Episode 2 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.

TELEPHONE RINGS

Addenbrooke's Major Trauma Centre.

We think she's triage tool positive under the pelvic fracture.

OK, has she had pain relief?

Now, across the country,

new regional networks are being geared up

for the most critical injuries.

-She's going straight down.

-Lovely.

-Kate is your team leader.

OK, quiet!

Medics with advanced lifesaving skills rush to the scene.

Can we take over the leadership?

Patients are stabilised in a local hospital

or flown direct by air ambulance...

The clock is ticking.

..to reach specialists trained to treat every life-threatening injury.

BEEPING

Pupils are not reactive.

The whole aim of the network is to get the most injured to us

as quickly as possible.

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.

And 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.

It's ten to eleven on a Saturday evening.

Critical care paramedic Neil Flowers and Dr Adam Chesters

are on shift in the East Anglia Air Ambulance rapid response vehicle.

Medic 88.

'Bit of a drive for you, to the north of Bedford.

'Trapped RTC, paramedic on scene, requesting medic attendance.'

Yeah, understood, we're mobile now.

SIREN WAILING

A car has hit a tree 30 miles east of Cambridge.

We've been requested by a crew on scene at a road traffic collision

where the patient is trapped and presumably quite unwell,

which is why they want the medical team there.

Adam and Neil have advanced life-saving training.

They also decide whether patients need to go to the Major Trauma Centre in Cambridge.

We have literally just jumped map books, bastards.

It's in the centre of what looks like quite a little village.

North to Peterborough here, so the one o'clock exit.

That kind of address is not suggestive

of a high-speed piece of road, is it?

We're trying to work out, just get a sort of idea,

a feel as to what we're going to.

So low-speed versus high-speed collisions - very different injury.

It's over an hour since the collision.

That's Medic 88 on scene.

There are two fire crews and an ambulance on scene.

Let's go and have a chat with the guy in the white hat first.

But they need Adam and Neil's medical skills

to safely remove the driver from the wreckage.

There's not a lot left of that vehicle.

The chap here, David, from what we can tell,

he was bombing down this hill, goodness knows what sort of speed.

You can see the sort of impact it's had.

-What's worrying me is what's going on abdominally downwards.

-Fair enough.

-David, are you happy there at the moment?

-I'm happy...

David's conscious, and he's trapped in the car by his legs.

It is actually a really high-speed collision.

He's completely smashed in the front end of the car.

So at the moment, I'm worried he's had

what we'll call a deceleration injury,

where the car's gone from going very fast

to being stationary very quickly.

What I'm worried about here is when we release him,

if he's got any bleeding down there.

The whole steering column and the dashboard is pinning him

by his thighs downwards.

So at the moment, the pressure of the car

is almost acting as direct pressure on a bleeding point

and as soon as we take that pressure off,

we could literally have blood everywhere.

Can we get a set of O-cutters at the steering wheel, please?

Guys, what we're going to do is put these around his thighs,

we're going to have them ready to tighten up when you make the cut,

so if anything does bleed, we can just tighten them.

With the tourniquet straps in position,

the pressure of the car can be eased off David's legs.

That's perfect, well done.

Guys, can we take over the leadership just to get this out?

So one voice.

Listen, doc's voice and doc's voice only, guys.

So, guys, what I want is the long board down the back

and then, I want hands on to get him straight vertically up the board

and it's going to be on, "Ready, set, move", OK?

Adam wants the team to keep David as straight as possible

to make sure there's no further damage to his spine.

Ready, set, move.

If Adam thinks David's injuries are life-threatening,

his priority will be to get him to the Major Trauma Centre,

at Addenbrooke's.

Yeah, looking good.

He's come out, his legs look intact.

Belly is fairly firm,

his chest seems intact.

Let's get him into the back of the truck.

He's a bit pale, because he's freezing cold.

He's got a decent radial pulse.

I'm thinking local, I think we go to the local, they scan him,

and he feeds into the network.

-So at the moment he's major trauma negative, yeah?

-He is, yeah.

-So we go to the local and we go from there, yeah?

-Yes.

Adam hasn't found any critical injury.

It's nearly two hours since the incident occurred.

And all of his physiological variables,

his heart rate, his blood pressure are all normal.

So at the moment, I don't think there's an immediate threat to life.

If I thought there was a chance he was very badly injured,

we'd be diverting to the Major Trauma Centre now.

David's had a lucky escape.

Adam and Neil can take him to the local hospital nearby.

It's one in the morning on a Friday at Addenbrooke's -

the Major Trauma Centre at the heart of the network.

Equal and reactive?

Let's get loaded and get to CT.

Consultant Ali Tomkins has been on shift for seven hours.

So far, she's been dealing with routine illness and injuries.

TELEPHONE RINGS

Hello, ED Sister.

An urgent call comes in about another collision.

Two gentlemen from the same car. 60 miles an hour.

I do believe it was car versus tree.

So this is the driver and this is the rear-seat passenger.

