0:00:02 > 0:00:09This programme contains scenes which some viewers may find upsetting.
0:00:11 > 0:00:14If you suffer a life-threatening injury,
0:00:14 > 0:00:16your chances of survival are changing.
0:00:16 > 0:00:20There's a revolution going on right now across the United Kingdom
0:00:20 > 0:00:22in the way that we treat patients with major trauma.
0:00:22 > 0:00:25'We've got a head-on collision, with people still trapped in the cars.'
0:00:25 > 0:00:27There's not a lot left of that vehicle.
0:00:27 > 0:00:29In the past, hundreds of patients have died
0:00:29 > 0:00:31who might otherwise have survived,
0:00:31 > 0:00:33had there been a more effective chain of survival.
0:00:33 > 0:00:35TELEPHONE RINGS
0:00:35 > 0:00:36Addenbrooke's Major Trauma Centre.
0:00:36 > 0:00:39We think she's triage tool positive under the pelvic fracture.
0:00:39 > 0:00:42OK, has she had pain relief?
0:00:42 > 0:00:44Now, across the country,
0:00:44 > 0:00:46new regional networks are being geared up
0:00:46 > 0:00:48for the most critical injuries.
0:00:48 > 0:00:50- She's going straight down.- Lovely. - Kate is your team leader.
0:00:50 > 0:00:52OK, quiet!
0:00:52 > 0:00:56Medics with advanced lifesaving skills rush to the scene.
0:00:56 > 0:00:58Can we take over the leadership?
0:00:58 > 0:01:01Patients are stabilised in a local hospital
0:01:01 > 0:01:03or flown direct by air ambulance...
0:01:03 > 0:01:05The clock is ticking.
0:01:05 > 0:01:09..to reach specialists trained to treat every life-threatening injury.
0:01:09 > 0:01:10BEEPING
0:01:10 > 0:01:12Pupils are not reactive.
0:01:12 > 0:01:15The whole aim of the network is to get the most injured to us
0:01:15 > 0:01:16as quickly as possible.
0:01:21 > 0:01:24The BBC has followed the first regional Major Trauma Network
0:01:24 > 0:01:26to be fully operational,
0:01:26 > 0:01:29based at Addenbrooke's Hospital, in Cambridge.
0:01:31 > 0:01:34This is the frontline of emergency medicine.
0:01:34 > 0:01:37Just don't keep anything from me.
0:01:37 > 0:01:41We have people who arrive at the very limits of life.
0:01:41 > 0:01:43And I just thought she'd gone at that point.
0:01:43 > 0:01:46OK, stand clear, everyone, shocking.
0:01:46 > 0:01:48If you suffer a critical injury,
0:01:48 > 0:01:52these are the men and women with the best chance of saving your life.
0:02:04 > 0:02:06It's ten to eleven on a Saturday evening.
0:02:06 > 0:02:11Critical care paramedic Neil Flowers and Dr Adam Chesters
0:02:11 > 0:02:16are on shift in the East Anglia Air Ambulance rapid response vehicle.
0:02:16 > 0:02:18Medic 88.
0:02:18 > 0:02:21'Bit of a drive for you, to the north of Bedford.
0:02:21 > 0:02:26'Trapped RTC, paramedic on scene, requesting medic attendance.'
0:02:26 > 0:02:28Yeah, understood, we're mobile now.
0:02:28 > 0:02:31SIREN WAILING
0:02:31 > 0:02:35A car has hit a tree 30 miles east of Cambridge.
0:02:35 > 0:02:38We've been requested by a crew on scene at a road traffic collision
0:02:38 > 0:02:41where the patient is trapped and presumably quite unwell,
0:02:41 > 0:02:44which is why they want the medical team there.
0:02:44 > 0:02:48Adam and Neil have advanced life-saving training.
0:02:48 > 0:02:53They also decide whether patients need to go to the Major Trauma Centre in Cambridge.
0:02:53 > 0:02:58We have literally just jumped map books, bastards.
0:02:58 > 0:03:01It's in the centre of what looks like quite a little village.
0:03:01 > 0:03:05North to Peterborough here, so the one o'clock exit.
0:03:05 > 0:03:07That kind of address is not suggestive
0:03:07 > 0:03:10of a high-speed piece of road, is it?
0:03:10 > 0:03:12We're trying to work out, just get a sort of idea,
0:03:12 > 0:03:15a feel as to what we're going to.
0:03:15 > 0:03:19So low-speed versus high-speed collisions - very different injury.
0:03:21 > 0:03:24It's over an hour since the collision.
0:03:24 > 0:03:26That's Medic 88 on scene.
0:03:28 > 0:03:32There are two fire crews and an ambulance on scene.
0:03:32 > 0:03:36Let's go and have a chat with the guy in the white hat first.
0:03:36 > 0:03:38But they need Adam and Neil's medical skills
0:03:38 > 0:03:41to safely remove the driver from the wreckage.
0:03:41 > 0:03:45There's not a lot left of that vehicle.
0:03:45 > 0:03:48The chap here, David, from what we can tell,
0:03:48 > 0:03:51he was bombing down this hill, goodness knows what sort of speed.
0:03:51 > 0:03:53You can see the sort of impact it's had.
0:03:53 > 0:03:57- What's worrying me is what's going on abdominally downwards. - Fair enough.
0:03:57 > 0:03:59- David, are you happy there at the moment?- I'm happy...
0:03:59 > 0:04:03David's conscious, and he's trapped in the car by his legs.
0:04:03 > 0:04:06It is actually a really high-speed collision.
0:04:06 > 0:04:08He's completely smashed in the front end of the car.
0:04:08 > 0:04:11So at the moment, I'm worried he's had
0:04:11 > 0:04:13what we'll call a deceleration injury,
0:04:13 > 0:04:15where the car's gone from going very fast
0:04:15 > 0:04:17to being stationary very quickly.
0:04:17 > 0:04:19What I'm worried about here is when we release him,
0:04:19 > 0:04:21if he's got any bleeding down there.
0:04:21 > 0:04:24The whole steering column and the dashboard is pinning him
0:04:24 > 0:04:26by his thighs downwards.
0:04:26 > 0:04:28So at the moment, the pressure of the car
0:04:28 > 0:04:30is almost acting as direct pressure on a bleeding point
0:04:30 > 0:04:32and as soon as we take that pressure off,
0:04:32 > 0:04:34we could literally have blood everywhere.
0:04:34 > 0:04:39Can we get a set of O-cutters at the steering wheel, please?
0:04:39 > 0:04:42Guys, what we're going to do is put these around his thighs,
0:04:42 > 0:04:44we're going to have them ready to tighten up when you make the cut,
0:04:44 > 0:04:48so if anything does bleed, we can just tighten them.
0:04:48 > 0:04:50With the tourniquet straps in position,
0:04:50 > 0:04:53the pressure of the car can be eased off David's legs.
0:04:53 > 0:04:55That's perfect, well done.
0:04:57 > 0:05:00Guys, can we take over the leadership just to get this out?
0:05:00 > 0:05:02So one voice.
0:05:02 > 0:05:04Listen, doc's voice and doc's voice only, guys.
0:05:04 > 0:05:08So, guys, what I want is the long board down the back
0:05:08 > 0:05:11and then, I want hands on to get him straight vertically up the board
0:05:11 > 0:05:15and it's going to be on, "Ready, set, move", OK?
0:05:15 > 0:05:18Adam wants the team to keep David as straight as possible
0:05:18 > 0:05:21to make sure there's no further damage to his spine.
0:05:21 > 0:05:23Ready, set, move.
0:05:25 > 0:05:28If Adam thinks David's injuries are life-threatening,
0:05:28 > 0:05:31his priority will be to get him to the Major Trauma Centre,
0:05:31 > 0:05:33at Addenbrooke's.
0:05:35 > 0:05:37Yeah, looking good.
0:05:37 > 0:05:40He's come out, his legs look intact.
0:05:40 > 0:05:42Belly is fairly firm,
0:05:42 > 0:05:46his chest seems intact.
0:05:46 > 0:05:49Let's get him into the back of the truck.
0:05:49 > 0:05:51He's a bit pale, because he's freezing cold.
0:05:51 > 0:05:53He's got a decent radial pulse.
0:05:53 > 0:05:55I'm thinking local, I think we go to the local, they scan him,
0:05:55 > 0:05:57and he feeds into the network.
0:05:57 > 0:06:00- So at the moment he's major trauma negative, yeah?- He is, yeah.
0:06:00 > 0:06:04- So we go to the local and we go from there, yeah?- Yes.
0:06:04 > 0:06:07Adam hasn't found any critical injury.
0:06:07 > 0:06:10It's nearly two hours since the incident occurred.
0:06:10 > 0:06:12And all of his physiological variables,
0:06:12 > 0:06:15his heart rate, his blood pressure are all normal.
0:06:15 > 0:06:18So at the moment, I don't think there's an immediate threat to life.
0:06:18 > 0:06:21If I thought there was a chance he was very badly injured,
0:06:21 > 0:06:24we'd be diverting to the Major Trauma Centre now.
