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999 On the Front Line S13E02
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00:01Ambulance service is patient breathing.
00:04His tongue's swollen. He won't be able to breathe soon.
00:09He's lying on his floor. I think he's had a stroke.
00:13He's stopped breathing.
00:16Well, you know what I say, we'll see you when we get there.
00:20We're on board with the paramedics of West Midlands Ambulance Service.
00:25It can make a massive difference to someone's life.
00:27I think there's just something not right with your heart. No response to pain.
00:31I'm sorry, I was really scared.
00:33Saving lives and making a difference every day.
00:36Well, I'm asking if you've got a dressing on it because I want to help you.
00:40In a medical emergency, six million people rely on them.
00:45We've never been busier. Give her a little bit of oxygen. I'd rather be safe. Sorry.
00:49You're seven, you're 11. And you rang the ambulance on your own.
00:53Any pain where I'm pressing?
00:54Filming simultaneously with seven paramedic crews.
00:57I haven't been to that before.
00:59He couldn't breathe. Lips went blue.
01:01Capturing life on the front line.
01:05If we don't get to a patient on time, then ultimately they could die.
01:08It's 6.30 in the evening. And while most people have finished work for the day, the paramedics of West Midlands Ambulance Service are clocking on for a 12-hour night shift.
01:26Did you have a good sleep rate? I did actually, yeah. I was very tired when I got in this morning.
01:33I think it's going to be quite busy tonight and it's cold out there as well.
01:36It's very cold. If anyone's outside.
01:38I think we'll be wrapped up tonight, Amy.
01:42Got my hat to put my jacket on tonight, Sam.
01:43I know. I put mine on and I think I'm going to have to put on my high vis as well.
01:48Really? Is that cold?
01:49Yeah, I'm freezing.
01:50It's cold.
01:59As the paramedics head out, their thoughts are occupied by what tickles their taste buds.
02:05So if you was in the shop with the pick-a-mix, what would you go if it would be sweet, salty, sour?
02:13Sweet, all day. And I hate sour stuff.
02:16No, I'm sorry, but you were just walking around the other week with like a kilo bag of blue sour sweets.
02:21That's different. It wasn't like that sour, it was mainly sugar.
02:26I like sweet stuff, but not all the time.
02:29I do like a pasty, a pork pie, a scotch egg, all them very lovely things.
02:39If I go for a curry, I'll always go for like a pathia, which is quite a sour curry.
02:44So definitely sour for me. What are you going to go for?
02:48Salty. Love a bit of salt.
02:51Ready salted crisps are lovely.
02:53Salty popcorn.
02:55I do not have a sweet tooth at all.
02:57What are you going to get for dinner, do you reckon?
03:11I'll have to see what there is, I think.
03:13I don't want to get my hopes up like you did in there and it was there.
03:16Oh no, it was well good to make tuna pasta bake.
03:19So?
03:20That would really throw a spandering in the works.
03:21If we go and there's tuna pasta bake there now, then I won't know what to do myself.
03:27Isn't it annoying when you go to the shop and there isn't what you want there to eat?
03:31Yeah.
03:32You build your hopes up, your tuna pasta bake and if it's not there, then you're going back for a break and you're popping in the shop.
03:38You look forward to it all day and that's probably what's going to get you through the night shift.
03:43And then as well, you go into the hub and someone else has got a tuna pasta bake.
03:46BELL RINGS
03:50Ambulance service, is the patient breathing?
03:52Yes.
03:53Is the patient conscious?
03:54No.
03:55And is their breathing noisy or abnormal?
03:57Abnormal.
03:59I think it's having a...
04:01That's fine.
04:02No worries, just calm down.
04:03I'm going to go through some questions to get them some help.
04:05So just to confirm, are they unconscious, spitting or choking right now?
04:09He's stopped breathing.
04:10BELL RINGS
04:13BELL RINGS
04:14BELL RINGS
04:15BELL RINGS
04:16BELL RINGS
04:17BELL RINGS
04:18BELL RINGS
04:19BELL RINGS
04:20Yeah, I'll receive.
04:22A known patient over the age of 16 and it is a peri-arrest.
04:27And that's the only details about them in it.
04:30The period just before a cardiac arrest is called peri-arrest.
04:35This is when the condition of the patient is very unstable.
04:38When you get a peri-arrest through, you know how serious it's going to be.
04:42It's potentially life-threatening.
04:44This person could potentially be in cardiac arrest.
04:47Your adrenaline starts going, definitely.
04:49Because the reality is you may have to try and save this person's life.
04:53You have reached your destination.
04:57You can go, ma'am. This way.
04:59Who are we here to see?
05:01Ken.
05:02Ken, is it your relative?
05:03Er, yeah.
05:04Yeah? Cool.
05:05Hello, hello.
05:06Hello.
05:07Hi, guys.
05:09What's happened today, guys?
05:10All of a sudden.
05:11Yeah.
05:12He just came over very hot.
05:13OK.
05:14Er, very, very hot and then he just passed out.
05:17How long was he out for, do you reckon?
05:18It was only a few minutes, yeah.
05:20Yeah.
05:21Yeah.
05:22OK.
05:23He came to get us and then when we came...
