1
00:00:06,000 --> 00:00:07,720
[thrilling music playing]

2
00:00:11,120 --> 00:00:15,120
[Mamoun] Okay, guys, we have
a young male arriving by helicopter.

3
00:00:16,120 --> 00:00:19,240
A code black was declared 30 minutes ago.

4
00:00:19,320 --> 00:00:22,000
Should be here in two minutes,
helicopter's landing.

5
00:00:28,480 --> 00:00:33,760
The timeframe that is required
to save the patient's life is very short.

6
00:00:34,400 --> 00:00:37,520
Minutes, indeed seconds,
equal brain function.

7
00:00:42,520 --> 00:00:46,000
Like a Formula One pit stop,
it's absolutely critical

8
00:00:46,080 --> 00:00:49,240
that every member of the resus team
knows their role.

9
00:00:49,320 --> 00:00:51,920
Neurosurgery have now arrived. Anesthesia?

10
00:00:52,000 --> 00:00:53,800
Anesthetic consultant, Arch.

11
00:00:53,880 --> 00:00:55,720
-[Mamoun] Surgery?
-CC2, arm in.

12
00:00:55,800 --> 00:00:58,280
[Mamoun] Radiography, Mehmet.
Thank you very much.

13
00:00:58,360 --> 00:00:59,840
Stand by for the handover.

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00:01:00,640 --> 00:01:01,640
Just go ahead, please.

15
00:01:01,720 --> 00:01:04,320
[Jess] This is Jack. He's 34.

16
00:01:04,400 --> 00:01:07,640
At 15:20, he's been seen on CCTV

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00:01:07,720 --> 00:01:09,880
to be assaulted by someone
with a metal pole.

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00:01:09,960 --> 00:01:12,800
Hit around the head at least three times.

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00:01:12,880 --> 00:01:15,120
There are three wounds
to the back of the head.

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00:01:15,200 --> 00:01:18,280
He's got one large seven-centimeter wound
above the right eye,

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00:01:18,360 --> 00:01:20,880
and his immediate requirement
is a CT of his head.

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00:01:20,960 --> 00:01:25,440
Okay, guys, so in summary,
a potentially time-critical head injury.

23
00:01:25,520 --> 00:01:26,920
Blizzard out, scoop off.

24
00:01:27,000 --> 00:01:29,360
[man 1] Go on, lift. Ready, steady, lift.

25
00:01:29,440 --> 00:01:33,000
[Mamoun] There are very few emergencies
that are more life-threatening

26
00:01:33,080 --> 00:01:34,600
than a serious head injury.

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[man 2] So, the pupils are left-sided,
two, reactive but slow.

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00:01:40,120 --> 00:01:41,680
Right-sided, four.

29
00:01:41,760 --> 00:01:44,240
[Mamoun] CT is ready for us.

30
00:01:44,320 --> 00:01:48,320
In a code black,
the brain is under such extreme pressure,

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00:01:48,400 --> 00:01:49,760
the patient's life is at risk.

32
00:01:51,000 --> 00:01:57,074
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33
00:02:03,920 --> 00:02:05,360
[man 1] Ready, steady, move.

34
00:02:06,920 --> 00:02:11,200
[Mamoun] Get them on the CT scanner
'cause that's the key to the diagnosis.

35
00:02:12,800 --> 00:02:14,480
We'll be looking for fractures.

36
00:02:15,080 --> 00:02:17,160
We need to scan the patient's brain

37
00:02:17,240 --> 00:02:21,120
and diagnose the injuries
within the fastest possible timeframe.

38
00:02:21,200 --> 00:02:23,400
Every single minute is critical.

39
00:02:25,200 --> 00:02:29,040
[man 2] There's a fracture there.
The eye is completely torn.

40
00:02:30,640 --> 00:02:32,160
-There are some contusions.
-Yeah.

41
00:02:32,240 --> 00:02:33,600
Contusional hematomas.

42
00:02:35,040 --> 00:02:38,000
With so many fractures
in that orbital wall,

43
00:02:38,600 --> 00:02:39,800
it's a bit of a concern.

44
00:02:41,760 --> 00:02:46,440
The patient has skull fractures,
bleeding around the brain.

45
00:02:46,960 --> 00:02:49,080
Okay, let's get him back to resus.

46
00:02:49,160 --> 00:02:50,600
The brain is under pressure,

47
00:02:50,680 --> 00:02:56,120
risking the life-sustaining component
of the brain, which is the brain stem.

48
00:02:56,200 --> 00:02:57,760
[intense music playing]

49
00:03:02,760 --> 00:03:05,840
When you first encounter
a major trauma victim…

50
00:03:05,920 --> 00:03:08,000
With a pupil that's unreactive.

51
00:03:08,080 --> 00:03:10,960
…you're building a picture
of the injuries.

52
00:03:11,560 --> 00:03:14,040
You prioritize what you're going to do,

53
00:03:14,120 --> 00:03:18,480
and then you begin
to think of them as a person

54
00:03:19,320 --> 00:03:20,520
with a life

55
00:03:22,000 --> 00:03:23,560
and a family.

56
00:03:25,000 --> 00:03:29,400
That changes them
to a father, mother, or son.

57
00:03:29,920 --> 00:03:34,240
That's, without a doubt,
the most difficult aspect of the job.

58
00:03:35,120 --> 00:03:36,480
[gloomy music playing]

59
00:03:41,080 --> 00:03:45,120
[Fiona] I found out about Jack's assault
when we were on holiday.

60
00:03:47,080 --> 00:03:51,360
We were told that we really needed to get
to the hospital as soon as possible.

61
00:03:56,200 --> 00:03:59,840
I remember flying back to the UK,

62
00:03:59,920 --> 00:04:04,360
and looking at all the people around you
eating Pringles and having a drink,

63
00:04:04,440 --> 00:04:10,240
and how very, very different
the world inside my head was.