0:06:25 > 0:06:27David's had a lucky escape.
0:06:28 > 0:06:32Adam and Neil can take him to the local hospital nearby.
0:06:37 > 0:06:40It's one in the morning on a Friday at Addenbrooke's -
0:06:40 > 0:06:43the Major Trauma Centre at the heart of the network.
0:06:44 > 0:06:46Equal and reactive?
0:06:46 > 0:06:49Let's get loaded and get to CT.
0:06:49 > 0:06:52Consultant Ali Tomkins has been on shift for seven hours.
0:06:52 > 0:06:56So far, she's been dealing with routine illness and injuries.
0:06:56 > 0:06:58TELEPHONE RINGS
0:06:58 > 0:06:59Hello, ED Sister.
0:06:59 > 0:07:02An urgent call comes in about another collision.
0:07:06 > 0:07:09Two gentlemen from the same car. 60 miles an hour.
0:07:09 > 0:07:11I do believe it was car versus tree.
0:07:11 > 0:07:14So this is the driver and this is the rear-seat passenger.
0:07:14 > 0:07:16Multiple injuries on both patients.
0:07:16 > 0:07:20Neck injuries, pelvic injuries long-bone injuries...
0:07:20 > 0:07:22Yep, trauma boards on, blocks are ready.
0:07:22 > 0:07:24The network has been set up
0:07:24 > 0:07:27so that patients are taken to their nearest hospital
0:07:27 > 0:07:29if they're too far away from the Major Trauma Centre,
0:07:29 > 0:07:33they receive stabilisation with care in the Emergency Department.
0:07:33 > 0:07:36The crash happened 70 miles south of Cambridge
0:07:36 > 0:07:40and the patients have first been taken to their nearest hospital, in Colchester.
0:07:40 > 0:07:42Ortho know about both of them,
0:07:42 > 0:07:45neurosurgeons know about both of them...
0:07:45 > 0:07:49Medical notes sent ahead from Colchester suggest there's damage to the driver's spine.
0:07:49 > 0:07:51In a high-impact injury,
0:07:51 > 0:07:53there are massive forces transmitted to the spine,
0:07:53 > 0:07:56which at points is vulnerable to injury.
0:07:56 > 0:07:59So if it's over-bent or overstretched, the bones can break
0:07:59 > 0:08:02and the spinal cord can be at risk of serious damage.
0:08:02 > 0:08:06Adult trauma A&E resus. Adult trauma A&E resus.
0:08:08 > 0:08:14So what we have is a gentleman transferred from Colchester General Hospital, who is Daniel Andrews.
0:08:14 > 0:08:18He's a 31-year-old who was the trapped driver of a car,
0:08:18 > 0:08:2065-miles-per-hour, spun, hit a tree.
0:08:23 > 0:08:27Daniel, the driver, is first to arrive.
0:08:29 > 0:08:32It's probably one of the worst ones I've seen.
0:08:32 > 0:08:34The intrusion was so much that the driver was in the back seat.
0:08:34 > 0:08:37Normally, they would just take the roof off.
0:08:37 > 0:08:40Here, they had to literally cut small pieces of car away
0:08:40 > 0:08:43for us to be able to access him and give him treatment.
0:08:45 > 0:08:48- Do you know where we are at the moment?- Hospital.- OK, fine.
0:08:48 > 0:08:49Addenbrooke's.
0:08:49 > 0:08:52Can we get this blood up and under pressure, please?
0:08:52 > 0:08:54Heart rate is coming down.
0:08:54 > 0:08:57The trauma team rapidly assess Daniel.
0:08:57 > 0:08:59Airway is clear, he is talking to me.
0:08:59 > 0:09:02He is on a collar, he's not complaining about pain in his neck.
0:09:02 > 0:09:05- Try not to move your head and neck, please.- Sorry.
0:09:05 > 0:09:07He has vertical movement of his chest.
0:09:07 > 0:09:10The team discover his most urgent life-threatening injury,
0:09:10 > 0:09:15damage to his chest and lungs, was brought under control at Colchester.
0:09:15 > 0:09:18Chest drain on the right side of his chest.
0:09:18 > 0:09:20Daniel, I'm Ali, I'm one of the other doctors.
0:09:20 > 0:09:22Can you wiggle these toes for me?
0:09:22 > 0:09:24Move my toes?
0:09:24 > 0:09:27Yeah, move your toes.
0:09:28 > 0:09:30All right.
0:09:31 > 0:09:33They are not, at the moment.
0:09:35 > 0:09:37- Yeah.- Yeah.- Try this one.
0:09:37 > 0:09:40- Your right one. - The left one is moving.
0:09:42 > 0:09:46Ali's main concern now is the damage to Daniel's spine.
0:09:46 > 0:09:49Do we need to do a bit of morphine loading?
0:09:50 > 0:09:53His girlfriend, Louise, arrived with him.
0:09:53 > 0:09:55He managed to call her after the crash
0:09:55 > 0:09:58and she rushed straight to the scene.
0:09:58 > 0:10:02'It was awful, just a mangled-up mess with him stuck in it.
0:10:02 > 0:10:05'He kept going like, his eyes were shutting
0:10:05 > 0:10:07'and while they are doing their stuff, I'm going,
0:10:07 > 0:10:09'"Daniel wake up, wake up!"
0:10:09 > 0:10:11'I just kept thinking - "Keep him awake."'
0:10:11 > 0:10:14It's just, you know, he's only been at his job four months
0:10:14 > 0:10:15and he's really enjoying it...
0:10:18 > 0:10:20..and now, this.
0:10:23 > 0:10:27Neurosurgery specialist on duty, Dr Roy Chowdhury,
0:10:27 > 0:10:30has come to assess CT scans taken at Colchester.
0:10:32 > 0:10:35Can you feel your buttocks? Can you clench your buttocks?
0:10:38 > 0:10:40Can you feel your genitals?
0:10:40 > 0:10:43Do you want to touch them, shall I just, let me just get the...?
0:10:43 > 0:10:46I don't mind, you can grab my nuts, if you want.
0:10:46 > 0:10:48But I do need to check, so I'm just going to touch them...
0:10:48 > 0:10:50I think they shoved a finger up my bum earlier.
0:10:50 > 0:10:52- Could you feel that?- No.
0:10:52 > 0:10:53- You couldn't feel that?- No.
0:10:53 > 0:10:55And if I just touch on your genitals there.
0:10:58 > 0:10:59I can't feel nothing.
0:11:01 > 0:11:03The extent of the injury is very significant here.
0:11:03 > 0:11:07The spine basically shattered and, in the process,
0:11:07 > 0:11:09it's damaged the lower part of the spinal cord
0:11:09 > 0:11:11and the nerves going into his legs.
0:11:11 > 0:11:13And you can kind of just appreciate
0:11:13 > 0:11:15these blocks here of the spine,
0:11:15 > 0:11:17and then, suddenly, you notice this one
0:11:17 > 0:11:19which should be sitting under here,
0:11:19 > 0:11:20is all the way back here,
0:11:20 > 0:11:24and the nerves behind them are getting almost certainly injured.
0:11:31 > 0:11:33That's always a good sign.
0:11:33 > 0:11:36There's going to be some bruising and swelling around that bony injury,
0:11:36 > 0:11:38we'll get all of the specialist opinions
0:11:38 > 0:11:42and we'll get back to you as soon as we've got some more information.
0:11:42 > 0:11:46It's too early to be thinking about things like that.
0:11:46 > 0:11:47OK?
0:12:00 > 0:12:05Daniel's cousin Stuart is brought in from Colchester an hour after him.
0:12:10 > 0:12:13Daniel was taking Stuart to B&Q when they crashed.
0:12:16 > 0:12:19Families travel in cars together,
0:12:19 > 0:12:22you know, if one's injured then,
0:12:22 > 0:12:25it would be nice if none of the others were, but actually...
0:12:26 > 0:12:28- He's just arrived.- He's here? OK.
0:12:28 > 0:12:30HE MOANS
0:12:30 > 0:12:32OK, so can we get a hand over?
0:12:32 > 0:12:35His main complaint for pain has been his left hip,
0:12:35 > 0:12:36his left ankle, more than anything else.
0:12:36 > 0:12:38Ready, steady, go.
0:12:38 > 0:12:39HE MOANS
0:12:39 > 0:12:44- Keep your hand still, keep your hand still.- Sorry, sorry.- OK. Well done.
0:12:44 > 0:12:47He's got some significant pelvic traumas,
0:12:47 > 0:12:49as we can see from the position of his leg.
0:12:49 > 0:12:52Chris Lawrence, the orthopaedic specialist on duty,
0:12:52 > 0:12:56has been called to assess Stuart's bone injuries.
0:12:56 > 0:12:58We know that he's got a dislocation of the hip,
0:12:58 > 0:13:03which we need to do something about, I need to see the images first.
0:13:03 > 0:13:05When was...?
0:13:05 > 0:13:06I've just crashed it.