05:24And he sort of started to come in, yeah.
05:26OK.
05:27When 73-year-old Ken lost consciousness, his granddaughter Hannah rang 999.
05:34Wife Margaret is with him.
05:36OK.
05:37What's his medical history?
05:38There isn't one, really.
05:40Has he got any heart problems, any strokes, diabetes?
05:43Is he on any blood thinners?
05:45No.
05:46Er, are you still on blood thinners, Ken?
05:48No.
05:49No.
05:50Has he been unwell today?
05:52No, he hasn't.
05:53He's been fine.
05:54He's been absolutely fine.
05:55Do you feel hot and sweaty, darling?
05:58Oh, I did.
05:59He has been, yeah.
06:00OK.
06:01That's not supposed to work.
06:03I'll pop this on your chest and your tummy if that's all right, Ken.
06:06All right.
06:07Yeah.
06:08How are you feeling yourself, Ken?
06:09Nothing.
06:10Are you me right now?
06:12Yeah.
06:13How are you feeling yourself right now?
06:14Pretty warm.
06:15Warm, OK.
06:16You are pretty warm, yeah.
06:17He was showing all the classic signs of a heart attack.
06:21He was sweaty, he was clammy, he was warm to touch.
06:25And this is really serious.
06:27Have you got any pain at the moment, Ken?
06:30They're very children.
06:32To check if the pain is related to Ken's heart, Rachel carries out an ECG.
06:38I'm just going to do a tracing of your heart, Ken.
06:41Have you had any chest pain today, Ken?
06:43Oh, no.
06:44No?
06:45Just sit nice and still for me.
06:48No moving or talking, just for a couple of minutes.
06:51Stemmy, here, please.
06:54The ECG shows Ken is having a heart attack, known as a STEMI.
06:59We can get some oxygen on.
07:01Four litres is such a bit low.
07:03A STEMI is a serious condition.
07:06It means his heart is potentially dying from the lack of oxygen as there's a blockage somewhere in his arteries.
07:13At the moment, Ken, I think there might be something going on with your heart.
07:17All right, so I think we need to get you to the hospital as quickly as we can.
07:21And your oxygen levels are a little bit low, so I want to just pop some oxygen on you if that's all right.
07:26Yeah.
07:27And this pain in your shoulder, how long have you had that for?
07:30I'm trying to get close.
07:31Three years.
07:32Nothing in your left shoulder, nothing in your left arm.
07:35No?
07:36OK.
07:37And what I'm going to do, I'm just going to ring Coventry, because that's the place they deal with all the heart problems.
07:42Hello, it's Rachel from the ambulance service.
07:46I think I've got a STEMI patient for yourselves.
07:51Another paramedic has just arrived and helps to get Ken onto the ambulance.
07:58We've just literally got him in the ambulance.
08:00I'm just going to give him some aspirin, GTN, get a cannula in, and then we'll probably be about 20 minutes.
08:05Ken, I need you to chew this aspirin.
08:08Tastes a bit chalky and a bit lemony.
08:11OK, darling, got a good chew for me.
08:14Aspirin helps prevent the formation of blood clots.
08:17These can often be the cause of cardiac problems.
08:22Can I just have your arm, Ken?
08:23I just want to try and get a cannula in your arm if that's OK.
08:27Perfect.
08:28Have you finished chewing that, darling?
08:30Yes.
08:31OK, just lift your tongue up for me.
08:33I'm just going to spray this into your tongue.
08:35Lift it right up.
08:36Brilliant, thank you very much.
08:39Amy uses GTN spray to help widen Ken's blood vessels, reducing the pressure on his heart.
08:46I'm just going to drop some morphine and then we'll get ready to go if that's all right.
08:49Have you ever had morphine before, Ken?
08:51No, so I'm just going to give you a little bit now just to help relax your heart if that's all right.
08:56At the moment it's working quite hard and it might help with your shoulder pain as well.
09:02I'm ready to go when you're up.
09:03Yeah.
09:04OK.
09:05OK.
09:09All right, Ken.
09:10Just doing your blood pressure.
09:11Have you got any chest pain?
09:16Rachel contacts the hospital with an update on Ken's condition.
09:20Current blood pressure is 51 over 31.
09:23That is post-GTN.
09:24His initial blood pressure was 139.
09:27I'm just about to raise his legs.
09:29It was important to raise his legs to restore his blood pressure.
09:32Ken's blood pressure was low.
09:34It could be a sign that Ken's heart was starting to fail and he could go into cardiac arrest.
09:39I'd like to learn how to fly a plane, get my pilot's licence.
09:54I'd like to be able to fly a helicopter.
09:56I'd like to get my scuba diving.
09:58I want to get my skydiving.
10:00I just want to go and do courses just for the fun of it.
10:04So how realistic do you think your dreams are then, Sam?
10:07A private's pilot's licence is not cheap.
10:10We're talking tens of thousands of pounds.
10:12And I think I might be a little bit of an adrenaline junkie a little bit.
10:16So I think...
10:17I think you might.
10:18Would it surprise you to know that I did start my pilot's licence?
10:21Did you?
10:22Really?
10:23That's pretty cool.
10:24I didn't know that.
10:30Ambulance service, is the patient breathing?