64
00:04:12,080 --> 00:04:13,400
This is our child.

65
00:04:14,600 --> 00:04:16,280
So I know how to steer now.

66
00:04:17,440 --> 00:04:21,200
[Fiona] Our only son,
and the middle child between two girls.

67
00:04:22,320 --> 00:04:26,560
He's a good brother.
He clearly loves his sisters.

68
00:04:27,960 --> 00:04:28,960
Hey, stop there!

69
00:04:30,320 --> 00:04:32,120
[Mark] And he's also a great uncle.

70
00:04:33,400 --> 00:04:36,720
He's always very much valued his family.

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00:04:37,880 --> 00:04:42,920
But in an instant, we had to face the fact
that we could lose our son.

72
00:04:43,840 --> 00:04:47,680
And the utter sadness, horror,
that we couldn't be there.

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00:04:54,800 --> 00:04:57,280
[Mamoun] The scan has so far
showed a skull fracture,

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00:04:58,080 --> 00:05:00,560
multiple fractures of the eye socket.

75
00:05:01,480 --> 00:05:03,080
We have some bruising on the brain.

76
00:05:03,160 --> 00:05:06,800
So, I'm worrying
about a blood clot forming,

77
00:05:07,560 --> 00:05:09,440
creating such pressure

78
00:05:09,520 --> 00:05:12,880
that the center of life,
the brain stem, is affected.

79
00:05:14,520 --> 00:05:17,320
Hi, Radiology.
It's regarding the code black trauma.

80
00:05:17,400 --> 00:05:19,960
Have you had a chance
to look at the images?

81
00:05:20,040 --> 00:05:24,120
The priority now is to keep the patient
sedated to protect the brain,

82
00:05:24,200 --> 00:05:26,920
and we'll move the patient
to the intensive care unit.

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00:05:31,000 --> 00:05:34,240
When you encounter
such cases of extreme violence,

84
00:05:34,320 --> 00:05:36,560
it's actually thoroughly distressing.

85
00:05:37,080 --> 00:05:42,720
What circumstances have led to this
is very hard to understand.

86
00:05:43,240 --> 00:05:46,960
And the group of patients
that's most affected by violence

87
00:05:47,480 --> 00:05:50,800
and more likely to commit violence,
they're unfortunately young men.

88
00:05:53,640 --> 00:05:59,200
Even aside from violence,
more men engage in risk-taking activities.

89
00:05:59,920 --> 00:06:02,680
Men are more likely
to be riding motorbikes.

90
00:06:02,760 --> 00:06:05,440
Statistically, they're engaged
in more traffic collisions,

91
00:06:05,520 --> 00:06:09,600
and that's why,
if you're a male under the age of 45,

92
00:06:10,120 --> 00:06:11,640
trauma is the top killer.

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00:06:15,600 --> 00:06:18,320
[man] Two-five-one-three,
it's a male being assaulted.

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00:06:18,920 --> 00:06:22,000
-[woman 1] Holy moly.
-[man] We've got help coming now.

95
00:06:22,760 --> 00:06:25,360
Every second, there's a new job
tipping in on the screen.

96
00:06:26,080 --> 00:06:30,240
This gentleman has fallen 15, 20 feet
onto part of the embankment.

97
00:06:30,760 --> 00:06:33,960
Alpha 216, hello, mate.
It's David on the APP desk.

98
00:06:34,640 --> 00:06:36,480
There's a lot of calls coming to London.

99
00:06:36,560 --> 00:06:38,400
-Medic two.
-[woman 2] Medic two, go ahead.

100
00:06:38,480 --> 00:06:41,200
[David] We have a limited number
of Advanced Paramedics.

101
00:06:41,280 --> 00:06:44,520
And so we can only really send them
to the most critical patients.

102
00:06:44,600 --> 00:06:46,280
[sirens blaring]

103
00:06:46,360 --> 00:06:48,720
[automated voice]
New incident details received.

104
00:06:49,400 --> 00:06:53,320
[David] APPs are integral
to London's major trauma system,

105
00:06:54,120 --> 00:06:56,400
and they're critical
to making interventions

106
00:06:56,480 --> 00:06:57,680
to save people's lives.

107
00:06:57,760 --> 00:06:59,080
[sirens blaring]

108
00:07:00,280 --> 00:07:02,760
When I go into work,
I have literally no idea

109
00:07:02,840 --> 00:07:04,400
what I'm going to be dealing with,

110
00:07:05,240 --> 00:07:07,000
especially in a city like London.

111
00:07:07,520 --> 00:07:10,040
[woman] We have a pedestrian
that's been hit by a bus.

112
00:07:10,120 --> 00:07:12,600
They're unconscious and bleeding
from their head.

113
00:07:13,520 --> 00:07:17,200
[Pete] But if you can look after
a traumatically injured patient in London,

114
00:07:17,920 --> 00:07:19,840
I think you can do it
pretty much anywhere.

115
00:07:19,920 --> 00:07:22,560
-[dramatic music playing]
-Six-two, mate. I'm mobile.

116
00:07:23,640 --> 00:07:28,120
A few years back, I was an RAF paramedic
deployed out to Afghanistan.

117
00:07:28,200 --> 00:07:31,400
And I will, to the day I die,
remember the feeling

118
00:07:31,480 --> 00:07:34,160
of getting off the aircraft
at Camp Bastion.

119
00:07:34,960 --> 00:07:36,880
The casualties
that I was managing was done

120
00:07:36,960 --> 00:07:39,400
in the back of a moving helicopter.

121
00:07:39,920 --> 00:07:42,360
The environment was utterly different.

122
00:07:43,840 --> 00:07:45,400
But the medicine isn't.

