Episode 4 Junior Paramedics

'Ambulance service, what's happened?

'It's my husband,

-'I can't wake him.

-Just confirm for me, is he awake?

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

'Right, can't find his pulse.

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

'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?

-Yes.

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.

Have you got little ticklish feet?

Whenever 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!

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 will

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 in someone's house

and not be scared of the outcome.

I'm definitely quite worried, dealing with my first fatal,

or 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's not an option.

Six weeks of dealing with real people

in real emergencies is even tougher...

Five hours to go and I'm yawning all the time, and I'm shattered already.

..and over halfway through their placement,

it doesn't get any easier.

All right, Chris? What's wrong? Talk to us.

'I thought, "Oh, my God,'

-"this is horrendous."

-They're young,

-they're inexperienced...

-Oh, my God!

..and every day is a matter of life or death.

-I was like, "Agh!" Adrenaline.

-For these student paramedics,

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

Do you know how to open it? Stop!

Previously, on Junior Paramedics...

If I get fleas, I'll be severely...

Yeah, just don't move.

..Max proved he could perform under pressure at a serious road accident.

Just going to feel your stomach, Mick.

'I did play a big part in that crash. I wasn't just'

standing by and watching everybody do everything.

Mick, this is going to be uncomfortable.

'I was like, "This is really cool,'

"it's really exciting."

Amy realised how vulnerable you can be as a paramedic

when she was called out to a patient behaving erratically.

-He was about to kick off, that guy.

-Do you think?

-He was, definitely.

'It was the first situation'

when I actually genuinely really shit my pants.

-Is it painful all across your chest?

-Yeah.

And Vicky jumped to the wrong conclusion

when she was asked to diagnose a patient.

-A chest pain? I think it's more shoulder pain.

-Oh.

-What do you think?

-Don't know.

'I have learnt from it,'

you just feel a bit of a tool at the time.

The junior paramedics are four weeks into

their first ever six-week placement.

They're not the new kids on the block any more...

You're learning, girl, you're learning.

-..and are fast becoming part of the team.

-High-five, Bryn! Ow!

They're still the butt of jokes...

..and they're starting to learn it's this sense of humour

that keeps the paramedics sane when the job gets tough.

It's a full moon tonight. Paramedics don't like a full moon.

There is an increase in call volume on full moons.

-That's just what we were told.

-With a full moon, you always get

the weird and the wonderful out.

It is a Saturday night, so it could be a bit busy.

The myth is that it sort of changed the moods.

-Paramedic myths?

-Yeah.

Tonight, the junior paramedics are working late shifts

and will find out for themselves

whether a full moon means calm or chaos.

Hello, can we have your attendance, please?

Yes. Tell me exactly what's happened.

At Corby Ambulance Station, Steph's at the end of her night shift

when she gets a call that would test even an experienced paramedic.

Reports are coming through

that there's a lot of police at the scene...

..and it's making this 18-year-old trainee,

who's been on the job for just four weeks, nervous.

Oh, this is a big job.

Three police cars, a fire engine...

Is that riot police and a dog?

DOG BARKS

Okey-dokey.

The paramedic on scene hands over to Steph and Sam -

and briefs them on the patient's injuries.

He's got three lacerations that I've seen.

We turned up and there was, like, fire engines

and 14 armed officers surrounding him.

I was just terrified!

You go up there. Go and get yourself sorted on there, mate.

Let's get your bum right up here.

That's it. Feet up.

The police were initially concerned about

the man's disturbing behaviour,

but now, as he's treated in the ambulance, he's calmed down.

'I was like, there is no way'

anyone is putting me in a small, confined space

with someone who's just been arrested.

41/101 was his blood pressure.

Throughout her placement,

Steph relies on her mentor, Sam, to show her the way.

But even though Sam's been a paramedic for more than two years,

she has never been to a job quite like this one either.

Right, have you got any lacerations

anywhere else, or is it just your arms?

Your neck. Let's have a look at this,

then we'll clean your neck up.

Can we get some irri-pods and some swabs?

-Another one?

-What caused these?

Stanley knife. Did you do it to yourself?

The police assess the scene and an armed officer stands guard

so Steph and Sam can concentrate on the patient.

We need a full set of obs on him.

-Do you want me to start that now?

-Yeah.

I'm just going to put this round your arm. Yeah?

Just lift this arm up for me a touch.

That's it. Perfect...

'I knew it was full-on and I knew I was going to be

'thrown in at the deep end, but you go to some jobs where'

it takes your breath away a bit and you're like,

"Oh, I don't know what to do!"

Despite the tension of the situation,

Steph manages to keep calm and remember what she's learnt so far.

Do you mind if I just do a little blood test on your finger?

That's OK, is it, yeah?

The voices have stopped. You just keep talking to me.

'We're not supposed to be judgmental of people,

'but you do let your imagination... You look at him and think,'

"Oh, my God, he's going to get me!"

And he was just lovely, really.

Are you ready?

The pressure's still on for Steph.

She has the responsibility of handing the patient over

to A&E staff.