Multiple injuries on both patients.

Neck injuries, pelvic injuries long-bone injuries...

Yep, trauma boards on, blocks are ready.

The network has been set up

so that patients are taken to their nearest hospital

if they're too far away from the Major Trauma Centre,

they receive stabilisation with care in the Emergency Department.

The crash happened 70 miles south of Cambridge

and the patients have first been taken to their nearest hospital, in Colchester.

Ortho know about both of them,

neurosurgeons know about both of them...

Medical notes sent ahead from Colchester suggest there's damage to the driver's spine.

In a high-impact injury,

there are massive forces transmitted to the spine,

which at points is vulnerable to injury.

So if it's over-bent or overstretched, the bones can break

and the spinal cord can be at risk of serious damage.

Adult trauma A&E resus. Adult trauma A&E resus.

So what we have is a gentleman transferred from Colchester General Hospital, who is Daniel Andrews.

He's a 31-year-old who was the trapped driver of a car,

65-miles-per-hour, spun, hit a tree.

Daniel, the driver, is first to arrive.

It's probably one of the worst ones I've seen.

The intrusion was so much that the driver was in the back seat.

Normally, they would just take the roof off.

Here, they had to literally cut small pieces of car away

for us to be able to access him and give him treatment.

-Do you know where we are at the moment?

-Hospital.

-OK, fine.

Addenbrooke's.

Can we get this blood up and under pressure, please?

Heart rate is coming down.

The trauma team rapidly assess Daniel.

Airway is clear, he is talking to me.

He is on a collar, he's not complaining about pain in his neck.

-Try not to move your head and neck, please.

-Sorry.

He has vertical movement of his chest.

The team discover his most urgent life-threatening injury,

damage to his chest and lungs, was brought under control at Colchester.

Chest drain on the right side of his chest.

Daniel, I'm Ali, I'm one of the other doctors.

Can you wiggle these toes for me?

Move my toes?

Yeah, move your toes.

All right.

They are not, at the moment.

-Yeah.

-Yeah.

-Try this one.

-Your right one.

-The left one is moving.

Ali's main concern now is the damage to Daniel's spine.

Do we need to do a bit of morphine loading?

His girlfriend, Louise, arrived with him.

He managed to call her after the crash

and she rushed straight to the scene.

'It was awful, just a mangled-up mess with him stuck in it.

'He kept going like, his eyes were shutting

'and while they are doing their stuff, I'm going,

'"Daniel wake up, wake up!"

'I just kept thinking - "Keep him awake."'

It's just, you know, he's only been at his job four months

and he's really enjoying it...

..and now, this.

Neurosurgery specialist on duty, Dr Roy Chowdhury,

has come to assess CT scans taken at Colchester.

Can you feel your buttocks? Can you clench your buttocks?

Can you feel your genitals?

Do you want to touch them, shall I just, let me just get the...?

I don't mind, you can grab my nuts, if you want.

But I do need to check, so I'm just going to touch them...

I think they shoved a finger up my bum earlier.

-Could you feel that?

-No.

-You couldn't feel that?

-No.

And if I just touch on your genitals there.

I can't feel nothing.

The extent of the injury is very significant here.

The spine basically shattered and, in the process,

it's damaged the lower part of the spinal cord

and the nerves going into his legs.

And you can kind of just appreciate

these blocks here of the spine,

and then, suddenly, you notice this one

which should be sitting under here,

is all the way back here,

and the nerves behind them are getting almost certainly injured.

That's always a good sign.

There's going to be some bruising and swelling around that bony injury,

we'll get all of the specialist opinions

and we'll get back to you as soon as we've got some more information.

It's too early to be thinking about things like that.

OK?

Daniel's cousin Stuart is brought in from Colchester an hour after him.

Daniel was taking Stuart to B&Q when they crashed.

Families travel in cars together,

you know, if one's injured then,

it would be nice if none of the others were, but actually...

-He's just arrived.

-He's here? OK.

HE MOANS

OK, so can we get a hand over?

His main complaint for pain has been his left hip,

his left ankle, more than anything else.

Ready, steady, go.

HE MOANS

-Keep your hand still, keep your hand still.

-Sorry, sorry.

-OK. Well done.

He's got some significant pelvic traumas,

as we can see from the position of his leg.

Chris Lawrence, the orthopaedic specialist on duty,

has been called to assess Stuart's bone injuries.

We know that he's got a dislocation of the hip,

which we need to do something about, I need to see the images first.

When was...?

I've just crashed it.

This is the socket for the hip and this is the ball.

This ball's supposed to be present in the socket.

So the difficulty is he's got this dislocation of his hip,

which we need to get back in joint

to improve the blood supply to the ball as soon as we feasibly can.

Chris wants to put Stuart's hip back into place

in the Emergency Department.

But it's a painful procedure

and Ali's concerned she can't give the pain relief he'll need.

I need to try and put his leg into a better position.

I realise that.

Can I try it under entinox if I can't have anything else?