123
00:07:47,800 --> 00:07:49,200
[man] Did you witness what happened?

124
00:07:49,280 --> 00:07:50,720
[woman] He got hit by a van.

125
00:07:51,360 --> 00:07:53,480
Talk to me about
what's happening with his leg.

126
00:07:53,560 --> 00:07:54,960
Does it look deformed?

127
00:07:55,040 --> 00:07:57,400
Yeah, it looks as if it's hanging off.

128
00:07:58,200 --> 00:08:00,560
I think this is almost definitely
gonna be for us.

129
00:08:01,240 --> 00:08:03,360
[man] We've got an APP close to the call.

130
00:08:03,440 --> 00:08:06,440
-[David] It's only 11 minutes away.
-[alarm blaring]

131
00:08:06,520 --> 00:08:08,560
[automated voice]
New incident details received.

132
00:08:09,760 --> 00:08:12,480
Six-two, mobile, 5.6 miles.

133
00:08:13,720 --> 00:08:17,600
There's so much crossover
between London and Afghanistan.

134
00:08:18,840 --> 00:08:23,040
If a patient isn't properly managed
in the first few minutes of their injury,

135
00:08:23,120 --> 00:08:26,560
the damage has already been done
before you arrive at the hospital.

136
00:08:27,080 --> 00:08:30,120
You need a response there
that can do everything it can

137
00:08:30,200 --> 00:08:33,480
to minimize the effect
of that life-changing event.

138
00:08:34,680 --> 00:08:39,040
All of the work I do is seeing people
on the very worst day of their lives.

139
00:08:39,760 --> 00:08:42,600
You almost act like a human lightning rod.

140
00:08:42,680 --> 00:08:45,120
You have to absorb a lot of the energy.

141
00:08:47,160 --> 00:08:49,320
Hi, everybody. I'm Pete.

142
00:08:51,000 --> 00:08:55,520
[man] This is Jared. He's a 26-year-old
who's been hit off his motorcycle.

143
00:08:55,600 --> 00:08:58,640
He's been flung about ten feet in the air,
landed on the floor.

144
00:08:58,720 --> 00:09:00,960
So tib fib, I think
we've got some critical skin,

145
00:09:01,040 --> 00:09:03,960
and we haven't assessed circulation
or sensation down there yet.

146
00:09:04,040 --> 00:09:07,320
[Pete] I'm gonna sort your leg out.
I know you're in a load of pain.

147
00:09:07,400 --> 00:09:08,720
I'm gonna help you with that.

148
00:09:08,800 --> 00:09:10,360
-Are you family?
-Mum.

149
00:09:10,440 --> 00:09:13,080
Hi, Mum. It don't matter
how old you are in life, buddy,

150
00:09:13,160 --> 00:09:15,840
when you hurt yourself,
everybody wants their mum.

151
00:09:15,920 --> 00:09:16,760
Okay.

152
00:09:16,840 --> 00:09:19,920
-Mum, I'm going to chop his pants off.
-Okay.

153
00:09:20,000 --> 00:09:21,720
Look away if it's something

154
00:09:22,280 --> 00:09:25,320
that it's been a few years
since you wanna see.

155
00:09:25,400 --> 00:09:28,200
I'll cover him.
I don't want to flash him to anyone.

156
00:09:28,280 --> 00:09:29,640
That's it. Well done.

157
00:09:29,720 --> 00:09:31,720
Have we given him anything so far?

158
00:09:31,800 --> 00:09:34,680
Do you mind giving him just
two and a half to start with?

159
00:09:35,200 --> 00:09:36,760
And then give him some ketamine.

160
00:09:36,840 --> 00:09:39,400
Get that leg straight and pulled straight.

161
00:09:40,720 --> 00:09:42,400
Looking at Jared's leg,

162
00:09:42,480 --> 00:09:46,240
straightaway, I know
this is a limb-threatening injury.

163
00:09:46,320 --> 00:09:47,400
[Jared groans]

164
00:09:49,200 --> 00:09:50,760
[Pete] There's multiple breaks.

165
00:09:51,640 --> 00:09:54,440
And if you don't manage
a fracture properly

166
00:09:54,520 --> 00:09:56,160
in the pre-hospital phase,

167
00:09:56,240 --> 00:09:59,840
you can start causing
lifelong irreversible damage.

168
00:10:02,240 --> 00:10:04,640
I am going to give you
a nice, strong painkiller.

169
00:10:04,720 --> 00:10:06,520
It'll make you feel a bit lightheaded.

170
00:10:06,600 --> 00:10:09,920
While you're away with the fairies,
I'm gonna sort your leg out, okay?

171
00:10:10,000 --> 00:10:11,560
[Jared] Is it gonna stop my heart?

172
00:10:11,640 --> 00:10:13,640
[Pete] I'm definitely not
gonna stop your heart.

173
00:10:13,720 --> 00:10:17,080
Of all the things I'm gonna do for you,
that ain't one of them, all right?

174
00:10:17,920 --> 00:10:19,720
So, that's the good stuff gone in.

175
00:10:20,320 --> 00:10:23,480
We must realign the leg
as quickly as possible

176
00:10:23,560 --> 00:10:27,160
to make sure that the broken bones
aren't obstructing the blood flow.

177
00:10:28,160 --> 00:10:30,480
Otherwise, he could lose his leg.

178
00:10:31,680 --> 00:10:33,440
So all we're gonna have now

179
00:10:33,520 --> 00:10:36,400
is Mum's voice only,
but we don't want to wake him up.

180
00:10:37,480 --> 00:10:38,760
You're doing good.

181
00:10:39,760 --> 00:10:42,360
[Pete] Okay, you got it?
I want one hand under here.

182
00:10:42,920 --> 00:10:45,040
And we're gently going to lift his leg up.