Hand-overs are always a tricky thing for junior paramedics to master,

but with the patient in handcuffs and under police custody,

it's not a situation that could ever be taught in the classroom.

He's been self-harming and he's got

self-harm cuts on the left side of his neck and on his wrists

that are quite deep. His breathing's quite shallow, also.

Most of his observations are fairly normal,

but he was hypothermic when we got him, so we had to warm him up.

He's fairly responsive, but he's had a lot of alcohol.

Having nailed the hand-over, Steph can't quite believe

what she's just experienced!

That was quite interesting. I felt a little bit nervous at first.

I was kind of glad that the police officer was in there.

The thing is, he was quite, like, pleasant, weren't he?

Yeah, he was to us. He'd calmed down though.

Sometimes, you look at situations and think,

"Yeah, I'm running in the other direction."

But if you want to be a paramedic, they're the jobs that

you realise that you actually love them.

They're more interesting, It's the point of being a paramedic,

you're supposed to help them and patch up where it's bleeding.

You're actually helping someone, they need you.

Still on high alert, Steph heads home to wind down

after a challenging night shift.

But later that day, when 20-year-old Lucy Mellor

starts her night shift in Leicester, there's a very different vibe.

There was a good article in the Leicester Mercury,

with a picture of the first ever paramedics

-to be trained as paramedics.

-Really?

-Yeah. In the

-'80s. There was only paramedics in the '80s?

-Hmm?

-That was the first paramedics, in the

-'80s? '80s, yes.

Really? I thought it would have been absolutely hundreds of years ago.

No. Obviously, there's always been an ambulance service,

-but before that, it was like scoop and run.

-Scoop and run!

It was, yes. Pick up and run.

-Just get them straight to hospital...

-Yes.

I never realised that.

Now paramedics study for two years,

but lots of the skills they need still come on the job

and Alistair wants to make sure

that Lucy gets the most out of her placement.

So have you been practising your consultation, your history taking?

-Yeah, I've had a look over it.

-A look over it?

-Yes.

-Yes.

Have you been practising in the mirror?

THEY LAUGH

'Alistair is really laid-back and he kind of puts me at ease.'

When I'm doing things that maybe I'll be a bit nervous about

or not used to doing, I don't feel on edge, like I'm being

kind of watched and it's all strict, and things like that,

he's very chilled out, and he'll help me.

It's 3am, and Lucy and her mentor, Alistair,

are racing to a man with severe stomach pains.

When they get there, Alistair is keen for Lucy to push herself

and take the patient's medical history.

Hi, there.

She finds him writhing around on the floor in agony

and she quickly needs to establish what's wrong...

He's been struggling. The past three days, he's been absolutely in pain

and he's struggling to walk. I've given him codeine, paracetamol.

..but his distressed wife bombards her with information.

And it's got worse. I told him to sleep it off and wait till 8am

so we can call the doctor then, but he couldn't wait,

-so it got so severe, I had to call the ambulance, like, now.

-OK.

I don't really know what to say.

'He was like, "Are you going to take the lead?"

'I was like, "Yeah, that's fine."

'Then we went in and his wife obviously gave all these details'

and I was a bit like, "I don't know what else there is to ask."

'And obviously, the patient wasn't really in a fit state

'to be having a normal conversation about things,'

so Alistair took the lead and he showed me how it was done.

So when did the pain start, then?

And where is the pain exactly?

Would you be better off on the sofa, do you think?

If we ask you to score the pain between zero and ten,

if zero is no pain and ten was the worst you've ever had...

We'll get you some Entonox, gas and air.

-Do you want to...?

-Yes.

Alistair tries to get Lucy involved again.

-Twist it towards the plus sign?

-Yeah.

Try and take some of this pain relief.

We need to pop this in your mouth. That's it.

Have you been for a wee recently?

-Did it sting or burn?

-He did say there's been a lot of blood

coming out from his bottom as well

-when he goes to the toilet.

-Right, OK.

-Just red blood, do you know?

-Yes.

Have you had blood coming out of your bottom before?

He's got quite bad diarrhoea. I don't know if that's the cause of

-his discomfort in his stomach.

-Mm.

It could be, but it wouldn't normally cause this much pain.

Obviously difficult to know exactly what is causing the pain,

but if we can, we'll try and do some observations.

Do you want me to try and do a blood pressure?

Yeah. You're going to struggle.

Can I just pop this onto your arm, so I can get a blood pressure?

Just stay there, you don't need to move.

Just take the gas and air.

The man can't keep still enough

for her to take his observations properly.

OK, I'll take this off. Breathe the gas and air.

If he's in this much pain, we're probably going to have to pop him

down to the hospital. We're in the car, so we'll get another crew.

As they wait for the ambulance,

Alistair tries to make the man more comfortable.

Have you had morphine before?

We are just going to pop a little needle in your arm, OK?

Because Lucy is a student and morphine is a controlled drug,

she's not yet qualified to administer it herself.

You need to keep really still for a minute, while we do this.

That's it, straight in.

There we go, just given you a bit of morphine, all right?

It will take a few minutes to kick in.