Do you actually think...? I think that would be torturing this gentleman.

Given the urgency,

Chris is prepared to try gas and air, a mild pain relief.

His leg is in a position that is unacceptable,

we need to put it into a position that's acceptable.

I've never seen a posterior hip dislocation go back in,

no matter what it's associated with,

without sedation, I have to be honest, in my years in ED.

No, that's cos you always give it, you never do it without, isn't it?

Urm...yes, but...that's because it's mean.

There needs to be somebody maintaining an overall view

for what is best for the patient

and I think that, as a trauma team leader,

that is something that is within our responsibilities.

HE MOANS

Ali arranges for Stuart to go to the 24-hour trauma theatre.

It takes a few precious minutes,

but he'll be given a general anaesthetic

in the safest environment.

-Stuart, are you allergic to anything?

-No.

So what we are going to do with Stuart now

is we are going to try and pull his hip joint back into joint.

This is the socket,

there's the head of the femur.

That needs to be back in there.

It's very tricky, the cup is fractured, the hip is dislocated

and that side of the pelvis is unstable

because that's fractured as well.

So we are going to have to do this quite carefully.

Can you show me a picture there?

And again.

BONE CRACKS

Oh, that sounded good.

Picture, please.

OK.

It went back in with quite a clunk, so we know that's gone back in.

It's certainly just the start,

this is an emergency procedure that we needed to perform

to get his hip back into joint,

but at least we've bought some time now.

Are you OK?

Yep.

-Do you want to sit down?

-No, I'm better standing.

In the Emergency Department,

Roy Chowdhury wants to get the driver, Daniel,

to surgery as soon as possible

to release the pressure on his spinal cord.

So the main aim of the surgery is twofold.

One is to fix the spine,

because, obviously, you're in excruciating pain.

The other main reason for doing it

is to try and take the pressure off your nerves,

to give them the best chance of recovery.

Now, I'll be very honest with you - this is a serious injury.

There is a significant risk

of you having long-term problems with the nerves.

I cannot say now, there's no-one who can predict that...

In what way? That I can't walk?

That's a possibility.

But I cannot say that for certain

until we've done the surgery

and we've given you time to heal.

You've got to do just one step at a time.

Is it more likely I would be able to walk in time or not?

It's very difficult to call it right now.

So we need to fix it first,

we need to fix it first and then see recovery, OK?

-I know I've given you a lot of information.

-Yeah.

What else do you want to ask me?

HE MUMBLES

Really, it's just...

I don't know, mate. I'm just scared, really.

I know, I can imagine.

As dawn breaks, Daniel's taken to the Neuro Critical Care Unit

to gain strength before they operate on his spine.

His cousin Stuart's also here as he comes round from his hip procedure.

I was meant to be moving house today.

So it would have been nice to just settle into my new house,

but I take it I'll be in here for another week.

Just my cousin now, Daniel,

I've heard there's a 90% chance that he might not walk again,

so just have to deal with that when we get there.

It's Wednesday morning at the base of air ambulance charity Magpas.

Dr Nick Foster is starting his shift with the emergency medical team.

"So, why did you want to do this job, Dr Foster?"

Well, I felt that in my hospital role there just wasn't enough cleaning

and I really miss that part of the work, so...

Saving lives, one mop at a time.

At 20,000 square kilometres, the East of England Major Trauma Network

is the largest in the country.

The best way to get Nick and his colleagues to patients in remote areas is by helicopter.

We talk about the golden hour.

In that first hour after the injury,

that's when you can have the most difference.

The vast majority of people who are involved in major trauma,

that whole hour is spent before they get to hospital.

You need to bring the hospital interventions to the patient.

TELEPHONE RINGS

Yep, and what's the job?

Fall from a horse, right, yep.

OK, great, we're on our way.

Nick is joined by critical care paramedic Simon Standen.

We're just plotting our route by air

and we'll be making our way very shortly.

The call is for a woman who's been thrown from her horse

over 30 miles away.

We've been asked to attend by a crew that's on the scene already

and there's usually a specific thing they have in mind.

So either they want us to put the patient to sleep

or they want us to help get them out of a difficult situation.

The helicopter will get Nick and Simon to the scene twice as fast as by road.

It can also take a patient directly to Addenbrooke's,

without having to go via a local hospital.

'Control, Heli Medi 66 overhead scene.'

It's 45 minutes since the accident.

The ambulance crew have given the patient, Toni,

gas and air pain relief while waiting.

-She came off the horse and landed straight onto the concrete floor.

-OK.

Her pain score is nine out of ten now,

even with the entinox, it's not bringing it off at all.

-Hello, Toni.

-Hello.

She was just riding her pony through and something scared him,

he took off. She held on for as long as she could

and then just come off the side clean, straight onto her back.

She landed where she is,

she hasn't moved.

Where's it hurt, poppet?

My lower back and in the front...

OK, sweetheart.

-In the...what, in the front of your tummy or...?

-Yeah.

