Episode 1 Life Savers

This programme contains scenes which some viewers may find upsetting.

If you suffer a life-threatening injury,

your chances of survival are changing.

There's a revolution going on right now across

the United Kingdom in the way that we treat patients with major trauma.

'We've got a head-on collision with people still trapped in the cars.'

There's not a lot left of that vehicle.

In the past, hundreds of patients have died,

who might otherwise have survived had there been

a more effective chain of survival.

-PHONE RINGS

-Addenbrooke's Major Trauma Centre.

We think she's triage tool positive, and a pelvic fracture.

OK, has she had pain relief?

Now, across the country, a new co-ordinated system

is triggered by the most critical injuries.

-Now she's going straight down.

-Lovely.

-Kate is your team leader.

Medics with advanced lifesaving skills rush to the scene...

Can we take over the leadership?

A well-drilled Emergency Department prepares.

Pupils are not reactive.

The latest technology is waiting.

I want this patient through the scanner as quickly as possible.

And specialist surgeons stand by.

The clock is ticking.

The BBC has followed the first regional major trauma network

to be fully operational, based at Addenbrooke's Hospital in Cambridge.

This is the frontline of emergency medicine.

Just don't keep anything from me.

We have people who arrive at the very limits of life.

I just thought she'd gone at that point.

OK, stand clear everyone, shocking.

If you suffer a critical injury, these are the men

and women with the best chance of saving your life.

PHONE RINGS

Hello, Addenbrooke's ED...

It's five o'clock on a Saturday afternoon at Addenbrooke's Hospital.

Aw, killer.

Can you get Brendan to bring out some more pre-alert forms for there, please?

So far today, the doctors and nurses in the Emergency Department

have seen 174 ill and injured patients.

Anna, have you got any anaesthetic drugs out?

PHONE RINGS

Addenbrooke's Emergency Department...

Consultant Rod Mackenzie has just come on shift.

All right, thank you.

He's in charge of getting the hospital's new major trauma system

ready for life-threatening injuries from across the East of England.

So you're going to have a few stitches there.

You OK there?

'What's the address of the emergency?'

At ten minutes past five,

Ambulance Central control receives a call that triggers the new system.

'We've got a head-on collision.

'There's just two cars, one's in the middle of the road,

'one's on the side of the road and people still trapped in the cars.'

Four still trapped? All right, thank you, bye.

The maximum number of simultaneous major trauma patients that we

plan to see at one time is five.

Four or five patients requiring resuscitation at the same time

would really, would push us.

So there are four patients in total,

that have been trapped for a long time.

It's Neil here from Cambridge...

The first response is to send an Emergency Medical Team

to the accident, 30 miles north of Cambridge.

Cheers, Dave, bye-bye.

SIREN WAILS

'There are four patients still trapped.

'We've got a variation of chest, pelvic and femur injuries.

'Two men and two women, over.'

CCD, Medic 88, that's all received. Thank you so much.

Dr Auden Langhelle and critical care paramedic

Neil Flowers are specially trained to handle the worst incidents.

Being able to deploy a medical team to these incidents is really

important, because it takes, essentially, elements of the hospital care to the patient.

If there are four poorly patients on scene,

it's probably going to be quite chaotic.

It will be a difficult scene to manage, and there

will be a lot of decisions that are going to need to be made.

This is the East of England.

It stretches from the M25 up to the Wash, across to the East, to

Great Yarmouth and the coast, across to the Midlands and the M1 corridor.

20,000 square kilometres, 5.8 million population.

So nearest Trauma Centre is Addenbrooke's, nearest

hospital is Peterborough, which is a District General hospital.

So we just have to bear these things in mind.

So in the past, each hospital would work, effectively, in isolation.

In the new system, we're trying to get these patients to the

Major Trauma Centre in Cambridge.

So it's likely from what the initial report we've got,

these are patients who will have multiple injuries,

these are going to be very poorly patients.

It could be a life-threatening injury.

It's an hour since the collision took place.

Medic 88 on scene.

There are already 40 firefighters, six ambulance crews

and the police on scene.

But they need Neil

and Auden's advanced medical skills to help free the trapped patients.

Hello, there, I'm scene commander at the moment.

-There's one patient here.

-One patient there and three patients over there. All trapped.

