In the intense world of medical emergencies, >> one patient, three times stab wounds. >> There's nothing more extreme than a code red. >> Is a twocar RTC. >> That's correct. >> It means there's an immediate threat to life. >> One male still trapped in a vehicle. >> In the West Midlands, a highly specialist team are on call 24/7, ready to race to these major traumas. >> 4 minutes >> by road and air. 03. We are lifted from Coswood. >> Responding to the most severe 999 calls. >> Open up the Lucas device over there for me. >> Day and night. >> All right. Well done. >> From car crashes. >> Just need to check >> to stabbings. >> You going to put some oxygen on your pal. >> Here, where time is critical, lives will be saved. >> On roadsides, in back gardens, and inside homes. >> Okay. Coming off the chest. These emergency doctors and paramedics use cuttingedge trauma techniques and surgery normally only seen in operating theaters to save people from almost certain death. >> Sorry, mate. >> I know, mate. I know. We're going to sort you out. >> Filmed over two months with the critical care team. >> Ready, set, slide. >> We captured every vital second as these specialist crews work to save lives. >> On roll. Ready, steady, roll. Tonight in a rush hour collision, a motorcyclist is thrown head first from his bike. >> Mate, can you hear us? He hasn't got a radio pulse. Is he breathing? >> A builder's leg is sliced open. >> That piece of metal has gone through your skin. Can see my soul in fracture tissue. >> A man in cardiac arrest. >> Anything on that ECG? and medics lives are in danger as they treat a patient with suspected corona virus. >> Hi guys. Um we're not going to come in just yet. We're just going to have a chat to you if that's all right. >> Clear guard breathing filter. >> It's Monday morning and the start of shift for Pete Edwards. I don't know whether I'm a morning person. I, you know, the f first hour or so I take a little bit to warm up. >> He's been working in the ambulance service for 15 years. The last two as a highly trained critical care paramedic. >> It's just the initial getting up, isn't it? Get a cup of coffee and that's it. It's all it's all it's all good. Then get the vehicle checked and then it'll be on to uh crew welfare as we call it. But today there is no time for any morning cuppper service. Is the patient breathing? >> Let me just go over that. Is he breathing? He is breathing. >> Are they conscious? >> Uh, no. He's unconscious and he's bleeding quite badly. His helmet's come off. got a severe gas burn the top of his head. >> Was it a car versus a motor bike? >> Yeah, car versus mountain bike. >> We're heading towards a patient that has been reportedly hit by a car. The initial call said the patient was in cardiac arrest. So, it obviously sounds quite serious. An ambulance has already been dispatched, but the biker is thought to be so badly injured that Pete and another critical care team are being sent to give life-saving treatment. >> Because of the nature of the job, they've also responded Helmed 03 uh with a medic on board and that'll be coming from Cosford. >> Helmed 03, a Midlands Air ambulance, is also scrambled. On board is another critical care paramedic and a trauma doctor qualified to carry out roadside surgery. >> 62 at scene. >> Once on scene, Pete is briefed by the ambulance crew. >> Hi guys. >> Hi. >> How are we doing? >> Helmet came off in the crash. >> Has he been speaking to us? >> Not at all. He's been like since we got it. >> Okay. 21-year-old Curtis has been thrown from his motorbike after colliding with a car in the impact. His helmet came off before his head hit the road. >> Okay. >> He's a bit agitated, isn't he? >> Agitated. >> Curtis has a severe head wound. >> It's quite common when we get this sort of patient, big head injury, start getting agit. He doesn't It's not intentional. He doesn't know what he's doing. He's got a really reduced level of consciousness. He says he got a radial pulse. >> Okay, let's see if he'll tolerate an oxygen mask. All right, >> let's pull his stuff out. >> Yeah, that's it. We'll see if we can get him onto the uh scoop as best we can. His GCS, his eyes are open. >> To try and evaluate him, Pete uses the GCS or Glasgow coma scale. >> Mate, can you hear us? usual hazards. >> A scoring system that helps describe the level of consciousness. A normal score for speech is five. >> Verbally, it's probably a to his