When the ambulance crew arrive on scene, Lucy stands back

and lets Alistair do the hand-over.

Not really had chance to do much. He's been writhing around, really.

Sit down. Have you got the chair there? There you are.

Take some deep breaths.

-Concentrate.

-'Definitely still a huge amount to learn.

'Next time, next time, when it's'

a little bit less time critical, hopefully, I'll have a go.

-I thought it went really well!

-Oh, good. Fantastic.

I think it was a really brilliant effort on my part!

Yeah, a real structured approach.

-I mean, I think I did it all, pretty much.

-You did, yes.

Because we went in and she kind of told us everything,

and it kind of threw me off a bit.

I was like, I was ready with my signs and symptoms and my allergies

and she told me them all.

I was like, "I don't know what else to ask!"

In that situation, there is not a lot of...

It's just a matter of controlling the pain.

It's pointless trying to get observations, really.

You can see airway and breathing is fine. He's a good colour,

In that respect, you know, you need to get on top of the pain.

And now he's quite calm, now we can do some observations.

-Yes, now you can go to the start again.

-Yes. Exactly, yes.

-Shut the door, it's cold.

-The patient spent two days in hospital,

but doctors were unable to find the cause of his pain.

He's had no similar attacks since.

On shift, the junior paramedics

are constantly being thrown curve balls,

having to deal with incidents that are difficult to diagnose

and, in the case of mental health,

even more difficult for these young students to comprehend.

A 21-year-old female who's self-harming,

and the police are en route as well.

We're going to a 37-year-old male. Police are on the scene now.

He's very confused and dazed.

I feel aggressive, and I can change like that,

and I feel like seriously hurting people.

When you're in situations like that,

-always be aware of what's around you.

-Yeah.

-Go in and you can be out.

You've just got to keep your wits about you.

And where is the razor now?

'It's really, really hard to go into a mental health case'

because there's nothing, really... that I felt I could do.

How often are you cutting yourself?

It's purely a take it as it comes kind of scenario, really,

with each patient.

I don't know anything about mental health.

Relatives have just come rushing out saying

that he's head-butting the door

'I find it a little bit scary.

'It's just this massive, bottomless pit'

of the unknown.

'It was difficult to erm, actually remain calm'

in that situation

'where that much blood has been around.

'It's not always straightforward to actually fix them

'because you can fix the wounds or anything like that

'but you can't actually necessarily fix what's happening in their head.'

Throughout their placement, the trainees are finding out first-hand

just how hard the job can be sometimes.

So when they get a rare day off,

they make the most of it by visiting family and friends.

Steph's off to see her grandad.

I'm driving because it's, erm, chucking it down.

Instead of living in halls, Steph chose to stay at home

so her grandparents are close by.

They live about a two minute walk away from me.

When I was little, they lived opposite me, so...

I'm very close to them.

It was Steph's grandad who suggested this career

but he didn't think she'd be out with the armed police so soon.

Right, how did you get on then?

I was, like, quite nervous because I was like,

"Are me and Sam going to have to get

"in the back of the ambulance with this man?"

And he'd, like, cut all his neck, cut all his wrists and someone had hit...

-Sam's a woman?

-Yeah.

-Sam's a woman.

-Yeah.

Two, like, young women like in the back with this big man that

had like slit his wrists, slit his neck

and he was like one of the nicest patients I'd had, like, so far.

He was just so polite to me. It was just...

odd. I felt kind of guilty that I'd been, like, nervous of him and then

after meeting him, I was like, "Oh, OK, he's really nice to me.

"There's no reason for me to be nervous of him."

-Well, all the signs should have made you frightened.

-Yeah.

Policemen with guns and things like that.

Exactly, but I think it was all a bit like...

..what was said was more frightening than what he'd actually done.

-See you later.

-Yeah, keep us informed then, Steph.

-Will do.

While Steph enjoys some much needed time out,

over in Leicester, Lucy Wright started her 12-hour shift

at two in the afternoon.

Sausage, bean and cheese melt.

It's breakfast for me.

She's feeling more at ease with her crew mates now but chatting

to patients is still proving hard for Lucy to get to grips with.

The only thing I struggle with is the interaction with people.

When you are dealing with situations you've got to, you know,

try not to offend people.

I am really scared of offending people.

Lucy's next patient is a diabetic lady who's taken a potentially

dangerous amount of painkillers.

The paramedic on site has already checked her over.

Erm, when she was driving home she felt unwell

and had a vomiting episode.

She describes herself as feeling drunk, basically.

She's non-insulin-dependent diabetic,

at the moment her blood sugar level is 16.4...

With high blood sugar levels and a reaction to the painkillers,

Sadie is a complicated patient and she'll have to go to hospital.

But you see, I don't drink, I don't take illicit drugs

and to feel how I felt,

I knew I'd done something wrong by taking all these tablets.

'Sometimes when I walk in a room and there's paramedics there'

and I do know that they are qualified to do things,

it's quite daunting and you do think, "Oh, no, what do I say?"

You don't want to look like an idiot but you don't want to look

like a typical student paramedic and just not say anything at all.