183
00:10:47,160 --> 00:10:48,600
-You ready, Owen?
-Yeah.

184
00:10:53,200 --> 00:10:54,240
Nice.

185
00:10:58,520 --> 00:11:01,400
One of the most important things
that's come out of Afghanistan

186
00:11:01,480 --> 00:11:04,800
is the learning around
traumatically injured patients.

187
00:11:06,000 --> 00:11:09,360
You're just gonna keep applying
that nice, gentle southward pressure

188
00:11:09,440 --> 00:11:10,920
and pop the hand there.

189
00:11:11,920 --> 00:11:14,800
What we want to do
is go to a major trauma center.

190
00:11:14,880 --> 00:11:16,200
[woman] King's is closest.

191
00:11:16,280 --> 00:11:17,400
Yeah, perfect.

192
00:11:17,480 --> 00:11:20,720
This learning that was captured
in the hardest possible environment

193
00:11:20,800 --> 00:11:24,440
is now being used
in the major trauma network across London.

194
00:11:25,280 --> 00:11:27,240
[Jared] Mum, I feel weird.

195
00:11:27,320 --> 00:11:31,400
It will feel weird.
You're naked on Peckham High Street.

196
00:11:32,480 --> 00:11:35,440
First time in your life?
I'll pick my street, yeah.

197
00:11:36,000 --> 00:11:38,880
Owen, let's extend the scoop
to its full length.

198
00:11:38,960 --> 00:11:39,960
He's a tall chap.

199
00:11:40,040 --> 00:11:42,160
I tell the females 5' 11".

200
00:11:42,240 --> 00:11:43,480
[paramedics laugh]

201
00:11:44,080 --> 00:11:46,200
[Pete] Ready, brace, lift.

202
00:11:46,280 --> 00:11:48,760
Down he comes.
Couple of seatbelts on him, please.

203
00:11:48,840 --> 00:11:50,280
And then onto your vehicle.

204
00:11:50,360 --> 00:11:52,840
[Jared] Mum, this is scaring me.

205
00:11:52,920 --> 00:11:53,800
I love you, Mummy.

206
00:11:53,880 --> 00:11:55,080
[mother] You've got drugs.

207
00:11:55,160 --> 00:11:56,400
[Jared] Mummy!

208
00:11:56,480 --> 00:11:57,920
-Meet you at King's.
-[Jared] Okay.

209
00:11:58,000 --> 00:12:01,240
All right? No, calm down. Breathe for me.

210
00:12:01,760 --> 00:12:02,600
In.

211
00:12:03,480 --> 00:12:04,600
Good lad.

212
00:12:04,680 --> 00:12:06,520
[Jared] I'm not cold but shivering.

213
00:12:06,600 --> 00:12:08,560
[Pete] Let's get the doors shut,
please, guys.

214
00:12:08,640 --> 00:12:10,160
We need to start making a move.

215
00:12:11,320 --> 00:12:12,600
[sirens blaring]

216
00:12:13,880 --> 00:12:16,920
-[Jared] Your name's Peter?
-[Pete] That's it. Well remembered.

217
00:12:17,000 --> 00:12:20,160
You've done a great job, my friend.
Thank you so much.

218
00:12:20,240 --> 00:12:22,120
Can I high-five you with my other hand?

219
00:12:22,200 --> 00:12:24,120
Where's your hand?
Can you coordinate that?

220
00:12:24,200 --> 00:12:25,840
There you go. That'll do us for now.

221
00:12:27,080 --> 00:12:29,040
How long you been riding
your motorbike for?

222
00:12:29,120 --> 00:12:32,080
[Jared] For ten, 11 years now.

223
00:12:32,160 --> 00:12:34,160
All right, nice and slow
with your breathing.

224
00:12:34,240 --> 00:12:36,880
Don't get yourself distressed.
Think nice, slow. That's it.

225
00:12:36,960 --> 00:12:38,320
Nice, slow, deep breaths.

226
00:12:38,400 --> 00:12:41,320
Jared's body will've absorbed
a huge amount of energy,

227
00:12:41,400 --> 00:12:45,480
and he's at very high risk of having
some really significant injuries.

228
00:12:46,400 --> 00:12:50,040
You can help me, Jared,
by just thinking about your breathing.

229
00:12:51,000 --> 00:12:52,880
This is a complicated injury.

230
00:12:54,360 --> 00:12:55,920
And he could lose his leg.

231
00:12:57,200 --> 00:12:58,640
This is not an injury

232
00:12:58,720 --> 00:13:01,800
that every hospital
in London is set up to deal with.

233
00:13:05,600 --> 00:13:09,320
Jared needs
that multidisciplinary specialist care

234
00:13:09,400 --> 00:13:11,720
that he will get at a major trauma center.

235
00:13:12,880 --> 00:13:16,160
And he needs world-leading
orthopedic surgeons.

236
00:13:16,240 --> 00:13:17,760
[dramatic music playing]

237
00:13:20,800 --> 00:13:22,680
[man] I'm of Egyptian origin.

238
00:13:22,760 --> 00:13:26,560
And in Egypt, they're known
for being master builders.

239
00:13:26,640 --> 00:13:30,440
Dude, am I doing the nailing, yeah?
I'm doing the nailing?

240
00:13:30,520 --> 00:13:33,040
So, it's in my blood, yeah. [chuckles]

241
00:13:33,120 --> 00:13:34,680
The plan is to straighten it out.

242
00:13:35,400 --> 00:13:37,800
Orthopedic surgery, it's a craft.

243
00:13:37,880 --> 00:13:41,360
You have to be able
to be in tune with your tools.

244
00:13:42,080 --> 00:13:44,520
The drill. That's my favorite.

245
00:13:46,200 --> 00:13:48,920
What we do is we straighten bones.
We fix them.