0:13:09 > 0:13:14This is the socket for the hip and this is the ball.
0:13:14 > 0:13:17This ball's supposed to be present in the socket.
0:13:17 > 0:13:21So the difficulty is he's got this dislocation of his hip,
0:13:21 > 0:13:23which we need to get back in joint
0:13:23 > 0:13:27to improve the blood supply to the ball as soon as we feasibly can.
0:13:27 > 0:13:31Chris wants to put Stuart's hip back into place
0:13:31 > 0:13:33in the Emergency Department.
0:13:33 > 0:13:34But it's a painful procedure
0:13:34 > 0:13:39and Ali's concerned she can't give the pain relief he'll need.
0:13:39 > 0:13:41I need to try and put his leg into a better position.
0:13:41 > 0:13:43I realise that.
0:13:43 > 0:13:47Can I try it under entinox if I can't have anything else?
0:13:47 > 0:13:51Do you actually think...? I think that would be torturing this gentleman.
0:13:51 > 0:13:53Given the urgency,
0:13:53 > 0:13:57Chris is prepared to try gas and air, a mild pain relief.
0:13:57 > 0:13:59His leg is in a position that is unacceptable,
0:13:59 > 0:14:01we need to put it into a position that's acceptable.
0:14:01 > 0:14:04I've never seen a posterior hip dislocation go back in,
0:14:04 > 0:14:06no matter what it's associated with,
0:14:06 > 0:14:08without sedation, I have to be honest, in my years in ED.
0:14:08 > 0:14:12No, that's cos you always give it, you never do it without, isn't it?
0:14:12 > 0:14:16Urm...yes, but...that's because it's mean.
0:14:18 > 0:14:21There needs to be somebody maintaining an overall view
0:14:21 > 0:14:22for what is best for the patient
0:14:22 > 0:14:24and I think that, as a trauma team leader,
0:14:24 > 0:14:27that is something that is within our responsibilities.
0:14:27 > 0:14:28HE MOANS
0:14:28 > 0:14:32Ali arranges for Stuart to go to the 24-hour trauma theatre.
0:14:32 > 0:14:34It takes a few precious minutes,
0:14:34 > 0:14:37but he'll be given a general anaesthetic
0:14:37 > 0:14:39in the safest environment.
0:14:44 > 0:14:47- Stuart, are you allergic to anything?- No.
0:14:47 > 0:14:49So what we are going to do with Stuart now
0:14:49 > 0:14:53is we are going to try and pull his hip joint back into joint.
0:14:53 > 0:14:56This is the socket,
0:14:56 > 0:14:58there's the head of the femur.
0:14:59 > 0:15:01That needs to be back in there.
0:15:01 > 0:15:05It's very tricky, the cup is fractured, the hip is dislocated
0:15:05 > 0:15:08and that side of the pelvis is unstable
0:15:08 > 0:15:09because that's fractured as well.
0:15:09 > 0:15:12So we are going to have to do this quite carefully.
0:15:23 > 0:15:25Can you show me a picture there?
0:15:28 > 0:15:29And again.
0:15:34 > 0:15:35BONE CRACKS
0:15:35 > 0:15:37Oh, that sounded good.
0:15:37 > 0:15:38Picture, please.
0:15:40 > 0:15:41OK.
0:15:42 > 0:15:47It went back in with quite a clunk, so we know that's gone back in.
0:15:47 > 0:15:48It's certainly just the start,
0:15:48 > 0:15:51this is an emergency procedure that we needed to perform
0:15:51 > 0:15:53to get his hip back into joint,
0:15:53 > 0:15:55but at least we've bought some time now.
0:16:02 > 0:16:04Are you OK?
0:16:04 > 0:16:05Yep.
0:16:07 > 0:16:10- Do you want to sit down? - No, I'm better standing.
0:16:10 > 0:16:12In the Emergency Department,
0:16:12 > 0:16:14Roy Chowdhury wants to get the driver, Daniel,
0:16:14 > 0:16:16to surgery as soon as possible
0:16:16 > 0:16:19to release the pressure on his spinal cord.
0:16:19 > 0:16:22So the main aim of the surgery is twofold.
0:16:22 > 0:16:24One is to fix the spine,
0:16:24 > 0:16:27because, obviously, you're in excruciating pain.
0:16:27 > 0:16:28The other main reason for doing it
0:16:28 > 0:16:31is to try and take the pressure off your nerves,
0:16:31 > 0:16:33to give them the best chance of recovery.
0:16:33 > 0:16:37Now, I'll be very honest with you - this is a serious injury.
0:16:37 > 0:16:39There is a significant risk
0:16:39 > 0:16:42of you having long-term problems with the nerves.
0:16:42 > 0:16:45I cannot say now, there's no-one who can predict that...
0:16:45 > 0:16:48In what way? That I can't walk?
0:16:48 > 0:16:50That's a possibility.
0:16:50 > 0:16:51But I cannot say that for certain
0:16:51 > 0:16:53until we've done the surgery
0:16:53 > 0:16:55and we've given you time to heal.
0:16:55 > 0:16:57You've got to do just one step at a time.
0:16:57 > 0:17:01Is it more likely I would be able to walk in time or not?
0:17:01 > 0:17:03It's very difficult to call it right now.
0:17:03 > 0:17:05So we need to fix it first,
0:17:05 > 0:17:09we need to fix it first and then see recovery, OK?
0:17:12 > 0:17:14- I know I've given you a lot of information.- Yeah.
0:17:14 > 0:17:16What else do you want to ask me?
0:17:17 > 0:17:19HE MUMBLES
0:17:19 > 0:17:20Really, it's just...
0:17:20 > 0:17:23I don't know, mate. I'm just scared, really.
0:17:23 > 0:17:24I know, I can imagine.
0:17:31 > 0:17:35As dawn breaks, Daniel's taken to the Neuro Critical Care Unit
0:17:35 > 0:17:38to gain strength before they operate on his spine.
0:17:47 > 0:17:51His cousin Stuart's also here as he comes round from his hip procedure.
0:17:54 > 0:17:56I was meant to be moving house today.
0:17:58 > 0:18:01So it would have been nice to just settle into my new house,
0:18:01 > 0:18:03but I take it I'll be in here for another week.
0:18:06 > 0:18:09Just my cousin now, Daniel,
0:18:09 > 0:18:13I've heard there's a 90% chance that he might not walk again,
0:18:13 > 0:18:15so just have to deal with that when we get there.
0:18:30 > 0:18:36It's Wednesday morning at the base of air ambulance charity Magpas.
0:18:39 > 0:18:44Dr Nick Foster is starting his shift with the emergency medical team.
0:18:44 > 0:18:46"So, why did you want to do this job, Dr Foster?"
0:18:46 > 0:18:50Well, I felt that in my hospital role there just wasn't enough cleaning
0:18:50 > 0:18:54and I really miss that part of the work, so...
0:18:54 > 0:18:58Saving lives, one mop at a time.
0:18:58 > 0:19:04At 20,000 square kilometres, the East of England Major Trauma Network
0:19:04 > 0:19:07is the largest in the country.
0:19:07 > 0:19:12The best way to get Nick and his colleagues to patients in remote areas is by helicopter.
0:19:13 > 0:19:15We talk about the golden hour.
0:19:15 > 0:19:17In that first hour after the injury,
0:19:17 > 0:19:20that's when you can have the most difference.
0:19:20 > 0:19:23The vast majority of people who are involved in major trauma,
0:19:23 > 0:19:26that whole hour is spent before they get to hospital.
0:19:26 > 0:19:30You need to bring the hospital interventions to the patient.
0:19:30 > 0:19:32TELEPHONE RINGS
0:19:32 > 0:19:34Yep, and what's the job?
0:19:34 > 0:19:38Fall from a horse, right, yep.
0:19:38 > 0:19:41OK, great, we're on our way.
0:19:41 > 0:19:45Nick is joined by critical care paramedic Simon Standen.
0:19:45 > 0:19:47We're just plotting our route by air
0:19:47 > 0:19:49and we'll be making our way very shortly.
0:19:49 > 0:19:52The call is for a woman who's been thrown from her horse
0:19:52 > 0:19:54over 30 miles away.
0:19:55 > 0:19:58We've been asked to attend by a crew that's on the scene already
0:19:58 > 0:20:01and there's usually a specific thing they have in mind.
0:20:01 > 0:20:03So either they want us to put the patient to sleep
0:20:03 > 0:20:07or they want us to help get them out of a difficult situation.
0:20:12 > 0:20:16The helicopter will get Nick and Simon to the scene twice as fast as by road.
0:20:20 > 0:20:23It can also take a patient directly to Addenbrooke's,
0:20:23 > 0:20:25without having to go via a local hospital.
0:20:27 > 0:20:30'Control, Heli Medi 66 overhead scene.'
0:20:30 > 0:20:33It's 45 minutes since the accident.
0:20:38 > 0:20:41The ambulance crew have given the patient, Toni,
0:20:41 > 0:20:44gas and air pain relief while waiting.