knee. >> Further indication that Curtis may have a traumatic brain injury. >> We want to protect his brain and by taking over his ventilation and us doing it instead of him, we can protect his brain and stop it swelling. Hopefully, that means putting into an induced coma. Breathing automatically with a ventilator will allow Curtis's brain time to rest, calming the swelling. But an induced coma is a risky procedure, usually only carried out in hospital. >> Are we treating it as life-threatening this time? >> I would say it's got the potential for that. Yeah. The critical care team carry drugs and anesthesia normally only used in hospital operating theaters and intensive care units. >> We start the interventions that they start in hospital. We start them early and get people to hospital in the best shape that that we can. >> I'm just going to get some mazzlam and then at that point we'll put them onto my ventilator cuz it's just got it's just a bit better for them if that's okay. >> In cardiac arrest cases, these roadside treatments can make the difference between life and death. Ambulance services. Is a patient breathing? >> He's passed out. I can hardly feel him breathing. >> So, he's not breathing very often at all. >> No. >> You at home? >> Yeah. I'm He's sitting in the car. The next door neighbors. >> Okay, cool. Brilliant. Put your neighbor on the phone for me. >> Hello. >> Are we able to get him out of the car and onto the floor? >> We can do. Yes. >> Do that straight away for me. >> You need to start doing some basic life support. >> Uh oh my god. I've never done this before. >> I can talk you through it, sweetheart. What I need you to do is start pushing down hard and fast. Okay. Need to go two times a second. >> One. Yeah, that's it. Keep going at that speed. Fantastic job. >> One. Two. Now, don't worry about pushing too hard. Okay, keep your arms straight and just keep going for me. >> One, two. On it way. >> Yes, it's already on its way. I've got them coming to you as quickly as I can get them there. They are coming on blue lights. Okay. [Music] >> 8080 m west in field zone. >> An 80-year-old man is in cardiac arrest. As well as dispatching an ambulance, the code red emergency is passed to critical care paramedic Rob Davies. >> Go ahead. >> Yeah, basic. >> In cardiac arrest, the brain stops sending signals to the heart. It stops beating and oxygen ceases to pump around the body. Only one in 10 of hospital cardiac arrest patients survive. What was the call connect time, please? >> Yeah, call connect was at 1552. >> Yeah, 1552 call time. Yeah, roger. >> Without CPR, the brain can be irreparably damaged in just 6 minutes. >> The call connect time that I asked for is the time that the call comes into the ambulance service. So, that'll hopefully give me a fairly accurate time of when the cardiac arrest was identified. So, we're about 10 10 or 12 minutes into that. >> Rob arrives 14 minutes after the call, by which time the ambulance crew are already on scene. >> How we doing, guys? You all right? >> Yeah, good. How we doing? >> Still breathing for himself. >> Done. Brilliant. >> Feeling unwell, 8-year-old Keith asked his wife Monica to drive them home. As they arrived, he collapsed. Has he prescribed anything? Um, yes. But he stopped taking right. [Music] >> It's all in a quick time frame. He was making some gurgling noises. Fine. She's pulled up, got inside, called for us. Neighbor stopped to help. Okay. >> So, it's all in a quick time frame. >> A neighbor gave Keith CPR and got his heart beating again. >> He was making some respirator mild respirator during the CPR. One shot for 10 seconds. >> Beautiful. Good work. I'll just go and draw some drugs up. Right. So, the gentleman's had some bystander basic life support, some chest compressions. On the arrival of the paramedic, he's found his heart to be in a rhythm that he can shock. He's giving him a shock through the defibrillator. And now he's got a pulse back. I'm just going to drop a little bit of sedation just so that we can help with his breathing. Let's have him up on out then. Although Keith's heart is now beating, there's a danger it could stop again. >> And then we'll just place him on there. >> Up to 79% of hearts rearrest before reaching hospital. >> We got him up and away. >> Critical care paramedics like Rob are specially trained to fight those odds. >> Hold his arm there, Chap. I can't reach it. There we go. Right. So plan