In Scotland, there is a unique team in the heart of the National Health Service. >> Hi there. This is the pediatric transport service from Edinburgh. >> The pediatric retrieval service is an expert squad [music] of dedicated men and women. Skilled doctors and nurses working around the clock to transport children from all over the country into specialist care units. Whether on the roads or up in the air, it's a race [music] against time to get children the medical care they need. >> And for [music] the first time ever, they're allowing the cameras to follow them. In this episode, a 9-month-old baby in a desperate fight for life. has got the potential to become even sicker and uh there is not much leeway. >> The risk of dying in the situation [music] is significant. So we need to speak to the parents. >> How a spell of tonsillitis became an emergency caller. [music] I'm >> going to give you some really good medicine and make you feel better. Okay. >> Yeah. >> Is that [music] a little bit more comfortable now the bed? >> And a 10-year-old girl who's struggling to breathe is airlifted from Wick. Does he have any sort of temperature uh probes or anything at all? You've put Okay, great. And he feels nice and warm. >> 9-month-old baby Naim was born prematurely and has been in Nineworld's [music] hospital in Dundee all his life. A virus has inflamed Naim's already damaged lungs that were not fully formed at birth. [music] He's been struggling to absorb enough oxygen. Early this morning, he took a turn [music] for the worse and has been placed on a ventilator. But despite being given high [music] levels of oxygen, he's still struggling. >> Oxygen wise, is there any oxygen that we could use? >> Retrieval doctor Nandita Chinchanka has been called to the hospital. >> Is this one okay to undo this? Okay. >> Naimm needs urgent pediatric intensive care. Nandita will take him on a portable life support system to Yorkill Hospital in Glasgow. There's no time to waste. >> He's currently on a suit. >> Um >> just him. >> Just him. Just him because otherwise this will not shut. So we'll just take him. >> Uh yeah, we even the sheet. >> What about the invasive? Is that long enough? >> Hang on. Let's see. So, this this this brake is on. Let me just ensure that the >> moving a child as sick as slightly onto the portable life support system is an extremely delicate procedure. >> Okay. And just nice and slowly over and yeah, you're going to move the ventilator tubing as we go. Okay. >> Ready, steady, go. >> Done. >> That's good. Now, do you want anything under his head to >> Yeah, if there's sort of like a roll or something? >> Yeah. Under his shoulders or >> No, just just around his head as well. >> Y Okay. >> Naimm's ventilation, sedation, and heart rate monitoring is now all being provided by the portable retrieval trolley. As his condition has deteriorated so rapidly, Nandisa needs to be confident that he's stable enough for the journey. >> I've not actually seen his chest yesterday. I need to see that. >> In the past four, five days, he's deterated again, isn't it? The 2 L plus face mask has been since December, but four five days, requiring more and more oxygen, and then went on to BPAP essentially this morning or >> this morning. Um the last um 2 three days um he's had anywhere between two and um 9 liters of face mask variable over the course of the day next door. Um yesterday afternoon I saw him and he actually seemed to settle and then overnight he went up to 17 L. Didn't look good when I came I just came to speak to the parents this morning about this elective transfer to Edinburgh when they just moved him through. >> Okay. Despite his being on the ventilator and receiving 85% pure oxygen, Naim is struggling. >> Heart rate 149, sats 94, 95%, CO2 about 67. But he keeps swinging there. They were 94 95. They 89 now. They just keep swinging. Uh peripheral uh temperature because that could just go on his foot. >> This one? Yeah. Yeah, that just goes in reasonably good position, isn't it? With Naim showing [music] such instability, the window for transferring him safely is narrowing. >> Bit of gauze here just to support that. >> Nandita has to get him to intensive [music] care in Glasgow as soon as possible. >> That's us pretty much set, isn't it? >> Thank you. >> Thank you very much for coming. >> Yeah. >> What were your settings? We promised. So 32 32 over8 and oxygen is about 85 to 90%. Just this way because I've got to keep looking at the monitor. But just this way and then uh to the left bumpy here, isn't it? >> They have a 90m [music] journey ahead of them on life support and requiring high levels of oxygen. Naim's situation is critical. Nandita has [music] decided to give Naim some fluids. His heart will not have to work as hard if he's rehydrated. He's pretty sick. He's pretty sick. But what is in favor of him at the moment? It's it's only uh one system that's affected. His heart is functioning fine. So, he's not on any drugs to support his heart. The heart is functioning well. It's only the lungs that are affected here. >> Yes. Hi, this is Nadita. I'm one of the retrieval doctors from Edinburgh. Uh hi, we were just coming with uh Naim, this little baby from Dundee. His sugars have dropped. So, he was on 045 and 5 and the the blood sugar just before we left Dundy was 4.5, but it's dropped further down to 3.6. I've just changed him to 045 and 10. Um, and from the point of view of his ventilation while you're transferring him, have you been having to handbag him or is he managed on the ventilator? >> What's your ETA? How long do you think you'll