246
00:13:49,440 --> 00:13:52,400
What I love about it
is the fact that the patient

247
00:13:52,480 --> 00:13:54,120
who's in pain and discomfort…

248
00:13:54,200 --> 00:13:59,520
The shift between that and getting better,
it's an immediate thing.

249
00:14:00,480 --> 00:14:02,920
Nothing in medicine
gives you that immediacy.

250
00:14:05,480 --> 00:14:08,280
Good afternoon. This is 26-year-old Jared.

251
00:14:08,360 --> 00:14:10,600
He was the solo rider of a motorcycle

252
00:14:10,680 --> 00:14:13,080
negotiating through traffic
on Peckham High Road

253
00:14:13,160 --> 00:14:14,920
when he collided with another vehicle.

254
00:14:15,000 --> 00:14:19,200
Injuries, he has an open,
comminuted, distorted fib.

255
00:14:19,280 --> 00:14:20,280
[woman] Okay.

256
00:14:20,360 --> 00:14:22,560
[Pete] Posterior, somewhere
next to his sub-Achilles,

257
00:14:22,640 --> 00:14:25,440
is a two-to-three-centimeter
puncture wound,

258
00:14:25,520 --> 00:14:28,160
which looks like it's been done
by bone coming out.

259
00:14:28,680 --> 00:14:32,560
[groans] I think the drugs
are finally coming out of my system.

260
00:14:32,640 --> 00:14:33,480
I don't know.

261
00:14:33,560 --> 00:14:35,400
[woman 2] Don't worry.
I've got plenty more.

262
00:14:35,480 --> 00:14:37,560
-Can we have the scoop off, please?
-Yeah.

263
00:14:38,560 --> 00:14:39,800
[Jared groaning in pain]

264
00:14:39,880 --> 00:14:41,520
[man] Well done.

265
00:14:44,480 --> 00:14:46,280
[woman 3] We'll do a CT scan.

266
00:14:46,360 --> 00:14:49,320
Can we get ortho
to check the neurovascular status?

267
00:14:50,000 --> 00:14:52,400
Hi, my name's Remi.
I'm one of the orthopedic doctors.

268
00:14:52,480 --> 00:14:54,960
I want to have
a brief examination of your foot

269
00:14:55,040 --> 00:14:56,600
before you run off to the scanner.

270
00:14:56,680 --> 00:14:58,200
-All right?
-How am I gonna run?

271
00:14:58,280 --> 00:15:01,560
[Remi] That's it. Can you wiggle
both sets of toes for me?

272
00:15:02,280 --> 00:15:03,320
Close your eyes, mate.

273
00:15:03,400 --> 00:15:05,880
-Say yes if you can feel me touching you.
-[Jared] Yeah.

274
00:15:06,400 --> 00:15:08,520
[woman 3] We're doing
a full-body trauma scan.

275
00:15:08,600 --> 00:15:12,280
The reason is the mechanism,
the way the accident has happened.

276
00:15:12,360 --> 00:15:14,560
-[Jared groans]
-[Remi] Sorry, mate.

277
00:15:14,640 --> 00:15:17,320
[Saptha] We all know
that there's a nasty fracture.

278
00:15:17,400 --> 00:15:21,680
We may have to intervene imminently
so that we don't lose that leg.

279
00:15:22,880 --> 00:15:24,760
I think we have to take that down now.

280
00:15:25,520 --> 00:15:27,320
[Jared] Please, no. Don't amputate my leg.

281
00:15:27,920 --> 00:15:28,960
[Remi] Hopefully not.

282
00:15:29,040 --> 00:15:31,520
[Jared] Please. I'll die.

283
00:15:35,360 --> 00:15:37,000
[woman] I just saw Jared on the floor.

284
00:15:38,120 --> 00:15:40,240
And it was… Oh my gosh.

285
00:15:40,760 --> 00:15:42,480
[emotional music playing]

286
00:15:42,560 --> 00:15:43,920
I was scared.

287
00:15:44,520 --> 00:15:46,240
[Saptha] Ready, steady, slide.

288
00:15:47,040 --> 00:15:47,960
[Jared groans]

289
00:15:48,840 --> 00:15:50,320
I know he's a man.

290
00:15:51,320 --> 00:15:52,440
But he's my baby.

291
00:15:52,520 --> 00:15:53,760
He's my baby boy.

292
00:15:55,000 --> 00:15:57,200
[man] Jared, breathe normally, okay?

293
00:15:59,000 --> 00:16:01,480
[Tina] But he just kept on saying,
"Sorry, Mummy."

294
00:16:02,520 --> 00:16:05,040
He was really scared. [sobs]

295
00:16:12,440 --> 00:16:14,120
-[Tina] You'll be all right.
-Yeah.

296
00:16:14,200 --> 00:16:16,760
-Yeah?
-Don't cry. It's making me cry, bruv.

297
00:16:18,840 --> 00:16:21,240
I guess I can't take you out then,
you know?

298
00:16:21,960 --> 00:16:24,240
[Jared's sister] I guess not.

299
00:16:26,080 --> 00:16:27,080
But yeah.

300
00:16:27,600 --> 00:16:28,440
Yeah.

301
00:16:29,040 --> 00:16:31,680
[Remi] We've just had a report
from the radiologist.

302
00:16:32,320 --> 00:16:36,280
It's a fracture of both of the bones.
It's called your tibia and your fibula.

303
00:16:36,800 --> 00:16:41,680
Overlying that is a laceration or a cut,
which is more complicated.

304
00:16:41,760 --> 00:16:43,760
You're gonna need an operation here.

305
00:16:43,840 --> 00:16:45,200
[dramatic beat playing]

306
00:16:46,120 --> 00:16:49,720
[Saptha] Could you please leave ortho
to the major trauma and resus now?

