0:00:02 > 0:00:09This programme contains scenes which some viewers may find upsetting.
0:00:10 > 0:00:13If you suffer a life-threatening injury,
0:00:13 > 0:00:16your chances of survival are changing.
0:00:16 > 0:00:19There's a revolution going on right now across
0:00:19 > 0:00:22the United Kingdom in the way that we treat patients with major trauma.
0:00:22 > 0:00:26'We've got a head-on collision with people still trapped in the cars.'
0:00:26 > 0:00:28There's not a lot left of that vehicle.
0:00:28 > 0:00:30In the past, hundreds of patients have died,
0:00:30 > 0:00:32who might otherwise have survived had there been
0:00:32 > 0:00:34a more effective chain of survival.
0:00:34 > 0:00:37- PHONE RINGS - Addenbrooke's Major Trauma Centre.
0:00:37 > 0:00:40We think she's triage tool positive, and a pelvic fracture.
0:00:40 > 0:00:42OK, has she had pain relief?
0:00:42 > 0:00:46Now, across the country, a new co-ordinated system
0:00:46 > 0:00:48is triggered by the most critical injuries.
0:00:48 > 0:00:51- Now she's going straight down. - Lovely.- Kate is your team leader.
0:00:53 > 0:00:56Medics with advanced lifesaving skills rush to the scene...
0:00:56 > 0:00:59Can we take over the leadership?
0:00:59 > 0:01:02A well-drilled Emergency Department prepares.
0:01:03 > 0:01:05Pupils are not reactive.
0:01:05 > 0:01:07The latest technology is waiting.
0:01:07 > 0:01:10I want this patient through the scanner as quickly as possible.
0:01:10 > 0:01:12And specialist surgeons stand by.
0:01:12 > 0:01:13The clock is ticking.
0:01:18 > 0:01:22The BBC has followed the first regional major trauma network
0:01:22 > 0:01:27to be fully operational, based at Addenbrooke's Hospital in Cambridge.
0:01:27 > 0:01:32This is the frontline of emergency medicine.
0:01:32 > 0:01:34Just don't keep anything from me.
0:01:34 > 0:01:38We have people who arrive at the very limits of life.
0:01:38 > 0:01:40I just thought she'd gone at that point.
0:01:40 > 0:01:43OK, stand clear everyone, shocking.
0:01:43 > 0:01:46If you suffer a critical injury, these are the men
0:01:46 > 0:01:50and women with the best chance of saving your life.
0:01:59 > 0:02:01PHONE RINGS
0:02:01 > 0:02:03Hello, Addenbrooke's ED...
0:02:03 > 0:02:06It's five o'clock on a Saturday afternoon at Addenbrooke's Hospital.
0:02:09 > 0:02:11Aw, killer.
0:02:11 > 0:02:15Can you get Brendan to bring out some more pre-alert forms for there, please?
0:02:15 > 0:02:19So far today, the doctors and nurses in the Emergency Department
0:02:19 > 0:02:22have seen 174 ill and injured patients.
0:02:22 > 0:02:25Anna, have you got any anaesthetic drugs out?
0:02:25 > 0:02:27PHONE RINGS
0:02:27 > 0:02:30Addenbrooke's Emergency Department...
0:02:30 > 0:02:33Consultant Rod Mackenzie has just come on shift.
0:02:33 > 0:02:34All right, thank you.
0:02:36 > 0:02:39He's in charge of getting the hospital's new major trauma system
0:02:39 > 0:02:43ready for life-threatening injuries from across the East of England.
0:02:43 > 0:02:47So you're going to have a few stitches there.
0:02:47 > 0:02:49You OK there?
0:02:53 > 0:02:56'What's the address of the emergency?'
0:02:56 > 0:02:58At ten minutes past five,
0:02:58 > 0:03:01Ambulance Central control receives a call that triggers the new system.
0:03:04 > 0:03:06'We've got a head-on collision.
0:03:06 > 0:03:08'There's just two cars, one's in the middle of the road,
0:03:08 > 0:03:12'one's on the side of the road and people still trapped in the cars.'
0:03:12 > 0:03:15Four still trapped? All right, thank you, bye.
0:03:15 > 0:03:18The maximum number of simultaneous major trauma patients that we
0:03:18 > 0:03:19plan to see at one time is five.
0:03:19 > 0:03:23Four or five patients requiring resuscitation at the same time
0:03:23 > 0:03:25would really, would push us.
0:03:25 > 0:03:27So there are four patients in total,
0:03:27 > 0:03:29that have been trapped for a long time.
0:03:33 > 0:03:35It's Neil here from Cambridge...
0:03:35 > 0:03:39The first response is to send an Emergency Medical Team
0:03:39 > 0:03:42to the accident, 30 miles north of Cambridge.
0:03:42 > 0:03:44Cheers, Dave, bye-bye.
0:03:44 > 0:03:46SIREN WAILS
0:03:48 > 0:03:50'There are four patients still trapped.
0:03:50 > 0:03:54'We've got a variation of chest, pelvic and femur injuries.
0:03:54 > 0:03:57'Two men and two women, over.'
0:03:57 > 0:04:02CCD, Medic 88, that's all received. Thank you so much.
0:04:02 > 0:04:06Dr Auden Langhelle and critical care paramedic
0:04:06 > 0:04:10Neil Flowers are specially trained to handle the worst incidents.
0:04:10 > 0:04:12Being able to deploy a medical team to these incidents is really
0:04:12 > 0:04:16important, because it takes, essentially, elements of the hospital care to the patient.
0:04:16 > 0:04:19If there are four poorly patients on scene,
0:04:19 > 0:04:22it's probably going to be quite chaotic.
0:04:22 > 0:04:24It will be a difficult scene to manage, and there
0:04:24 > 0:04:26will be a lot of decisions that are going to need to be made.
0:04:26 > 0:04:28This is the East of England.
0:04:28 > 0:04:32It stretches from the M25 up to the Wash, across to the East, to
0:04:32 > 0:04:37Great Yarmouth and the coast, across to the Midlands and the M1 corridor.
0:04:37 > 0:04:4120,000 square kilometres, 5.8 million population.
0:04:41 > 0:04:45So nearest Trauma Centre is Addenbrooke's, nearest
0:04:45 > 0:04:48hospital is Peterborough, which is a District General hospital.
0:04:48 > 0:04:51So we just have to bear these things in mind.
0:04:51 > 0:04:56So in the past, each hospital would work, effectively, in isolation.
0:04:56 > 0:04:59In the new system, we're trying to get these patients to the
0:04:59 > 0:05:02Major Trauma Centre in Cambridge.
0:05:02 > 0:05:04So it's likely from what the initial report we've got,
0:05:04 > 0:05:06these are patients who will have multiple injuries,
0:05:06 > 0:05:08these are going to be very poorly patients.
0:05:08 > 0:05:10It could be a life-threatening injury.
0:05:14 > 0:05:17It's an hour since the collision took place.
0:05:17 > 0:05:19Medic 88 on scene.
0:05:22 > 0:05:26There are already 40 firefighters, six ambulance crews
0:05:26 > 0:05:28and the police on scene.
0:05:28 > 0:05:30But they need Neil
0:05:30 > 0:05:35and Auden's advanced medical skills to help free the trapped patients.
0:05:37 > 0:05:39Hello, there, I'm scene commander at the moment.
0:05:39 > 0:05:43- There's one patient here.- One patient there and three patients over there. All trapped.
0:05:43 > 0:05:45All P1s at the moment.
0:05:45 > 0:05:47We have someone over there with no blood pressure
0:05:47 > 0:05:49and reduced air entry over there.