But Lucy does need to get involved and once on the ambulance,

it's the perfect opportunity for her to face her fears

about talking to patients.

-Right I'm going to do another BM on you.

-Do you have to?

-Was it on this finger originally?

-Yeah.

-I'll do it on another one.

-Sharp scratch.

-Prack. Prick. It's the worst prick ever. Isn't it?

-I know. We hate doing it to people as well.

-I can imagine.

My friend, she tests me every day.

-Here you are look.

-Well, you're supposed to but I avoid it.

Yeah.

-15.9.

-It's coming down, 16. Yeah man.

-Come down a bit.

Sadie's blood sugar levels are dropping

and without that to worry about, she wants to know more about Lucy.

-How long you been a student then?

-About 10 weeks.

-Oh, just!

-Yeah.

-She's literally just come out.

-Sugar. Well done to you.

-Thank you.

-How old are you? Because you're not very old?

-Have a guess.

She's looking at you. From top to bottom she's looking at you.

20, 19-20.

-19.

-Yeah, I'm normally good.

-She's accurate it's good.

INDISTINCT CHATTER

The chat's going well but Lucy's got work to do.

Next, it's blood pressure - normally a painless procedure.

Argh!

-Just keep it...

-Argh!

-..nice and relaxed, Sadie,

because otherwise it will go tighter.

I think they're uncomfortable as well.

They ought to invent a new thing for this.

Whoever invented this blood pressure thing was nutty.

Weren't normal at the time.

Oh, it's vile.

Oh, it's done, it's done.

Thank God for that.

With the checks complete, there's time for more small talk.

It's something that Sadie can teach Lucy a thing or two about.

So, you've just started being a student, this job?

Yeah, I only started in September.

So, what did you do before?

A bit of everything really. I used to work at Halfords.

And what made you want to be a paramedic?

I don't know, a bit of madness.

-It's not madness.

-No, it's lovely.

I met someone who was a paramedic

and I used to really like writing and I started

getting into medicine and I liked the fast pace of being a paramedic.

So there we go. We're here.

Wow.

-Is it rewarding?

-It is, yeah. It's lovely, yeah.

I love doing it. Love the shifts as well.

And what's the hardest, children, middle-aged or the elderly?

-Elderly for me.

-Is it?!

-Yeah, it's just talking to people.

-No, the elderly are lovely.

I know they're lovely, I just get so het up about offending people...

-Ah, bless you.

-..and I don't want to offend anyone.

Lucy's got no worries here.

Having Sadie on the ambulance has been a big boost to her confidence.

-When you've done your two years...

-Yeah.

..you want to be like Natalie, obviously.

-Yeah, I will be. I'll be qualified.

-Will you?

-Yes.

Ah, bless you. And you're good with words.

Very encouraging that a young girl of her age is doing it, isn't it?

Yeah.

# We will never be as young as we are now

# Faces in the crowd are thinning out... #

'I'm not afraid to talk to patients any more.

'I'm still afraid of offending older people

'but then again, it's just...'

you know, having the life experience, really and I'm only young

so I'm not going to have, you know, loads of it.

But I try and do what I can to, like, build my confidence.

Perfecting bedside manner is something you can't teach

but the junior paramedics have intensive classroom training

for the medical procedures.

-It's hard when you're fingers are wet.

-Don't worry.

And during their placement, they have a check list

of over 100 skills to tick off.

Can I have a backup green response, please?

Ready, brace, lift.

Everything from chest compressions, to blood pressure.

I feel like there's so much knowledge you need to understand

and actually get a grip with that, I, you know...

It's a long road.

It is a long road and we're only part of the way down it.

At this stage of their training, the juniors are finding themselves

wishing for things they never thought they would.

And even when Nick gets a night off with his girlfriend,

he can't get the check list off his mind.

I don't want a cardiac arrest to happen.

Because it's a horrible thought...

-It is, yeah.

-..to think that someone's going through that

-and you're gaining from it.

-Yeah.

-Which is horrible.

-Yeah.

But when a cardiac arrest actually happens, I'd like to be there

because, erm, I need to tick it off.

# Every night I go

# Every night I go sneaking out the door

# I lie a little more

# Baby I'm helpless... #

When Nick gets back on a day shift,

he doesn't get called to a cardiac arrest

but he does get something else he's not experienced yet.

-Ah! RTC.

-Oh, is it?

Oh, it is an RTC.

Attending a road traffic collision

is a rite of passage for these trainees.

This is my first RTC.

I'm a little bit excited. I'd really love to wear my helmet

-but I don't think Jonny will let...

-If you want to wear your helmet,

-Nick, by all means do so.

-But can you wear yours as well?

-No.

-Aw.

Are you sure we don't need a helmet? That tree looks a bit suspect.

As it's a new kind of case for Nick,

Jonny takes the lead with the patient.

Her car is in the ditch

but another motorist stopped to let her shelter in his van.

Where's hurting at the minute?

The middle part of my back.

Right, just lean forward for me.

There's nothing the matter with your spine at the minute.