307
00:16:51,640 --> 00:16:53,440
[Ibraheim] So, this is Jared's scan.

308
00:16:54,080 --> 00:16:55,880
He's got quite a nasty injury.

309
00:16:56,480 --> 00:16:59,000
It looks like his bones exploded.

310
00:17:00,640 --> 00:17:03,840
And not only exploding,
but the fragments coming through the leg,

311
00:17:05,040 --> 00:17:09,120
tearing through the muscle of the skin,
creating what's called an open fracture.

312
00:17:09,200 --> 00:17:10,640
This is a serious injury.

313
00:17:12,240 --> 00:17:13,920
If the operation doesn't go well,

314
00:17:14,440 --> 00:17:16,760
Jared might not be able
to walk properly again.

315
00:17:19,960 --> 00:17:21,120
[alarm blares]

316
00:17:35,920 --> 00:17:37,960
[Mamoun] Jack is
a seriously injured patient,

317
00:17:38,040 --> 00:17:40,760
having been struck on the head
with a metal bar.

318
00:17:40,840 --> 00:17:43,360
He's been in ICU for two days.

319
00:17:44,400 --> 00:17:47,440
My colleagues are lightening his sedation
to wake him up.

320
00:17:50,520 --> 00:17:52,640
This is always a crucial time.

321
00:17:54,480 --> 00:17:56,160
Our job now is to prioritize

322
00:17:56,240 --> 00:17:58,640
his next sequence
of operations and procedures

323
00:17:58,720 --> 00:18:03,880
to get him back as close as possible
to who he was before this injury occurred.

324
00:18:07,960 --> 00:18:11,680
[Jess] The tube has come out,
so he's no longer on a ventilator.

325
00:18:11,760 --> 00:18:13,160
He's breathing for himself.

326
00:18:14,200 --> 00:18:16,680
But Jack could have
life-changing injuries.

327
00:18:18,280 --> 00:18:23,040
As well as being a flight doctor,
I'm also a consultant in critical care.

328
00:18:23,120 --> 00:18:27,640
Having, like, a true understanding
of the journey that patient's been on

329
00:18:27,720 --> 00:18:29,200
is really beneficial.

330
00:18:31,160 --> 00:18:32,960
Hi, how are you doing?

331
00:18:33,040 --> 00:18:34,640
-[Jack] Yeah, not too bad.
-Good.

332
00:18:35,360 --> 00:18:36,560
And how's your pain?

333
00:18:37,200 --> 00:18:39,000
I mean, yeah, it's not as bad.

334
00:18:40,360 --> 00:18:41,520
Obviously the right eye.

335
00:18:42,120 --> 00:18:43,960
I'm seeing, like, what looks like a…

336
00:18:44,480 --> 00:18:47,160
I can describe it as a spider's leg
coming out of this eye.

337
00:18:47,240 --> 00:18:48,280
Okay.

338
00:18:48,960 --> 00:18:51,800
Biggest concern
for us right now with Jack is

339
00:18:51,880 --> 00:18:56,360
that he's got multiple facial fractures,
mostly around the eye socket.

340
00:18:56,960 --> 00:19:00,600
This could lead
to long-term disfigurement to the face,

341
00:19:01,120 --> 00:19:03,600
and Jack may lose the vision in that eye.

342
00:19:05,000 --> 00:19:07,880
He will need urgent surgery
to have those fixed.

343
00:19:09,400 --> 00:19:13,160
You're gonna be seen by max fax,
the maxillofacial surgeons.

344
00:19:13,240 --> 00:19:15,680
They look after the broken bones
in the face.

345
00:19:15,760 --> 00:19:18,000
So they'll be able
to look at it properly. Okay?

346
00:19:18,080 --> 00:19:20,000
-All right, you're doing well.
-[Jack] Thank you.

347
00:19:20,080 --> 00:19:22,000
[Jess] That's okay. My pleasure.

348
00:19:24,800 --> 00:19:28,120
There are jobs that sometimes
makes you think of somebody

349
00:19:28,200 --> 00:19:29,560
that you know or you love.

350
00:19:31,000 --> 00:19:34,120
And one of the things you realize
working on the intensive care unit

351
00:19:34,200 --> 00:19:36,320
is how these traumatic injuries,

352
00:19:36,400 --> 00:19:39,120
they have ripple effects
on the rest of the family,

353
00:19:39,200 --> 00:19:41,640
and how that can really impact everybody.

354
00:19:42,240 --> 00:19:44,200
-[Mark] Left or right?
-[Jack's sister] Left.

355
00:19:44,280 --> 00:19:46,120
I think they call him John in here.

356
00:19:46,640 --> 00:19:49,400
'Cause he was in that one.
That's the higher dependency.

357
00:19:50,360 --> 00:19:52,840
It's the first time I've seen Jack today.

358
00:19:53,600 --> 00:19:54,800
[woman] Do you need help?

359
00:19:54,880 --> 00:19:56,720
Yeah, we've just come to see John.

360
00:19:57,400 --> 00:19:59,280
[Mark] But I'm here with my daughter.

361
00:19:59,920 --> 00:20:01,320
We're a close family.

362
00:20:02,080 --> 00:20:03,480
[woman] Second door on your right.

363
00:20:03,560 --> 00:20:04,680
[Jack's sister] Thank you.

364
00:20:05,480 --> 00:20:06,960
[Mark] We're just shocked.

365
00:20:08,640 --> 00:20:13,000
I kind of know a bit of what to expect,
but I'm still nervous.

366
00:20:15,240 --> 00:20:16,320
[Jack's sister] Here.

367
00:20:16,840 --> 00:20:17,840
-All right?
-Yeah.

368
00:20:17,920 --> 00:20:18,880
-You sure?
-Yeah.