All P1s at the moment.

We have someone over there with no blood pressure

and reduced air entry over there.

The Peugeot here, this vehicle's got a single occupant in it.

The Astra, which is in the hedge, has got a family in it,

with mum and dad and daughter.

The daughter in the rear is quite ill.

The two cars were travelling in opposite directions

and have hit head-on.

Hi, guys.

The guy in the car there.

Again, is a 30 yr old guy, completely awake, GCS 15,

appears to have good chest.

But again, pelvis and femurs.

The man driving alone has told medics he's called Matthew.

He was driving to his girlfriend's.

The family of three - the Davises -

were on their way to a local concert.

What we want is your guys, coordinated,

literally hands-on, nice and big and strong, have her out.

With a long board.

-This one, yeah?

-Yeah. No messing around.

Neil and Auden see the daughter is wedged between the front seats,

trapping her parents.

PATIENT CRIES OUT

There's a patient in the back of the car,

she has a femoral - right-sided thigh fracture.

We need to just get her pain under control.

Neil suspects her leg was broken

when the impact forced her into the seats in front.

This is ketamine. It's a big dose of ketamine.

We're unable to get I/V access on this lady

so we're going to give her an intramuscular injection.

Lift, one-two-three, lift!

PATIENT CRIES OUT

An hour and 20 minutes after the collision,

the fire crew lift Dawn, the daughter, clear.

-Move up, more along everyone.

-That's it, lovely job!

Another Emergency Medical Team have got Matthew out of his car

and are assessing him.

This patient's sustained some quite nasty lower leg injuries.

We've given him a pre-hospital sedation,

we've managed his fractures, and we're now going to go

to Addenbrooke's as the Major Trauma Centre.

The team's worried that as well as his leg, he's broken his pelvis too.

PHONE RINGS

Hello. He's got an open femur and you're worried about his pelvis.

OK, that's fine. Bye.

Is that two?

That's the first one.

-Diego, your patient.

-Yep.

30-year-old male.

He's got a query pelvic fracture, right open femur.

He was awake. He was sedated for the extrication.

Which nursing staff are a part of this?

You're going to stick with this bay.

We're getting now that the first patient will be

arriving in the next few minutes, and you can see we've

created a number of different teams with one kind of overarching

team leader - myself - to coordinate what needs to happen.

Critical care paramedic Jemma Varela assesses Dawn,

now she's out of the car.

At the moment the patient looks like she's got a nasty isolated

femur fracture and possibly her pelvis.

So we've managed to give her some drugs to help with the pain,

and we'll just take her straight to the Major Trauma Centre.

Now Dawn's on her way to Addenbrooke's,

Neil and Auden's priority is her parents, still trapped in the car.

To get the patients out - they're in a bit of pain -

we need to give them something for the pain.

So we're just trying to speed that up, so we can speed up

getting the patients out so we can fully assess them.

An hour and a half after the accident,

the team lift Teresa, the mother, clear from the passenger seat.

You're going to be with an ambulance shortly, OK?

OK.

Finally, they free the father, John.

Is this bearable? Pain in your tummy?

There? Just relax.

As soon as Neil and Auden are clear there's no immediate threat

to life, both patients can be moved on.

Can we get her inside an ambulance?

Cos this is too noisy.

What are your thoughts,

-still thinking about Addenbrooke's or...?

-Yes, Addenbrooke's.

The first of the ambulances arrives at the Major Trauma Centre

with Matthew, the single driver.

He's 36 years old.

Ready, brace, move.

Everyone happy, then?

At approximately half-past five, so two hours ago this evening

he was involved in a road traffic collision head-on.

He was the driver of one vehicle and was trapped for over an hour.

Injuries top-to-toe, he's got some cracked teeth,

some blood from his mouth, but no airway issues.

Query pelvis. Angulated, open right femur, and that's us.

Just going to get all of this off you, mate.

Lots of people all about, sweetheart.

In each bay, you'll see there is an emergency physician who's

the team leader, then there are two nursing staff.

And then in each team there is an airway doctor

and then someone else, a runner, if you like, to support them.

So six, a minimum of six people in each bay.

I'm just going to borrow this arm to put the blood pressure cuff on.

The Trauma Team rapidly assesses Matthew for life-threatening

injuries beyond his broken leg.