At the moment, she is complaining of pain in her tummy and in her pelvis.

So the pelvis, it looks a bit like this

and if you break your pelvis, you can open it up like a book

and in doing that, you can disrupt the blood vessels.

So you can bleed an awful lot into your pelvis.

So we need to keep a very close eye on her.

Are you cold, do you want another blanket on you?

Heli Medi 66. Yeah, just a clinical update with this patient.

We think she's triage tool positive under the pelvic fracture heading,

so we will be transporting her to Addenbrooke's.

OK, are they going to ring us when they land at the gogs?

Thank you, bye.

Got a 43-year-old suspected fractured pelvis.

She's been on the floor for quite some time.

Right, have we got all the bits and bobs ready then?

Dr Kurrum Iftikhar will lead the trauma team.

With this kind of injury, the main worry is bleeding,

you could easily lose up to two to three litres

due to an unstable pelvic fracture.

But there's a problem with Nick and Simon's transport plan.

-The aircraft is having to relocate, as it's sinking.

-It's sinking!

My only concern is that if they don't park somewhere close by,

we're still going to be in a position where we have to move by road.

BM is 5.9.

Right, we're good to turn.

We're going to lose the big thick blankets just for a minute, OK?

SHE MOANS

We're going to pop a pelvic splint and a stretcher, special stretcher

to keep her straight and packaged and immobilised.

All right, babe, they're nearly there, Ton.

Nick and Simon fit the pelvic splint, a wide belt,

to prevent Toni's pelvis damaging her major blood vessels.

SHE MOANS

Ready, brace, roll. There you go, Toni, well done, mate, well done.

She's quite cold, so our priority is to get her off the ground

and into the aircraft and start warming her up.

Lovely.

Waiting on firmer ground,

the helicopter can speed Toni to Addenbrooke's.

If she is bleeding from the pelvis,

that can take half an hour, an hour to become apparent.

And the whole way there, you are a little bit, "Stay well, stay well."

Just an update with ETA.

We are packaging in the aircraft now

and we've got a ten-minute flight to the gogs.

OK, lovely, trauma team is here waiting for you.

Bye.

Just get as prepared as you can before they get here.

I'm in a lot of pain and I'm cold.

Hi, Orthopaedics, hello, you OK?

Kurrum has put out a call for spinal and bone specialists

to come to the Emergency Department.

-Shall we get her across?

-Yes, yes, please, yeah.

Ready, steady, move.

Toni is 43 and was riding a horse,

she's come down heavy onto the left hip/pelvis.

So, Toni, I've just turned the bear hugger on,

it's a little sheet underneath you, you'll feel it inflate, OK?

It's going to help you keep warm.

-Right, are the pupils equal and reactive?

-Pupils equal and reactive.

The plan will be to get her round to CT scan as soon as possible,

to exclude any life-threatening injuries.

Toni, we're just going to roll you side to side and check your back.

But before they can send Toni for a scan,

the team need to be sure there's no immediate danger.

Ready, steady, roll.

SHE MOANS

Well done, Toni.

Toni, any pain down the middle there at all?

No.

-Nothing?

-Nothing?

Ow, there, there, there, there.

That's very sore down there? OK.

Ready, steady, roll.

Can you just wiggle your toes for me?

That's lovely, thank you very much.

Kurrum thinks Toni's back is stable enough to go to scan.

OK, Toni, the contrast is going to start now,

so you're going to get the hot flush feeling, just relax

and the scan will start very shortly.

Getting patients through CT, a rotating X-ray scanner,

gives doctors a vital 3D internal map of the body.

The advantage of CT is that you do scan top to toe

identifying any significant injury.

It's much more sensitive than clinical examination or plain X-rays alone.

'Breathe normally.'

From here, it appears that she doesn't have anything significant

in her chest or abdomen.

I can't see anything in the pelvis either at the moment.

So I'm going to scroll through, the socket is there,

that looks fine, there's the ball,

I can't see any fractures there, so, on these images,

I'm happy that there isn't a significant pelvic or proximal femur fracture.

Now, from my point of view, I was very interested in your hips.

I don't think you've broken anything, so that's all good news,

but you've got a lot of bruising and swelling around your hip.

-All right.

-OK.

She's very lucky and she hasn't got any significant injuries,

just blood collection around the muscle and that doesn't need an imminent operation.

She should expect recovery within two to six weeks.

-Wave.

-Yeah, I'm right here.

-Love you, baby.

-Me too.

It's 18 hours since Daniel crashed into a tree,

severely injuring his chest and back.

He's been left with very little movement in his legs.

Daniel, we need another scan. Have you got pain in your chest?

-No.

-Can you feel me doing that?

-Yeah.

Mr Rikin Trivedi is a neurosurgeon, specialising in spinal injuries.

Can you wiggle your toes?

-Now.

-Yeah, there.

He's keen to operate on Daniel's back

as soon as the CT scan gives the all clear.

You know, a spinal cord injury is very time-sensitive.