be? >> Well, I think I think it's probably half an hour to 40 minutes. >> Great. >> Okay, that's perfect. We'll see you in half an hour then. >> Thank you very much. Thanks. Bye. >> The pediatric team in Glasgow are preparing an oscillating ventilator. >> The concern is because he's requiring such a lot of pressure to actually make his uh chest go up and down. um I mean he's needing that to to provide adequate oxygenation. So we needing to give him that much pressure but that much pressure is also damaging to the lungs. So that's why we've got to sort of uh weigh the sort of risks and benefits and that's why he might benefit with this different type of ventilation which is the high frequency and what that does is it's it sort of vibrates uh the ch the chest wall and uh sort of oxygen and carbon dioxide exchange takes place with the vibration. So you don't need to give as high pressures. It's got the potential to become even sicker and uh there is not much leeway as well. >> Millie is a 2-year-old from F. She's in the Royal Hospital for sick children in Edinburgh. Millie arrived an hour ago with a serious chest infection and Dr. John McCormack is attending to her. >> Would you pick a nap? Okay. >> Okay. >> She's a previously well 2-year-old um who I think started off about 2 weeks ago with tonsilitis or a throat infection that throughout the population at this time of year um is pretty unremarkable. But it has progressed and it's rather than just a simple viral tonsilitis, it's progressed into what we assume is this bacterial infection. That's that's tracked out with the throat and now down through the neck and to the chest. >> Are you thirsty, Ch? >> Oh, well, do you know what? We're going to give you something a lot better than that. We're going to give you some really good medicine and make you feel better. Okay. [screaming] >> Oh, you're so brave. >> Do you know that? Do you know how >> it's likely Millie will be going into surgery, so it's important that she doesn't drink any fluids. >> Right. So, first things we'll do, mom, is we'll get on to monitors so we can keep an eye on our numbers and such. Like, while we're popping off to sleep, I'll check her drips are working. Okay, I'll give her a few flush and then once we're happy everything's good, we'll get ready with our gear and we'll just pop her off to sleep. >> John is going to take Millie through to the pediatric intensive care unit at the Royal Hospital for sick children in York Hill where they have a specialist heart and chest service to see if they can deal with the abscess in her chest. So, we're going to take her through to the intensive care unit in York Hill. And as part of that unit, they have a cardiothoracic service. And I've spoken to the the thoracic fellow through there. And when we get there, they're going to review this patient with a view to taking her to theater tonight and explore and see what this abscess is and if they can do anything about it. >> Hi there. Can I give you a heads up call for a pediatric transfer from ITU in Edinburgh Sick Children's to ITU in Glasgow Sick Children's. Hey, we're going to go to a new hospital and we're going to make it all better. Okay. >> John needs to sedate Millie and put her on a ventilator. He's concerned that her breeding difficulties may worsen on the [music] journey to Glasgow. >> Try to bring the parents in as much as we can to to everything [music] we do on transport. We'll try and get a parent in the ambulance or in the aircraft. And you know, if we're doing really aggressive resuscitation, we always want the parents in. >> No, you'll get drunk just really soon. Okay. >> Okay. >> Right. Mom, so what we're going to do now is we're just going to go do a final check and then we're going to um give her anesthetic, pop her off to sleep. We've just asked you just to step outside for a couple of minutes just so that we can focus completely on her. We don't had the odd parent fainting on us, which we don't want in the midst of it because we want to look after Millie. [crying] I love you. >> Would you be happy to take Grand and Grandad are just sitting out the front there and I just won't give you a shout when we're back in. Milliey's mom's really upset, really tearful. What I find from my anesthetic experience, sometimes parents can get really distressed when they see their kid going off to sleep and going all floppy and pale. I have to focus 100% on the patient. And what I can't be doing is focusing on a parent that's maybe, you know, feeling unwell or feeling faint or anything like that. So, I find for these critical moments, and it's only for a few minutes, once the critical moment's over, get them back in. Right, Millie? You've been so brave. Okay. And we're going to make you feel so much better now. Okay. Yeah. You want we make you feel better? >> Yeah. Okay, then let's go. Okay, I'm going to give you a wee bit of oxygen to breathe there. >> There you go. There you go. We're going to make you feel sleepy. >> Sedation only takes a few moments to work. >> John has been ventilating Millie by hand, but now he needs to put her onto the ventilation machine. >> This will allow [music] the retrieval team to move Millie across the country comfortably while they monitor and contain her condition. Okay. So, looks pretty normal down there. That's 12 cm of blitz. If we look at her airway, it was a we bit red and inflamed, but there was no difficulties with incubation. [music] It was quite smooth and she tolerated it very well. Sometimes we can see blood pressure swings about if children are very septic, but she tolerated it