Ask the radiologist to do a run-off, so get this patient stable for CT.

Let's get him packaged, get him round to CT.

Definitely he's got a right femur fracture,

but we're querying a pelvic fracture and that's why we're doing the CT.

That patient's been here 17 minutes now,

so I want this patient through the scanner as quickly as possible.

The system's designed to get patients to CT

as fast as possible.

We really worry about pelvic fractures,

as there are big veins that travel through the back of the pelvis that can be disrupted

and there can be torrential bleeding inside the body in a patient with a pelvic fracture

that we can't see, so we need to get to CT very quickly to do that.

The CT's a rotating X-ray scanner.

In minutes, the doctors will have a full 3-D map of the body

to spot any internal injuries.

Ten minutes later, the second ambulance arrives

with the daughter from the family, Dawn.

You're at Addenbrooke's hospital in Cambridge.

Matthew, is there anyone we need to let know...?

Ow, ow, ow!

-Is it in the thigh or below the knee?

-Oh, ow!

Remember to keep this arm still.

Can we get some ketamine, please?

100mg in a ten-mil syringe.

Ow, ow, ow! Sorry, sorry, sorry!

The Emergency Medical Team fitted a traction splint at scene,

to pull the two pieces of the thigh bone apart.

She's getting muscle spasm and these spasms are pain.

But Rod thinks Dawn's pain is due to the splint coming loose.

I want you to reposition the top straps, just undo them,

make sure they're in the right position.

And I will reposition the ankle halter.

We're going to try and adjust this splint to get it to hold your leg better.

SHE GROANS

Oh!

So, toe, knee and super iliac spine.

-Yep.

-Look at that position compared to what it was earlier on.

Makes a much more comfortable position for her.

Do you want me to put the catheter first?

Three hours after the collision,

an Emergency Medical Team bring in John, Dawn's father.

Kate is your Team Leader.

Ready, set, move.

So from the top, airway is fine, trachea is central, we've got

visible contusions to the abdominal wall in to both iliac crests.

So we're suspecting chest, abdomen and pelvic injuries, OK?

If he's stable, let's go to CT.

OK, you happy with that?

Yeah.

With three seriously injured patients already

and another on the way, Rod's system is being pushed close to capacity.

Do you want to get a porter ready and everything ready?

'When will patient four leave scene?'

Patient four could be 20 to 30 minutes before they leave scene,

over.

Neil and Auden have been delayed at scene.

Their final patient, Teresa, has become too ill to be driven

to Addenbrooke's.

OK - so the indication is for head injury.

Head injury, falling GCS.

Yep, head and chest injury, she's not ventilated.

One-two-three, slide.

They've discovered the impact has broken Teresa's ribs,

which have punctured her lungs.

Have we got blood pressure?

140 over 107, OK?

Her oxygen levels are dropping fast and her life is in serious danger.

Check the sats. Crack that suction open so it's ready to go.

Leave it on there so it can just stretch across.

Neil and Auden are trained in the technique that could save her -

putting a tube down her throat to push air into her damaged lungs.

So that's three of fentanyl.

So that's three micrograms per kilo, eight threes are 24.

240 micrograms, that's five mils.

Thank you, that's fine, lovely, lovely.

-I'm seeing chest rise.

-Nice air entry on the right side.

It's also on the left side, but it's lower.

But after the procedure, there's a new problem.

Air is being forced out of the holes in her lungs into her chest cavity,

causing her left lung to collapse.

Her oxygen levels are falling lower still.

Just going to do a thoracostomy, which is basically putting

a small hole in the side of her chest.

Neil wants to make a cut between her ribs to release the trapped air.

I think that....a gross area check,

a hand in there...I think that is the fourth or the fifth.

-Do you agree?

-Yeah.

Something like that?

OK, the left lung is up.

I don't feel any rib fractures. OK, so that's good.

With the pressure in her chest released,

Teresa's lung has re-inflated.

We're good to go, just go nice and steady.

Obviously lights on but steady, and just get us through the traffic, OK?

PHONE RINGS

Addenbrooke's trauma.

Hello, this is Dr Langhelle from the East Anglian Air Ambulance.

The patient is anaesthetised, intubated, ventilated.

ETA is 15 - one, five - minutes.