As it is, you know, his chances of neurological recovery are small,

but there is a chance that we could get some recovery that's meaningful

and he's young, so we have to give him the best opportunity we can.

So we've got, in my mind, a 24-hour window.

He's got a large pneumothorax.

It's normal lung there.

Got all this air in his pleural space.

The scan shows that air's leaking through holes

made in Daniel's lungs by his broken ribs.

Your lung is collapsing on the one side, there's a lot of air inside it.

Anaesthetist Dr Eschtike Schulenburg

can't put Daniel to sleep for his operation,

as there's not enough oxygen getting into his blood.

We need to get the air out of your chest first

-before we can give you the anaesthetic.

-Right.

OK, so they are just quickly getting ready to put the drain in your chest.

As each hour goes by,

in my mind, his window of recovery is becoming less and less and less.

Already small to start off with,

but it's not zero and I want to try and get this done.

HE MOANS

You've got lots of broken ribs here, which makes it very difficult, OK?

Using a local anaesthetic,

doctors make a hole through the wall of Daniel's chest.

I didn't say cut my circulation off.

HE COUGHS

-That's good, that's a bit of air coming out.

-Thank you very much.

You're quite a big lad, aren't you?

-Do you play a lot of sport?

-No.

-You play rugby?

-No.

-Were you a bouncer before?

-No.

THEY CHUCKLE

-Do you eat a lot?

-Yeah.

-I'm distracting him.

-I can see that.

HE MOANS

OK, so we're nearly there.

You still got feeling here, yeah, what do you feel?

Your hand round my thigh.

Is it gentle, is it hard?

Mediocre.

Scared, scared, scared...

He keeps worrying he's not going to come round.

They've told him they're going to keep him asleep

for a couple of days, which I think is best.

-I might not be able to walk again.

-A little rest.

We'll get you off to sleep now. Can I get you to say goodbye?

And we'll give you a shout a bit later.

Love you, baby.

We can take this off...

Rikin must now work quickly

to give Daniel the best chance of walking again.

We are talking about reconstituting that alignment,

so it's in line with that

and getting these fragments out of what we call the central canal,

freeing the nerves which are squashed between here and here.

If we do this quickly, it gives him a chance.

Right, who's taking the legs?

Daniel has to be turned over to give Rikin access to his back.

-OK, brake on.

-Keep it in line.

Can we get rid of this?

On three, OK? One, two, three.

Right, can someone put their hands on his chest, on his tummy,

as he turns, so he doesn't flop on to us?

Right, can someone just keep hold of the chest drains

which my fingers have got? Just keep hold of them.

-He looks good at the axillas.

-Yeah.

But in this position,

the pressure on Daniel's chest makes it harder to support his breathing.

It's easier to ventilate someone who's standing up,

harder if they're lying on their back,

even more difficult if someone's lying on their front.

And for this surgery,

he'll be on his front for two and a half, three hours.

Eschtike needs to be certain that Daniel's breathing is strong enough

to keep him stable throughout the operation.

The problem is, if it was a really short procedure, then it would be fine,

but it's a very long anaesthetic.

So we need things to...

Come on, wash your hands, paint his back.

We don't cut skin until we're absolutely happy, but get ready.

His...his chest is very, very unstable,

he's got a huge leak on his chest drain and I'm slightly concerned

that his ventilation is going to be a problem in such a long case.

Right, not too shabby, right.

While Rikin makes his final preparations,

Eschtike tries to get Daniel's lungs working as well as possible.

Um...

If it was a quick operation and we could bail out easily, I'd say, "We'll give it a go,"

but it's not going to be, we're going to end up...

It would be two hours. It would be two hours.

-I don't think I could do...

-Two hours?

-It would be two hours.

-Yeah.

I mean, timing-wise though, he's got movement,

he's got some movement in his legs, that's the only issue.

If we can postpone until tomorrow or next week,

it makes no difference to his neurology.

The only reason to do it now is there is a very, very small chance,

very small chance of some recovery.

-He's got movement?

-He's got some movement.

Well, there's a lot for him to lose as well.

Yeah, well, it's losing legs to losing life,

because that's what we are, that's what we are...

OK, no, this is...this is a bad idea.

So we are going to postpone,

because there are some serious issues.

Surgeons traditionally are always going to be optimistic

about how quickly things will get done,

and these guys are there to provide some reality checks.

So it's, you know, it's frustration, I think, for all of us.

Slowly, one, two, three.

I would have zero expectation,

with an operation tomorrow or any day thereafter,

zero expectation of having neurological recovery.

He might be that one in a million that proves me wrong,

he might just be and I wish he is.

He'll be paralysed from his waist down for the rest of his life.

In terms of being the man he was at his young age,

I don't think there's a realistic possibility of that happening.

Out of every ten patients treated for major trauma at Addenbrooke's,

eight are injured on the region's roads.

It's six o'clock on a Tuesday evening.

TELEPHONE RINGS

Do you want me to get it? It could be the child.