is then if somebody can stay in the back with me. What I'd like to do, we're going to have a little look and just see if we can give him a little bit of sedation and then just get him onto an eye gel. >> To ensure sufficient oxygen reaches his lungs, Rob must insert an eye gel tube down Keith's throat so the paramedic can control his breathing. >> Yeah. Chuck a bit of lube on it. >> Okay. So just go with him on that. Can you do the ECG? >> An ECG or electroc cardiogram records the electrical activity of the heart. >> Just give him a little bit of sedation just so that we can ventilate him a bit better. We might look at a bit more of that. Okay, let's have the rest of these clothes off. >> Uh, anything on that ECG? All right, chat. >> Georgie, how long to the QE? >> Uh, about 15 minutes. >> 15. Lovely. Smooth but rapid. Lovely. >> Keith is seriously ill, but Rob's goal is to get him to the nearest cardiac center alive. >> Okay. Still going against that a little bit, is he? We can go. [Music] Dr. Matt Rowley and critical care paramedic Tom Waters are starting their shift just as paramedic Kerry Pen Ashman is finishing hers. >> Remember your PPE. Remember to wipe over the car. >> These medics are used to facing danger. But at the outbreak of the Corona virus pandemic, the level has significantly increased. >> Following the Corona outbreak, how we approach people and how safe we've got to be has just completely changed. Corona virus has huge implications for us as health care professionals and it means that we're having to be more careful about how we protect ourselves. We're having to carry quite a bit of PPE which is personal protective equipment stuff that protects us against um this particular virus. Without PPE, patients might unknowingly infect the medics with COVID 19. And the medics might infect their patients with a deadly virus. >> Because there's a potential that we're going down to the patient's face, that we're going to do things that might mean that the the patient is going to get droplets of sputum, any sort of bodily fluid into our space. So, you have a hood that fits on onto your face that goes over the top of your head. And then you have a little um portion there that fits onto these sorts of respirators. And you put that on your face and that gives you quite a few hours, potentially about 6 hours um of good, clean air. >> For most of the critical care team, the need for PPE in the eye of a pandemic is a new experience. But not for paramedic Tom. Did Tom tell you was out when the Ebola outbreak happened as well? Went out to volunteer, didn't you? Bit of a hero, aren't you? Really? >> Ambulance service. Is the patient breathing? >> Not very well. >> Are they awake? No unconscious. >> How old are you? >> Is it regular breathing? >> No, he's not. Okay. >> He was just standing at the end of the bar. Just swap to the floor on the edge of the bar and he went unconscious. >> We're coming as quickly as we can. Don't be alarmed if they're coming wearing face masks. Okay. >> Okay. >> Not coming at all. A collapsed man with a suspected head trauma can be a category 1 emergency. >> Yeah, I can. That should have come through now. >> A local ambulance is almost at scene and 30 mi away, Tom and Dr. Matt are on route, but want to know if the patient could be a risk to them. >> Have we got any symptoms that are suspicious of COVID for this chat before uh we go anywhere near? >> I believe that was affirmative. He's high risk for COVID. He's come through as um coughing and difficulty breathing. >> As the patient has suspected corona virus symptoms, the medics need to wear their PPE, but it takes several minutes to put on precious time that could be used treating him. With the with the nature of um of what's going on at the moment, we need to make sure that we protect ourselves with our personal protective equipment and make a decision from there. >> Tom and Dr. Matt might need to save their patients life while knowingly risking their own. >> If we need to do advanced procedures and interventions, we will do them, but we have to balance that against the the personal risk and also the risk of not delaying that patient getting to a hospital. I think definitely when we get back we need to get the hoods and stuff out now. >> In Aubry, critical care paramedic Pete is treating 21-year-old Curtis, who has been thrown head first from his motorbike after colliding with a car. >> Let's just try and keep