0:05:49 > 0:05:53The Peugeot here, this vehicle's got a single occupant in it.
0:05:53 > 0:05:57The Astra, which is in the hedge, has got a family in it,
0:05:57 > 0:05:59with mum and dad and daughter.
0:05:59 > 0:06:01The daughter in the rear is quite ill.
0:06:01 > 0:06:05The two cars were travelling in opposite directions
0:06:05 > 0:06:07and have hit head-on.
0:06:07 > 0:06:08Hi, guys.
0:06:08 > 0:06:10The guy in the car there.
0:06:10 > 0:06:14Again, is a 30 yr old guy, completely awake, GCS 15,
0:06:14 > 0:06:16appears to have good chest.
0:06:16 > 0:06:19But again, pelvis and femurs.
0:06:19 > 0:06:22The man driving alone has told medics he's called Matthew.
0:06:22 > 0:06:25He was driving to his girlfriend's.
0:06:28 > 0:06:31The family of three - the Davises -
0:06:31 > 0:06:33were on their way to a local concert.
0:06:37 > 0:06:39What we want is your guys, coordinated,
0:06:39 > 0:06:42literally hands-on, nice and big and strong, have her out.
0:06:42 > 0:06:43With a long board.
0:06:43 > 0:06:45- This one, yeah? - Yeah. No messing around.
0:06:45 > 0:06:49Neil and Auden see the daughter is wedged between the front seats,
0:06:49 > 0:06:51trapping her parents.
0:06:51 > 0:06:52PATIENT CRIES OUT
0:06:52 > 0:06:54There's a patient in the back of the car,
0:06:54 > 0:06:56she has a femoral - right-sided thigh fracture.
0:06:56 > 0:06:59We need to just get her pain under control.
0:06:59 > 0:07:02Neil suspects her leg was broken
0:07:02 > 0:07:05when the impact forced her into the seats in front.
0:07:06 > 0:07:08This is ketamine. It's a big dose of ketamine.
0:07:08 > 0:07:11We're unable to get I/V access on this lady
0:07:11 > 0:07:13so we're going to give her an intramuscular injection.
0:07:15 > 0:07:17Lift, one-two-three, lift!
0:07:17 > 0:07:19PATIENT CRIES OUT
0:07:19 > 0:07:21An hour and 20 minutes after the collision,
0:07:21 > 0:07:24the fire crew lift Dawn, the daughter, clear.
0:07:26 > 0:07:29- Move up, more along everyone. - That's it, lovely job!
0:07:33 > 0:07:36Another Emergency Medical Team have got Matthew out of his car
0:07:36 > 0:07:38and are assessing him.
0:07:41 > 0:07:44This patient's sustained some quite nasty lower leg injuries.
0:07:44 > 0:07:47We've given him a pre-hospital sedation,
0:07:47 > 0:07:50we've managed his fractures, and we're now going to go
0:07:50 > 0:07:52to Addenbrooke's as the Major Trauma Centre.
0:07:52 > 0:07:56The team's worried that as well as his leg, he's broken his pelvis too.
0:07:58 > 0:08:00PHONE RINGS
0:08:00 > 0:08:05Hello. He's got an open femur and you're worried about his pelvis.
0:08:05 > 0:08:08OK, that's fine. Bye.
0:08:08 > 0:08:10Is that two?
0:08:10 > 0:08:12That's the first one.
0:08:12 > 0:08:15- Diego, your patient.- Yep.
0:08:15 > 0:08:1730-year-old male.
0:08:17 > 0:08:20He's got a query pelvic fracture, right open femur.
0:08:20 > 0:08:24He was awake. He was sedated for the extrication.
0:08:24 > 0:08:26Which nursing staff are a part of this?
0:08:26 > 0:08:28You're going to stick with this bay.
0:08:28 > 0:08:30We're getting now that the first patient will be
0:08:30 > 0:08:33arriving in the next few minutes, and you can see we've
0:08:33 > 0:08:37created a number of different teams with one kind of overarching
0:08:37 > 0:08:41team leader - myself - to coordinate what needs to happen.
0:08:47 > 0:08:51Critical care paramedic Jemma Varela assesses Dawn,
0:08:51 > 0:08:52now she's out of the car.
0:08:52 > 0:08:56At the moment the patient looks like she's got a nasty isolated
0:08:56 > 0:08:58femur fracture and possibly her pelvis.
0:08:58 > 0:09:01So we've managed to give her some drugs to help with the pain,
0:09:01 > 0:09:04and we'll just take her straight to the Major Trauma Centre.
0:09:05 > 0:09:08Now Dawn's on her way to Addenbrooke's,
0:09:08 > 0:09:12Neil and Auden's priority is her parents, still trapped in the car.
0:09:12 > 0:09:15To get the patients out - they're in a bit of pain -
0:09:15 > 0:09:17we need to give them something for the pain.
0:09:17 > 0:09:20So we're just trying to speed that up, so we can speed up
0:09:20 > 0:09:22getting the patients out so we can fully assess them.
0:09:22 > 0:09:24An hour and a half after the accident,
0:09:24 > 0:09:27the team lift Teresa, the mother, clear from the passenger seat.
0:09:34 > 0:09:36You're going to be with an ambulance shortly, OK?
0:09:36 > 0:09:38OK.
0:09:45 > 0:09:48Finally, they free the father, John.
0:09:48 > 0:09:51Is this bearable? Pain in your tummy?
0:09:53 > 0:09:56There? Just relax.
0:09:56 > 0:09:58As soon as Neil and Auden are clear there's no immediate threat
0:09:58 > 0:10:01to life, both patients can be moved on.
0:10:01 > 0:10:03Can we get her inside an ambulance?
0:10:03 > 0:10:05Cos this is too noisy.
0:10:05 > 0:10:06What are your thoughts,
0:10:06 > 0:10:10- still thinking about Addenbrooke's or...?- Yes, Addenbrooke's.
0:10:25 > 0:10:29The first of the ambulances arrives at the Major Trauma Centre
0:10:29 > 0:10:32with Matthew, the single driver.
0:10:32 > 0:10:34He's 36 years old.
0:10:40 > 0:10:42Ready, brace, move.
0:10:50 > 0:10:51Everyone happy, then?
0:10:51 > 0:10:56At approximately half-past five, so two hours ago this evening
0:10:56 > 0:10:58he was involved in a road traffic collision head-on.
0:10:58 > 0:11:02He was the driver of one vehicle and was trapped for over an hour.
0:11:02 > 0:11:05Injuries top-to-toe, he's got some cracked teeth,
0:11:05 > 0:11:08some blood from his mouth, but no airway issues.
0:11:08 > 0:11:14Query pelvis. Angulated, open right femur, and that's us.
0:11:16 > 0:11:18Just going to get all of this off you, mate.
0:11:20 > 0:11:22Lots of people all about, sweetheart.
0:11:22 > 0:11:26In each bay, you'll see there is an emergency physician who's
0:11:26 > 0:11:30the team leader, then there are two nursing staff.
0:11:30 > 0:11:32And then in each team there is an airway doctor
0:11:32 > 0:11:35and then someone else, a runner, if you like, to support them.
0:11:35 > 0:11:37So six, a minimum of six people in each bay.
0:11:37 > 0:11:40I'm just going to borrow this arm to put the blood pressure cuff on.
0:11:40 > 0:11:44The Trauma Team rapidly assesses Matthew for life-threatening
0:11:44 > 0:11:47injuries beyond his broken leg.
0:11:47 > 0:11:51Ask the radiologist to do a run-off, so get this patient stable for CT.