10:32Yes, he is.
10:33He's just woken up and his tongue's swollen.
10:37OK.
10:38Would you be able to talk to me?
10:39He can't speak at all.
10:40His tongue's swollen.
10:41He won't be able to breathe soon.
10:42He won't be able to breathe soon.
10:49Cat 1, 71-year-old male, clearly anaphylaxis.
10:52Yeah, that's for C, thank you.
10:57We've got Cat 1.
10:58Yeah.
10:5971-year-old male with tongue swelling.
11:01And that's all the details we've got.
11:07Anaphylaxis with tongue swelling is absolutely life-threatening emergency.
11:13It's really important that we get there quickly.
11:16Really important that we start treatment.
11:19This, this, this can kill people.
11:26Hello, you all right?
11:27Is it Jim, James?
11:28Jim.
11:29Jim, hello, Jim.
11:30Well, you really are swollen now, aren't you?
11:32You all right, Ken?
11:33You okay?
11:34You feeling hot?
11:35In Warwick, paramedic Rachel and student paramedic Amy are with Ken, who's having a heart attack.
11:51The tent is 35-9.
11:55He's very hot and clammy.
11:57Rachel provides medical staff at the hospital with an update.
12:01Do you feel it worse than you did before?
12:04No, you feel okay?
12:06Ken's blood pressure is dangerously low.
12:09Just straighten this arm up for me.
12:11I'm just going to pop some fluid into your arm, okay?
12:13Just because your blood pressure's a little bit low.
12:16This will just help to raise it a little bit.
12:18All right.
12:19At this point, Ken is still time critical.
12:23His condition is still deteriorating with a low blood pressure.
12:26He was in a life-threatening situation.
12:3013 minutes later, Ken arrives at University Hospital Coventry.
12:35All right, Ken, a few bumps on the way out, all right?
12:40Having been alerted by Rachel, the cardiology team will be ready and waiting to treat Ken.
12:49Ken was really lucky. His wife acted so quickly, wasn't he?
12:52Yeah, definitely. I think her actions certainly saved his life.
12:56It was a bit hairy at one point where his blood pressure dropped dramatically, but luckily he came more with it.
13:07And, yeah, I hope he has a speedy recovery, eh?
13:11What does your throat feel like? Itchy? Sore?
13:21Itchy.
13:22Oh, you're struggling to swallow?
13:24Yeah.
13:25In Coventry, student paramedic Sam and paramedic Chris are treating 71-year-old Jim.
13:32When his tongue swelled up and he was struggling to breathe, wife Susan rang 999.
13:37Are you allergic to any medication, Jim?
13:40Not, no, I'm not.
13:41No, okay.
13:42Might just give you something to get that swelling down a little bit, all right?
13:46Because we certainly don't want it getting any worse, do we?
13:49All right.
13:50It did back time.
13:52Eh?
13:53It did back time.
13:54I've had it before.
13:56You have had it before.
13:58Six months ago, Jim was in hospital with anaphylaxis, a life-threatening emergency.
14:04We're just going to give you a little injection in the top of your arm, okay?
14:08People who are actually in anaphylaxis are some of the most critically unwell patients that we will see.
14:13It's kind of as poorly as you can really get outside of hospital, and you can deteriorate so quickly.
14:19Essentially, you're not getting air into your lungs because of an occlusion with your airway, and this can be fatal.
14:28Right, I'm going to give you a little bit of an injection in your arm, okay?
14:33Sam gives Jim adrenaline.
14:35This should help reduce the swelling.
14:38I'm on a lot of medication.
14:40Well, you've had a heart operation, haven't you, Jim?
14:42Mm.
14:43Yeah.
14:44Need a bypass?
14:45No?
14:46A heart transplant.
14:47A heart transplant?
14:48No.
14:49Okay.
14:50So you are going to be on a lot of medication, aren't you?
14:53Yeah.
14:54When did you have your heart transplant?
14:5812 years.
14:59There you go.
15:01We're going to be heading off to the hospital, aren't we?
15:03Yeah.
15:04You're happy with that, Jim, Sue?
15:06Yeah.
15:07This is a really serious situation.
15:09We need to get that swelling down and stop the potential for his airway to close, so we need
15:13to treat him as quickly as we can and get him to hospital as fast as possible.
15:17And what we'll do, Sam, we'll let them know we're coming.
15:20Yep.
15:21Chris places a cannula in Jim's arm so drugs can be given intravenously.
15:26How's that tongue feeling?
15:28Chest feeling okay?
15:29Not tight or anything?
15:30No.
15:32Are you happy for another dose?
15:34Uh-huh.
15:35Hello.
15:36Coming to stab you again, I'm afraid.
15:38So if we just relax this arm down for me.
15:40What are you like on your feet, Jim?
15:42You walk normally, yeah?
15:43I'll go and get your pouch.
15:45Yeah, I'm comfortable.
15:47And we're 15 away?
15:49Yeah.
15:50Yeah, yeah, yeah.
15:51Right then, folks, are we good to go?
15:57Hang on, Jim.
15:58Let me come and make sure you get there all right.
16:00Do you want to take my...
16:01There we go.
16:02...take my hand?
16:03Brilliant.