him as still as we can. All right, >> the impact dislodged his helmet and he now has a suspected brain injury. >> Pop his legs onto there. We'll get him on the stretcher. He's I think he's a bit hypotensive cuz I can't feel a radio pulse. Curtis's condition is so serious that he needs a trauma doctor to put him into a coma to protect his brain. But the air ambulance carrying one is still 8 minutes away. I think the priority right if we can get him on the back of the vehicle and we can do a proper assessment on we'll get some access. >> Curtis is losing blood from his head but his weak pulse indicates internal bleeding too. >> We'll get full monitoring on him. We'll see what his BP is. I suspect his BP might be low. So it may be that he needs some TXA. All right. If we could get some head blocks on just to keep his head still. All right. So >> you've got IV access. >> Nice one. All right. Is that the TXA? Is it? Yeah, >> Pete needs to give Curtis tranexamic acid or TXa, which helps prevent excessive blood loss. >> Let's get full monitoring on him if we can and let's see what his observations are. Let's cut his trousers off and get that skin-to-skin. All right. The doctor on board the air ambulance is now just moments away, but Curtis is deteriorating by the second. Is he breathing? >> Yeah. >> His rest is very shallow. >> It's obviously quite pearly. Let's get an airway in him if we can. What we might need is a BVM as well once we've got that. So, let's get that eye gel in first. >> 29 minutes after the 999 call. The Midlands Air Ambulance arrives with critical care paramedic Ryan James and trauma doctor Ben Taylor. >> He's collided with that car or the car's collided with him. throwing him off. His helmet's come off in the impact. He's got a big head injury. >> He's been spontaneously breathing, although he's very shallow. I'm setting up for RSI. >> I'll have you set up carry. >> All right. Yes, please. Yeah. Is that right? Sort of drugs out. >> He's had some TXA due to mechanism. >> Yeah. I've drawn some ketamine off. Um there's 160 left there, Ben. Because he's had 40. Yeah. My 200. The critical care team use a range of powerful anesthetics like ketamine not carried by ambulance crews. They can also perform procedures normally only done in hospital. >> Going to give an anesthetic just to um protect his protect his brain and give him the best possible chance of recovering from his injuries. Putting Curtis into an induced coma might give his brain precious time to recuperate and encourage any dangerous swelling inside his skull to subside. >> So finally RSI within the next 5 minutes >> to place Curtis into a coma. He first requires RSI, rapid sequence induction, an advanced critical care respiration procedure that Pete decides is safest to do outside the ambulance. because the process is is quite risky. We need to have 360° access. So if patient starts deteriorate for any reason or we're having difficulty with the airway, we've got good access and we're not sort of fighting over each other. >> Dr. Ben then prepares to put Curtis into a coma with two injections, a seditive and a paralyzing agent. >> BPM. >> Yeah. On reading at 3.0 Zero >> BP to start >> elasttoic with 127 >> and cycle set >> cycle set every 3 minutes automatic >> saturations. Okay, drugs going in now. >> Okay, fentinel's in. >> Okay, everybody ready? Okay, so oxygen mask is coming off. Okay, there's no loose teeth that we've seen. So, got the blade and I'm going to open his mouth as wide as I can. >> Going to go for the video first. >> Videoscope first with a size four blade. Okay, we've got a backup of a Mac 4. >> Yeah. >> Batteries check charges. >> Okay. >> A linja scope, a camera with a screen, allows Pete to look into Curtis's airway for obstructions. I'm going down the right hand side of his mouth, sweeping the tongue to the left, and I'm going to walk down as I go and looking for landmarks. I've got the epiglotus, but okay. Bit of suction, please. >> Suction. >> It's quite a lot of flame at the back of his throat. >> Okay, I've got a grade one view there. I can see the cords. >> With a clear path, the breathing tube can be inserted into the trachea. Okay, I think through the cords and the black line we are 22 at the teeth, Ben. Okay, we've got misting of the tube. >> Okay, I'm coming out with the blade. >> Cheers. Thanks. >> Curtis is now in an induced coma and breathing with the aid of a ventilator. Dr. Ben and