The Emergency Department have had early warning

of a patient coming from a network hospital

who's been in a road traffic accident.

That's the pre-alert, ten minutes.

All stations, could Dr Major please make contact with Resus immediately?

Thank you.

We don't know much about the actual crash. It's a little ten-month-old girl,

the story that we've heard is that the car had an accident

at, we think, at about 30 miles an hour.

She'd gone into Luton alert and conscious

and then deteriorated at Luton and then been put to sleep at Luton.

TELEPHONE RINGS

We're the Paediatric Intensive Care Unit for the whole of the region here,

so we do see lots of really sick children.

-Have we seen the scans?

-Yes, I've seen the scans.

They've not been reported on yet by our guys here.

-Have the neurosurgeons seen the scans?

-I don't know.

A consultant in paediatric intensive care, Roddy O'Donnell,

has responded to the trauma call.

The question is whether we repeat the scans.

Most people coming across children from the ambulance team,

through A&E,

gulp hard when they see a child coming through the doors.

It has a great deal more impact

and there's a tendency perhaps for people to step back because it's frightening.

Hey, guys, we're going to do a primary assessment on your trolley,

if that's OK and the bed's ready...

Ten-month-old Zunny arrives with a doctor from Luton Hospital,

where her mother is still being treated for a broken wrist.

So when she was brought into A&E, she was crying,

but my colleague said she was making some posturing movements

-and not moving one side.

-OK.

BEEPING

She's going a bit tachycardiac, her heart rate is going up a little bit,

so we're just trying to stabilise that at the moment.

Zunny has been put to sleep

because the way she was moving worried doctors.

This little girl has had depressed level of consciousness at the scene

and some odd movements, some posturing movements

where they flex their arms up to their chest and other movements

where they'll extend their arms which is another form of posturing.

They look sinister and they imply dysfunction deep within the brain.

Luton Hospital have done CT scans,

but it's not clear what is causing Zunny's abnormal movements.

It's the brain we're really worried about, also the neck.

The scans that have been done aren't thin enough slices

for us to make good conclusions about neck injury.

The plan is from the neurosurgeons,

so we need to take her and do another scan.

Can we go top to toe because of the liver and the drop in haemoglobin?

-Is that all right?

-Yeah, that's fine.

Yes, just do it, just repeat it.

The team hope another scan will identify the problem.

Ready, steady, go.

Everybody happy? We're going to go back on my go again.

Ready, steady, go.

Do you want to have a quick look at that before we go on to the rest?

The funny thing is we don't see any sort of bruising.

Even with the more sensitive scans, Roddy can't find any major damage.

We've got no blood...

But spinal injuries are often hard to spot in very young children.

You are much more likely

to have significant injury with no fractures.

Compared with an adult,

everything is a big head on a very, very thin little neck

and a lot of flexion and extension associated with the deceleration

can damage children's spinal cords

without causing any fractures at all.

Until we see her moving normally,

we have to assume that there may be a problem with her neck.

There's only one way left to try and identify the issue.

We're planning to wake her up.

So all these medications are off from her body.

We'll see how her arms and legs are moving, how she's waking up.

Zunny's mum has been treated at Luton,

and Mum and Dad are now by her side.

She loves the Hoover, she loves switching the button on and off

and then, when it's on, she gets really scared and then she backs off.

I just kept on praying to Allah, like, you know when she was born,

like, how she was complete, with her hands, her feet, her eyes...

I want her exactly back like that, I don't want anything less.

I want her exactly the way he gave her to me.

BABY CRIES ON VIDEO

Mum was driving back from Zunny's grandmother

when she had the collision.

Maybe I'm just being tested, innit?

I don't know what for.

We'll be keeping a close eye on how her arms and legs are moving

because of the injury in the spine.

And we expect the movement to be symmetrical, that means both sides.

If one side of the body is moving and not the other,

then that's a concern.

She's ticklish there, so...

She's moving, oh, she's moving.

She's moving, but she's not moving.

Are you all right, sweetheart?

Are you going to open those eyes for me?

SHE SPEAKS IN HER OWN LANGUAGE

Any movement is a good sign,

but there's still very little on one side of Zunny's body.

She is not moving her right arm,

but I think it's too early,

so we'll make this assessment again.

So next 48 hours will give some sort of idea which way we are going.

It's not unusual for them not to bounce back that quickly, you know.

The drugs are wearing off, but there are still some in there.

She needs to open her eyes, though.

She does need to open her eyes, but she is trying,

you can see her trying to lift those lids, can't you?

But we're getting steady progress

and that's what we've got to concentrate on, OK?

But I can't tell you everything is going to be fine, I wish I could.

The doctors decide to put Zunny back to sleep

to prevent further damage to her neck.

They'll wake her regularly to check for progress.

Morning, how's things?

Hey, sweetheart, happy birthday.

I got you cake, Charlie made it,

but you can't have it so it's for the nurses.

Today, six days after his accident, is Daniel's 32nd birthday.

He's still under sedation on the Critical Care Unit.