Thank you.

Phoned to say they'll be here in 15 minutes.

General Surgery and Orthopaedics - they're hovering in the middle.

-Sats going down.

-Can you work on that?

Just five miles out from Addenbrooke's,

Auden and Neil see Teresa's oxygen levels are dropping again.

Right, where are we? In terms of from Addenbrooke's?

About five minutes...

OK, so it's getting harder, sats are dropping, end-tidal's not great,

let's just rethink that thoracostomy.

Because we need to get this sorted out.

There's still too much pressure in her chest.

Neil attempts to reopen the hole in her chest wall.

Find out where that bloody hole is.

Sats increasing.

Teresa arrives in a highly critical condition.

We need to sometimes be very aggressive in the way

we resuscitate someone and I mean that word deliberately.

We really need to attack the patient who's sick when they arrive.

So on slide, ready set, slide.

Pupils are not reactive. Not reactive.

Equal, both of them not reactive.

You carry on focusing on the patient. We'll work around you.

John, chest drain's on.

We're putting the chest drain on the other side now?

It's the turn of Rod's trauma team to try and release the pressure

from Teresa's chest, and stop her oxygen levels falling further still.

All right, so let's make sure both sides of her chest are decompressed.

They've made a second hole between her ribs.

John, is that lung up on that side?

I'm in right chest now, I've no blood

-and the lung is up under my finger.

-Great.

With the pressure released, her lungs have re-inflated.

Is she ventilating well?

She's ventilating fine

and John can feel the lung is up under his finger.

Teresa's out of immediate danger.

The arm keeps moving, I'm struggling to get a reading,

but everything is fine.

Her two sons and daughter-in-law have been waiting to see her.

John actually called us from the car.

He didn't know how bad it was, but he was very calm.

We're still waiting to hear on Mum.

Basically we were told just to be prepared for whatever.

Which is difficult.

Let's get her ready to go to CT as soon as they're ready.

-You guys ready for scan?

-Yes, we are ready.

So she's got significant chest injuries.

We just need to find out exactly what.

Orthopaedic registrar Chris Lawrence is on duty

as one of the Trauma Centre specialists available around the clock.

All right, Matthew?

He's been assessing Matthew's CT scans.

Matthew's mum has also arrived

and is waiting to hear about his injuries.

I'm going to take these blocks off, because the CT scan has been

clear of your neck, which is good.

-Right, happy?

-Yeah.

The scan has also cleared Matthew's pelvis.

But it's revealed a new injury.

This is the chin and you can see the jaw is in multiple pieces.

If we come up slowly you can see more pieces appear

where his jaw has been shattered at the lower border.

Matthew's jaw has taken the force of the impact.

He doesn't have any serious injury in the brain.

Although it's very unpleasant and must be incredibly painful for him,

it's actually served as a bit of a crumple zone for the brain itself.

HE GROANS

Matthew needs surgery tomorrow,

but for now none of his injuries are life-threatening.

His girlfriend of six months, Saffron, has arrived.

This is the first time she's met his mum.

He must be feeling better, he's thinking about food.

Yeah, that's it, he's feeling hungry.

He's more coherent than I thought he would be. Definitely.

Certainly more than I thought he would be...from the way

we were brought in.

That was quite horrendous, yeah.

I was at home when two police officers landed on my doorstep.

So immediately you know there's something wrong.

I absolutely assumed that he had already died.

Rod prepares the next step in Teresa's

chain of survival at the Critical Care Unit.

Right, so, a lady who is very sick is in scan now.

I'd like her to come from scan to here. Is that all right?

-Yep.

-So she's got big pulmonary contusions, lots of fractures,

so she's definitely coming to you and I'd like her to come from scan.

The scan shows that Teresa has broken ribs on both sides,

and the accident's left her lungs badly cut and bruised.

So she's now moving to the Critical Care Unit,

where she's going to be kept on a breathing machine to allow

her lungs some chance to recover from this injury.

And that's going to take a little while, so she's going to be

kept asleep for a while, she's going to need to be sedated

in order to tolerate the breathing machines over the next few days.

While the staff in Critical Care monitor Teresa,

her husband's been told that he's the only family member

who hasn't been seriously hurt.

Oh, dear, oh, dear.

I've seen everything.