She escaped with just some soft tissue damage,

so even though the car's a write-off

there's no need for her to go to hospital.

Which leaves Nick with some time to indulge his curiosity.

Having a look at the mechanism of injury to the car.

There's been a bump in it.

Seasoned paramedic Jonny has seen it all before.

-Fortunately, all of that at the back is a crumple zone.

-Yeah.

-So everything has done exactly what it's supposed to do.

-Yeah.

So that's taken all the impact so that she doesn't have to.

Can you see me under me hood?

Me beaky cap!

There are more than 2,000 traffic accidents in this area every year

and no sooner are they back in the car than another call comes through.

-Oh, for heaven's sake!

-Another one!

Another RTC! Woo!

I bet you it's going to be

in the field on the corner at the bottom of this road.

How much do you want to bet?

-Three years' salary.

-No, you're all right.

Well...

-You've not got a salary.

-You've got much more to lose than I have.

The car lost control and ended up in this field.

The patient walked away with minor injuries again,

so Nick and Jonny are quickly back on the road,

ready for the next call.

It's another RTC, his third in a row.

But this time, it's far more serious.

The things that would be really hard for me to see would be

anything with small children.

Who do we have here, then?

All right, sweetie.

Could I squeeze in there, buddy?

Could I trouble somebody just to hold the blanket over him

so he's not getting very wet? That's brilliant, thank you.

The child was crossing the road when a car hit him.

The injuries he sustained could be life-threatening.

'I was expecting an adult, you've got kind of a mental image going on

'and then it's a child in front of you.'

-Do you want me to help?

-Yeah, if you can hold his elbow for me so

he doesn't bend his arm. Nick, shine the light straight at his hand.

With a case as serious as this, every junior paramedic needs to know

when to step back and leave it to those with more experience.

BOY CRIES

Good boy. You hold my hand, then.

-Good boy.

-Watching his mentor Jonny

will give Nick valuable knowledge for the future.

He's bull's-eyed this car here.

He what, sorry?

Bull's-eyed the windscreen, so I'd query loss of consciousness

-but I can't confirm, I would imagine so.

-OK.

Has vomited. Pupils were unequal but are both reacting.

Well done. I know this isn't nice.

'I've never seen my mentor stressed or panicked.

'I think he is exceptionally good at his job

'and I think he has a really good ability to make people feel at ease.'

BOY CRIES

-All right.

-Well done.

It's a chaotic scene but Nick needs to hold his nerve.

With a risk of spinal injuries,

the patient needs to be secured to a rigid stretcher.

'It is upsetting to see anyone like that.

'It's just an unnatural thing

'to see somebody so kind of young and that poorly, really.

'It isn't very nice at all.'

The boy was taken to hospital and put into an induced coma

while they ran tests to determine the extent of his injuries.

I don't know if you get used to it.

I don't know if you get actually better at handling it.

That, again, is a learning curve.

He needed brain surgery

but, four weeks later, had made a good recovery.

The junior paramedics are over halfway through

their first placement.

-Sorry...

-Rosemary, darling...

-Sorry!

-I got whacked!

I didn't mean it!

They're on the front line, seeing everyone from the very young...

It's quite different to obviously having an older patient

that can talk and respond to you

but he's cute, so it makes it...

..to the very old.

Can you say, "British constitution" for me?

British constitution.

Good. And "baby hipp...hippopotamus"?

-Baby hippopotamus.

-Good. You can do it better than I can.

But when it gets dark, they get a different kind of patient.

LAUGHTER

TECHNO MUSIC

And rookie Lucy is about to get first-hand experience

of being on the other side of a student night out

when she does a night shift with mentor Natalie.

We're going to a bar and it's a 20-year-old male with a head injury.

Wednesday nights in Leicester

are when the uni students go out on the razz

and sometimes have one sherbet too many.

-Sit down. Sit down.

-Sit down.

-Ron, sit down!

What's happened to him? Obviously he's drunk.

I literally don't know.

I came outside and he was just laying on the floor.

-I think he got kicked out.

-Are you his friends?

-Yeah, yeah.

- We know him from social, so... - OK, right.

-We was at the same place.

-Right.

-How much has he drank, do you know?

-I have no idea.

-No.

-I thought he was fine.

-Right.

A few minutes ago he was fine.

Oi, Ron, put it away, man!

He's going to need to go down to the hospital.

What are you doing?

He's going for a wee, I think.

He already wee'd. I made him wee.

Thank you very much.

He just filled his own hand with urine from his own penis,

like it was just floating in urine, his own hand.

Do you want to get him to cover up a bit?

Like Lucy, the patient is a student

but, right now, their university experiences are poles apart.

Oh, he's pissing, he's pissing. He just pissed.

FRIEND: I'm so sorry.

It was just really embarrassing for him and me, to be honest.

Because I am his age and he's not doing our age group any favour.

'And I don't want to say anything bad about him

'but I just can't believe he got in that state.'

Open your eyes.

No, come on. Ah, ah, ah.

No. Oh, pull them up.

The night is young for Leicester's students, but for this one,

they've already called time.

-Right, go up towards the ladies'.