0:11:51 > 0:11:54Let's get him packaged, get him round to CT.
0:11:54 > 0:11:58Definitely he's got a right femur fracture,
0:11:58 > 0:12:04but we're querying a pelvic fracture and that's why we're doing the CT.
0:12:04 > 0:12:06That patient's been here 17 minutes now,
0:12:06 > 0:12:09so I want this patient through the scanner as quickly as possible.
0:12:12 > 0:12:14The system's designed to get patients to CT
0:12:14 > 0:12:16as fast as possible.
0:12:19 > 0:12:21We really worry about pelvic fractures,
0:12:21 > 0:12:25as there are big veins that travel through the back of the pelvis that can be disrupted
0:12:25 > 0:12:29and there can be torrential bleeding inside the body in a patient with a pelvic fracture
0:12:29 > 0:12:32that we can't see, so we need to get to CT very quickly to do that.
0:12:34 > 0:12:36The CT's a rotating X-ray scanner.
0:12:36 > 0:12:41In minutes, the doctors will have a full 3-D map of the body
0:12:41 > 0:12:44to spot any internal injuries.
0:12:55 > 0:12:58Ten minutes later, the second ambulance arrives
0:12:58 > 0:13:02with the daughter from the family, Dawn.
0:13:02 > 0:13:06You're at Addenbrooke's hospital in Cambridge.
0:13:07 > 0:13:10Matthew, is there anyone we need to let know...?
0:13:10 > 0:13:11Ow, ow, ow!
0:13:13 > 0:13:18- Is it in the thigh or below the knee?- Oh, ow!
0:13:18 > 0:13:21Remember to keep this arm still.
0:13:21 > 0:13:23Can we get some ketamine, please?
0:13:23 > 0:13:26100mg in a ten-mil syringe.
0:13:26 > 0:13:28Ow, ow, ow! Sorry, sorry, sorry!
0:13:28 > 0:13:32The Emergency Medical Team fitted a traction splint at scene,
0:13:32 > 0:13:36to pull the two pieces of the thigh bone apart.
0:13:36 > 0:13:39She's getting muscle spasm and these spasms are pain.
0:13:39 > 0:13:42But Rod thinks Dawn's pain is due to the splint coming loose.
0:13:42 > 0:13:47I want you to reposition the top straps, just undo them,
0:13:47 > 0:13:49make sure they're in the right position.
0:13:49 > 0:13:52And I will reposition the ankle halter.
0:13:52 > 0:13:57We're going to try and adjust this splint to get it to hold your leg better.
0:13:57 > 0:13:58SHE GROANS
0:14:02 > 0:14:04Oh!
0:14:04 > 0:14:07So, toe, knee and super iliac spine.
0:14:07 > 0:14:10- Yep.- Look at that position compared to what it was earlier on.
0:14:10 > 0:14:14Makes a much more comfortable position for her.
0:14:17 > 0:14:19Do you want me to put the catheter first?
0:14:31 > 0:14:33Three hours after the collision,
0:14:33 > 0:14:37an Emergency Medical Team bring in John, Dawn's father.
0:14:37 > 0:14:39Kate is your Team Leader.
0:14:39 > 0:14:42Ready, set, move.
0:14:44 > 0:14:49So from the top, airway is fine, trachea is central, we've got
0:14:49 > 0:14:53visible contusions to the abdominal wall in to both iliac crests.
0:14:53 > 0:14:57So we're suspecting chest, abdomen and pelvic injuries, OK?
0:14:59 > 0:15:02If he's stable, let's go to CT.
0:15:02 > 0:15:04OK, you happy with that?
0:15:04 > 0:15:05Yeah.
0:15:05 > 0:15:08With three seriously injured patients already
0:15:08 > 0:15:12and another on the way, Rod's system is being pushed close to capacity.
0:15:12 > 0:15:15Do you want to get a porter ready and everything ready?
0:15:15 > 0:15:19'When will patient four leave scene?'
0:15:19 > 0:15:22Patient four could be 20 to 30 minutes before they leave scene,
0:15:22 > 0:15:23over.
0:15:23 > 0:15:26Neil and Auden have been delayed at scene.
0:15:29 > 0:15:34Their final patient, Teresa, has become too ill to be driven
0:15:34 > 0:15:35to Addenbrooke's.
0:15:39 > 0:15:41OK - so the indication is for head injury.
0:15:41 > 0:15:43Head injury, falling GCS.
0:15:43 > 0:15:45Yep, head and chest injury, she's not ventilated.
0:15:45 > 0:15:46One-two-three, slide.
0:15:46 > 0:15:49They've discovered the impact has broken Teresa's ribs,
0:15:49 > 0:15:51which have punctured her lungs.
0:15:51 > 0:15:53Have we got blood pressure?
0:15:55 > 0:15:58140 over 107, OK?
0:15:58 > 0:16:03Her oxygen levels are dropping fast and her life is in serious danger.
0:16:03 > 0:16:06Check the sats. Crack that suction open so it's ready to go.
0:16:06 > 0:16:09Leave it on there so it can just stretch across.
0:16:09 > 0:16:12Neil and Auden are trained in the technique that could save her -
0:16:12 > 0:16:16putting a tube down her throat to push air into her damaged lungs.
0:16:16 > 0:16:19So that's three of fentanyl.
0:16:19 > 0:16:22So that's three micrograms per kilo, eight threes are 24.
0:16:22 > 0:16:26240 micrograms, that's five mils.
0:16:28 > 0:16:33Thank you, that's fine, lovely, lovely.
0:16:35 > 0:16:37- I'm seeing chest rise. - Nice air entry on the right side.
0:16:37 > 0:16:40It's also on the left side, but it's lower.
0:16:40 > 0:16:43But after the procedure, there's a new problem.
0:16:43 > 0:16:47Air is being forced out of the holes in her lungs into her chest cavity,
0:16:47 > 0:16:50causing her left lung to collapse.
0:16:50 > 0:16:53Her oxygen levels are falling lower still.
0:16:53 > 0:16:56Just going to do a thoracostomy, which is basically putting
0:16:56 > 0:16:58a small hole in the side of her chest.
0:16:58 > 0:17:02Neil wants to make a cut between her ribs to release the trapped air.
0:17:02 > 0:17:06I think that....a gross area check,
0:17:06 > 0:17:09a hand in there...I think that is the fourth or the fifth.
0:17:09 > 0:17:10- Do you agree?- Yeah.
0:17:14 > 0:17:16Something like that?
0:17:16 > 0:17:18OK, the left lung is up.
0:17:18 > 0:17:21I don't feel any rib fractures. OK, so that's good.
0:17:21 > 0:17:24With the pressure in her chest released,
0:17:24 > 0:17:26Teresa's lung has re-inflated.
0:17:26 > 0:17:29We're good to go, just go nice and steady.
0:17:29 > 0:17:32Obviously lights on but steady, and just get us through the traffic, OK?
0:17:32 > 0:17:35PHONE RINGS
0:17:38 > 0:17:40Addenbrooke's trauma.
0:17:40 > 0:17:44Hello, this is Dr Langhelle from the East Anglian Air Ambulance.
0:17:44 > 0:17:50The patient is anaesthetised, intubated, ventilated.
0:17:50 > 0:17:55ETA is 15 - one, five - minutes.
0:17:55 > 0:17:56Thank you.
0:18:02 > 0:18:04Phoned to say they'll be here in 15 minutes.
0:18:04 > 0:18:07General Surgery and Orthopaedics - they're hovering in the middle.
0:18:07 > 0:18:10- Sats going down. - Can you work on that?