"Dear Dan, happy birthday. Love, Ady."

Better than yesterday's get-well card.

Critical care doctor Andrea Livinio

has been working on fixing his lungs.

Chest is much better.

I think it's actually stable enough for surgery now.

Even if Daniel's chances of walking again have faded,

it's important that his spine is stabilised.

He needs this surgery.

He's on a life-support machine at the moment

and the only way we can wean him off the ventilator,

is that for us to be able to sit him up,

which we can't do because he has a highly unstable lumbar fracture.

So surgery is still a life-saving surgery

and that's why it's crucial for us

to be able to perform.

I can't get excited though, because you get one bit of good news

and then something horrible happens.

So, anyway, fingers crossed.

We are talking about putting some screws in, two like that,

two like that and they'll be connected by a rod.

Daniel's placed on his front on the operating table,

while the anaesthetist closely monitors his oxygen levels.

If the anaesthetists have doubts and concerns,

then, that's a major issue.

It's a question of having something straightforward...

This time, Rikin's colleague, John Crawford, is the surgeon on duty.

If it swings the balance, I can fix one level above, one below,

and take just over an hour surgical time.

John and his team prepare Daniel's back.

Right, this is where we got to last week.

The drains are working.

The ventilation now is much better, I think we can proceed.

-Thanks, great.

-Best of luck.

We're just exposing the spine,

so we're not really cutting through the muscle,

we're teasing it off the bone and going underneath the muscle,

but minimising the amount of blood loss while we do that.

John removes any fragments of shattered bone,

keeping them to use later.

'Second part of the operation is then putting the screws

'into the individual bones in the vertebrae.'

With a screw in each piece of the spine

above and below the dislocated vertebrae,

John can loosely join them with connecting rods.

So the screws are deliberately made really long,

so that you then manipulate the spine.

He hopes to work the dislocated section

back into the right position.

OK. Flash again, OK.

Just go north again with your X-ray,

flash please.

Yeah, save that.

The spine has come back into line,

and John can now tighten the rods to hold it firm.

The fixation of the whole thing's in place,

but only for a finite amount of time.

The screws would loosen or the rods might break,

so you need the bone to take over.

Now, we're just going to put the bone graft in,

we sort of crunch it up and put it back in,

so it lies on top of the spine.

It basically makes the spine think that there's a fracture,

so the body produces even more bone to glue all that together.

It's good. I mean, it's gone as well as it could have gone.

And we've got a correction.

I think if we weren't able to do that,

then we may not be having any sort of degree of optimism,

but it gives him a good chance.

Although his chances of walking again are still slim,

Daniel can now be sat up to help strengthen his breathing.

On the Paediatric Intensive Care Unit,

ten-month-old Zunny is still sedated.

Oh, and a poo.

That might be it, we might be all right there.

Ahh, that's a relief.

The first attempt to wake her up two days ago confirmed Roddy's fears

that she suffered damage to her neck.

The nerve fibres that have been cut,

they're not fixable.

But in this situation,

it may well be that there's a lot of swelling and bruising

and that what we've got is sort of dysfunction of those nerves

related to swelling and bruising.

Only time will tell us that.

Roddy now thinks it's time to wake her up again.

OK, here comes the tube. Well done.

OK, now...

Saturations are 100%, which is really good.

OK.

All right, there you go.

Zunny?

She opened her eyes, yeah, she opened her eyes.

The crucial question

is whether Zunny will now have movement on both sides of her body.

She's doing quite good, it's good, isn't it?

SHE SPEAKS IN HER OWN LANGUAGE

This arm was moving quite a lot

and she's got more power in this leg now as well, yeah,

so it's looking good, yeah.

You know what?

I know she's going to be fine, I can feel it in my heart.

We asses conscious level frequently by response to voice,

response to pain or spontaneous eye opening.

We want to see that.

She's opened her eyes for her mum,

that implies a bit of recognition which is a good thing.

The goal would be to move her out of intensive care

into a ward environment where she can continue her recovery.

It's very early and I think the best outcomes are gained

where you assume that there can be complete recovery.

Children make amazing recoveries and that's what we need to go for.

Daniel's been kept sedated on the Neuro Critical Care Unit

for nearly three weeks since his back operation

and Dr Andrea Livinio believes his lungs are getting stronger.

His cousin Stuart has recovered from his surgery,

and is well enough to go home.

Andrea's preparing to wake Daniel up.

We haven't had the chance to have the conversation about his injuries.

That's going to be the next difficult bit, I guess,

when we have to break the news that he's been asleep for 20 days

and that he's suffered a severe injury to his spine.

Seeing his cousin walking

and hearing about things his cousin is doing,

when they were both involved in that same crash,

it's going to take a lot of resolve

to overcome that psychological strain.

As these drugs are being washed out of his system,

his brain activity is slowly coming back to life.

In terms of brain impulses, these drugs are messing with your mind,

they are, they're putting you to sleep.

Are you in pain here?