0:20:44 > 0:20:47- She came off the horse and landed straight onto the concrete floor. - OK.
0:20:47 > 0:20:49Her pain score is nine out of ten now,
0:20:49 > 0:20:51even with the entinox, it's not bringing it off at all.
0:20:51 > 0:20:53- Hello, Toni.- Hello.
0:20:53 > 0:20:57She was just riding her pony through and something scared him,
0:20:57 > 0:20:59he took off. She held on for as long as she could
0:20:59 > 0:21:03and then just come off the side clean, straight onto her back.
0:21:03 > 0:21:05She landed where she is,
0:21:05 > 0:21:06she hasn't moved.
0:21:06 > 0:21:09Where's it hurt, poppet?
0:21:09 > 0:21:11My lower back and in the front...
0:21:11 > 0:21:12OK, sweetheart.
0:21:12 > 0:21:16- In the...what, in the front of your tummy or...?- Yeah.
0:21:16 > 0:21:19At the moment, she is complaining of pain in her tummy and in her pelvis.
0:21:19 > 0:21:21So the pelvis, it looks a bit like this
0:21:21 > 0:21:24and if you break your pelvis, you can open it up like a book
0:21:24 > 0:21:27and in doing that, you can disrupt the blood vessels.
0:21:27 > 0:21:29So you can bleed an awful lot into your pelvis.
0:21:29 > 0:21:31So we need to keep a very close eye on her.
0:21:31 > 0:21:35Are you cold, do you want another blanket on you?
0:21:35 > 0:21:40Heli Medi 66. Yeah, just a clinical update with this patient.
0:21:40 > 0:21:45We think she's triage tool positive under the pelvic fracture heading,
0:21:45 > 0:21:48so we will be transporting her to Addenbrooke's.
0:21:48 > 0:21:51OK, are they going to ring us when they land at the gogs?
0:21:51 > 0:21:53Thank you, bye.
0:21:53 > 0:21:56Got a 43-year-old suspected fractured pelvis.
0:21:56 > 0:21:59She's been on the floor for quite some time.
0:21:59 > 0:22:01Right, have we got all the bits and bobs ready then?
0:22:01 > 0:22:05Dr Kurrum Iftikhar will lead the trauma team.
0:22:05 > 0:22:07With this kind of injury, the main worry is bleeding,
0:22:07 > 0:22:10you could easily lose up to two to three litres
0:22:10 > 0:22:13due to an unstable pelvic fracture.
0:22:14 > 0:22:18But there's a problem with Nick and Simon's transport plan.
0:22:19 > 0:22:22- The aircraft is having to relocate, as it's sinking.- It's sinking!
0:22:22 > 0:22:25My only concern is that if they don't park somewhere close by,
0:22:25 > 0:22:29we're still going to be in a position where we have to move by road.
0:22:29 > 0:22:30BM is 5.9.
0:22:30 > 0:22:32Right, we're good to turn.
0:22:32 > 0:22:34We're going to lose the big thick blankets just for a minute, OK?
0:22:34 > 0:22:36SHE MOANS
0:22:36 > 0:22:40We're going to pop a pelvic splint and a stretcher, special stretcher
0:22:40 > 0:22:43to keep her straight and packaged and immobilised.
0:22:44 > 0:22:47All right, babe, they're nearly there, Ton.
0:22:47 > 0:22:51Nick and Simon fit the pelvic splint, a wide belt,
0:22:51 > 0:22:55to prevent Toni's pelvis damaging her major blood vessels.
0:22:55 > 0:22:56SHE MOANS
0:22:56 > 0:23:02Ready, brace, roll. There you go, Toni, well done, mate, well done.
0:23:02 > 0:23:06She's quite cold, so our priority is to get her off the ground
0:23:06 > 0:23:08and into the aircraft and start warming her up.
0:23:08 > 0:23:10Lovely.
0:23:10 > 0:23:12Waiting on firmer ground,
0:23:12 > 0:23:15the helicopter can speed Toni to Addenbrooke's.
0:23:15 > 0:23:17If she is bleeding from the pelvis,
0:23:17 > 0:23:21that can take half an hour, an hour to become apparent.
0:23:21 > 0:23:25And the whole way there, you are a little bit, "Stay well, stay well."
0:23:25 > 0:23:26Just an update with ETA.
0:23:26 > 0:23:28We are packaging in the aircraft now
0:23:28 > 0:23:30and we've got a ten-minute flight to the gogs.
0:23:30 > 0:23:33OK, lovely, trauma team is here waiting for you.
0:23:33 > 0:23:35Bye.
0:23:35 > 0:23:38Just get as prepared as you can before they get here.
0:23:40 > 0:23:43I'm in a lot of pain and I'm cold.
0:23:55 > 0:23:57Hi, Orthopaedics, hello, you OK?
0:23:57 > 0:24:01Kurrum has put out a call for spinal and bone specialists
0:24:01 > 0:24:03to come to the Emergency Department.
0:24:05 > 0:24:07- Shall we get her across? - Yes, yes, please, yeah.
0:24:07 > 0:24:09Ready, steady, move.
0:24:10 > 0:24:12Toni is 43 and was riding a horse,
0:24:12 > 0:24:16she's come down heavy onto the left hip/pelvis.
0:24:16 > 0:24:18So, Toni, I've just turned the bear hugger on,
0:24:18 > 0:24:21it's a little sheet underneath you, you'll feel it inflate, OK?
0:24:21 > 0:24:22It's going to help you keep warm.
0:24:22 > 0:24:26- Right, are the pupils equal and reactive?- Pupils equal and reactive.
0:24:26 > 0:24:30The plan will be to get her round to CT scan as soon as possible,
0:24:30 > 0:24:34to exclude any life-threatening injuries.
0:24:34 > 0:24:38Toni, we're just going to roll you side to side and check your back.
0:24:39 > 0:24:41But before they can send Toni for a scan,
0:24:41 > 0:24:45the team need to be sure there's no immediate danger.
0:24:45 > 0:24:46Ready, steady, roll.
0:24:46 > 0:24:48SHE MOANS
0:24:48 > 0:24:50Well done, Toni.
0:24:50 > 0:24:54Toni, any pain down the middle there at all?
0:24:54 > 0:24:55No.
0:24:55 > 0:24:58- Nothing?- Nothing?
0:24:58 > 0:24:59Ow, there, there, there, there.
0:24:59 > 0:25:01That's very sore down there? OK.
0:25:01 > 0:25:03Ready, steady, roll.
0:25:05 > 0:25:08Can you just wiggle your toes for me?
0:25:08 > 0:25:10That's lovely, thank you very much.
0:25:12 > 0:25:17Kurrum thinks Toni's back is stable enough to go to scan.
0:25:17 > 0:25:19OK, Toni, the contrast is going to start now,
0:25:19 > 0:25:22so you're going to get the hot flush feeling, just relax
0:25:22 > 0:25:24and the scan will start very shortly.
0:25:27 > 0:25:31Getting patients through CT, a rotating X-ray scanner,
0:25:31 > 0:25:35gives doctors a vital 3D internal map of the body.
0:25:36 > 0:25:38The advantage of CT is that you do scan top to toe
0:25:38 > 0:25:40identifying any significant injury.
0:25:40 > 0:25:44It's much more sensitive than clinical examination or plain X-rays alone.
0:25:44 > 0:25:46'Breathe normally.'
0:25:46 > 0:25:49From here, it appears that she doesn't have anything significant
0:25:49 > 0:25:51in her chest or abdomen.
0:25:51 > 0:25:53I can't see anything in the pelvis either at the moment.
0:25:53 > 0:25:57So I'm going to scroll through, the socket is there,
0:25:57 > 0:25:59that looks fine, there's the ball,
0:25:59 > 0:26:02I can't see any fractures there, so, on these images,
0:26:02 > 0:26:08I'm happy that there isn't a significant pelvic or proximal femur fracture.
0:26:09 > 0:26:12Now, from my point of view, I was very interested in your hips.
0:26:12 > 0:26:15I don't think you've broken anything, so that's all good news,
0:26:15 > 0:26:18but you've got a lot of bruising and swelling around your hip.
0:26:18 > 0:26:19- All right.- OK.
0:26:19 > 0:26:22She's very lucky and she hasn't got any significant injuries,
0:26:22 > 0:26:25just blood collection around the muscle and that doesn't need an imminent operation.
0:26:25 > 0:26:28She should expect recovery within two to six weeks.
0:26:37 > 0:26:40- Wave.- Yeah, I'm right here. - Love you, baby.- Me too.
0:26:40 > 0:26:44It's 18 hours since Daniel crashed into a tree,
0:26:44 > 0:26:46severely injuring his chest and back.
0:26:46 > 0:26:50He's been left with very little movement in his legs.
0:26:50 > 0:26:54Daniel, we need another scan. Have you got pain in your chest?
0:26:54 > 0:26:57- No.- Can you feel me doing that? - Yeah.
0:26:57 > 0:27:02Mr Rikin Trivedi is a neurosurgeon, specialising in spinal injuries.