0:18:13 > 0:18:15Just five miles out from Addenbrooke's,
0:18:15 > 0:18:18Auden and Neil see Teresa's oxygen levels are dropping again.
0:18:18 > 0:18:22Right, where are we? In terms of from Addenbrooke's?
0:18:22 > 0:18:25About five minutes...
0:18:25 > 0:18:28OK, so it's getting harder, sats are dropping, end-tidal's not great,
0:18:28 > 0:18:30let's just rethink that thoracostomy.
0:18:30 > 0:18:33Because we need to get this sorted out.
0:18:33 > 0:18:35There's still too much pressure in her chest.
0:18:35 > 0:18:37Neil attempts to reopen the hole in her chest wall.
0:18:37 > 0:18:40Find out where that bloody hole is.
0:18:42 > 0:18:44Sats increasing.
0:18:52 > 0:18:55Teresa arrives in a highly critical condition.
0:18:57 > 0:19:00We need to sometimes be very aggressive in the way
0:19:00 > 0:19:04we resuscitate someone and I mean that word deliberately.
0:19:04 > 0:19:07We really need to attack the patient who's sick when they arrive.
0:19:07 > 0:19:10So on slide, ready set, slide.
0:19:15 > 0:19:18Pupils are not reactive. Not reactive.
0:19:18 > 0:19:21Equal, both of them not reactive.
0:19:21 > 0:19:23You carry on focusing on the patient. We'll work around you.
0:19:23 > 0:19:25John, chest drain's on.
0:19:25 > 0:19:27We're putting the chest drain on the other side now?
0:19:27 > 0:19:31It's the turn of Rod's trauma team to try and release the pressure
0:19:31 > 0:19:35from Teresa's chest, and stop her oxygen levels falling further still.
0:19:35 > 0:19:40All right, so let's make sure both sides of her chest are decompressed.
0:19:40 > 0:19:42They've made a second hole between her ribs.
0:19:47 > 0:19:49John, is that lung up on that side?
0:19:49 > 0:19:51I'm in right chest now, I've no blood
0:19:51 > 0:19:53- and the lung is up under my finger. - Great.
0:19:53 > 0:19:57With the pressure released, her lungs have re-inflated.
0:19:57 > 0:19:59Is she ventilating well?
0:19:59 > 0:20:01She's ventilating fine
0:20:01 > 0:20:03and John can feel the lung is up under his finger.
0:20:03 > 0:20:05Teresa's out of immediate danger.
0:20:05 > 0:20:10The arm keeps moving, I'm struggling to get a reading,
0:20:10 > 0:20:12but everything is fine.
0:20:19 > 0:20:23Her two sons and daughter-in-law have been waiting to see her.
0:21:13 > 0:21:15John actually called us from the car.
0:21:15 > 0:21:21He didn't know how bad it was, but he was very calm.
0:21:21 > 0:21:26We're still waiting to hear on Mum.
0:21:26 > 0:21:32Basically we were told just to be prepared for whatever.
0:21:34 > 0:21:35Which is difficult.
0:21:39 > 0:21:43Let's get her ready to go to CT as soon as they're ready.
0:21:43 > 0:21:46- You guys ready for scan? - Yes, we are ready.
0:22:11 > 0:22:13So she's got significant chest injuries.
0:22:13 > 0:22:16We just need to find out exactly what.
0:22:18 > 0:22:22Orthopaedic registrar Chris Lawrence is on duty
0:22:22 > 0:22:25as one of the Trauma Centre specialists available around the clock.
0:22:25 > 0:22:27All right, Matthew?
0:22:28 > 0:22:31He's been assessing Matthew's CT scans.
0:22:34 > 0:22:37Matthew's mum has also arrived
0:22:37 > 0:22:40and is waiting to hear about his injuries.
0:22:40 > 0:22:44I'm going to take these blocks off, because the CT scan has been
0:22:44 > 0:22:46clear of your neck, which is good.
0:22:48 > 0:22:49- Right, happy?- Yeah.
0:22:58 > 0:23:01The scan has also cleared Matthew's pelvis.
0:23:01 > 0:23:04But it's revealed a new injury.
0:23:05 > 0:23:09This is the chin and you can see the jaw is in multiple pieces.
0:23:09 > 0:23:12If we come up slowly you can see more pieces appear
0:23:12 > 0:23:15where his jaw has been shattered at the lower border.
0:23:17 > 0:23:20Matthew's jaw has taken the force of the impact.
0:23:20 > 0:23:24He doesn't have any serious injury in the brain.
0:23:24 > 0:23:27Although it's very unpleasant and must be incredibly painful for him,
0:23:27 > 0:23:32it's actually served as a bit of a crumple zone for the brain itself.
0:23:32 > 0:23:33HE GROANS
0:23:35 > 0:23:37Matthew needs surgery tomorrow,
0:23:37 > 0:23:41but for now none of his injuries are life-threatening.
0:23:45 > 0:23:50His girlfriend of six months, Saffron, has arrived.
0:23:50 > 0:23:52This is the first time she's met his mum.
0:23:52 > 0:23:57He must be feeling better, he's thinking about food.
0:23:57 > 0:24:01Yeah, that's it, he's feeling hungry.
0:24:01 > 0:24:05He's more coherent than I thought he would be. Definitely.
0:24:07 > 0:24:10Certainly more than I thought he would be...from the way
0:24:10 > 0:24:11we were brought in.
0:24:11 > 0:24:14That was quite horrendous, yeah.
0:24:14 > 0:24:18I was at home when two police officers landed on my doorstep.
0:24:18 > 0:24:21So immediately you know there's something wrong.
0:24:21 > 0:24:24I absolutely assumed that he had already died.
0:24:32 > 0:24:35Rod prepares the next step in Teresa's
0:24:35 > 0:24:39chain of survival at the Critical Care Unit.
0:24:39 > 0:24:43Right, so, a lady who is very sick is in scan now.
0:24:43 > 0:24:46I'd like her to come from scan to here. Is that all right?
0:24:46 > 0:24:49- Yep.- So she's got big pulmonary contusions, lots of fractures,
0:24:49 > 0:24:52so she's definitely coming to you and I'd like her to come from scan.
0:24:57 > 0:25:00The scan shows that Teresa has broken ribs on both sides,
0:25:00 > 0:25:04and the accident's left her lungs badly cut and bruised.
0:25:09 > 0:25:11So she's now moving to the Critical Care Unit,
0:25:11 > 0:25:15where she's going to be kept on a breathing machine to allow
0:25:15 > 0:25:18her lungs some chance to recover from this injury.
0:25:18 > 0:25:21And that's going to take a little while, so she's going to be
0:25:21 > 0:25:24kept asleep for a while, she's going to need to be sedated
0:25:24 > 0:25:27in order to tolerate the breathing machines over the next few days.
0:25:36 > 0:25:40While the staff in Critical Care monitor Teresa,
0:25:40 > 0:25:44her husband's been told that he's the only family member
0:25:44 > 0:25:46who hasn't been seriously hurt.
0:25:50 > 0:25:53Oh, dear, oh, dear.
0:26:00 > 0:26:02I've seen everything.
0:26:02 > 0:26:06I've handled every conceivable combination of injury,
0:26:06 > 0:26:10from assaults and murders through to war injuries.
0:26:12 > 0:26:17The incidents I struggle with most are road traffic collisions,
0:26:17 > 0:26:20usually involving family groups.
0:26:24 > 0:26:30Family groups that are torn apart in a single instant
0:26:30 > 0:26:35are what I struggle to reconcile in my mind.
0:26:39 > 0:26:44Mum's in intensive care. Is she OK?