very smoothly. Yep. A short time [music] later, Millie and her mother are reunited. >> Okay, Mom. >> Well, have a we seat, Mom, for a few minutes while we sort out her other bits and bobs. As I say, she's got that we breathing tube in. So, she's effectively had an anesthetic. That [music] tube's just protecting her airway. There's a ventilator down there working away. And we've got can see all her numbers on that monitor there. And we've got medicines running to keep [music] her comfortable, keep her sedated, and keep her nice and relaxed. Okay. So, as I say, it was all very smooth. What I'm going to do is I'm going to make some phone calls now and then we'll get ready to go. >> Okay. >> Once the paperwork is closely checked, John is ready to take Millie to Glasgow for surgery to remove the abscess from her chest. [music] >> All right. Yeah. Nandita has arrived at Glasgow's York Hospital with little Naim who's seriously ill. 9month-old Naim was born prematurely and has remained in hospital in Dundee ever since. He has a severe chest infection and his condition has become critical. >> The intensive care team have prepared an oscillating ventilator which may help his body absorb more oxygen. >> First, Nandita needs to hand over the responsibility of her patient to the intensive care team. So this is little Naim who's a 8-month-old little boy. Uh he's an ex uh Prem born at 28 weeks um and has essentially got chronic lung disease and he's had an acute respiratory deterioration. >> Mhm. >> France, will we get him across sorted and then let you guys just on three? One, two, three. Yeah, please. Uh500 >> 600 >> with nine safely handed over to the York Hill team. Nandita can head back to Edinburgh. She still has 14 hours of her 24-hour shift to go. >> Definitely. >> It's only 6:00, so it's like early days. So, could be out again tonight. In just [music] 8 minutes, Naim's saturation levels, the concentration of oxygen in his blood, has dropped from 97 to 68. Anything below 80 can result in organ failure in nitric. >> Dr. Davidson is concerned for Naim's life. >> He's got worse on that. >> I think we're just impacting the RV. just shows the degree of heart dysfunction that there is. >> He's considering whether Naim needs to go onto ECMO, a piece of equipment that will oxygenate Naim's blood outside his body. ECMO is the last line of care for a child who is so poorly. But it requires surgery that carries its own risks to Naim's life. Without ECMO, the doctor believes that Naim won't make it through the next 4 to 8 hours. [music] But it's not a straightforward decision. Well, I'm just not sure there's a great reversible pathology here looking at him and looking at his X-rays. So, I think from uh an extra corporial support angle, if we're going to offer support, we do it tonight. Um so, I think we're probably going to end up uh we'll trial him on ECMO. I think there's significant risks to that. Um the risk would be bleed into his head, bleed [music] into his lungs. The risk of dying in the situation is significant. So we need to speak to the parents to to to get those thoughts. >> ECMO stands for extra corprial membrane oxygenation. Yorkill is the only hospital in Scotland that offers this care. However, because of the existing damage to Naim's lungs, even the ECMO machine may not be able to save him. And so ECMO will um support his lungs and um enable us to take carbon dioxide out of his bloodstream and give oxygen into his bloodstream. So it'll offer uh him time to see if his lungs will get better. That time's limited. So we need to to step in now. If we leave it longer, our our our window for effect is closing. So we need to step in and do that tonight. His chance of survival um on Echo, I would estimate, are about 25% chance that he's going to make it. if we don't put him on on Echo, I think his chances of of making are much smaller. You five 10 percent something like that. So, in discussion with all the rest of the the team, we've agreed that we would offer ECMO. Um, but there's significant risks to to to doing that and the parents are fully aware of those risks. >> ECMO is only offered in the most extreme circumstances. Surgeon Carl Davis will perform the surgery to put Naim onto the ECMO machine. It's a delicate procedure which can be lifethreatening especially on such a young [music] and baby won't >> be needed until such time. >> Tell me when you >> we're going to be putting the main canula in. It's a 16 in bike. >> Under anesthetic tubes are inserted into his jugular vein. He was rock stable during it. But a lot of times when we're doing this, we have patients who are are are um very unstable. So it's a kind of a race against time, but in this case, it was it was nice and controlled. And we we didn't really have any problems from that point of view. He was nice and stable throughout. Just >> now it's a matter of waiting to see if Naim will improve. >> This virus has got to go through its natural cycle of of being is defeated by the body. We're not going to be able to do that. weaken the system by doing physiootherapy and such like. But essentially what we're doing is we're taking over his lung function, protecting his lungs while that natural process um takes place. And what we don't know is exactly how long that's going to be. >> Naim's parents have been waiting anxiously to see him. >> Okay, so Na's fast asleep. Okay, he's coped really really well with having the the tube put in. Okay, is actually you looks the same as it did before. So, we're still very very concerned about his lungs from just now and for the next several