the ambulance crew have done all they can. >> Just nice and steady, buddy. the importance of our services. Um, we're bringing some of the emergency department to the patient rather than the patient having to wait to get to the emergency department. He's been aniththetized a lot faster by us getting a doctor quickly to seeing. So, we've saved him some time and hopefully improved his outcome that way. [Music] Critical care paramedic Alistister McNeel has just come on shift and romance is in the air. >> Is Valentine's Day today, so whether we'll get any uh squables between couples, you never know. >> Paramedics are much more likely to deal with violent crime than lovers tiffs. Last year, there were over 90,000 in the West Midlands alone. Many ending with on street life-saving trauma treatment. >> I'll be father has beaten son with a pole potentially. The son has a hole in his head and he's bleeding. >> The son's 37 and the father is age 63. Is there a lot of blood there? Can we ask? >> The blood is dripping. Brain matter cannot be seen. Uh, however, there is a big hole. >> A violent assault likely to result in catastrophic brain injury is an immediate category 1 emergency. >> So, we're often addressing Dudley, uh, which is coming through as a serious assault. I believe somebody battered with a pole. With over 14,000 physical assaults a year on emergency workers, critical care paramedics like Alistister are in real and present danger. >> There's potentially some suggestion whoever's got this pole and has been battering somebody is still on scene or near to scene. I believe controller leazing with police for finding um a standby point for us. Six tur >> when you got to the junction where the Tesco is probably just pulling there. >> Yeah, mate. That's all received. I can picture where you mean uh speed. >> It sounds like there is somebody who's carried out potentially a serious assault. [Music] >> His patient may have potentially fatal brain injuries requiring urgent trauma care. But for his own safety, before Alistister can approach the scene, the police must declare it safe. >> The annoyance is that we could be delaying care here. The police know far more about this than we do. [Music] >> He collapsed, went to an arrest. He was still trying to ascertain um a BP. Critical care paramedic Tom Waters and trauma doctor Matt Rowley are on their way to a collapsed patient displaying symptoms of Corona virus and they've just heard that the man's condition has become critical. >> So there's a an ambulance crew on scene with a patient who has had a cardiac arrest. They've resuscitated him and managed to get his heart restarted again because his heart has been stopped for a period of time. There's been a lack of oxygen going to his brain. So now that his heart has restarted, he's quite agitated and combative and they're struggling to manage him at the moment. So we're going to try and intercept them on the way to the hospital and um see if we can offer anything potentially uh giving this man an anesthetic to stabilize his condition and transfer him onto a hospital. >> They've decided to meet the ambulance on route as it will save time and ensure the patient gets vital treatment as quickly as possible. We're going to make a one day view point for thinking M42 junction 9 at crew is leaving scene. So that looks like it's going to be the best place. >> The issue that we've got with this patient is they're quite a long way away. So the plan ideally is going to be for them to load the patient on the ambulance if it's safe and then travel towards us and us meet them on the way to hospital just to try and save delaying any time there. If we're looking um to RSI, it's going to be aerosol generating procedure. This triggers for high risk PPE. Um so that's four high PP. >> Yeah. All right. We are at the RVP. Anyway, we'll wait for the crew to get to us. If the patient's heart stops again, Matt and Tom may have to perform life-saving interventions in the closed confines of an ambulance on a patient suffering a killer virus. >> If so, they'll need their PPE, but it takes 10 minutes to put on. >> So, what we might do is just open the door, just chat to them, and then make a decision from there. >> Hi, guys. You all right? >> Um, we're not going to come in just yet. We're just going to have a chat to you if that's all right. From our understanding, it's a cardiac arrest. You've then shocked him or >> No, no shock. >> No