0:26:44 > 0:26:48The nurse, or the doctor down there has sat down
0:26:48 > 0:26:50and gone right through everything.
0:26:50 > 0:26:54What their concerns were, and what they've found.
0:26:54 > 0:26:59At the moment, they're just keeping her comfortable by sedating her,
0:26:59 > 0:27:01and doing their best.
0:27:01 > 0:27:02OK, how's Dad?
0:27:02 > 0:27:07He's sitting up, obviously worried about Mum.
0:27:07 > 0:27:10Because they couldn't get to him in the car.
0:27:10 > 0:27:11SHE SOBS
0:27:11 > 0:27:15Don't, because you'll start me off.
0:27:18 > 0:27:19Thank you.
0:27:22 > 0:27:25Just don't keep anything from me
0:27:25 > 0:27:28SISTER-IN-LAW: We won't, I promise.
0:27:28 > 0:27:32Thank you. Just don't keep anything from me.
0:28:03 > 0:28:07It's a Thursday afternoon.
0:28:07 > 0:28:09PHONE RINGS
0:28:09 > 0:28:11Hello, Addenbrooke's Major Trauma Centre.
0:28:13 > 0:28:16In the Emergency Department, Dr Tom Larsen
0:28:16 > 0:28:18gets a warning of a possible major trauma.
0:28:18 > 0:28:22OK, fine and ETA is about ten minutes?
0:28:22 > 0:28:25Fine, OK.
0:28:27 > 0:28:29I've just been grabbed from Minor Injuries.
0:28:29 > 0:28:32Apparently, there's a 24-year-old lady, been driving a car,
0:28:32 > 0:28:35apparently without a seatbelt, and run into a wall.
0:28:44 > 0:28:45Here we are.
0:28:49 > 0:28:51The patient's name is Lauren.
0:28:54 > 0:28:57After driving through a brick wall at 50 miles an hour,
0:28:57 > 0:29:00she managed to phone her parents for help.
0:29:00 > 0:29:03Apparently she skidded on something in the road,
0:29:03 > 0:29:07lost control of the car, and ended up spinning 360 degrees,
0:29:07 > 0:29:10then she ended up in someone's front garden.
0:29:10 > 0:29:13Crashed into the wall, which is no more.
0:29:13 > 0:29:17It could have been a lot worse, it could have been much worse.
0:29:17 > 0:29:19Let me know if anywhere I touch you on your tummy causes any...
0:29:19 > 0:29:21Just up there, yeah?
0:29:21 > 0:29:24Even though Lauren seems stable, Tom knows the force of her impact
0:29:24 > 0:29:27means a complete assessment is vital.
0:29:27 > 0:29:29How would you rate your pain at the minute
0:29:29 > 0:29:34- If ten out of ten was the worst pain you could imagine?- About eight.
0:29:34 > 0:29:39Pain in her head, pain in her chest and tenderness in her abdomen
0:29:39 > 0:29:41so potentially quite a few sites of injury.
0:29:50 > 0:29:54The initial look at the scan, there seems to be some bleeding
0:29:54 > 0:29:58in the abdomen, so we're just looking for what might be causing that.
0:29:58 > 0:30:00Spleen's completely gone.
0:30:00 > 0:30:03You think it's from the spleen, do you?
0:30:03 > 0:30:05Completely lacerated spleen.
0:30:06 > 0:30:08So quite a few things to do now.
0:30:08 > 0:30:11We need to get her various injuries sorted out.
0:30:11 > 0:30:13I'm going to call the general surgeon.
0:30:13 > 0:30:17The result of the CT triggers a full major trauma response -
0:30:17 > 0:30:21a shattered spleen can cause sudden massive bleeding.
0:30:21 > 0:30:25Within the Major Trauma Centre, we have a dedicated major trauma
0:30:25 > 0:30:29emergency theatre, an operating theatre, available 24 hours a day.
0:30:29 > 0:30:32So what we need to decide is a plan of attack.
0:30:32 > 0:30:37Dr Irum Amin has arrived from the Emergency Trauma theatre.
0:30:37 > 0:30:40Fairly significant injury, I think.
0:30:40 > 0:30:42There's quite a lot of free fluid there.
0:30:42 > 0:30:46You've got a fairly significant injury to your spleen.
0:30:46 > 0:30:50If it wasn't as significant, there was potentially a chance
0:30:50 > 0:30:54we could not operate, but I think with the degree of injury
0:30:54 > 0:30:57you've got, we need to do an operation to remove your spleen.
0:30:57 > 0:31:00I can understand it's all very scary
0:31:00 > 0:31:02and quite a lot to take in, but I think from our point of view
0:31:02 > 0:31:05it's quite important we get you to theatre fairly quickly.
0:31:07 > 0:31:09Lauren's taken straight to surgery.
0:31:10 > 0:31:15Abnormal position and we need to get on with it.
0:31:15 > 0:31:21Some people have a big injury to the spleen, they're bleeding,
0:31:21 > 0:31:24they seem well for a while and then suddenly
0:31:24 > 0:31:28they go off a precipice, and become very unwell indeed.
0:31:28 > 0:31:29- Hello there.- Hello.
0:31:29 > 0:31:31- Is your name Harries?- Yes.
0:31:31 > 0:31:34Richard Hardwick's my name, hi, consultant surgeon.
0:31:34 > 0:31:38If your spleen is salvageable we'll save it, but it often isn't
0:31:38 > 0:31:42in this situation, so you may end up without it.
0:31:47 > 0:31:49The clock is ticking.
0:31:49 > 0:31:53So it is a relatively tense time with any trauma.
0:31:53 > 0:31:55And now the important thing is that we keep moving.
0:32:03 > 0:32:06Right, let's see what the damage is.
0:32:09 > 0:32:13Richard first needs to take a close look at the state of Lauren's spleen.
0:32:15 > 0:32:17It's a very clever organ.
0:32:17 > 0:32:20It filters your blood and takes out all sorts of things,
0:32:20 > 0:32:23like old red blood cells.
0:32:23 > 0:32:28It's an important part of your immune system and we try, if we can,
0:32:28 > 0:32:30to save it.
0:32:30 > 0:32:34If Richard does remove the spleen, Lauren will have to take antibiotics
0:32:34 > 0:32:38every day for the next five years to protect herself against infection.
0:32:38 > 0:32:41So I'm going to mobilise the spleen and have a look at the back.
0:32:41 > 0:32:44It's just conceivable we might end up being able to save this.
0:32:46 > 0:32:50It's horrible - sitting here waiting is horrible.
0:32:50 > 0:32:53But no-one can tell us anything, because they don't know
0:32:53 > 0:32:55until they've done it, do they?
0:32:55 > 0:32:59So...it's not nice.
0:32:59 > 0:33:02Sitting here with our fingers crossed now.
0:33:02 > 0:33:04It's five minutes on the clock, but when you're sitting here
0:33:04 > 0:33:07waiting for news, it might as well be an hour. It's awful.
0:33:09 > 0:33:13So now, interestingly, it's just fresh blood starting to ooze
0:33:13 > 0:33:16through the clot, which suggests that there's a deeper injury
0:33:16 > 0:33:18and that would fit with the CT scan.
0:33:20 > 0:33:22She's smashed that good and proper.
0:33:22 > 0:33:26I have a feeling this is now looking much less likely to be saved.
0:33:28 > 0:33:31This is the swab that I put in coming out.
0:33:31 > 0:33:33There's lots of blood in it.
0:33:33 > 0:33:36It's clearly bleeding posteriorly and it's not salvageable,
0:33:36 > 0:33:39this spleen, so we're going to take it out.