I've handled every conceivable combination of injury,

from assaults and murders through to war injuries.

The incidents I struggle with most are road traffic collisions,

usually involving family groups.

Family groups that are torn apart in a single instant

are what I struggle to reconcile in my mind.

Mum's in intensive care. Is she OK?

The nurse, or the doctor down there has sat down

and gone right through everything.

What their concerns were, and what they've found.

At the moment, they're just keeping her comfortable by sedating her,

and doing their best.

OK, how's Dad?

He's sitting up, obviously worried about Mum.

Because they couldn't get to him in the car.

SHE SOBS

Don't, because you'll start me off.

Thank you.

Just don't keep anything from me

SISTER-IN-LAW: We won't, I promise.

Thank you. Just don't keep anything from me.

It's a Thursday afternoon.

PHONE RINGS

Hello, Addenbrooke's Major Trauma Centre.

In the Emergency Department, Dr Tom Larsen

gets a warning of a possible major trauma.

OK, fine and ETA is about ten minutes?

Fine, OK.

I've just been grabbed from Minor Injuries.

Apparently, there's a 24-year-old lady, been driving a car,

apparently without a seatbelt, and run into a wall.

Here we are.

The patient's name is Lauren.

After driving through a brick wall at 50 miles an hour,

she managed to phone her parents for help.

Apparently she skidded on something in the road,

lost control of the car, and ended up spinning 360 degrees,

then she ended up in someone's front garden.

Crashed into the wall, which is no more.

It could have been a lot worse, it could have been much worse.

Let me know if anywhere I touch you on your tummy causes any...

Just up there, yeah?

Even though Lauren seems stable, Tom knows the force of her impact

means a complete assessment is vital.

How would you rate your pain at the minute

-If ten out of ten was the worst pain you could imagine?

-About eight.

Pain in her head, pain in her chest and tenderness in her abdomen

so potentially quite a few sites of injury.

The initial look at the scan, there seems to be some bleeding

in the abdomen, so we're just looking for what might be causing that.

Spleen's completely gone.

You think it's from the spleen, do you?

Completely lacerated spleen.

So quite a few things to do now.

We need to get her various injuries sorted out.

I'm going to call the general surgeon.

The result of the CT triggers a full major trauma response -

a shattered spleen can cause sudden massive bleeding.

Within the Major Trauma Centre, we have a dedicated major trauma

emergency theatre, an operating theatre, available 24 hours a day.

So what we need to decide is a plan of attack.

Dr Irum Amin has arrived from the Emergency Trauma theatre.

Fairly significant injury, I think.

There's quite a lot of free fluid there.

You've got a fairly significant injury to your spleen.

If it wasn't as significant, there was potentially a chance

we could not operate, but I think with the degree of injury

you've got, we need to do an operation to remove your spleen.

I can understand it's all very scary

and quite a lot to take in, but I think from our point of view

it's quite important we get you to theatre fairly quickly.

Lauren's taken straight to surgery.

Abnormal position and we need to get on with it.

Some people have a big injury to the spleen, they're bleeding,

they seem well for a while and then suddenly

they go off a precipice, and become very unwell indeed.

-Hello there.

-Hello.

-Is your name Harries?

-Yes.

Richard Hardwick's my name, hi, consultant surgeon.

If your spleen is salvageable we'll save it, but it often isn't

in this situation, so you may end up without it.

The clock is ticking.

So it is a relatively tense time with any trauma.

And now the important thing is that we keep moving.

Right, let's see what the damage is.

Richard first needs to take a close look at the state of Lauren's spleen.

It's a very clever organ.

It filters your blood and takes out all sorts of things,

like old red blood cells.

It's an important part of your immune system and we try, if we can,

to save it.

If Richard does remove the spleen, Lauren will have to take antibiotics

every day for the next five years to protect herself against infection.

So I'm going to mobilise the spleen and have a look at the back.

It's just conceivable we might end up being able to save this.

It's horrible - sitting here waiting is horrible.

But no-one can tell us anything, because they don't know

until they've done it, do they?

So...it's not nice.

Sitting here with our fingers crossed now.

It's five minutes on the clock, but when you're sitting here

waiting for news, it might as well be an hour. It's awful.