-Mate, don't do that.

Don't do that. That's not very nice, is it?

'Before I came on placement and went on shift

'I just thought drunks were...'

you know, violent, aggressive all the time

but it's surprised me because not everyone is.

But then obviously alcohol's a factor,

so you've got to always be wary.

Someone might seem calm and then they can flip.

So your opinion does change

but you can't really think, "Oh, God, everyone's going to punch me,"

because it's not the right way to go about it.

With the usual checks out of the way, Lucy has the unenviable task

of going through his wee-soaked pockets.

Erm...

Have you got any ID on you? Yeah?

What pocket is it in?

Is it in this one?

I had to get his ID out of his pocket

'and it was just absolutely soaked with urine

'and gloves did not make me feel safe at all.'

There we go.

Lovely. He's got some ID.

Cheers.

For paramedics, drunk patients are treated just like any other

and if they can't get themselves home,

they're taken to hospital to sober up.

How does it make you feel? Because, obviously, he's older than you.

-Only just.

-Yeah.

But I'd never wee myself in public or get that drunk to do that.

I mean, it's only - what - 11.40pm, so the night is young.

Yeah. Not for him, because he's now going to be in hospital.

And his friends are out again, so...

The first of many, I'm sure.

SIREN BLARES

As Lucy's night shift comes to an end,

the 6am early shift for Steph in Corby

also starts with a drink-related call.

Call-outs involving alcohol make up a fifth of all paramedic jobs.

Most don't really need an ambulance,

and the risk of violence from these patients is a real concern.

Just be wary, cos sometimes they don't like an ambulance turning up

when they're having a nice little sleep on the pavement.

'In 18 months, I will have just turned 20'

and will able to stand there and say I am a registered paramedic.

I'm qualified to go out on my own.

'The idea of being on the car on my own absolutely terrifies me.'

The police are not necessarily attending.

If he starts being abusive at all, we'll just get back in the car

and drive away.

Dealing with drunks is a whole new ball game for Steph.

At just 18, she's the youngest trainee,

and has not had much chance to sample Northampton's nightlife yet.

I've only been out three times,

and if I've had any alcohol, I can't sleep.

Everyone says to me that's really weird, but I'm, like,

bouncing off the walls.

-You haven't had enough, then.

-STEPH LAUGHS

Probably.

Let's get rid of them.

Right.

Hello. Can you hear me? It's the ambulance service.

-OK. So he's...

-Eyes?

-..breathing. Yeah, check his pupils.

-OK.

-That's quite big, isn't it?

-Yeah.

-You're laid on the floor in the middle of the street.

-Uh-huh. Yeah.

Yeah? Can you get up for us now?

-Otherwise we'll have to get the police.

-Yeah.

-Yeah?

Can you sit up, then?

Vulnerable patients who refuse medical help

often get referred to the police.

What can I call you?

-Beautiful.

-SHE LAUGHS

Ain't ya? Ain't ya?

What's your name, and where do you live?

-Do you want a hand to get up?

-No.

-OK. Where do you live?

-Do you know where we are now?

-Mm-hm.

Yeah? Where are you going?

Down here.

Another life saved.

At least he had a jacket on.

STEPH LAUGHS

RADIO BEEPS

131, you can stand the crew down.

We've woke the patient up and he's decided to walk home.

And they've not been back at base long

when they get another call, to another drunk patient.

-RADIO:

-'They can't get him up off the ground.

'He doesn't know what's happened to him. He's just lying on the path.'

-Is it the same guy?

-Sounds like it.

That's really annoying if it's the same guy.

It's got to be, hasn't it? Same area.

Same problem.

# Over and over and over and over

# And over

# Like a monkey with a miniature cymbal... #

We need to find out his address

because if it's only round the corner, we can just walk him home.

Yeah.

It's the same guy.

Oh, there is he is.

But this time he's found a grass bit to lay on.

He'll be soaking wet now.

Hello!

We know that you've just walked here. We've... Just... That's it.

Sit against the fence.

Right, you've had two ambulances now.

Where do you live?

Right, on your feet.

Right, tell me your address. We need to get you home.

Let's start with the number. What number do you live at?

HE MUMBLES

He may have been happy to sleep on the pavement, but now,

it seems, he's capable of finding his own way home.

How far have you got to go?

Erm...round the corner.

131, yet again, we've woke the patient up and he's got up

and walked off, but he won't let us assist him home.

I think if they ring again it's more a police job,

because there's nothing medically wrong with him.

-We'll drive up there because we'll only get a call back to him.

-Yeah.

-He's definitely sobering up a bit more, anyway, isn't he?

-Yeah.

-He actually was able to speak that time, so...

-Yeah.

6 to 12...

He's home. Right, if you book us clear on there

and put "refused treatment and travel" again.

-"Left scene" first, yeah?

-Status and then clear at scene.

Steph's seen for herself the pressure drunk patients

put on East Midlands Ambulance Service.

# Kids again

# Let's behave like kids again. #

But later that day...

..not averse to having a drink themselves,

junior paramedics Amy and Max meet up with Lucy and Bryn

for a cocktail and a catch-up.