shock. CPR. Uh, two lots of adrenaline. >> Okay. >> And we got a Ross back. >> Yeah. >> Went off again. CPR about 2 minutes. Come back across >> maintaining zone airway syn. >> I honestly think that by the time we've dawned is going to take us 20 minutes. >> So, I think if you're happy, we just drive. We'll follow behind you. It's not a point of us not wanting to do it, but I think by the time we've done it, >> we'll be there. Okay, perfect. Yeah, I'm over there. >> This patient has an airway is a GCS of 15 is Bradicardic. >> So, we have 10 minutes. >> Tom and Matt decide the best course of action is to follow the ambulance and not delay its journey further. So the plan currently is is to follow the crew into hospital. Should they need any assistance and we're here we'll have to pull over and have to get our PPE on. But ultimately the best thing for this chap to get into hospital as quick as possible. >> Pete just planning ahead. Um have you spoke to Harland? Cuz obviously if we put this in as a high-risisk COVID um it's going to put the hospital into probably a bit of a state of emergency. Have you had a discussion with Heartlands already regarding this? >> Um, I haven't. No, but I certainly can do. >> Emergency departments will have a protocol that they now follow for patients that will attend with suspected COVID 19. Again, that is probably going to tie up a significant amount of staff. So, it's probably going to need an RSI on arrival. So, again, if you do do the high-risisk CO thing, that'll be great. And we'll be there in just under 10. It's cumbersome and time consuming to put on, but over the next few weeks and months, the NHS will come to rely on supplies of PPE like never before. [Music] Quite rightly, the ambulance crew that had treated him had put their high-risk personal protective equipment on, which involves a suit, boot covers, and a respirator so that they're not breathing any any infected air or any infected air droplets around them. For us to do that would probably take around 10 minutes for myself and Tom to both put our PPE on. So that's 10 minutes wasted where the patient needs to be at hospital and at definitive care. So because the patient was relatively stable at this point, we made the decision not to delay things further, but to escort the crew to hospital with us being available should he need any interventions. >> The patient is transferred into a COVID 19 ready cardiac unit. Numbers at the moment pulse 115 1419 end tidle 4.2 two sats are 86% but he's cold >> in Hills Owen critical care paramedic Rob Davies is on route to hospital with 80-year-old Keith who is critically ill following a cardiac arrest >> go 50 um to start off with does that sound reasonable >> his condition is so serious Rob phones ahead to discuss his plans for treating Keith >> my plan is to give him some rockuronium just so that I can just better ventilate [Music] Rockeronium bromide or rock relaxes the muscles and allows the team to completely control Keith's breathing and optimize the oxygen getting into his body which is vital after a cardiac arrest. >> He's probably uh 80 kilos something like that. So 50 seems about reasonable doesn't it? We got a good entital trace. >> A correct dosage is crucial. Essentially, what we're trying to do is buy some time to keep the major organs oxygenated, primarily, you know, the brain, heart, and lungs. >> I'm going to have that out to some vomit there. >> But Keith's condition worsens when he begins to vomit. >> Okay. >> To prevent him from choking, Rob uses a suction probe to clear Keith's mouth and throat. >> Let's just have the You got it there. I'll just go down the side. So the end title I think is blocked now. You can hear it. Yeah. >> Vomit blocking his ventilation tube could starve Keith's brain and other vital organs of oxygen. >> Just going to get a new [ __ ] [Music] That's what we're going to do. Just going to swap that out and swap that straight onto there. Okay. So if you vent on that, that one can go on the floor. We got entitle back. Airway cleared. Keith stabilizes and now has a chance of survival. Early bystander CPR and early defibrillation make a massive difference into this patient group. By doing that CPR, we then have a viable heart which to shock. Um, if if nothing was done for that gentleman, I think it would Well, no, it would be a very, very different outcome. >> What I'd like to do is just strip all this off him. Doesn't