So now, interestingly, it's just fresh blood starting to ooze

through the clot, which suggests that there's a deeper injury

and that would fit with the CT scan.

She's smashed that good and proper.

I have a feeling this is now looking much less likely to be saved.

This is the swab that I put in coming out.

There's lots of blood in it.

It's clearly bleeding posteriorly and it's not salvageable,

this spleen, so we're going to take it out.

Scissors, please.

Gently, gently, easy, easy, easy.

Yep, OK, bucket, thank you.

Right, let's have some string to tie these off.

Less than four hours after arriving at the Emergency Department,

Lauren's life-saving operation is complete.

We want to try and get her up, sitting out of bed,

moving around tomorrow.

We want her up and get her moving,

we don't want her lying in bed for a week, that's a recipe for disaster.

Richard Hardwick, consultant surgeon, nice to meet you.

She's fine.

It wasn't salvageable.

We couldn't save it, so she's lost her spleen.

She'll be all right?

She'll be fine, but without a spleen.

And that's...?

You can live a perfectly normal life without a spleen.

She's going to have to have some antibiotics for a while.

She's all right and I'm so glad.

She could've gone through the windscreen,

she could have been killed - so...small price to pay.

Thank God.

Lauren will be able to leave hospital in a week,

and she should be fully healed in three months.

It's a day since the Davis family were cut out of their car.

Teresa is being kept sedated on the Critical Care Unit.

A breathing machine is keeping her alive,

and giving her damaged lungs a chance of recovery.

Mum's the centre of the family.

She has the purest and kindest heart of anyone I've ever known.

I've known a few people.

She's just...unique.

It's difficult in any situation to go into A&E

with one relative, but trying to split yourself between three

and not knowing what's going on and...

When they brought Mum in and Mum was just...and they wouldn't let me near her.

I just thought she'd gone at that point.

So this is just oxygen. As I say, it might smell a bit rubbery. Well done.

Teresa's daughter, Dawn, is having her broken leg fixed.

Matthew, the driver from the other car,

is also about to be operated on.

I don't even remember what happened.

I don't even remember if I was overtaking,

like being overtaken, put my brakes on, hit a corner, whatever.

So, without knowing that, I could have been worse, I could have been dead.

Two different surgical teams are going to operate on Matthew at once.

So here you can see a fairly simple fracture through

the shaft of the thigh bone.

And our aim is to put a rod down the centre, having reduced the fracture.

While orthopaedic registrar Henry Budd pins the leg...

Ready steady, slide.

..Facial surgeon Malcolm Cameron will work on the shattered jaw.

The important and painful part for him is his fractured lower jaw,

which you can see at the left side at the front.

My intention is to open up the fracture and put two metal

plates onto his lower jaw to bring it into the correct position.

The metal plates will sit on the front of his jaw

and then opening and closing will be normal afterwards.

However, he won't be chewing a normal diet for six weeks.

He'll be on a soft diet, soft, sloppy diet for six weeks.

This double operation reduces the time Matthew must spend

under general anaesthetic.

There's the loose tooth out of the jaw.

6mm screws loaded up.

Malcolm will fasten the two halves of Matthew's jaw together

using titanium plates.

It's effectively now a custom-made, specially bent plate,

eight holes long, to cover the extent of this fracture.

With several loose pieces of bone in the chin,

Matthew needs the long plate to join together the shattered area.

The trouble is we have to adapt the Meccano to fit the injury.

The entire operation is being done through a cut below Matthew's gum,

to avoid any scarring to his face.

And importantly, I'm trying to keep it underneath this nerve,

and I'm trying to put the plate underneath that nerve

so that nerve is retained so he doesn't end up with a numb lower lip.

Another 6mm screw, please.

Good wash of the hole there.

It's not the easiest fracture in the world to fix for a mandible,

but it's gone very well, and we've got a nice reduction

and it's nicely fixed. It's very firm now.

He's a young, fit, healthy man

and his jaw will heal normally afterwards.

Matthew should be able to use his jaw to chew again in six weeks.

And with a metal rod in his thigh bone,

he should be up on crutches in a fortnight.

Very good.

In the year ending June 2012,

just under 1,800 people were killed in the United Kingdom

in road traffic collisions, and just under 25,000 people

were killed and seriously injured combined.

That's 25,000 people.