0:33:42 > 0:33:43Scissors, please.
0:33:45 > 0:33:48Gently, gently, easy, easy, easy.
0:33:48 > 0:33:53Yep, OK, bucket, thank you.
0:33:55 > 0:33:57Right, let's have some string to tie these off.
0:34:01 > 0:34:04Less than four hours after arriving at the Emergency Department,
0:34:04 > 0:34:07Lauren's life-saving operation is complete.
0:34:07 > 0:34:10We want to try and get her up, sitting out of bed,
0:34:10 > 0:34:12moving around tomorrow.
0:34:12 > 0:34:13We want her up and get her moving,
0:34:13 > 0:34:17we don't want her lying in bed for a week, that's a recipe for disaster.
0:34:19 > 0:34:22Richard Hardwick, consultant surgeon, nice to meet you.
0:34:22 > 0:34:24She's fine.
0:34:24 > 0:34:26It wasn't salvageable.
0:34:26 > 0:34:28We couldn't save it, so she's lost her spleen.
0:34:29 > 0:34:31She'll be all right?
0:34:31 > 0:34:34She'll be fine, but without a spleen.
0:34:34 > 0:34:36And that's...?
0:34:36 > 0:34:40You can live a perfectly normal life without a spleen.
0:34:40 > 0:34:43She's going to have to have some antibiotics for a while.
0:34:51 > 0:34:54She's all right and I'm so glad.
0:34:54 > 0:34:57She could've gone through the windscreen,
0:34:57 > 0:35:01she could have been killed - so...small price to pay.
0:35:03 > 0:35:05Thank God.
0:35:05 > 0:35:07Lauren will be able to leave hospital in a week,
0:35:07 > 0:35:12and she should be fully healed in three months.
0:35:26 > 0:35:32It's a day since the Davis family were cut out of their car.
0:35:32 > 0:35:36Teresa is being kept sedated on the Critical Care Unit.
0:35:37 > 0:35:40A breathing machine is keeping her alive,
0:35:40 > 0:35:44and giving her damaged lungs a chance of recovery.
0:35:44 > 0:35:48Mum's the centre of the family.
0:35:48 > 0:35:53She has the purest and kindest heart of anyone I've ever known.
0:35:53 > 0:35:55I've known a few people.
0:35:55 > 0:35:59She's just...unique.
0:36:00 > 0:36:04It's difficult in any situation to go into A&E
0:36:04 > 0:36:08with one relative, but trying to split yourself between three
0:36:08 > 0:36:12and not knowing what's going on and...
0:36:12 > 0:36:17When they brought Mum in and Mum was just...and they wouldn't let me near her.
0:36:18 > 0:36:21I just thought she'd gone at that point.
0:36:25 > 0:36:29So this is just oxygen. As I say, it might smell a bit rubbery. Well done.
0:36:31 > 0:36:37Teresa's daughter, Dawn, is having her broken leg fixed.
0:36:44 > 0:36:46Matthew, the driver from the other car,
0:36:46 > 0:36:48is also about to be operated on.
0:36:49 > 0:36:52I don't even remember what happened.
0:36:52 > 0:36:55I don't even remember if I was overtaking,
0:36:55 > 0:36:59like being overtaken, put my brakes on, hit a corner, whatever.
0:36:59 > 0:37:06So, without knowing that, I could have been worse, I could have been dead.
0:37:08 > 0:37:12Two different surgical teams are going to operate on Matthew at once.
0:37:12 > 0:37:16So here you can see a fairly simple fracture through
0:37:16 > 0:37:19the shaft of the thigh bone.
0:37:19 > 0:37:24And our aim is to put a rod down the centre, having reduced the fracture.
0:37:24 > 0:37:27While orthopaedic registrar Henry Budd pins the leg...
0:37:27 > 0:37:30Ready steady, slide.
0:37:30 > 0:37:34..Facial surgeon Malcolm Cameron will work on the shattered jaw.
0:37:34 > 0:37:37The important and painful part for him is his fractured lower jaw,
0:37:37 > 0:37:40which you can see at the left side at the front.
0:37:40 > 0:37:43My intention is to open up the fracture and put two metal
0:37:43 > 0:37:46plates onto his lower jaw to bring it into the correct position.
0:37:46 > 0:37:49The metal plates will sit on the front of his jaw
0:37:49 > 0:37:52and then opening and closing will be normal afterwards.
0:37:52 > 0:37:56However, he won't be chewing a normal diet for six weeks.
0:37:56 > 0:38:00He'll be on a soft diet, soft, sloppy diet for six weeks.
0:38:02 > 0:38:05This double operation reduces the time Matthew must spend
0:38:05 > 0:38:07under general anaesthetic.
0:38:14 > 0:38:16There's the loose tooth out of the jaw.
0:38:19 > 0:38:216mm screws loaded up.
0:38:25 > 0:38:29Malcolm will fasten the two halves of Matthew's jaw together
0:38:29 > 0:38:31using titanium plates.
0:38:31 > 0:38:35It's effectively now a custom-made, specially bent plate,
0:38:35 > 0:38:38eight holes long, to cover the extent of this fracture.
0:38:40 > 0:38:42With several loose pieces of bone in the chin,
0:38:42 > 0:38:46Matthew needs the long plate to join together the shattered area.
0:38:48 > 0:38:51The trouble is we have to adapt the Meccano to fit the injury.
0:38:59 > 0:39:02The entire operation is being done through a cut below Matthew's gum,
0:39:02 > 0:39:04to avoid any scarring to his face.
0:39:11 > 0:39:15And importantly, I'm trying to keep it underneath this nerve,
0:39:15 > 0:39:17and I'm trying to put the plate underneath that nerve
0:39:17 > 0:39:21so that nerve is retained so he doesn't end up with a numb lower lip.
0:39:23 > 0:39:24Another 6mm screw, please.
0:39:28 > 0:39:29Good wash of the hole there.
0:39:30 > 0:39:33It's not the easiest fracture in the world to fix for a mandible,
0:39:33 > 0:39:36but it's gone very well, and we've got a nice reduction
0:39:36 > 0:39:38and it's nicely fixed. It's very firm now.
0:39:39 > 0:39:40He's a young, fit, healthy man
0:39:40 > 0:39:42and his jaw will heal normally afterwards.
0:39:45 > 0:39:49Matthew should be able to use his jaw to chew again in six weeks.
0:39:50 > 0:39:52And with a metal rod in his thigh bone,
0:39:52 > 0:39:55he should be up on crutches in a fortnight.
0:39:55 > 0:39:56Very good.
0:40:14 > 0:40:16In the year ending June 2012,
0:40:16 > 0:40:19just under 1,800 people were killed in the United Kingdom
0:40:19 > 0:40:23in road traffic collisions, and just under 25,000 people
0:40:23 > 0:40:25were killed and seriously injured combined.
0:40:25 > 0:40:27That's 25,000 people.
0:40:31 > 0:40:32I'm an emergency physician
0:40:32 > 0:40:35because when I was having a driving lesson aged 17,
0:40:35 > 0:40:37there was a head-on collision in front of me.
0:40:37 > 0:40:41That was my first exposure to multiply injured, trapped people,
0:40:41 > 0:40:45and I felt completely helpless.
0:40:49 > 0:40:51OPERATOR: '073, go ahead.'
0:40:51 > 0:40:53'We have three patients.'
0:40:54 > 0:40:58'One is P1. Second one is P2.'
0:40:58 > 0:41:01There's been a serious three-car accident on a B-road,
0:41:01 > 0:41:0355 miles west of Cambridge.