16:04And Jim, can we have your jacket back off before you sit down?
16:11Is that okay?
16:12There we go.
16:13I'll have that.
16:14And you need to park the bum there.
16:19Sit, get them legs up.
16:22So, last time this happened, it took Jim's tongue eight days to go down
16:27and he ended up on a ventilator.
16:29Okay, Jim, nice and straight with that arm.
16:32Right then, it's going to be another injection in here, I'm afraid.
16:37Just relax this arm down for me.
16:39I'm just going to go in here again.
16:41This is Jim's fourth dose of adrenaline,
16:44but it appears to have had little effect.
16:47Open up for me, Jim.
16:49Let's have her do the best you can.
16:52Okay.
16:53It hasn't really gone to the back of your tongue.
16:56It's very more the front, which is good.
16:59Very good.
17:00So, it took a while, didn't it, before, Sue, to go down.
17:03Eight days.
17:05When I realised that Jim had had a previous anaphylactic reaction
17:09that had led to quite a long period of time in hospital,
17:13I realised that we needed to get Jim to the hospital quite quickly.
17:17It was a big anaphylactic reaction.
17:27And how long an operation is it, a heart transplant?
17:31It's just trying to take the old ones out.
17:34It's a little new one.
17:36Getting all the plumbing right.
17:37That's it, yeah.
17:46What we've done, we've let them know that you're coming.
17:48Yes.
17:49So we're not going to have to wait.
17:51They'll be ready for you, basically, Jim.
17:55After a seven-mile journey,
17:57Jim and Susan arrive at University Hospital Coventry.
18:02All right, Jim.
18:03Tuck them arms in.
18:05Fantastic.
18:07Happy?
18:08Yeah.
18:11Here, medical staff will attempt to get Jim's anaphylaxis under control.
18:15I have never seen a tongue quite that big before, I have to say.
18:28I'm very pleased it didn't get any bigger.
18:30I know.
18:31Really nice guy.
18:32Yeah, and wife as well.
18:33Yeah, yeah, yeah.
18:34And I just think between the two of us,
18:35we worked really well as a team on that one.
18:37Oh, what you did was great.
18:38A job well done.
18:45Yeah.
18:46Flagging already.
18:47Uh-oh.
18:48I think it'll be time for a hot drink.
18:50Already no need a drink now, innit you?
18:51Yeah.
18:52I'll have me hot drink like a little old man.
18:54Oh, it's too late.
18:55Yeah, Sam.
18:56I think we should both be tucked up in bed.
18:57Oh, don't.
18:58I feel like when we're tucked up in bed.
18:59Oh, don't.
19:00I feel like when we talk about sleep on a night shift, it does make us really sad.
19:01Yeah, because I would much rather be in bed than on a night shift.
19:02Yeah.
19:03And then when we see, like, people walking the streets at 3am, I'm like, you are taking advantage
19:15because you could be asleep right now.
19:16I physically can't.
19:17Yeah.
19:18I physically can't.
19:19Yeah.
19:20I think it'll be time for a hot drink or an energy drink, though, innit you?
19:21Yeah.
19:22I'll have me hot drink like a little old man.
19:23Oh, it's too late.
19:24Yeah, Sam.
19:25I think we should both be tucked up in bed.
19:26Oh, don't.
19:27I feel like when we talk about sleep on a night shift, it does make us really sad.
19:29I physically can't.
19:30And that really upsets me.
19:31Ambulance services to patient breathing.
19:32It's myself.
19:33For what's the reason?
19:34Ambulance.
19:35I can't have fun at all.
19:36Again, have you injured yourself?
19:37No, I've got going to neck cancer.
19:38I'm, er, totally dehydrated.
19:39I can't get enough down.
19:40I can't swallow.
19:41We are getting up and down.
19:42I can't swallow.
19:43We are going to a 58-year-old male who is dehydrated and has collapsed.
19:44Symptoms on set within the last four hours.
19:58Um, patients had head and neck cancer, chemo radiotherapy, dehydrated as he isn't able to swallow.
20:15Um, he passed out.
20:16Okay.
20:17Bless him.
20:18Well, we'll have to go see what's going on with him.
20:21Make sure he's not, like, neutropenic sepsis.
20:22Is there anything?
20:23I'd like to say.
20:24Neutropenic sepsis is a severe reaction to an infection.
20:25It's a serious condition that can be life-threatening.
20:38See if we can get him off off the floor.
20:40See when his last chemo was, really.
20:42He's at high risk of infection due to the cancer and the radiotherapy.
20:47It suppresses his immune system, which makes him more vulnerable to infection.
20:51So there is a very strong chance that this man is in a really bad situation.
20:56You have reached your destination.
21:04Hello.
21:05Hello.
21:06How are you?
21:07How are you, bud?
21:08I'm James.
21:09This is Chloe.
21:10How are we feeling?
21:12Terrible.
21:13Terrible.
21:14How long have you been feeling like that for?
21:16A couple of days.
21:18A couple of days?
21:19I'm just going to chuck some wires on your bud while he has a chat.
21:22OK.
21:23When he goes to the sandal, he just collapses.
21:2858-year-old Mark has been diagnosed with head and neck cancer.