need these. >> 52 minutes after the 999 call, the ambulance arrives at hospital where Keith is handed over to the team in A&E. >> Okay, let's go. Uh, so he's got pulse back. We tried to sort his airway out. It's quite difficult. >> He's on a ventilator. It'll be 24, 48 hours, I think, before they perhaps try and wake him up and see how he is um neurologically. Critical care paramedics undergo 2 years of specialist training for code red emergencies. >> Right, we're going to cut this off. Whether it's resuscitating a person in cardiac arrest or saving someone after a horrific accident. >> Doing a great job. Well done. Nice deep breaths. Nice deep breaths. Keep going. >> 762. Go ahead. >> And a call's just come through. That's about to test the trauma skills of critical care paramedic Steve Mason. >> Roger. Thanks a lot for that. Ambulance service. This is a patient breathing. >> Uh, yes. What's happened? >> Um, had a cut leg. Quite a bit of blood loss. >> What's a basement construction site? Cut his leg on something down there. >> How much blood did you say he's lost? >> Fine. >> Don't move him. We'll be there as soon as we can. Accidents on building sites can be extremely challenging for the critical care teams. Dealing with life-threatening injuries in hazardous environments cause for calm under pressure. An ambulance crew is already on scene, but because of the potential severity of the accident, critical care paramedic Steve is also on route. >> Uh 62 just arriving on scene. Is there any other resource on Steve? Uh the crew booked in attendance 1406 over >> soon after the hoarding. Take a left. >> Okay. Cheers buddy. Thank you. >> Arriving at the site of a large office block development. Steve is directed down to the basement level. >> Roger made contact. >> Lift up with his good leg. >> There we go. shifted across onto here. >> 59year-old Mark is being looked after by colleagues who bandaged the wound with a towel to try and stop the bleeding. >> Step back. >> What? >> It's not really sharp, is it? Quite sharp. >> It's not not even sharp, is it? It's just >> Yeah. Yeah. Mark was carrying some pipe when he fell 2 m onto the end of a scaffolding pole which has sliced into his calf, leaving a wound at least 2 in deep. >> 62. Just a brief update. Got 59. >> Can't get any signal around here. So, >> with no signal underground, Steve is unable to contact the regional trauma desk to ask them to alert the hospital that Mark may need urgent surgery. The ambulance crew carry him out to the back of the ambulance where Steve can properly assess the wound. >> So, how did you do it? >> Trying to take some pipe down. I just lost my foot. >> So, he must have fallen down because it's it's not that sharp, is it? But because I suppose with your body weight falling down probably caused it to go through your car. Was it spurting, you know, or >> Well, I don't spurt it coming out pretty fast. >> Was it? >> He's already lost a pint of blood. If the wound is spurting, it means Mark might have cut a major artery. >> Just get ready just in case it starts spurting. >> In Dudley, there are reports of a serious assault, a code red emergency. >> Sounds like there is somebody who's carried out potentially a serious assault and could well come back to this address. So, don't really want to be in somebody's living room when somebody comes back with a a weapon. >> Critical care paramedic Alistister McNeel is awaiting police protection before he can approach the house. >> 62 paramedic, please. [Music] >> I'll go and have a look if they're happy. Once given the all clear, please give Alistister a brief assessment of the scene. >> It's 4:25 p.m. >> Hello. Do you all right? >> Yeah. >> Have we got a large hole in the head or not? >> Two males in here. Yeah. One's got an injury to his mouth. Look smacked in the face. >> Right. >> And the other one's got a the injury I can see on his head here. Bit of a wound maybe about that. >> Fair enough. Let's just come and have a look at him then. Okay. >> Yeah. Right, folks. What's happened to you both? >> He's got he got it to the head. >> Okay. >> Push to the floor and to the end. Yeah. >> Okay. Any weapons used on you? >> No. >> No. And is it literally just your heads that have been hit? >> Were you knocked out when this happened? Can you remember? >> Go remember. here. >> Harry says he and his son Alan were attacked on their way home from the pub, but no weapons were used. >> How