Oh, it's so nice.

-Hi, guys.

-Hi.

-Hello.

-What's yours, Amy?

I don't know.

I asked her to recommend something and she said something,

and I was like, "Oh, yeah - I'll have that."

THEY LAUGH

I've got no life since I've started this placement.

You don't when you're on shift. You just don't see anybody at all.

The drunks are just the worst.

There was one guy who was exposing himself every two minutes

and weeing everywhere.

It's kind of... It's not funny, but when you have to get your hands

into their urine-soaked trousers to get their ID out...

-It's gross.

-Yeah.

-I think this is, like, the make- or-break placement, isn't it?

-Mm.

It puts everything into perspective.

All the things you learn in the classroom you actually do use,

but are very, very different from how you'd do it in the classroom.

It's really good to get that whole consolidation

of what we've actually learnt.

And it's good...

I know, from my first day, that it was the career for me anyway.

But it was nice to actually have that first shift

and you're like, "This is actually definitely..."

To have that complete validation where you can go,

-"This is definitely the career for me."

-Yeah.

In Northampton, oldest trainee Ashley couldn't make the party.

She's on shift with mentor Simon.

They're about to get a call that will test whether Ashley

really has what it takes to become a paramedic.

TECHNO MUSIC

SIREN WAILS

We have just witnessed a fire engine go flying past,

so maybe it's indication of potential burns victims, smoke inhalation,

and if they're still trapped, that's quite daunting, really.

We're driving pretty fast.

I think this is the fastest I've been.

SIREN BLARES

I'm going to vomit.

When they arrive, it's carnage.

It's a pretty bad fire, pretty bad fire.

The building's still ablaze and fire fighters are battling to control it.

You step out and it's blue lights, you know, from us, police, fire.

You're nervous because you have a jacket on that doesn't indicate that

you're a student. People are going to think that I'm going to know stuff,

but in a really strange way, you're really excited to be there.

Two local men broke down the doors to check no-one was trapped.

Ashley's patient, Chris, is one of them.

He's inhaled a serious amount of smoke and needs urgent attention.

-What would you like me to do - obs?

-Yeah, listen to his chest.

-Listen to chest?

-Yeah.

-Let's get this off.

-And then one bloke started having a panic.

-HE COUGHS

-Excuse me.

-No, you're all right.

Can you sit forward, if that's OK?

I'm just going to listen to your back. Take some deep breaths.

HE COUGHS AND SPLUTTERS

Inhaling a lot of smoke can damage the lungs and airways.

It's hard to spot, but can be fatal,

so the pressure's on for Ashley to complete his observations quickly.

Ever so slight, ever so slight crackle.

-Yeah.

-It's a big responsibility for rookie Ashley.

Every move is marked towards this placement

and could be the difference between a pass or a fail.

-Right, I just need to listen to the front, if that's OK?

-Yeah.

-Are you all right, love?

-Yes, it's just all hitting home.

Nothing whatsoever, honestly.

No, nothing.

Nothing at all, honestly.

-It's just all hit home a bit now, I think.

-Yeah.

With the patient stable and the fire under control,

it's a chance to find out more about what happened.

So you were just indoors and you heard shouts for help, or...?

We were just coming out of here, just about to get into the car,

-and then we see the family standing on the road...

-And the smoke.

-And

fire, and they were standing right in front of where the window was.

-Mm.

-I'm telling you, it was two minutes after - bang!

The whole window went up.

HE EXHALES

Anyone was in that house - finished. I'm telling you.

Mentor Simon needs an update,

and it's up to Ashley to prove she's got things under control.

-Chest is clear?

-Chest is clear, yes.

Checked posterior to anterior, and it was clear.

There was an ever so slight wheeze,

patient's right-hand side lower, but he's asthmatic, so...

-OK. Just keep an eye on things for a bit.

-Yep.

With the immediate danger passed,

the scale of what could have happened starts to hit home.

If they had had, sort of, ten people down there,

and you needed to sort of triage on who you treat when, based on what's

wrong with them, I'm not at that level to understand that yet, but

I would have been like, "Where do you start? What do you do?" You know.

Yeah, it's like adrenaline and everything's up here,

but I suppose I'm starting to have a bit of a comedown,

I'm starting to kind of go, "OK, there's no-one else,

"the gentleman is OK," So it's a relief. It's a real relief.

But just when Ashley thought she had it all under control...

What's wrong?

What's wrong?

What's wrong?

-Chris, sit back for me the best you can.

-Let's sit back.

'In that moment, I kind of questioned everything,

'and I just thought, "Oh, my God. This is horrendous." '

Are you all right, Chris? What's wrong? Talk to us.

Talk to us. Chris, talk to us.

A sudden change in a patient is something every paramedic dreads.

Chris?

Chris?

-Chris.

-Chris.

I just thought, "Oh, my God. What have I missed?"

Not just me, but, "What have WE missed?" You know?

And you do feel a bit of responsibility, like,

"Have I been really stupid? Have I just completely not thought

"of something that I should have been doing?"