21:33Friends Debbie and Julie are with him.
21:36Can we have any of that?
21:37Friday on camera.
21:38Yeah, when we should last session.
21:40Today.
21:41Today.
21:42OK.
21:43When we first walked in to Mark, I immediately looked at him and thought,
21:46this man is not well at all.
21:48Mm-hm.
21:49We needed to get some observations on him as soon as we could.
21:52And we knew as soon as we walked in that this man would be coming to hospital with us.
21:56We'll have an idea of food for six weeks now.
21:59OK.
22:00Pop your finger in here.
22:02I don't swallow anything.
22:03OK.
22:04How long's the swallowing?
22:05Is it just today?
22:06Yeah.
22:07Not today.
22:08OK.
22:09You had any vomiting or anything?
22:10Oh, no.
22:11They're sick.
22:12They're sick and flam all at your own, aren't they?
22:13Yeah.
22:14What colour is it?
22:15Is it like white, green?
22:16Green.
22:17How long has it been green for?
22:18There it goes.
22:19There it goes.
22:20What's the temperature, man?
22:2238.3.
22:23A high temperature and green phlegm are indications of an infection.
22:41Yeah, you've worn yourself a fit into hospital, bud.
22:44Are you living here?
22:45No.
22:46Because you're on your chemo and radiotherapy.
22:50It weakens your immune system.
22:53Mark needed to go to hospital because he was at high risk of developing neutropenic sepsis,
22:59which can be fatal if not treated.
23:02I understand why he didn't want to go to hospital because I feel like Mark constantly feels like he's at hospital all the time,
23:09especially while he's undergoing treatment for cancer.
23:12After blue light, you're in.
23:14What would happen if he goes in, though?
23:16Because he's got a bit radier.
23:17So he'd put for nine o'clock, I think, in the morning.
23:19Is that at?
23:20QA.
23:21At QA.
23:22I couldn't really tell yesterday, to be honest.
23:25But with your temperature, I wouldn't do it.
23:28Because they'd be concerned you've got neutropenic sepsis.
23:33Not again.
23:35Not again?
23:36You had it before?
23:37Sorry.
23:38When did you have it?
23:39No.
23:40After the first and second came out.
23:42Neutropenic sepsis is just when you've got a low level of white blood cells in your body
23:48and you've got an infection at the same time.
23:50People on chemotherapy and radiotherapy are at high risk of this,
23:55as those treatments suppress your immune system.
23:57So it's really important that we get Mark to hospital, as it could be fatal for them.
24:02As the West Midlands sleeps, we're on board with seven paramedic crews simultaneously, as they work a typical 12-hour night shift.
24:24You're going to be sick, would?
24:25Yeah.
24:26In Birmingham, paramedic James and student paramedic Chloe are with Mark.
24:39He's receiving cancer treatment and is showing signs of neutropenic sepsis, a life-threatening condition.
24:46Just coming off your chest or are you being sick?
24:49Are these all the medications that you're on?
24:53I did really feel for Mark because at such a young age of 58, it's younger than my own dad
25:00and he's going through such a traumatic time for him with the cancer and just feeling so generally unwell every day.
25:07It must be absolutely heartbreaking for him and his family.
25:14A couple of bumps on the way up, bud.
25:19Last bump. Lovely.
25:22Pop yourself in that chair for me, sweet.
25:25Yeah, whichever one.
25:27As long as you can pop your seatbelt on, I'll be happy.
25:30Friend Debbie will come with Mark to the hospital.
25:33Hi, can I pass a medical alert, please?
25:37Yeah.
25:3858-year-old male, neutropenic sepsis.
25:43Chloe calls ahead so medical staff can be ready to treat Mark.
25:47It will be about seven minutes.
25:50OK.
25:51Right, thank you.
25:55Hopefully you'll start to feel better once they get you in and they'll start treating you.
26:00Good, it's nice that you've got good friends around him.
26:09We're not too far from the hospital now, bud, OK?
26:15After a journey of five miles, Mark arrives at Heartlands Hospital in Birmingham.
26:23Get your arms in for me, bud.
26:25Here, doctors will find out if Mark has neutropenic sepsis for a third time.
26:38When we ring 999, the first voice we hear from the ambulance service is the call assessor.
26:44Listen, listen, listen, calm down, calm down.
26:47She lost any blood from anywhere at all.
26:50They decide which calls require the most urgent response.
26:55It's not a job for the faint-hearted.
26:57It is really important because it's life for Dev, it's life-threatening.
27:05So, out of all my jobs that I've done, this job is the most important job.
27:11Ambulance service is the patient breathing?
27:15It's for myself.
27:17OK, what's the reason why you need an ambulance?
27:20I've just been upset and I just want to hurt myself, serious.
27:24I've just been fed up. I've been outside.
27:27So, we have arranged help. We will be going out to you as soon as possible, OK?
27:31You know, I just want to do what I've got to do, head serious.
27:36OK, so we are aware that you are feeling suicidal. Is that right?
27:42Yeah, how about David?
27:44So, you feel like you're going to do it now?
27:47How about David?
27:49When a patient tells us that they're going to kill their self,
27:53we'll never get used to that.
27:55What's the plan that you've got?