I'm an emergency physician

because when I was having a driving lesson aged 17,

there was a head-on collision in front of me.

That was my first exposure to multiply injured, trapped people,

and I felt completely helpless.

OPERATOR: '073, go ahead.'

'We have three patients.'

'One is P1. Second one is P2.'

There's been a serious three-car accident on a B-road,

55 miles west of Cambridge.

Trauma resus, five minutes, thank you.

The Emergency Department have received early warning.

There's been a big accident.

There's been several people ejected from the vehicles as well,

which is suggestive of quite a significant mechanism of injury.

An emergency medical team brings in a female patient

direct from the scene.

She's 37 years old, and her name is Dionne.

So this was a rather nasty three-car road traffic collision.

Very nasty scene, so one of the cars was being towed by another car

and both of those managed to somehow go head on into another vehicle.

This is Dionne.

Involved in a head-on collision with another vehicle,

so there's three vehicles involved in total.

One of the ejected patients was pronounced life extinct at scene.

Any pain in your tummy at all?

Sats are 100%.

Haemodynamically, she's stable.

She's got a fracture of her lower leg.

OK, we've organized a CT scan

and we're now waiting to go to the CT scan.

So, looking through, first on the arterial phase,

we can see there's some bruising in the skin,

but we're really looking to see if there's any arterial injury,

and this is all looking fine.

So we've dealt with the life-threatening,

and then we move to any of the other injuries,

so, has she broken her foot or her hands.

We know from the scene of the accident, from the paramedics

and doctors at the scene, that there is one deceased patient,

and we do believe it's the partner of the lady

that we're currently treating.

I'm Ian Gray. I'm with the traffic police at Cambridgeshire.

I do have to tell you some bad news.

The person driving the red Polo, which I believe was doing the towing,

unfortunately didn't make it as a result of the accident.

He's died of his injuries.

He's my partner.

OK.

Would that have been Paul?

-Yeah.

-OK.

I'm very sorry to have to tell you that unfortunately he didn't make it

and he died as a result of the accident.

Are you sure I can't get you any painkillers,

or is that OK at the moment?

Yeah, I'm all right at the moment, thank you.

Just achy, but it's not drastic.

So I'm going to have a chat with the nurse in charge

and see if there's any beds upstairs,

so it'll be a lot quieter than down here. That all right?

Yeah, yeah.

Don't seem real, really.

Two days after her accident,

Teresa is still on a breathing machine in the Critical Care Unit.

But the doctors are reducing her sedation.

I've now heard from my son that my wife is waking up, so...

So I suppose...

..all I can hope is that she comes through this

as well as I do, in the end.

Teresa, I think your husband's coming down to see you.

John and Teresa have been married for 45 years.

They haven't seen each other since being cut out of their car.

Hello!

They're looking after you?

Good. They're looking after me.

How are you feeling? OK?

You be careful with that hand, you've broken it.

Do you want to write on a piece of paper? Here we go.

No, there's no way on earth you're going to get rid of me.

You still haven't run the licence out

on your marriage certificate, Teresa.

OK? Got a few years to go yet.

We're all three here, all three of us.

No problems, we're all three here.

The family's no smaller than it was the other day.

OK?

And I love you, too, as well, sweetheart.

Matthew's condition has got worse.

The operations on his leg and jaw have taken their toll.

When you have a life-threatening injury,

you can think of that as the first hit.

Some people need extensive surgery, and that,

from the perspective of the body, is like a second hit.

It's like having another accident, almost.

Matthew had this operation done,

and you can see that the orthopaedic team have inserted

this stabilizing rod through the centre of his thigh bone,

and that releases into the bloodstream marrow

and things that get filtered by the lungs,

and, in some cases, that can contribute to the development

of lung problems after this sort of operation.

He's had a scan which showed up the pneumonia.

His lungs aren't working well enough because of the pneumonia, they said,

so he needs higher oxygen levels.

This picture is consistent with pneumonia.

This is quite a serious problem, it can be life-threatening.

Doctors move Matthew to the Critical Care Unit as he deteriorates.

The pneumonia is clogging up his lungs,

stopping them from absorbing enough oxygen.

When you've got this sort of problem, you need support,

you need ventilatory support,

and it kind of pushes air in every time you take a breath,

and that mask can be really uncomfortable for people

at the best of times, let alone if you've got a broken jaw.