Just relax, Chris. You're just having a bit of a faint-headed...

A bit of a faint, Chris. Lift your legs up.

CHRIS GROANS AND COUGHS

-Come down to the bed.

-Yeah.

CHRIS GROANS

Right, what's hurting, Chris?

My head. Oh, Jesus Christ.

HE COUGHS AND WHEEZES

It's intense, and for a trainee with just four weeks on the job,

this is a real test of whether Ashley's got what it takes.

Just shaving you, Chris, just to get these leads on, OK?

You're on an ambulance.

And who are you?

I'm Ashley. I'm a student paramedic, and you're on an ambulance.

HE COUGHS

Chris's deterioration is a shock to inexperienced Ashley.

'At that point, you don't know

'if they'll suddenly come round and be OK,'

or if it's going to go into, like, a full, serious, like,

respiratory arrest or something, like, really major.

How you doing, buddy? Open your eyes. Good lad.

Mentor Simon needs to do the final assessment,

and for this, he relies on the results of Ashley's checks.

Did his sats drop?

He was on 95, and he was sitting, talking,

everything fine - there was no change in his position.

We were just starting our secondary obs and he just, er, just went,

"I don't feel right," and just completely slumped out of the chair.

Chris?

Yep?

Just lift up.

You all right, Chris?

I think you've inhaled probably more than you think,

because you was in there for quite a while. Ten minutes in each place.

That's a long time, and it's a lot of smoke.

Tell you what, buddy, we'll have to pop you up to the General.

Calls like this are rare, but Ashley's proved

she's got what it takes to hold her nerve under pressure.

'This is one of the big jobs,'

but it makes you understand why you really couldn't do those

back-to-back, and they don't happen back-to-back, but you couldn't,

you know? It takes a lot of resources, it takes a lot of emotion.

It just takes it out of you. You do have...

I am having a bit of a comedown, where you go,

"OK, it is all OK, you did help out, you did contribute."

Chris spent a night in hospital for investigation,

but was discharged the next day.

That was a situation where you go, "Is that what I can do?" You know,

I can talk to people all day, I can work on communication, and I can work

on assessments and learn things, but you can't learn how to manage fear

and you can't learn how to manage adrenaline, and that's - I think -

your fight-or-flight moment on how do you, as a person,

suddenly cope with that?

And for me, that was the... That, really, for me, was,

"Yeah, you can do this."

You can learn all the other stuff you are learning, you know.

It's a learning curve, there's lots to do, but actually, when it hits it,

I responded well to pressure.

It's been a testing week for the junior paramedics.

This is a big job.

You just keep talking to me.

'no-one taught me at uni how to sit in this small, confined ambulance,

'with a man possibly violent,'

and say, "Yeah, I know how not to be frightened in this situation."

They've learnt that the key to success in this job

is being part of a team.

There's some jobs that you go into and every pair of hands counts.

OK? Ready, steady, roll.

The amount of teamwork that goes into it, I just have to think,

"Wow - these people are absolutely running like clockwork, really,

"and it's amazing."

4023.

But when every case throws up a new challenge,

there's still a lot to learn.

You definitely have to learn fast. Particularly when your mentor's

always ten steps ahead of you and you're trying to keep up with them.

-Is that the crew?

-Yes.

Right, we need to... Right, you ready? We need to go.

It is difficult, because you don't always know

exactly what's going to happen until you get there.

And then, yeah, that's it - it's all systems go.

And as they go into their final two weeks of this placement,

every case counts towards getting a good grade.

Cold outside, isn't it, Alan?

You want to look good for your mentor. You want to make sure

they're going to give you a good grade and stuff,

and they might scrutinize you, and just want to look good

and make sure you're doing everything right.

-Well done.

-Thank you very much. Thanks for letting me kind of...

Ready?

For me, being out on the road is just invaluable experience

that I can't get from a classroom.

I have made some mistakes along the way.

Do you want to...? That's it.

Make sure you don't stab yourself with it.

Rather than just seeing them as mistakes, I see them as

learning curves, like, "I won't do that again."

Argh! I did.

-You just stabbed yourself with it?

-Yeah.

Next time...

With two weeks to go, the junior paramedics are finding

the patients don't get any easier.

-Right, hands here. No, no, no! Right!

-Put him down.

With drunk patients, you don't know what they're going to do,

and it is really scary to be with them in such a small space as well.

Do NOT put your hands out to us, OK?

Bryn's having a problem with babies.

'I find it really difficult to deal with children.'

You don't like that, do you?

It is a scary thing.

The bonnet on the floor, there.

And Steph is faced with a teenager trapped under a car.

The way that they'd hit, it looked horrendous.

'I just saw all this blood.

'I was like, "Oh, my God. What's all that from?'

# Gonna rock your ship under my control

# Like a yo-yo

# Ooh, when you catch my drift can you ride the flow?

# Act a little yo-yo

# Ooh gonna rock your ship under my control

# Like a yo-yo

# Ooh

# Ooh b-b-b-bounce

# Ooh b-b-b-bounce

# Ooh b-b-b-bounce. #