0:27:02 > 0:27:05Can you wiggle your toes?
0:27:05 > 0:27:07- Now.- Yeah, there.
0:27:07 > 0:27:09He's keen to operate on Daniel's back
0:27:09 > 0:27:12as soon as the CT scan gives the all clear.
0:27:14 > 0:27:17You know, a spinal cord injury is very time-sensitive.
0:27:17 > 0:27:21As it is, you know, his chances of neurological recovery are small,
0:27:21 > 0:27:25but there is a chance that we could get some recovery that's meaningful
0:27:25 > 0:27:29and he's young, so we have to give him the best opportunity we can.
0:27:29 > 0:27:32So we've got, in my mind, a 24-hour window.
0:27:37 > 0:27:39He's got a large pneumothorax.
0:27:39 > 0:27:41It's normal lung there.
0:27:41 > 0:27:43Got all this air in his pleural space.
0:27:43 > 0:27:46The scan shows that air's leaking through holes
0:27:46 > 0:27:49made in Daniel's lungs by his broken ribs.
0:27:50 > 0:27:54Your lung is collapsing on the one side, there's a lot of air inside it.
0:27:54 > 0:27:57Anaesthetist Dr Eschtike Schulenburg
0:27:57 > 0:27:59can't put Daniel to sleep for his operation,
0:27:59 > 0:28:03as there's not enough oxygen getting into his blood.
0:28:03 > 0:28:05We need to get the air out of your chest first
0:28:05 > 0:28:07- before we can give you the anaesthetic.- Right.
0:28:07 > 0:28:11OK, so they are just quickly getting ready to put the drain in your chest.
0:28:11 > 0:28:13As each hour goes by,
0:28:13 > 0:28:20in my mind, his window of recovery is becoming less and less and less.
0:28:20 > 0:28:22Already small to start off with,
0:28:22 > 0:28:26but it's not zero and I want to try and get this done.
0:28:28 > 0:28:29HE MOANS
0:28:29 > 0:28:33You've got lots of broken ribs here, which makes it very difficult, OK?
0:28:33 > 0:28:34Using a local anaesthetic,
0:28:34 > 0:28:38doctors make a hole through the wall of Daniel's chest.
0:28:38 > 0:28:40I didn't say cut my circulation off.
0:28:40 > 0:28:42HE COUGHS
0:28:42 > 0:28:44- That's good, that's a bit of air coming out.- Thank you very much.
0:28:44 > 0:28:46You're quite a big lad, aren't you?
0:28:46 > 0:28:48- Do you play a lot of sport?- No.
0:28:48 > 0:28:49- You play rugby?- No.
0:28:49 > 0:28:51- Were you a bouncer before?- No.
0:28:51 > 0:28:52THEY CHUCKLE
0:28:52 > 0:28:54- Do you eat a lot?- Yeah.
0:28:54 > 0:28:56- I'm distracting him.- I can see that.
0:28:56 > 0:28:58HE MOANS
0:28:58 > 0:28:59OK, so we're nearly there.
0:28:59 > 0:29:03You still got feeling here, yeah, what do you feel?
0:29:03 > 0:29:04Your hand round my thigh.
0:29:04 > 0:29:06Is it gentle, is it hard?
0:29:06 > 0:29:08Mediocre.
0:29:08 > 0:29:11Scared, scared, scared...
0:29:14 > 0:29:17He keeps worrying he's not going to come round.
0:29:17 > 0:29:20They've told him they're going to keep him asleep
0:29:20 > 0:29:23for a couple of days, which I think is best.
0:29:23 > 0:29:26- I might not be able to walk again. - A little rest.
0:29:26 > 0:29:30We'll get you off to sleep now. Can I get you to say goodbye?
0:29:30 > 0:29:33And we'll give you a shout a bit later.
0:29:36 > 0:29:37Love you, baby.
0:29:59 > 0:30:00We can take this off...
0:30:00 > 0:30:02Rikin must now work quickly
0:30:02 > 0:30:05to give Daniel the best chance of walking again.
0:30:05 > 0:30:09We are talking about reconstituting that alignment,
0:30:09 > 0:30:10so it's in line with that
0:30:10 > 0:30:15and getting these fragments out of what we call the central canal,
0:30:15 > 0:30:18freeing the nerves which are squashed between here and here.
0:30:18 > 0:30:21If we do this quickly, it gives him a chance.
0:30:21 > 0:30:24Right, who's taking the legs?
0:30:24 > 0:30:29Daniel has to be turned over to give Rikin access to his back.
0:30:29 > 0:30:32- OK, brake on.- Keep it in line.
0:30:32 > 0:30:33Can we get rid of this?
0:30:33 > 0:30:37On three, OK? One, two, three.
0:30:37 > 0:30:40Right, can someone put their hands on his chest, on his tummy,
0:30:40 > 0:30:43as he turns, so he doesn't flop on to us?
0:30:43 > 0:30:45Right, can someone just keep hold of the chest drains
0:30:45 > 0:30:48which my fingers have got? Just keep hold of them.
0:30:48 > 0:30:50- He looks good at the axillas.- Yeah.
0:30:50 > 0:30:52But in this position,
0:30:52 > 0:30:56the pressure on Daniel's chest makes it harder to support his breathing.
0:30:56 > 0:30:58It's easier to ventilate someone who's standing up,
0:30:58 > 0:31:01harder if they're lying on their back,
0:31:01 > 0:31:04even more difficult if someone's lying on their front.
0:31:04 > 0:31:05And for this surgery,
0:31:05 > 0:31:08he'll be on his front for two and a half, three hours.
0:31:08 > 0:31:12Eschtike needs to be certain that Daniel's breathing is strong enough
0:31:12 > 0:31:15to keep him stable throughout the operation.
0:31:15 > 0:31:18The problem is, if it was a really short procedure, then it would be fine,
0:31:18 > 0:31:20but it's a very long anaesthetic.
0:31:20 > 0:31:23So we need things to...
0:31:23 > 0:31:25Come on, wash your hands, paint his back.
0:31:27 > 0:31:30We don't cut skin until we're absolutely happy, but get ready.
0:31:34 > 0:31:38His...his chest is very, very unstable,
0:31:38 > 0:31:41he's got a huge leak on his chest drain and I'm slightly concerned
0:31:41 > 0:31:45that his ventilation is going to be a problem in such a long case.
0:31:46 > 0:31:48Right, not too shabby, right.
0:31:48 > 0:31:51While Rikin makes his final preparations,
0:31:51 > 0:31:56Eschtike tries to get Daniel's lungs working as well as possible.
0:32:07 > 0:32:08Um...
0:32:14 > 0:32:17If it was a quick operation and we could bail out easily, I'd say, "We'll give it a go,"
0:32:17 > 0:32:20but it's not going to be, we're going to end up...
0:32:20 > 0:32:22It would be two hours. It would be two hours.
0:32:22 > 0:32:26- I don't think I could do...- Two hours?- It would be two hours.- Yeah.
0:32:28 > 0:32:31I mean, timing-wise though, he's got movement,
0:32:31 > 0:32:33he's got some movement in his legs, that's the only issue.
0:32:33 > 0:32:36If we can postpone until tomorrow or next week,
0:32:36 > 0:32:38it makes no difference to his neurology.
0:32:38 > 0:32:42The only reason to do it now is there is a very, very small chance,
0:32:42 > 0:32:44very small chance of some recovery.
0:32:44 > 0:32:47- He's got movement? - He's got some movement.
0:32:51 > 0:32:54Well, there's a lot for him to lose as well.
0:32:54 > 0:32:56Yeah, well, it's losing legs to losing life,
0:32:56 > 0:32:59because that's what we are, that's what we are...
0:33:01 > 0:33:04OK, no, this is...this is a bad idea.
0:33:12 > 0:33:15So we are going to postpone,
0:33:15 > 0:33:18because there are some serious issues.
0:33:18 > 0:33:21Surgeons traditionally are always going to be optimistic
0:33:21 > 0:33:24about how quickly things will get done,
0:33:24 > 0:33:27and these guys are there to provide some reality checks.
0:33:29 > 0:33:35So it's, you know, it's frustration, I think, for all of us.
0:33:35 > 0:33:36Slowly, one, two, three.
0:33:40 > 0:33:42I would have zero expectation,
0:33:42 > 0:33:45with an operation tomorrow or any day thereafter,
0:33:45 > 0:33:49zero expectation of having neurological recovery.
0:33:49 > 0:33:52He might be that one in a million that proves me wrong,
0:33:52 > 0:33:55he might just be and I wish he is.
0:33:59 > 0:34:03He'll be paralysed from his waist down for the rest of his life.
0:34:03 > 0:34:06In terms of being the man he was at his young age,
0:34:06 > 0:34:10I don't think there's a realistic possibility of that happening.
0:34:23 > 0:34:27Out of every ten patients treated for major trauma at Addenbrooke's,
0:34:27 > 0:34:30eight are injured on the region's roads.