Dionne is recovering on a ward.

It's two days since the collision that killed her partner.

I just remember a car,

I could see the man's face, and it was just pure fear and panic...

..and then there was just a big bang, really.

And then the police officer came to see me,

and he just said that...

the person in the Volkswagen Polo hadn't survived...

..and I knew...

..I knew that was Paul's car.

They said it must have been very instant...

..so he didn't suffer at all, from what we can gather.

Paul was only 46,

and now five kids...

..haven't got their dad any more.

It's four days since Teresa's collision,

and she's made a huge step forward.

The tubes have been removed from her throat,

and she's breathing for herself once again.

I've got to get this right.

I think it's six ribs on that side, four on this one.

I think that's right.

I thought I was going to die, when I blacked out.

I'd gone deaf, I couldn't see very well,

and then everything, this black curtain came down.

I can't quite believe how well I am feeling.

Just have this problem with my chest.

As Teresa's slowly improves,

the critical care doctors want to find out if her lungs

have healed enough to move her on to a rehab ward.

John is a great Star Trek fan, so I'm quite used

to seeing lots of this technology in Star Trek episodes.

Breathe normally.

I just want to know the result now.

Teresa is breathing for herself now, she's starting to recover.

This CT scan, which now we're over a week after the injury,

is showing that her lungs are recovering

and things are looking good,

and there's no suggestion that she's developing

any serious long-term complications from this injury.

On a ward at the other end of the hospital,

Teresa's daughter Dawn is also recovering well.

We're going to see my daughter. She has no idea!

A surprise!

Well, I didn't expect to be out of bed today.

I thought the first step would be to sit on the edge of the bed,

but I've actually got up and out.

-We won't do this too often, I tell you.

-No.

I can't get out of bed to get to you.

-Don't hurt yourself.

-No, I won't.

Oh, wow! Oh, wow!

I can't go fast enough.

Hello!

How's the breathing feeling? Can you give me a big cough?

HE COUGHS

On the Critical Care Unit,

doctors have kept Matthew on high levels of oxygen for two days,

and he's winning his fight against pneumonia.

Do I have bruising in my lungs?

You did, very bad. But your breathing seems very good.

The fact that you're able to talk in full sentences is a good thing.

So lots of things to be cheerful about.

I've never been in anything close to this position.

And first, you, sort of, you're getting your bearings.

Then you're starting to realise that things are pretty serious.

You're starting to think, "Am I going to..."

You know, "Am I going to make it?"

But I survived it, you know what I mean, and I'm still here.

Go on, Shannon, after you.

That's brilliant!

Mum and daughter race.

Less than two weeks after their collision,

all four patients are well on their way to recovery.

As recently as six months ago, we wouldn't necessarily have been able

to handle four simultaneous patients at once

in the emergency department in the way that we did.

I'm obviously not pleased that they had the injury event

in the first place, but I'm really pleased that the system is working.

That's, like, amazing.

Literally two days ago you were struggling to...

Well, you couldn't move your feet, could you?

I'm having a bit of a competition with the Grim Reaper,

and if I can snatch someone from the Grim Reaper

and we can save a life, then actually, that's hugely rewarding.

That's hugely, hugely rewarding for the whole team.

The Davises are holding a family gathering.

The first since the collision almost two months ago.

Looking back on it now, it was definitely a very crazy time,

and the relief of being here today, now,

and everybody home, back in one place, is just brilliant.

They're OK, they're alive. What more could you ask for?

This top is nice.

He's got a T-Rex in his bedroom window.

It's a dog.

Hello, Mum.

I just couldn't imagine this family being without them in it.

It just wouldn't be right.

-Sausage?

-Yes, please.

'I mean, it could have been so much worse.'

Where's your knife, did you forget it? Ah!

'It really does make you think, you know,

'that life can change in a second,'

and life is precious.

It is.

Squeeze in, everyone on the edge.

It's drawn us closer together as a family,

and that is possible, even when you're close.

Because it then was quite obvious to everybody that we're all mortal.

Squeeze!

'It's never going to be forgotten,

'it's going to be there for the rest of our lives.'

Tell me if I'm squeezing you too hard.

No, you're not!

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