days. Um, we'll need to keep him on this machine. He will not be ready to come off the machine for at least a week. Okay? And while he's still on Echo, then there's significant risks to that that we talked about about bleeding, infection, and so on as well. Realistically, best case scenario is that we get him off ECMO off this circuit in a week, 2 weeks, 3 weeks. Okay? And we'll need to challenge him, challenge his lungs in in a few days time. And it might be a week's time, 10 days time before he's ready to be challenged. We'll give him time for the this the swelling and the inflammation and the injury to his lungs to settle down. And then at that point in time that once that's settled down, we'll see if we can get him off the machine. >> Okay. Ladies and gentlemen, [music] It's almost 6:00 a.m. [music] and Dr. Nandita has returned to York Hill with another patient. She's traveled 230 m north to Cave Nest [music] General Hospital in Wick to collect 10-year-old Lauren who is struggling to breathe. [music] An ambulance has brought them in from the airport. >> Okay. Lauren is being taken to the accident and [music] emergency department of the hospital. >> Lauren had an ordinary cough that worsened this afternoon. Concerned that she was struggling to breathe. Her GP called the retrieval team. >> She's been reasonably stable in in in the plane and uh we did have to nebilize her and give her some oxygen on route, but otherwise she was relatively stable. Uh so when we brought her here to AE and she's going to be assessed by uh the doctors here in AE and then they'll decide whether she warrants high dependency or whether she's okay to go to a ward. >> Are you comfortable there? >> Nandita hands over her patient to Dr. Christina Hari from the intensive care unit. >> So this is her first episode. Uh she does have hay fever >> and mom and sister have got hay fever. Okay. >> Uh her aunt and cousins have got asthma. >> Okay. So history anatomy. >> Yeah. She had a set of uses or gas her she's had a set of usernes and her >> it is essential that the receiving hospital have as much information as possible. The patient's medical history and any medication they have been given will help build a complete picture to assist planning their ongoing care. >> Now that Nandita has handed over her patient, she can return to Edinburgh. Since the call came [music] for Naim at midday, she's been on the go for 18 hours. At this point, her shift is definitely over. [music] >> It's been 6 days since Nandita transferred 9month-old baby Naim from Dundee to Glasgow. Naim has been on the echo machine ever since and his parents have been by his side throughout. Pray all the time and positivity of all my mom, my dad, my sister, everyone's on saying to me, "No, he will be okay. He will be okay. You stay positive. You stay positive." Na was [music] born prematurely and developed chronic lung disease. He's been struggling to fight off a virus that has affected his [music] chest. Doctors have concerns that his lungs may not recover sufficiently to enable him to be taken off the ECMO machine. >> You got to think positive for your baby. And they they they know what they're doing. They work day and night. When [music] we come here, they treat our baby like their baby. That that does make us more comfortable. Lauren is making a good recovery from her asthma attack. The journey from Wick to Glasgow bothered her more than the asthma. >> Didn't really like the airplane. It was weird cuz it was the first time I've been on an airplane. They were giving me uh oxygen to help me breathe cuz I couldn't really breathe very well on the plane. It started with a a sore a headache and then the next day I had a sore throat and a really bad cough. And then just last night I was I was struggling to breathe. >> I'm not quite sure yet home. >> A few days later, Lauren was discharged from York Hill and returned home to Wick. She was given drugs to help keep her asthma under control. Following her transfer from Edinburgh to York Hill, 2-year-old Millie underwent surgery. The absess that had formed in her lungs was drained. And after spending two weeks in the intensive care unit, she made a good recovery and was allowed home. After 2 weeks on ECMO, Naim's condition failed to improve. He suffered severe bleeding in his brain and under the advice of doctors, his parents consented to the ECMO machine being switched off. Naim died aged just 9 months. Several months later, Naim's parents felt able to talk about their loss. Lame born on 8th May and at that time uh he was premature and his weight is hardly 900 g. He's so tiny, so cute baby. And uh I feel like I always keep saying mama's mama's life, papa's life. It looks like life is going like very beautiful and very happy and hopefully he's getting better and everything will be okay. >> Naim was never well enough to leave the hospital, but his parents were by his side every day. every time I visited him and uh she and me especially me I used to do it then you know eyes and nose and lippy so when you when you say lippy he take you he take his tongue out so it's mean he's happy that was the most uh touching my heart that thing our life was only based on our son >> lot of pictures I have and always thank God that he gave me such a beautiful boy. On average, the [music] transport team makes 300 retrievalss every year to bring children to either Glasgow or Edinburgh for crucial life-saving medical intervention. Despite having the best doctors and nurses and state-of-the-art equipment, [music] it's a sad reality that not all children can be saved. >> [music] [music]