0:41:05 > 0:41:07Trauma resus, five minutes, thank you.
0:41:09 > 0:41:11The Emergency Department have received early warning.
0:41:17 > 0:41:18There's been a big accident.
0:41:18 > 0:41:21There's been several people ejected from the vehicles as well,
0:41:21 > 0:41:25which is suggestive of quite a significant mechanism of injury.
0:41:27 > 0:41:30An emergency medical team brings in a female patient
0:41:30 > 0:41:32direct from the scene.
0:41:33 > 0:41:36She's 37 years old, and her name is Dionne.
0:41:41 > 0:41:46So this was a rather nasty three-car road traffic collision.
0:41:46 > 0:41:50Very nasty scene, so one of the cars was being towed by another car
0:41:50 > 0:41:54and both of those managed to somehow go head on into another vehicle.
0:41:54 > 0:41:55This is Dionne.
0:41:55 > 0:41:57Involved in a head-on collision with another vehicle,
0:41:57 > 0:41:59so there's three vehicles involved in total.
0:41:59 > 0:42:04One of the ejected patients was pronounced life extinct at scene.
0:42:04 > 0:42:05Any pain in your tummy at all?
0:42:10 > 0:42:11Sats are 100%.
0:42:13 > 0:42:15Haemodynamically, she's stable.
0:42:15 > 0:42:17She's got a fracture of her lower leg.
0:42:17 > 0:42:20OK, we've organized a CT scan
0:42:20 > 0:42:22and we're now waiting to go to the CT scan.
0:42:37 > 0:42:40So, looking through, first on the arterial phase,
0:42:40 > 0:42:42we can see there's some bruising in the skin,
0:42:42 > 0:42:44but we're really looking to see if there's any arterial injury,
0:42:44 > 0:42:46and this is all looking fine.
0:42:46 > 0:42:49So we've dealt with the life-threatening,
0:42:49 > 0:42:52and then we move to any of the other injuries,
0:42:52 > 0:42:55so, has she broken her foot or her hands.
0:42:58 > 0:43:01We know from the scene of the accident, from the paramedics
0:43:01 > 0:43:06and doctors at the scene, that there is one deceased patient,
0:43:06 > 0:43:09and we do believe it's the partner of the lady
0:43:09 > 0:43:10that we're currently treating.
0:43:16 > 0:43:19I'm Ian Gray. I'm with the traffic police at Cambridgeshire.
0:43:19 > 0:43:22I do have to tell you some bad news.
0:43:22 > 0:43:26The person driving the red Polo, which I believe was doing the towing,
0:43:26 > 0:43:29unfortunately didn't make it as a result of the accident.
0:43:29 > 0:43:31He's died of his injuries.
0:43:31 > 0:43:33He's my partner.
0:43:33 > 0:43:34OK.
0:43:36 > 0:43:38Would that have been Paul?
0:43:38 > 0:43:39- Yeah.- OK.
0:43:39 > 0:43:42I'm very sorry to have to tell you that unfortunately he didn't make it
0:43:42 > 0:43:44and he died as a result of the accident.
0:44:01 > 0:44:03Are you sure I can't get you any painkillers,
0:44:03 > 0:44:05or is that OK at the moment?
0:44:05 > 0:44:09Yeah, I'm all right at the moment, thank you.
0:44:09 > 0:44:11Just achy, but it's not drastic.
0:44:11 > 0:44:14So I'm going to have a chat with the nurse in charge
0:44:14 > 0:44:16and see if there's any beds upstairs,
0:44:16 > 0:44:19so it'll be a lot quieter than down here. That all right?
0:44:19 > 0:44:20Yeah, yeah.
0:44:38 > 0:44:39Don't seem real, really.
0:44:59 > 0:45:01Two days after her accident,
0:45:01 > 0:45:04Teresa is still on a breathing machine in the Critical Care Unit.
0:45:07 > 0:45:09But the doctors are reducing her sedation.
0:45:12 > 0:45:16I've now heard from my son that my wife is waking up, so...
0:45:23 > 0:45:25So I suppose...
0:45:27 > 0:45:30..all I can hope is that she comes through this
0:45:30 > 0:45:33as well as I do, in the end.
0:45:39 > 0:45:42Teresa, I think your husband's coming down to see you.
0:45:44 > 0:45:47John and Teresa have been married for 45 years.
0:45:49 > 0:45:51They haven't seen each other since being cut out of their car.
0:45:58 > 0:45:59Hello!
0:46:10 > 0:46:12They're looking after you?
0:46:13 > 0:46:15Good. They're looking after me.
0:46:15 > 0:46:18How are you feeling? OK?
0:46:19 > 0:46:21You be careful with that hand, you've broken it.
0:46:24 > 0:46:27Do you want to write on a piece of paper? Here we go.
0:46:42 > 0:46:45No, there's no way on earth you're going to get rid of me.
0:46:45 > 0:46:47You still haven't run the licence out
0:46:47 > 0:46:49on your marriage certificate, Teresa.
0:46:49 > 0:46:51OK? Got a few years to go yet.
0:46:53 > 0:46:55We're all three here, all three of us.
0:46:56 > 0:46:59No problems, we're all three here.
0:46:59 > 0:47:02The family's no smaller than it was the other day.
0:47:02 > 0:47:04OK?
0:47:12 > 0:47:14And I love you, too, as well, sweetheart.
0:47:23 > 0:47:25Matthew's condition has got worse.
0:47:26 > 0:47:30The operations on his leg and jaw have taken their toll.
0:47:30 > 0:47:32When you have a life-threatening injury,
0:47:32 > 0:47:34you can think of that as the first hit.
0:47:34 > 0:47:37Some people need extensive surgery, and that,
0:47:37 > 0:47:40from the perspective of the body, is like a second hit.
0:47:40 > 0:47:42It's like having another accident, almost.
0:47:46 > 0:47:48Matthew had this operation done,
0:47:48 > 0:47:52and you can see that the orthopaedic team have inserted
0:47:52 > 0:47:55this stabilizing rod through the centre of his thigh bone,
0:47:55 > 0:47:58and that releases into the bloodstream marrow
0:47:58 > 0:48:01and things that get filtered by the lungs,
0:48:01 > 0:48:04and, in some cases, that can contribute to the development
0:48:04 > 0:48:06of lung problems after this sort of operation.
0:48:07 > 0:48:13He's had a scan which showed up the pneumonia.
0:48:13 > 0:48:17His lungs aren't working well enough because of the pneumonia, they said,
0:48:18 > 0:48:21so he needs higher oxygen levels.
0:48:21 > 0:48:23This picture is consistent with pneumonia.
0:48:23 > 0:48:26This is quite a serious problem, it can be life-threatening.
0:48:28 > 0:48:32Doctors move Matthew to the Critical Care Unit as he deteriorates.
0:48:33 > 0:48:35The pneumonia is clogging up his lungs,
0:48:35 > 0:48:37stopping them from absorbing enough oxygen.
0:48:42 > 0:48:45When you've got this sort of problem, you need support,
0:48:45 > 0:48:46you need ventilatory support,
0:48:46 > 0:48:49and it kind of pushes air in every time you take a breath,
0:48:49 > 0:48:52and that mask can be really uncomfortable for people
0:48:52 > 0:48:54at the best of times, let alone if you've got a broken jaw.
0:49:10 > 0:49:12Dionne is recovering on a ward.
0:49:13 > 0:49:16It's two days since the collision that killed her partner.
0:49:18 > 0:49:21I just remember a car,
0:49:21 > 0:49:28I could see the man's face, and it was just pure fear and panic...