369
00:20:24,520 --> 00:20:25,400
[Jack] Yeah.

370
00:20:25,960 --> 00:20:29,120
[man] Just gonna head
to the window and back, and then…

371
00:20:29,640 --> 00:20:30,800
-Hello.
-[Jack's sister] Hello.

372
00:20:30,880 --> 00:20:34,720
Obviously if there's any dizziness,
just let me know, okay? Step this way.

373
00:20:34,800 --> 00:20:35,960
-This way?
-Yeah.

374
00:20:36,560 --> 00:20:38,760
-Good. You okay?
-[Jack] Yeah.

375
00:20:39,560 --> 00:20:40,880
[emotional music playing]

376
00:20:41,640 --> 00:20:43,040
[man] Breathe a little bit.

377
00:20:45,360 --> 00:20:47,640
And this is obviously
quite a significant change

378
00:20:47,720 --> 00:20:49,120
from your normal walking.

379
00:20:49,200 --> 00:20:50,840
[Jack] Just a little bit, yeah.

380
00:20:53,360 --> 00:20:55,520
-You're doing all right?
-[Mark] Yeah.

381
00:20:56,440 --> 00:20:57,560
As long as you are.

382
00:21:09,480 --> 00:21:12,000
-[Jacks sister] All right?
-[Mark] Yeah. I'm fine.

383
00:21:22,920 --> 00:21:25,040
-Is that the first time you've walked out?
-[Jack] Yeah.

384
00:21:25,120 --> 00:21:27,160
I didn't realize
you were gonna be out there.

385
00:21:27,240 --> 00:21:28,600
It's not the best look.

386
00:21:30,120 --> 00:21:32,960
-[Mark] We were your first audience.
-Yeah, I know.

387
00:21:33,480 --> 00:21:35,400
Sorry to bring you back from holiday.

388
00:21:35,480 --> 00:21:38,320
That's all right.
What's Italy compared with…

389
00:21:38,400 --> 00:21:42,800
What's 28 degrees of sunshine
compared with London?

390
00:21:44,240 --> 00:21:45,720
How much do you remember?

391
00:21:46,240 --> 00:21:48,240
[Jack] I only remember getting hit once,

392
00:21:48,320 --> 00:21:50,480
and then I lost all vision,
and it went black.

393
00:21:52,240 --> 00:21:54,600
[Mark] Maybe you don't want
to talk about that right now.

394
00:21:54,680 --> 00:21:55,840
[eerie music playing]

395
00:22:02,760 --> 00:22:05,000
[Jack] Last night, I didn't sleep
until 3:00 or 4:00.

396
00:22:06,440 --> 00:22:08,800
That was the first time the penny dropped.

397
00:22:08,880 --> 00:22:09,960
I could have died.

398
00:22:12,760 --> 00:22:13,600
[Fiona] Jack!

399
00:22:15,200 --> 00:22:17,720
[Jack] I've always been
pretty small in height.

400
00:22:19,800 --> 00:22:22,400
I took steps over the years
to mitigate that.

401
00:22:25,080 --> 00:22:28,880
By doing jiujitsu training, some boxing.

402
00:22:38,120 --> 00:22:41,080
-[Mark] Do you want your phone?
-I've got it on my lap here. Thank you.

403
00:22:44,680 --> 00:22:46,280
Tuesday afternoon,

404
00:22:46,920 --> 00:22:49,120
went to Tesco's up the road from my house.

405
00:22:50,680 --> 00:22:54,000
And I got into a stupid argument
with a man in the store,

406
00:22:54,720 --> 00:22:56,120
which just escalated.

407
00:23:01,320 --> 00:23:02,280
-[woman] You okay?
-Yeah.

408
00:23:04,200 --> 00:23:08,920
And I've seen the man running at me
with a metal pole.

409
00:23:09,760 --> 00:23:11,640
-[man] Can I examine you?
-Yeah, sure.

410
00:23:12,560 --> 00:23:13,560
Follow my finger.

411
00:23:15,440 --> 00:23:17,080
[Jack] And I decided to run.

412
00:23:18,400 --> 00:23:20,560
-[man] Any double?
-A little bit now.

413
00:23:21,680 --> 00:23:23,440
That's the last thing I remember.

414
00:23:27,640 --> 00:23:30,280
I've been struggling to sleep
'cause the incident's been…

415
00:23:30,360 --> 00:23:31,800
[man] Replaying over in your mind.

416
00:23:31,880 --> 00:23:35,440
And trying to think, "If I'd done this,
or if I'd done that." You know?

417
00:23:35,520 --> 00:23:37,800
-And then it's 4 a.m. and you're like…
-Yeah.

418
00:23:37,880 --> 00:23:40,280
But that's just the way it is.
I think that's natural.

419
00:23:40,360 --> 00:23:43,520
[man] Yeah, it is, but it's something
that we need to deal with.

420
00:23:44,480 --> 00:23:46,800
-Okay, buddy.
-[Jack] Thanks for your help.

421
00:23:48,360 --> 00:23:49,960
It was a pathetic argument.

422
00:23:50,640 --> 00:23:52,760
Shouldn't have got into a fight.

423
00:23:54,280 --> 00:23:58,040
I could have and should have
walked away from the situation.

424
00:24:00,160 --> 00:24:02,640
It's almost cost me my life.

425
00:24:11,160 --> 00:24:12,880
[David] Medic One, go ahead.

426
00:24:12,960 --> 00:24:16,320
One-fifty, all received,
bilateral open, clear pelvis.

427
00:24:16,400 --> 00:24:19,120
Medic One, thank you.
Ground escort to St George's.

428
00:24:19,200 --> 00:24:20,520
[sirens blaring]

429
00:24:26,040 --> 00:24:27,440
[Ibraheim] Hey, mate.