27:57I've got nobody. I've got no friend, Ryan.
27:59Just lose you.
28:01So, you're feeling quite low with no friends at the moment?
28:04Oh, look.
28:06Nobody's going to find me.
28:08I'm not going to be here. I'm just going out.
28:11So, we are doing everything we can to get you some help today.
28:15It's really hard to hear that somebody hasn't got any friends
28:19and he did say he has been taken for granted.
28:23And, you know, it does make me feel sad.
28:26Everybody just take my liberty.
28:29I'm sorry to hear that. I'm very sorry to hear that.
28:33I'm going to take my life off just the way it's going to go.
28:36OK, so, sir, we have arranged help for you.
28:39We will be with you as soon as possible.
28:43That's probably gone.
28:45All right.
28:46Bye.
28:48Sir?
28:51Hello?
28:53After I took the call, I spoke to my supervisor
28:57and just let them know that I'm feeling a bit rubbish.
29:02I feel like, you know, I wanted to do more,
29:06but I just wasn't able to because the line disconnected.
29:10An ambulance was sent to this patient.
29:13After an assessment, the crew recommended that he go to hospital,
29:17but the patient refused.
29:18Oh, it's so peaceful at night, isn't it?
29:38It's so pretty sick.
29:40Tranquil? Tranquil.
29:42Yeah, that's it.
29:43Have you ever written with a quill before?
29:45No.
29:47Well, give it a go, though.
29:48It's quite hard, yeah, because the tip's very fragile.
29:51Right.
29:52I don't know, I feel like writing with a quill,
29:53you can feel very fancy and posh while doing it.
29:55Very fancy, yeah.
29:56I feel like it would be nice to write out invitations.
29:58Yeah.
29:59If you want to look fancy.
30:01Yeah, make an effort.
30:02My handwriting's awful.
30:03Yeah, mine is too.
30:04Yeah.
30:05And I'm here to thank you for doing it.
30:10Ambulance services are patient breathing?
30:13Yes, there's a line on his floor in the back.
30:15The car can't pick him up because I'm slightly disabled.
30:18I think he's had a stroke.
30:20Is he conscious?
30:22No, I'm trying to see if he's got a pulse.
30:23So it looks like we are going to a Category 1, male, 68 years old, unconscious.
30:35How far?
30:36Three minutes?
30:37That's not fair.
30:38Yeah, quite close.
30:39Yeah, fingers crossed.
30:40Outside.
30:41Explosive elements.
30:42Patient has had a few drinks, fallen over, unconscious.
30:44Patient has incurred in the last few days.
30:47Notice his face has dropped on one side.
30:49Okay.
30:50Quite a lot of things going on then.
30:51Yeah.
30:52The first thing you think about is that they've had a drink and they've got a bit tipsy
30:57and fallen over.
30:58But what we need to be really careful of is that there's nothing else going on.
31:02With the fact that the caller has reported that they've got a facial droop, we need to
31:07be considering a stroke.
31:08There can be lots of causes that can sometimes look like a patient's drunk when they're actually
31:13not.
31:19Tom and Ryan are met by the patient's brother who made the 999 call.
31:24We've only had a couple.
31:25When you say a couple, like two, three?
31:28About four.
31:29About four.
31:30Okay.
31:31I was just trying to get him home.
31:32He just wanted to go home.
31:33What kind of medical issues does he have?
31:35Like, any high blood pressure?
31:37Has he been here for long on the floor?
31:38No, no, no.
31:39I'm amazing.
31:40How quick he turned up.
31:41You weren't too far, thankfully.
31:42Sats 97, 98 with a good waveform.
31:43Pulse is 60.
31:44Blood pressure's coming down now.
31:45He was on the floor.
31:46It was very cold as well, which I was thinking about.
31:47You know, it was probably freezing.
31:48Bless him.
31:49I feel like because he said he'd had four drinks, it's quite a state to be in for only four
31:54drinks.
31:55Yeah.
31:56So is there actually something else going on?
31:57Yeah.
31:58Yeah.
31:59Any history of streaks in the family at all?
32:04We were all falling out of this moment with a strong friends.
32:18So just fours, but not like?
32:21The patient is now conscious, but not very responsive.
32:25responsive. How are you feeling at the moment? Not very well? In what way? I think he's
32:35fairly awake enough to stand up and walk, yeah. Should I give it a go? Yeah, I'll try it.
32:41Try and set up for me.
32:44OK. OK. You ready? Fantastic. Pop yourself on here. That's it. Perfect. A few bumps, mate.