0:34:35 > 0:34:37It's six o'clock on a Tuesday evening.
0:34:37 > 0:34:39TELEPHONE RINGS
0:34:39 > 0:34:42Do you want me to get it? It could be the child.
0:34:43 > 0:34:45The Emergency Department have had early warning
0:34:45 > 0:34:48of a patient coming from a network hospital
0:34:48 > 0:34:51who's been in a road traffic accident.
0:34:51 > 0:34:53That's the pre-alert, ten minutes.
0:34:53 > 0:34:57All stations, could Dr Major please make contact with Resus immediately?
0:34:57 > 0:34:59Thank you.
0:34:59 > 0:35:03We don't know much about the actual crash. It's a little ten-month-old girl,
0:35:03 > 0:35:06the story that we've heard is that the car had an accident
0:35:06 > 0:35:08at, we think, at about 30 miles an hour.
0:35:08 > 0:35:10She'd gone into Luton alert and conscious
0:35:10 > 0:35:13and then deteriorated at Luton and then been put to sleep at Luton.
0:35:13 > 0:35:15TELEPHONE RINGS
0:35:15 > 0:35:18We're the Paediatric Intensive Care Unit for the whole of the region here,
0:35:18 > 0:35:21so we do see lots of really sick children.
0:35:21 > 0:35:24- Have we seen the scans? - Yes, I've seen the scans.
0:35:24 > 0:35:26They've not been reported on yet by our guys here.
0:35:26 > 0:35:29- Have the neurosurgeons seen the scans?- I don't know.
0:35:29 > 0:35:33A consultant in paediatric intensive care, Roddy O'Donnell,
0:35:33 > 0:35:36has responded to the trauma call.
0:35:36 > 0:35:39The question is whether we repeat the scans.
0:35:39 > 0:35:41Most people coming across children from the ambulance team,
0:35:41 > 0:35:42through A&E,
0:35:42 > 0:35:45gulp hard when they see a child coming through the doors.
0:35:45 > 0:35:47It has a great deal more impact
0:35:47 > 0:35:50and there's a tendency perhaps for people to step back because it's frightening.
0:35:50 > 0:35:53Hey, guys, we're going to do a primary assessment on your trolley,
0:35:53 > 0:35:57if that's OK and the bed's ready...
0:35:57 > 0:36:01Ten-month-old Zunny arrives with a doctor from Luton Hospital,
0:36:01 > 0:36:05where her mother is still being treated for a broken wrist.
0:36:05 > 0:36:07So when she was brought into A&E, she was crying,
0:36:07 > 0:36:10but my colleague said she was making some posturing movements
0:36:10 > 0:36:12- and not moving one side.- OK.
0:36:12 > 0:36:14BEEPING
0:36:14 > 0:36:17She's going a bit tachycardiac, her heart rate is going up a little bit,
0:36:17 > 0:36:19so we're just trying to stabilise that at the moment.
0:36:19 > 0:36:21Zunny has been put to sleep
0:36:21 > 0:36:24because the way she was moving worried doctors.
0:36:25 > 0:36:29This little girl has had depressed level of consciousness at the scene
0:36:29 > 0:36:31and some odd movements, some posturing movements
0:36:31 > 0:36:34where they flex their arms up to their chest and other movements
0:36:34 > 0:36:38where they'll extend their arms which is another form of posturing.
0:36:38 > 0:36:44They look sinister and they imply dysfunction deep within the brain.
0:36:51 > 0:36:53Luton Hospital have done CT scans,
0:36:53 > 0:36:57but it's not clear what is causing Zunny's abnormal movements.
0:36:57 > 0:37:00It's the brain we're really worried about, also the neck.
0:37:00 > 0:37:03The scans that have been done aren't thin enough slices
0:37:03 > 0:37:06for us to make good conclusions about neck injury.
0:37:10 > 0:37:12The plan is from the neurosurgeons,
0:37:12 > 0:37:14so we need to take her and do another scan.
0:37:14 > 0:37:17Can we go top to toe because of the liver and the drop in haemoglobin?
0:37:17 > 0:37:19- Is that all right? - Yeah, that's fine.
0:37:19 > 0:37:21Yes, just do it, just repeat it.
0:37:21 > 0:37:24The team hope another scan will identify the problem.
0:37:24 > 0:37:26Ready, steady, go.
0:37:30 > 0:37:33Everybody happy? We're going to go back on my go again.
0:37:33 > 0:37:34Ready, steady, go.
0:37:49 > 0:37:52Do you want to have a quick look at that before we go on to the rest?
0:37:52 > 0:37:56The funny thing is we don't see any sort of bruising.
0:37:56 > 0:38:01Even with the more sensitive scans, Roddy can't find any major damage.
0:38:01 > 0:38:03We've got no blood...
0:38:05 > 0:38:10But spinal injuries are often hard to spot in very young children.
0:38:10 > 0:38:12You are much more likely
0:38:12 > 0:38:14to have significant injury with no fractures.
0:38:14 > 0:38:16Compared with an adult,
0:38:16 > 0:38:20everything is a big head on a very, very thin little neck
0:38:20 > 0:38:24and a lot of flexion and extension associated with the deceleration
0:38:24 > 0:38:28can damage children's spinal cords
0:38:28 > 0:38:30without causing any fractures at all.
0:38:30 > 0:38:31Until we see her moving normally,
0:38:31 > 0:38:34we have to assume that there may be a problem with her neck.
0:38:39 > 0:38:42There's only one way left to try and identify the issue.
0:38:42 > 0:38:44We're planning to wake her up.
0:38:44 > 0:38:47So all these medications are off from her body.
0:38:47 > 0:38:51We'll see how her arms and legs are moving, how she's waking up.
0:38:58 > 0:39:00Zunny's mum has been treated at Luton,
0:39:00 > 0:39:04and Mum and Dad are now by her side.
0:39:04 > 0:39:07She loves the Hoover, she loves switching the button on and off
0:39:07 > 0:39:11and then, when it's on, she gets really scared and then she backs off.
0:39:12 > 0:39:15I just kept on praying to Allah, like, you know when she was born,
0:39:15 > 0:39:19like, how she was complete, with her hands, her feet, her eyes...
0:39:19 > 0:39:23I want her exactly back like that, I don't want anything less.
0:39:23 > 0:39:26I want her exactly the way he gave her to me.
0:39:26 > 0:39:28BABY CRIES ON VIDEO
0:39:33 > 0:39:35Mum was driving back from Zunny's grandmother
0:39:35 > 0:39:37when she had the collision.
0:39:38 > 0:39:40Maybe I'm just being tested, innit?
0:39:40 > 0:39:42I don't know what for.
0:39:55 > 0:39:58We'll be keeping a close eye on how her arms and legs are moving
0:39:58 > 0:40:00because of the injury in the spine.
0:40:02 > 0:40:05And we expect the movement to be symmetrical, that means both sides.
0:40:05 > 0:40:08If one side of the body is moving and not the other,
0:40:08 > 0:40:09then that's a concern.
0:40:13 > 0:40:14She's ticklish there, so...
0:40:16 > 0:40:19She's moving, oh, she's moving.
0:40:21 > 0:40:23She's moving, but she's not moving.
0:40:30 > 0:40:32Are you all right, sweetheart?
0:40:33 > 0:40:35Are you going to open those eyes for me?
0:40:35 > 0:40:39SHE SPEAKS IN HER OWN LANGUAGE
0:40:54 > 0:40:56Any movement is a good sign,
0:40:56 > 0:41:01but there's still very little on one side of Zunny's body.
0:41:01 > 0:41:03She is not moving her right arm,
0:41:03 > 0:41:04but I think it's too early,
0:41:04 > 0:41:07so we'll make this assessment again.
0:41:07 > 0:41:12So next 48 hours will give some sort of idea which way we are going.
0:41:12 > 0:41:16It's not unusual for them not to bounce back that quickly, you know.
0:41:16 > 0:41:19The drugs are wearing off, but there are still some in there.
0:41:19 > 0:41:20She needs to open her eyes, though.
0:41:20 > 0:41:22She does need to open her eyes, but she is trying,
0:41:22 > 0:41:25you can see her trying to lift those lids, can't you?
0:41:25 > 0:41:27But we're getting steady progress
0:41:27 > 0:41:30and that's what we've got to concentrate on, OK?
0:41:30 > 0:41:34But I can't tell you everything is going to be fine, I wish I could.
0:41:36 > 0:41:39The doctors decide to put Zunny back to sleep
0:41:39 > 0:41:42to prevent further damage to her neck.
0:41:42 > 0:41:45They'll wake her regularly to check for progress.
0:41:57 > 0:41:59Morning, how's things?
0:42:01 > 0:42:04Hey, sweetheart, happy birthday.
0:42:07 > 0:42:09I got you cake, Charlie made it,
0:42:09 > 0:42:12but you can't have it so it's for the nurses.
0:42:12 > 0:42:19Today, six days after his accident, is Daniel's 32nd birthday.
0:42:19 > 0:42:22He's still under sedation on the Critical Care Unit.