They have a dark side to them, causing hallucinations and so forth,

so it may take some time before he's fully re-orientated

to where he is and what's happened.

Louise and Daniel's mum, Brenda,

have been told that he's coming round.

My heart goes, my chest clenches,

every time I walk through these doors.

-Hey, darling, OK? Mum's here, look.

-Hello!

You all right? You want to go home?

We want you to come home too, darling,

but you've got to get better first.

Well, you've got a lot of things wrong, sweetheart,

and they're mending you.

What, darling, where's this leg?

It's here.

-All right?

-They haven't chopped your legs off or nothing.

-You need to keep still then.

-You had an operation on your back.

You can't remember.

You had an accident, darling, a car accident.

About walking, what about it?

We don't know, darling.

At the minute, you've got a bad back.

Coming off sedation may be a shock,

but Daniel's chest and back are healing well.

Now his life is safe, the work of the Major Trauma Centre is complete.

He can be transferred back to his local hospital, in Colchester,

until he's strong enough for his rehab to begin.

Zunny has been observed on the non-critical paediatric ward for 10 days,

ever since she was woken up.

In order to make a proper assessment of her brain,

it's much easier to make an assessment at this age

than it would be if she was a tiny little baby.

There's a lot of communication going on already, even if it's not verbal.

Normal interaction and play, you know,

normal play will tell us a lot about her brain function.

-She's probably going to go back home and start beating her sister up.

-Yeah.

-She loves pulling her ear.

One of the doctors was just asking me,

"How do you find her speech and the way she's responding?"

I was like, she's doing everything normally the way she would be doing

and you know when we used to do that peekaboo game,

like, she was, like, "Yeah!", and then she was doing that sort of sound

and the way how we used to tickle her, she used to giggle,

so everything seems like, yeah.

The improvement in Zunny's responses has been encouraging

and Mum and Dad can now take her home to finish her recovery.

-And hopefully, she's only going to have this collar on for...

-Three months.

Three months or it even could be quicker than that,

depending on her recovery, so it's all looking good.

-You happy?

-Oh, yeah.

-Okey-doke.

The moment that she was at the scene of the accident,

the potential for stopping breathing and dying

or being left with very profound injury was very real.

What that means is that each person in the chain, from the roadside,

through Accident And Emergency, through the transfer here,

all the way in and out of the scanner,

each one, and it would only take one to do a foolish thing,

has contributed and done the right thing.

Daniel's in his third month

at the National Spinal Injuries Centre, at Stoke Mandeville.

Big shock, big shock.

Never saw myself being like this, but you don't, do you?

But then, it happens to you

and you've got a completely different outlook on life, really.

He has rehab sessions with his physio, Kara Hoskins, every day.

-OK, so what we're going to do today, Dan, is get you into the parallel bars.

-Yeah.

Get you up and get you doing a couple of lengths of the bars.

That's it.

Feel quite happy?

There you go, he's upright!

Look how tall he is!

Don't forget to get those hips forward, that's it.

Hips forward, good, that's where your balance is going to need to be.

Lovely!

Do you want to try a frame?

-No!

-You sure?

-Yeah.

I wouldn't say it if I didn't think you could do it.

-Yeah, I know, I know.

-Yeah.

-Come on, you can do it.

-Come on, then, sod it.

OK.

'I can sniff it, it's within reaching distance.'

And it's just whether I can actually get to grab it or not.

I'm absolutely chuffed to hear that he's less than six months out

and he can stand and mobilise with a frame,

from having some minor movements in one foot.

From a medical point of view,

it's amazing that he's got this far, this soon.

Being told I can't do something, I'm more determined to do it.

I'll prove you wrong.

I'm speechless.

I didn't think for a minute we'd be in this situation ever.

You've done brilliantly,

you've exceeded expectations today by coming up with the frame, OK?

All right, yep.

Can I have a quick kiss?

THEY CHUCKLE

I went to the hospital Christmas Day and, on his little side bit,

there was a little bag and a card and the card said,

"Will you marry me?"

And he had his trachie in, so he couldn't ask me himself,

so it was in the card.

And yeah, I said, "Of course I will, I'd love to."

I was thinking about it and I thought, "Why should I put her through this?"

Why would she want to be stuck with a cripple

when she could go out and meet someone else?

A lot of mixed emotions.

In probably about three weeks, four weeks,

I want you doing laps of the gym by yourself.

You laugh, but that's what I'm expecting now.

You never know, I might be able to walk down the aisle when we get married.

That'll be my main goal.

I think he's got everything to look forward to.

You know, walking her back down the aisle on the way out of the church,

it'll be the biggest day of their life and there's every reason to expect that can happen.

Daniel has enough movement to be allowed home for the weekend,

but he'll be back to continue his rehab.

They saved my life,

without them, I'd be dead.

So, yes. You can't fault them, really,

from Colchester to Addenbrooke's to Stoke.

-'They've done me well.'

-Well done.

Yeah, quite chuffed, quite chuffed.

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