33:04Once in the ambulance, Tom and Ryan can carry out a thorough assessment. If I touch here,
33:10does it feel normal? Does it feel normal? Yeah? This side. Can you stick out your tongue for
33:18me? Stick out your tongue for me. Your tongue. Fantastic. Puff out your cheeks. Keep them
33:26inflated. I need to check something. So puff out your cheeks for me. Can you lift this
33:34leg for me? Lift this leg for me. Mm-hmm. Sure. Can you lift this leg? Why? Can you make
33:42sure you're OK? These simple tasks are designed to show if the patient has had a stroke. If
33:48there's no actual weakness, his speech doesn't seem acutely slurred. Perfect. Ryan's checks
33:57suggest this patient hasn't had a stroke, but he's also carried out an ECG, and that's showing
34:02some irregularities with his heart. He's on two types of beat blockers. OK. The patient's
34:10medical records show he has a history of heart problems. Don't use that. Just a blanket because
34:17you're a bit cold, mate. That's all. Why? Because you're cold. Am I OK to put a cannula in your
34:24little needle? At the moment, we think you're intoxicated. I was intoxicated. Yeah. And you've
34:38got some ECG changes that we are not completely happy with. When a patient doesn't really comply
34:44with my assessment, it makes things a lot more difficult than it needed to be. If a patient
34:49was just do as you say, it makes it a lot easier to rule out any red flags and any big, sick
34:56symptoms.
34:57So I'm going to put a needle in your arm to give you some fluids.
35:01Why? Because you're intoxicated at the moment and your blood pressure is on the lower side
35:06of normal for yourself. It is legal. It is legal, yes. Do you know where you are at the moment?
35:13No. What vehicle are we on? No vehicle? Yeah. Any question you have? Ryan inserts a cannula
35:24in the patient's arm. This allows direct access to his bloodstream should drugs need to be
35:30given intravenously. It's just water. That's all. That's what you said. I can't believe you.
35:38See, at the moment, you don't have mental capacity. That's why you can't believe us.
35:42You have what? Mental capacity. I do.
35:45So you don't understand what's happening or where you are at the moment?
35:48Bullshit. Mental capacity is the ability a patient has to make a decision for themselves.
35:55However, this patient did not have mental capacity, so it's important that we make the best interest
36:00decisions on his behalf. You're scared of that.
36:03I just want to make sure you're OK.
36:14Of course.
36:16Near Coventry, technician Tom and paramedic Ryan are treating a drunk patient who's being
36:22verbally abusive.
36:24Treating a verbally abusive patient is very difficult. On one hand, you have to remain
36:37professional, so you can't really react to the verbal abuse you receive. But on another
36:43hand, as a person, as a human being, it feels quite hurtful at times, and it can be very,
36:49very hard to try and do what you need to do for the patient. I have a legal duty to ensure
36:56that your life is kept safe. So I can't leave at home if I don't think you'd be safe at home.
37:03I won't, though, because you can't remember falling over.
37:08I didn't fall over. You did fall over.
37:11What?
37:12You are unable to retain information. That deems you...
37:17Not to have...
37:18It's not absolute bollocks, I can assure you.
37:23With their abusive patient on board, Tom drives through the deserted early morning streets.
37:30I think it makes it really difficult sometimes when you're dealing with these drunk people
37:33because they're not always the most compliant. You know, you're sat there with this patient
37:37when there's a load of people who desperately need an ambulance.
37:40They obviously would not be safe to leave at home
37:42because they can't look after themselves in this current state.
37:45So A&E is kind of the available place to go.
37:48Yeah, and it ends up taking a bed away from someone who might be seriously ill and needs it.
37:52So your blood pressure is now 99 and 55.
37:56What's up, man?
37:58So it means your tissues and cleaning your brain is not getting enough oxygen.
38:05No more.
38:07Say what?
38:08It means it's not very good for your health, is it?
38:10Tom, Ryan and their intoxicated patient arrive at George Eliot Hospital in Nuneaton.
38:17Where the hell are you?
38:18I'm the driver. I was just here five minutes ago.
38:22In A&E, more ECGs will be run to check his heart.
38:26He'll also be watched over until he sobers up.
38:29In Birmingham, student paramedic Chloe and paramedic James have just finished their second job of the night.
38:43Weren't you going for a meal round here the other night?
38:46Yeah, Castle Brown.
38:47It was nice, but I got the barbecue chicken thinking that it would be nice and it was spicy and I was like, what?
38:55I just ate the chips.
38:57I can't handle spice. Can I? At all.
38:59You think the mayonnaise is spicy?
39:01Yeah, I used to think sausage rolls were spicy until about two years ago.
39:04And gingerbread.
39:05And gingerbread, yeah. We had gingerbread before and couldn't hack that. No. Plain girl. No sauce, no spice.
39:15Is the call for you or someone else? No, it's for my husband.
39:22And what's the reason for the call?
39:24So, he's tweaked his back earlier today and it's just all of a sudden, it's just gone mad.
39:31He's got, like, shooting pain down his leg and he's currently laying on the floor and can't get out.
39:36He's saying it's, like, excruciating.
39:38We are after 48, 38-year-old male, lower back pain, pain down the leg as well.
39:50That's all we've got.
39:52OK.
39:53With this patient, they had lower back pain and sensations down their leg,
39:58which immediately rings alarm bells to me.
40:01And so it's really important that we get there quickly as the patient could be in quite a lot of pain.
40:08999.
40:15Are you down here cos it's comfortable for the pain?
40:17Yes.
40:18So you've not had a fall or anything?
40:19No, as I tried to get up, my legs...
40:22Just went.
40:23Just went.
40:24We were swimming.
40:25He picked up a bag and my...my bag.
40:29Simply bending down has left postman David in agony.
40:33Wife Jennifer is with him.
40:35He has a history of bad back, so...
40:37OK.