0:42:22 > 0:42:25"Dear Dan, happy birthday. Love, Ady."
0:42:25 > 0:42:28Better than yesterday's get-well card.
0:42:32 > 0:42:34Critical care doctor Andrea Livinio
0:42:34 > 0:42:37has been working on fixing his lungs.
0:42:37 > 0:42:39Chest is much better.
0:42:39 > 0:42:42I think it's actually stable enough for surgery now.
0:42:42 > 0:42:45Even if Daniel's chances of walking again have faded,
0:42:45 > 0:42:48it's important that his spine is stabilised.
0:42:48 > 0:42:50He needs this surgery.
0:42:50 > 0:42:52He's on a life-support machine at the moment
0:42:52 > 0:42:56and the only way we can wean him off the ventilator,
0:42:56 > 0:42:58is that for us to be able to sit him up,
0:42:58 > 0:43:01which we can't do because he has a highly unstable lumbar fracture.
0:43:01 > 0:43:05So surgery is still a life-saving surgery
0:43:05 > 0:43:07and that's why it's crucial for us
0:43:07 > 0:43:10to be able to perform.
0:43:10 > 0:43:14I can't get excited though, because you get one bit of good news
0:43:14 > 0:43:17and then something horrible happens.
0:43:18 > 0:43:20So, anyway, fingers crossed.
0:43:27 > 0:43:30We are talking about putting some screws in, two like that,
0:43:30 > 0:43:33two like that and they'll be connected by a rod.
0:43:36 > 0:43:40Daniel's placed on his front on the operating table,
0:43:40 > 0:43:43while the anaesthetist closely monitors his oxygen levels.
0:43:45 > 0:43:49If the anaesthetists have doubts and concerns,
0:43:49 > 0:43:50then, that's a major issue.
0:43:50 > 0:43:53It's a question of having something straightforward...
0:43:53 > 0:43:58This time, Rikin's colleague, John Crawford, is the surgeon on duty.
0:43:58 > 0:44:01If it swings the balance, I can fix one level above, one below,
0:44:01 > 0:44:04and take just over an hour surgical time.
0:44:05 > 0:44:08John and his team prepare Daniel's back.
0:44:08 > 0:44:11Right, this is where we got to last week.
0:44:15 > 0:44:17The drains are working.
0:44:17 > 0:44:20The ventilation now is much better, I think we can proceed.
0:44:20 > 0:44:22- Thanks, great.- Best of luck.
0:44:28 > 0:44:30We're just exposing the spine,
0:44:30 > 0:44:33so we're not really cutting through the muscle,
0:44:33 > 0:44:36we're teasing it off the bone and going underneath the muscle,
0:44:36 > 0:44:40but minimising the amount of blood loss while we do that.
0:44:40 > 0:44:43John removes any fragments of shattered bone,
0:44:43 > 0:44:45keeping them to use later.
0:44:47 > 0:44:51'Second part of the operation is then putting the screws
0:44:51 > 0:44:54'into the individual bones in the vertebrae.'
0:44:54 > 0:44:57With a screw in each piece of the spine
0:44:57 > 0:44:59above and below the dislocated vertebrae,
0:44:59 > 0:45:02John can loosely join them with connecting rods.
0:45:02 > 0:45:05So the screws are deliberately made really long,
0:45:05 > 0:45:07so that you then manipulate the spine.
0:45:07 > 0:45:09He hopes to work the dislocated section
0:45:09 > 0:45:11back into the right position.
0:45:12 > 0:45:15OK. Flash again, OK.
0:45:20 > 0:45:22Just go north again with your X-ray,
0:45:22 > 0:45:24flash please.
0:45:24 > 0:45:26Yeah, save that.
0:45:26 > 0:45:28The spine has come back into line,
0:45:28 > 0:45:31and John can now tighten the rods to hold it firm.
0:45:33 > 0:45:35The fixation of the whole thing's in place,
0:45:35 > 0:45:37but only for a finite amount of time.
0:45:37 > 0:45:39The screws would loosen or the rods might break,
0:45:39 > 0:45:41so you need the bone to take over.
0:45:41 > 0:45:43Now, we're just going to put the bone graft in,
0:45:43 > 0:45:45we sort of crunch it up and put it back in,
0:45:45 > 0:45:47so it lies on top of the spine.
0:45:47 > 0:45:50It basically makes the spine think that there's a fracture,
0:45:50 > 0:45:53so the body produces even more bone to glue all that together.
0:45:56 > 0:45:59It's good. I mean, it's gone as well as it could have gone.
0:45:59 > 0:46:00And we've got a correction.
0:46:00 > 0:46:02I think if we weren't able to do that,
0:46:02 > 0:46:07then we may not be having any sort of degree of optimism,
0:46:07 > 0:46:09but it gives him a good chance.
0:46:13 > 0:46:17Although his chances of walking again are still slim,
0:46:17 > 0:46:21Daniel can now be sat up to help strengthen his breathing.
0:46:36 > 0:46:38On the Paediatric Intensive Care Unit,
0:46:38 > 0:46:41ten-month-old Zunny is still sedated.
0:46:41 > 0:46:44Oh, and a poo.
0:46:44 > 0:46:46That might be it, we might be all right there.
0:46:47 > 0:46:49Ahh, that's a relief.
0:46:50 > 0:46:54The first attempt to wake her up two days ago confirmed Roddy's fears
0:46:54 > 0:46:57that she suffered damage to her neck.
0:46:57 > 0:47:01The nerve fibres that have been cut,
0:47:01 > 0:47:03they're not fixable.
0:47:03 > 0:47:04But in this situation,
0:47:04 > 0:47:07it may well be that there's a lot of swelling and bruising
0:47:07 > 0:47:12and that what we've got is sort of dysfunction of those nerves
0:47:12 > 0:47:14related to swelling and bruising.
0:47:14 > 0:47:16Only time will tell us that.
0:47:19 > 0:47:22Roddy now thinks it's time to wake her up again.
0:47:22 > 0:47:28OK, here comes the tube. Well done.
0:47:28 > 0:47:31OK, now...
0:47:31 > 0:47:34Saturations are 100%, which is really good.
0:47:34 > 0:47:36OK.
0:47:36 > 0:47:38All right, there you go.
0:47:47 > 0:47:48Zunny?
0:48:02 > 0:48:05She opened her eyes, yeah, she opened her eyes.
0:48:07 > 0:48:09The crucial question
0:48:09 > 0:48:13is whether Zunny will now have movement on both sides of her body.
0:48:16 > 0:48:21She's doing quite good, it's good, isn't it?
0:48:21 > 0:48:24SHE SPEAKS IN HER OWN LANGUAGE
0:48:26 > 0:48:28This arm was moving quite a lot
0:48:28 > 0:48:30and she's got more power in this leg now as well, yeah,
0:48:30 > 0:48:32so it's looking good, yeah.
0:48:35 > 0:48:36You know what?
0:48:36 > 0:48:39I know she's going to be fine, I can feel it in my heart.
0:48:50 > 0:48:54We asses conscious level frequently by response to voice,
0:48:54 > 0:48:57response to pain or spontaneous eye opening.
0:48:57 > 0:48:58We want to see that.
0:48:58 > 0:49:00She's opened her eyes for her mum,
0:49:00 > 0:49:04that implies a bit of recognition which is a good thing.
0:49:04 > 0:49:09The goal would be to move her out of intensive care
0:49:09 > 0:49:13into a ward environment where she can continue her recovery.
0:49:13 > 0:49:20It's very early and I think the best outcomes are gained
0:49:20 > 0:49:24where you assume that there can be complete recovery.
0:49:24 > 0:49:28Children make amazing recoveries and that's what we need to go for.
0:49:35 > 0:49:40Daniel's been kept sedated on the Neuro Critical Care Unit
0:49:40 > 0:49:43for nearly three weeks since his back operation
0:49:43 > 0:49:47and Dr Andrea Livinio believes his lungs are getting stronger.
0:49:51 > 0:49:54His cousin Stuart has recovered from his surgery,
0:49:54 > 0:49:56and is well enough to go home.
0:49:59 > 0:50:02Andrea's preparing to wake Daniel up.
0:50:04 > 0:50:08We haven't had the chance to have the conversation about his injuries.
0:50:09 > 0:50:11That's going to be the next difficult bit, I guess,
0:50:11 > 0:50:18when we have to break the news that he's been asleep for 20 days
0:50:18 > 0:50:21and that he's suffered a severe injury to his spine.
0:50:23 > 0:50:25Seeing his cousin walking
0:50:25 > 0:50:29and hearing about things his cousin is doing,
0:50:29 > 0:50:32when they were both involved in that same crash,
0:50:32 > 0:50:34it's going to take a lot of resolve
0:50:34 > 0:50:38to overcome that psychological strain.
0:50:49 > 0:50:52As these drugs are being washed out of his system,
0:50:52 > 0:50:55his brain activity is slowly coming back to life.