much you had to drink? >> You remember? Or do you know, Harry? How much have you both had today? >> Few cans. Look at my nose. >> You just bought. >> A drunken brawl is not usually a code red emergency, but Alistister is concerned by Allen's demeanor. >> And while you've been with him, has he been drowsy like this? cuz he's a bit sleepy. Was he like that beforehand because of the alcohol or is this >> He's concerned Allan may have concussion, a type of traumatic brain injury. I >> guess we're heading towards Are we popping into hospital? Yay. Nay. I'd say probably yay because of the the drowsy. Yeah. Which comes to you, Alan. Are we popping you down the hospital? You're a little bit drowsy with a little bit of a lump on your head. >> Yeah. The problem Harry is he's a bit drowsy, isn't he? While we're talking to you and you're aware, >> he keeps sort of nodding off to sleep. >> I'm sorry to >> We really are not going to win, are we? I don't think we're quite at a point where we can force >> because Allan is just about conscious. The law says Alistister cannot make him go to hospital. >> We'd really like him to get some attention in hospital. Is what it is, I'm afraid. Just can't make them go anywhere. If you can't wake him up at some point in the next hour or two, you need to call 999. >> Okay. >> Yeah. Anything that's giving you serious concern, >> Yeah. >> we need to know and come back. >> Yeah. >> Make sure you ring us if something changes. >> Okay. >> And so we're bleeding quite a lot. Can you move your foot? Yeah. On a Birmingham building site, construction worker Mark has lost a lot of blood after falling and ripping open his right calf on a scaffold pole. >> And that's the only injury that you've got in your >> colleagues bandage the wound, but now critical care paramedic Steve needs to assess the injury and see if it requires immediate surgery. >> I'm going to cut your jeans up a bit, fell. >> Okay, >> so you get the the bandage ready. one of these. >> A serious arterial wound can result in death in 5 minutes. So, who did this? Your colleagues. >> Yeah, they did really well then to stop. >> Yeah, he's >> a little bit soaked. >> Okay. So, what we'll do, I'll cut it, keep the pressure on it, and then lift and then >> have a quick cursory look, >> you know. >> The soaked through temporary dressing is removed to reveal an 8 in wide gaping wound. >> So, let's cover it up so I can see muscle and fatty tissue. You know, it needs some cleaning at hospital. Probably need to go to theaters for it just to get it washed out. >> Yeah, >> that piece of metal has gone through your skin and gone to muscle uh sort of layers, but you've got good circulation. You got good movement. So, it's just an isolated injury. So, we're just going to find out the best hospital to take you. >> Yeah. >> Confident that Mark isn't at risk of bleeding out, Steve now wants to get him to hospital as quickly as possible. >> Hi, Ben. It's Steve. Uh, hi mate. >> Yeah, it's not very good. So, you got 59y old male patient that uh he was working up on a little bit of a height and then he's sort of fallen back and as he's fallen back his right calf has gone past a metal sort of sharp object uh and and sort of torn his right calf open, but is it's the whole length of his right calf. So, GS of 15, heart rate of 68, uh blood pressure of 167 over 73. It does look quite nasty. There's some skin loss. I'll probably think it's probably best to go to the QE just because of this injury. >> Mark's wound may require a skin graft, so he is sending him to the specialist doctors at Birmingham's Queen Elizabeth Hospital. >> So, you don't want any pain relief at all? You're happy? With the situation under control, Steve decides to leave Mark in the care of the ambulance crew for the journey to hospital. >> Needs to be good. >> Happy. >> Happy. Thank you. >> Look after yourself. >> Thanks a lot. Thanks. >> Yeah. >> No worries. All >> good. >> As Steve waits for his next emergency, he can reflect on how much worse things could have been for Mark. >> What we we need to be worried about is people suffering with catastrophic hemorrhage. So, if it had nicked an archery and they hadn't have got uh pressure on that to stop that artery from bleeding, then things could be a lot worse. But although it does look quite bad, you know, hopefully it'll make a a speedy recovery. [Music] Heat. Heat. 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