40:38It was like...
40:39So you normally suffer with a bit of a bad back anyway?
40:41Two surgeries.
40:42Oh, OK.
40:43Yeah.
40:44He was doing a...
40:45Something...
40:46Equine syndrome.
40:47Basically, a disc came out and broke into his spinal cord.
40:50When nerves at the base of the spine get compressed, it can cause a condition called chordaequinae.
40:57Without treatment, permanent paralysis is a possibility.
41:01He'd previously had surgery on his back due to slipped discs, which had damaged his spinal cord and he's had chordaequinae in the past.
41:09There are multiple risks that he could be suffering from chordaequinae again or have another slipped disc.
41:15Have you taken any pain relief?
41:17He's had paramol.
41:18What time?
41:19A while ago now.
41:20Hasn't made a difference.
41:21If you scored the pain out of ten, ten being the worst pain...
41:24Ten.
41:25OK.
41:26Do you take any regular medications?
41:27No.
41:28Normally fit and well.
41:29Er, yes.
41:30OK.
41:31He's a postman, so he walks all the time.
41:34Oh, OK.
41:35I'm just going to have a little fear that your back is well, all right.
41:36Any pain here, bud?
41:37No.
41:38No.
41:39Is it more down by like your coccyx?
41:40Yeah, it's right in the centre.
41:41Right in the centre of your coccyx.
41:42Oh, God.
41:43Are you all right if I pop a little needle in your arm, bud?
41:44Yeah.
41:45Right, bud, sharp scratch.
41:46James gives David liquid paracetamol intravenously.
41:49This should help ease his pain.
41:51Really important we got David to hospital, especially with his intense pain score and his history
42:09of back problems puts him more at risk of future complications with his back.
42:13Yeah.
42:14So, if we didn't take David to the hospital for a scan, the back problem could have
42:18potentially got worse throughout the night and he could have woke up paralysed.
42:22Right.
42:23You ready, Jay?
42:24Mm-hm.
42:25Right, then.
42:26On lift.
42:27Ready, steady, lift.
42:31Couple of bumps.
42:42Last little bump.
42:43I'll get this morphine sorted out for you, bud.
42:46Wicked.
42:48Intravenous morphine will help reduce David's pain.
42:59So, you know your pain was a ten in the arms.
43:01What would you say it is now after that morphine?
43:04Has it changed?
43:05Yeah.
43:06What would you say?
43:07About a six.
43:08I thought he was going to go to zero.
43:10It's so much more comfortable in here.
43:12Yeah.
43:13Was you in Heartlands for your operations last time?
43:15No.
43:16QA.
43:17QA.
43:18The first was emergency surgery.
43:20Really?
43:21Yeah, because I fell on the stairs and my legs stopped working.
43:24Are you joking?
43:25She was seven months pregnant.
43:26It was a nightmare.
43:27Aw.
43:31After four miles, David arrives at Heartlands Hospital in Birmingham.
43:34Hey, you'll have to have some of them grippy socks to keep your feet low.
43:41Here, x-rays will show the extent of the damage to David's spine and reveal if he'll need more surgery.
43:49I'm sorry.
43:50I'm sorry.
43:51I'm sorry.
43:56An MRI scan showed he'd slipped a disc.
44:01This had caused his back muscles to go into spasm.
44:05David was discharged the next day and was off work for two weeks.
44:11Ken, who collapsed with chest pain, was having a heart attack.
44:15He had two stents fitted to widen his arteries and spent four days in hospital.
44:22Mark, who had cancer, was diagnosed with neutropenic sepsis for a third time.
44:27He was given intravenous antibiotics and spent eight days in hospital.
44:37And Jim, who had an anaphylactic reaction causing his tongue to swell, spent a night in intensive care.
44:44They x-rayed my throat to see if my airways were compromised.
44:49But this time, they weren't.
44:51They think it was the medication that I was taking.
44:55And they've stopped that medication now.
44:58And we hope that everything's sorted.
45:02But anything that stops your breathing, you start to panic.
45:05It's very scary.
45:06It is scary.
45:07I haven't had another episode since.
45:10The paramedics, I'd like to say, thanks very much for getting me there and sorting the issue out.
45:16Because if I didn't get there, then there could have been a bigger problem.
45:19Next time.
45:21So what's been happening then?
45:23The volume is, they changed.
45:25A man is complaining of chest pain.
45:28When doing the 12-lead ECG, we did notice some changes which could indicate there is a problem with his heart.
45:35Any pain where I'm pressing?
45:36It's quite short.
45:37Any pain in your neck at all?
45:38A woman falls, injuring her head.
45:42With the elderly and head injuries, it can be quite serious and life-threatening.
45:47Have you been on the floor a while, do you think? About half hour.
45:52And a man with a head injury is found lying underneath his bed.
45:56He's definitely took a big hit on his head.
45:58Very swollen, black eye.
45:59And it makes you think what other injuries are going on.
46:01And it really makes you think about, has he got a bleed on the head?
46:04On the brain.
46:05And it really makes you think about, has he got a bleed on the brain?
46:34Good night.
46:35Good night.
46:36Good night, my day.
46:37Good night.
46:38Good day.
46:39Good night.
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