0:50:55 > 0:50:59In terms of brain impulses, these drugs are messing with your mind,
0:50:59 > 0:51:01they are, they're putting you to sleep.
0:51:01 > 0:51:02Are you in pain here?
0:51:05 > 0:51:09They have a dark side to them, causing hallucinations and so forth,
0:51:09 > 0:51:13so it may take some time before he's fully re-orientated
0:51:13 > 0:51:15to where he is and what's happened.
0:51:16 > 0:51:18Louise and Daniel's mum, Brenda,
0:51:18 > 0:51:21have been told that he's coming round.
0:51:21 > 0:51:23My heart goes, my chest clenches,
0:51:23 > 0:51:26every time I walk through these doors.
0:51:26 > 0:51:30- Hey, darling, OK? Mum's here, look. - Hello!
0:51:32 > 0:51:35You all right? You want to go home?
0:51:35 > 0:51:38We want you to come home too, darling,
0:51:38 > 0:51:40but you've got to get better first.
0:51:40 > 0:51:43Well, you've got a lot of things wrong, sweetheart,
0:51:43 > 0:51:44and they're mending you.
0:51:44 > 0:51:47What, darling, where's this leg?
0:51:47 > 0:51:49It's here.
0:51:52 > 0:51:56- All right?- They haven't chopped your legs off or nothing.
0:51:56 > 0:52:00- You need to keep still then. - You had an operation on your back.
0:52:00 > 0:52:02You can't remember.
0:52:02 > 0:52:06You had an accident, darling, a car accident.
0:52:13 > 0:52:16About walking, what about it?
0:52:17 > 0:52:19We don't know, darling.
0:52:20 > 0:52:22At the minute, you've got a bad back.
0:52:29 > 0:52:31Coming off sedation may be a shock,
0:52:31 > 0:52:34but Daniel's chest and back are healing well.
0:52:40 > 0:52:45Now his life is safe, the work of the Major Trauma Centre is complete.
0:52:49 > 0:52:53He can be transferred back to his local hospital, in Colchester,
0:52:53 > 0:52:56until he's strong enough for his rehab to begin.
0:53:14 > 0:53:19Zunny has been observed on the non-critical paediatric ward for 10 days,
0:53:19 > 0:53:21ever since she was woken up.
0:53:21 > 0:53:24In order to make a proper assessment of her brain,
0:53:24 > 0:53:27it's much easier to make an assessment at this age
0:53:27 > 0:53:29than it would be if she was a tiny little baby.
0:53:29 > 0:53:33There's a lot of communication going on already, even if it's not verbal.
0:53:33 > 0:53:36Normal interaction and play, you know,
0:53:36 > 0:53:39normal play will tell us a lot about her brain function.
0:53:42 > 0:53:48- She's probably going to go back home and start beating her sister up. - Yeah.- She loves pulling her ear.
0:53:48 > 0:53:50One of the doctors was just asking me,
0:53:50 > 0:53:54"How do you find her speech and the way she's responding?"
0:53:54 > 0:53:57I was like, she's doing everything normally the way she would be doing
0:53:57 > 0:53:59and you know when we used to do that peekaboo game,
0:53:59 > 0:54:03like, she was, like, "Yeah!", and then she was doing that sort of sound
0:54:03 > 0:54:06and the way how we used to tickle her, she used to giggle,
0:54:06 > 0:54:09so everything seems like, yeah.
0:54:10 > 0:54:14The improvement in Zunny's responses has been encouraging
0:54:14 > 0:54:18and Mum and Dad can now take her home to finish her recovery.
0:54:18 > 0:54:21- And hopefully, she's only going to have this collar on for... - Three months.
0:54:21 > 0:54:23Three months or it even could be quicker than that,
0:54:23 > 0:54:27depending on her recovery, so it's all looking good.
0:54:32 > 0:54:35- You happy?- Oh, yeah.- Okey-doke.
0:54:35 > 0:54:38The moment that she was at the scene of the accident,
0:54:38 > 0:54:41the potential for stopping breathing and dying
0:54:41 > 0:54:45or being left with very profound injury was very real.
0:54:45 > 0:54:50What that means is that each person in the chain, from the roadside,
0:54:50 > 0:54:52through Accident And Emergency, through the transfer here,
0:54:52 > 0:54:54all the way in and out of the scanner,
0:54:54 > 0:54:58each one, and it would only take one to do a foolish thing,
0:54:58 > 0:55:01has contributed and done the right thing.
0:55:10 > 0:55:12Daniel's in his third month
0:55:12 > 0:55:15at the National Spinal Injuries Centre, at Stoke Mandeville.
0:55:18 > 0:55:21Big shock, big shock.
0:55:23 > 0:55:26Never saw myself being like this, but you don't, do you?
0:55:26 > 0:55:27But then, it happens to you
0:55:27 > 0:55:31and you've got a completely different outlook on life, really.
0:55:32 > 0:55:36He has rehab sessions with his physio, Kara Hoskins, every day.
0:55:36 > 0:55:40- OK, so what we're going to do today, Dan, is get you into the parallel bars.- Yeah.
0:55:40 > 0:55:43Get you up and get you doing a couple of lengths of the bars.
0:55:43 > 0:55:44That's it.
0:55:46 > 0:55:48Feel quite happy?
0:55:48 > 0:55:50There you go, he's upright!
0:55:50 > 0:55:51Look how tall he is!
0:55:53 > 0:55:56Don't forget to get those hips forward, that's it.
0:55:56 > 0:56:01Hips forward, good, that's where your balance is going to need to be.
0:56:01 > 0:56:02Lovely!
0:56:07 > 0:56:08Do you want to try a frame?
0:56:08 > 0:56:11- No!- You sure?- Yeah.
0:56:11 > 0:56:13I wouldn't say it if I didn't think you could do it.
0:56:13 > 0:56:15- Yeah, I know, I know.- Yeah.
0:56:16 > 0:56:19- Come on, you can do it. - Come on, then, sod it.
0:56:21 > 0:56:23OK.
0:56:23 > 0:56:27'I can sniff it, it's within reaching distance.'
0:56:27 > 0:56:31And it's just whether I can actually get to grab it or not.
0:56:38 > 0:56:42I'm absolutely chuffed to hear that he's less than six months out
0:56:42 > 0:56:44and he can stand and mobilise with a frame,
0:56:44 > 0:56:48from having some minor movements in one foot.
0:56:48 > 0:56:50From a medical point of view,
0:56:50 > 0:56:53it's amazing that he's got this far, this soon.
0:56:53 > 0:56:58Being told I can't do something, I'm more determined to do it.
0:56:58 > 0:57:00I'll prove you wrong.
0:57:00 > 0:57:02I'm speechless.
0:57:02 > 0:57:07I didn't think for a minute we'd be in this situation ever.
0:57:07 > 0:57:09You've done brilliantly,
0:57:09 > 0:57:12you've exceeded expectations today by coming up with the frame, OK?
0:57:12 > 0:57:14All right, yep.
0:57:14 > 0:57:15Can I have a quick kiss?
0:57:15 > 0:57:17THEY CHUCKLE
0:57:17 > 0:57:23I went to the hospital Christmas Day and, on his little side bit,
0:57:23 > 0:57:26there was a little bag and a card and the card said,
0:57:26 > 0:57:28"Will you marry me?"
0:57:28 > 0:57:32And he had his trachie in, so he couldn't ask me himself,
0:57:32 > 0:57:33so it was in the card.
0:57:33 > 0:57:37And yeah, I said, "Of course I will, I'd love to."
0:57:37 > 0:57:40I was thinking about it and I thought, "Why should I put her through this?"
0:57:40 > 0:57:42Why would she want to be stuck with a cripple
0:57:42 > 0:57:45when she could go out and meet someone else?
0:57:45 > 0:57:47A lot of mixed emotions.
0:57:47 > 0:57:49In probably about three weeks, four weeks,
0:57:49 > 0:57:52I want you doing laps of the gym by yourself.
0:57:53 > 0:57:56You laugh, but that's what I'm expecting now.
0:57:56 > 0:58:00You never know, I might be able to walk down the aisle when we get married.
0:58:00 > 0:58:02That'll be my main goal.
0:58:02 > 0:58:05I think he's got everything to look forward to.
0:58:05 > 0:58:08You know, walking her back down the aisle on the way out of the church,
0:58:08 > 0:58:12it'll be the biggest day of their life and there's every reason to expect that can happen.
0:58:14 > 0:58:17Daniel has enough movement to be allowed home for the weekend,
0:58:17 > 0:58:20but he'll be back to continue his rehab.
0:58:21 > 0:58:23They saved my life,
0:58:23 > 0:58:26without them, I'd be dead.
0:58:26 > 0:58:28So, yes. You can't fault them, really,
0:58:28 > 0:58:31from Colchester to Addenbrooke's to Stoke.
0:58:31 > 0:58:33- 'They've done me well.'- Well done.
0:58:33 > 0:58:37Yeah, quite chuffed, quite chuffed.
0:59:07 > 0:59:10Subtitles by Red Bee Media Ltd