0:49:30 > 0:49:34..and then there was just a big bang, really.
0:49:38 > 0:49:40And then the police officer came to see me,
0:49:40 > 0:49:42and he just said that...
0:49:45 > 0:49:50the person in the Volkswagen Polo hadn't survived...
0:49:51 > 0:49:53..and I knew...
0:49:55 > 0:49:57..I knew that was Paul's car.
0:50:03 > 0:50:08They said it must have been very instant...
0:50:09 > 0:50:15..so he didn't suffer at all, from what we can gather.
0:50:22 > 0:50:25Paul was only 46,
0:50:25 > 0:50:28and now five kids...
0:50:30 > 0:50:32..haven't got their dad any more.
0:50:51 > 0:50:54It's four days since Teresa's collision,
0:50:54 > 0:50:56and she's made a huge step forward.
0:50:56 > 0:50:59The tubes have been removed from her throat,
0:50:59 > 0:51:01and she's breathing for herself once again.
0:51:04 > 0:51:06I've got to get this right.
0:51:06 > 0:51:11I think it's six ribs on that side, four on this one.
0:51:11 > 0:51:13I think that's right.
0:51:13 > 0:51:16I thought I was going to die, when I blacked out.
0:51:18 > 0:51:21I'd gone deaf, I couldn't see very well,
0:51:21 > 0:51:25and then everything, this black curtain came down.
0:51:27 > 0:51:29I can't quite believe how well I am feeling.
0:51:32 > 0:51:35Just have this problem with my chest.
0:51:41 > 0:51:43As Teresa's slowly improves,
0:51:43 > 0:51:45the critical care doctors want to find out if her lungs
0:51:45 > 0:51:48have healed enough to move her on to a rehab ward.
0:51:49 > 0:51:55John is a great Star Trek fan, so I'm quite used
0:51:55 > 0:52:00to seeing lots of this technology in Star Trek episodes.
0:52:06 > 0:52:08Breathe normally.
0:52:19 > 0:52:21I just want to know the result now.
0:52:29 > 0:52:32Teresa is breathing for herself now, she's starting to recover.
0:52:32 > 0:52:36This CT scan, which now we're over a week after the injury,
0:52:36 > 0:52:39is showing that her lungs are recovering
0:52:39 > 0:52:41and things are looking good,
0:52:41 > 0:52:44and there's no suggestion that she's developing
0:52:44 > 0:52:47any serious long-term complications from this injury.
0:52:50 > 0:52:53On a ward at the other end of the hospital,
0:52:53 > 0:52:55Teresa's daughter Dawn is also recovering well.
0:53:00 > 0:53:03We're going to see my daughter. She has no idea!
0:53:03 > 0:53:05A surprise!
0:53:07 > 0:53:10Well, I didn't expect to be out of bed today.
0:53:10 > 0:53:15I thought the first step would be to sit on the edge of the bed,
0:53:15 > 0:53:17but I've actually got up and out.
0:53:21 > 0:53:24- We won't do this too often, I tell you.- No.
0:53:33 > 0:53:35I can't get out of bed to get to you.
0:53:37 > 0:53:39- Don't hurt yourself. - No, I won't.
0:53:39 > 0:53:42Oh, wow! Oh, wow!
0:53:44 > 0:53:45I can't go fast enough.
0:53:51 > 0:53:52Hello!
0:54:08 > 0:54:11How's the breathing feeling? Can you give me a big cough?
0:54:11 > 0:54:13HE COUGHS
0:54:13 > 0:54:15On the Critical Care Unit,
0:54:15 > 0:54:19doctors have kept Matthew on high levels of oxygen for two days,
0:54:19 > 0:54:21and he's winning his fight against pneumonia.
0:54:21 > 0:54:24Do I have bruising in my lungs?
0:54:24 > 0:54:27You did, very bad. But your breathing seems very good.
0:54:27 > 0:54:31The fact that you're able to talk in full sentences is a good thing.
0:54:31 > 0:54:33So lots of things to be cheerful about.
0:54:34 > 0:54:37I've never been in anything close to this position.
0:54:37 > 0:54:40And first, you, sort of, you're getting your bearings.
0:54:41 > 0:54:44Then you're starting to realise that things are pretty serious.
0:54:44 > 0:54:47You're starting to think, "Am I going to..."
0:54:48 > 0:54:50You know, "Am I going to make it?"
0:54:52 > 0:54:58But I survived it, you know what I mean, and I'm still here.
0:55:05 > 0:55:07Go on, Shannon, after you.
0:55:09 > 0:55:11That's brilliant!
0:55:11 > 0:55:12Mum and daughter race.
0:55:12 > 0:55:15Less than two weeks after their collision,
0:55:15 > 0:55:18all four patients are well on their way to recovery.
0:55:20 > 0:55:23As recently as six months ago, we wouldn't necessarily have been able
0:55:23 > 0:55:25to handle four simultaneous patients at once
0:55:25 > 0:55:27in the emergency department in the way that we did.
0:55:27 > 0:55:30I'm obviously not pleased that they had the injury event
0:55:30 > 0:55:34in the first place, but I'm really pleased that the system is working.
0:55:35 > 0:55:38That's, like, amazing.
0:55:38 > 0:55:40Literally two days ago you were struggling to...
0:55:42 > 0:55:44Well, you couldn't move your feet, could you?
0:55:44 > 0:55:46I'm having a bit of a competition with the Grim Reaper,
0:55:46 > 0:55:49and if I can snatch someone from the Grim Reaper
0:55:49 > 0:55:52and we can save a life, then actually, that's hugely rewarding.
0:55:52 > 0:55:55That's hugely, hugely rewarding for the whole team.
0:56:14 > 0:56:17The Davises are holding a family gathering.
0:56:17 > 0:56:20The first since the collision almost two months ago.
0:56:21 > 0:56:24Looking back on it now, it was definitely a very crazy time,
0:56:24 > 0:56:28and the relief of being here today, now,
0:56:28 > 0:56:32and everybody home, back in one place, is just brilliant.
0:56:34 > 0:56:37They're OK, they're alive. What more could you ask for?
0:56:37 > 0:56:38This top is nice.
0:56:46 > 0:56:48He's got a T-Rex in his bedroom window.
0:56:48 > 0:56:49It's a dog.
0:56:56 > 0:56:57Hello, Mum.
0:56:59 > 0:57:02I just couldn't imagine this family being without them in it.
0:57:04 > 0:57:06It just wouldn't be right.
0:57:07 > 0:57:08- Sausage?- Yes, please.
0:57:09 > 0:57:12'I mean, it could have been so much worse.'
0:57:12 > 0:57:15Where's your knife, did you forget it? Ah!
0:57:17 > 0:57:19'It really does make you think, you know,
0:57:19 > 0:57:21'that life can change in a second,'
0:57:22 > 0:57:25and life is precious.
0:57:25 > 0:57:27It is.
0:57:27 > 0:57:29Squeeze in, everyone on the edge.
0:57:31 > 0:57:33It's drawn us closer together as a family,
0:57:33 > 0:57:36and that is possible, even when you're close.
0:57:37 > 0:57:41Because it then was quite obvious to everybody that we're all mortal.
0:57:41 > 0:57:43Squeeze!
0:57:46 > 0:57:47'It's never going to be forgotten,
0:57:47 > 0:57:49'it's going to be there for the rest of our lives.'
0:57:53 > 0:57:55Tell me if I'm squeezing you too hard.
0:57:55 > 0:57:56No, you're not!
0:58:21 > 0:58:24Subtitles by Red Bee Media Ltd