patient is given another massive electric shock

to try and restart the heart.

Lovely. Back on the chest.

But it's not working.

Feel the pulse. There's the fluid. Just feel for a pulse.

-No, he's not got a pulse. That's gone VT, hasn't it?

-Yes.

-Yeah.

-Right, we need to shock him again.

-Stand clear.

-Yeah.

-Lovely.

OK, that's four shocks. He's had that now, hasn't he?

Despite their best efforts,

Lucy and the paramedics are losing the battle to save their patient.

And in consultation with his wife,

there's some tough decisions to be made.

-His heart's not beating.

-Would you prefer us to just stop?

-Well, I... I don't want him suffering.

-No.

I think we're just going to stop.

The family said that they don't want him to go to hospital,

they prefer him to just stay here.

It's left to Lucy to check the patient's eyes

for any last sign of life.

They're fixed and dilated, yes?

So we'll go with the family's wishes. They want him to stay here.

Lucy's just witnessed her first death

since becoming a junior paramedic.

-I feel really emotional. I feel emotional for once.

-Do you?

-Yeah.

What do you feel emotional about?

I just feel sad. It's the end of his life

and he's been suffering for a very long time, by the sounds of it.

-And...

-Yeah.

-He wasn't in, you know...

He was in pain anyway, but...

This is it, you know. Like I said.

His wife, as well, doesn't want him to be in pain.

-No.

-I think, you know...

And the doctor had obviously heard her.

It's not like a complete shock,

-but, still, it isn't nice.

-No.

It is very shocking still.

Having previously struggled to engage with her patients,

the man's death is a major turning point for Lucy.

I think, yeah, it's good that you do feel something.

I think a lot of paramedics will say the same. No-one's a robot.

Everyone has feelings, it'll affect you eventually.

I feel a bit more human than normal.

I'm just really sad. I've got a heavy heart now, so...

SIREN WAILS

Next time... The long shifts begin

to take their toll on the junior paramedics.

I'm too tired to talk.

They are pushed to the brink with some traumatic cases.

He was about to kick off, that guy.

It was the first situation when I actually genuinely really

shit my pants.

And Max shows nerves of steel...

-Are you all right? Are you staying with us?

-Yeah.

..in his first major road accident.

I've got to keep calm and kind of get the job done.

# If you gave me a chance I would take it

# It's a shot in the dark but I'll make it

# Knowing no way you can shame me

# When I am with you There's no place I'd rather be

# No place I'd rather be

# No, no, no place I'd rather be

# When I am with you There's no place I'd rather be. #