430
00:24:27,520 --> 00:24:29,240
It's been really busy.

431
00:24:30,200 --> 00:24:33,000
From the moment I wake up,
it doesn't stop.

432
00:24:33,080 --> 00:24:34,280
Dude, hiya.

433
00:24:34,360 --> 00:24:35,600
I'm on the phone.

434
00:24:35,680 --> 00:24:37,120
Absolutely.

435
00:24:38,480 --> 00:24:39,760
Speaking to colleagues.

436
00:24:39,840 --> 00:24:42,520
Umar, how are you? Good to see you, dude.

437
00:24:42,600 --> 00:24:46,240
About patients,
about operations, about life in general.

438
00:24:46,920 --> 00:24:48,960
So yeah, I'm always running behind time.

439
00:24:49,040 --> 00:24:50,280
Let's go.

440
00:24:50,360 --> 00:24:52,320
I need to master time management.

441
00:24:54,320 --> 00:24:55,760
Okay, shall we…

442
00:24:57,120 --> 00:24:58,880
[man] This is the first time he's on time.

443
00:24:58,960 --> 00:25:01,200
[Ibraheim] I know. [laughs]

444
00:25:02,320 --> 00:25:04,040
I think I lose track of time.

445
00:25:04,640 --> 00:25:06,400
But there's always something.

446
00:25:06,480 --> 00:25:09,000
I've had some really weird stuff
happen to me, like…

447
00:25:09,080 --> 00:25:13,280
I dropped the only key to my car
in the drain outside my house.

448
00:25:13,360 --> 00:25:16,160
It just went, "Plop."
And then I was like, "Oh."

449
00:25:16,240 --> 00:25:18,160
But I managed to get it.

450
00:25:18,800 --> 00:25:23,080
The council have this sort of service
where they come and suck it up.

451
00:25:23,160 --> 00:25:25,440
Got this big machine.
It came quite quickly.

452
00:25:25,520 --> 00:25:27,360
What are the odds of that?

453
00:25:27,440 --> 00:25:29,480
Go on, Remi. Present, please.

454
00:25:29,560 --> 00:25:30,600
[Remi] Thanks, mate.

455
00:25:32,240 --> 00:25:34,600
[Ibraheim] When it comes to
the way we operate,

456
00:25:34,680 --> 00:25:38,200
it's a collection of
some of the best minds in the country

457
00:25:38,280 --> 00:25:43,200
coming together and offering an opinion
on what's best for that patient.

458
00:25:43,720 --> 00:25:48,760
So Jared is a 26-year-old gentleman
who had a motorcycle versus car.

459
00:25:48,840 --> 00:25:53,640
He suffered an open fracture,
comminuted distal tib fib.

460
00:25:53,720 --> 00:25:56,400
Can you show us a picture of the…
of the wound there?

461
00:25:57,640 --> 00:25:59,440
[Remi] So, three medial wounds.

462
00:25:59,520 --> 00:26:03,160
There was what looked like tibia
basically protruding through the skin.

463
00:26:04,000 --> 00:26:05,720
[Ibraheim] Okay,
so we'll go down and start.

464
00:26:05,800 --> 00:26:06,680
See you there.

465
00:26:11,160 --> 00:26:14,520
This first operation
is so crucial and critical.

466
00:26:15,080 --> 00:26:17,080
It's fraught with a lot of danger.

467
00:26:18,760 --> 00:26:21,120
The most important thing
with open fractures

468
00:26:21,200 --> 00:26:23,200
is the decision-making.

469
00:26:23,280 --> 00:26:28,040
It's to decide
when to do definitive fixation

470
00:26:28,120 --> 00:26:31,800
versus temporary fixation
and come back another day.

471
00:26:31,880 --> 00:26:36,120
We'll be assessing the soft tissue,
and we'll be assessing the patient's limb.

472
00:26:36,960 --> 00:26:39,440
We'll make a decision on the table.
So at the moment,

473
00:26:39,520 --> 00:26:41,960
it could go either way. It's fifty-fifty.

474
00:26:44,960 --> 00:26:48,720
[Jared] I was travelling along
Peckham Road, and a van collided into me.

475
00:26:49,320 --> 00:26:53,360
I took out my phone,
and I called Mum instead of 999.

476
00:26:55,800 --> 00:26:58,520
I said,
"Mum, I just had my first accident."

477
00:27:00,200 --> 00:27:03,480
My family, it's just me, my two sisters,

478
00:27:04,240 --> 00:27:05,080
and my mum.

479
00:27:06,760 --> 00:27:08,600
[Tina] It's a bit of a windy stair.

480
00:27:09,280 --> 00:27:12,600
Mummy is pretty much
the most powerful person I've ever met.

481
00:27:13,120 --> 00:27:14,080
You know?

482
00:27:14,160 --> 00:27:16,200
And she empowers me. So…

483
00:27:17,000 --> 00:27:20,560
If I talk about her anymore,
it's gonna make me start crying. [laughs]

484
00:27:23,760 --> 00:27:25,080
[Tina] His little bedroom.

485
00:27:26,720 --> 00:27:28,400
It worked well, I think.

486
00:27:30,360 --> 00:27:33,320
These are all his clothes
that got cut off.

487
00:27:34,880 --> 00:27:36,920
That's his new leathers.

488
00:27:37,680 --> 00:27:39,680
It was an early birthday pressie.

489
00:27:40,880 --> 00:27:42,080
We are close.

490
00:27:42,160 --> 00:27:44,880
We've been through quite a bit together.

491
00:27:45,920 --> 00:27:47,480
We're quite a close unit.

492
00:27:48,200 --> 00:27:50,760
When one of us wobbles a bit,

493
00:27:50,840 --> 00:27:54,040
it's like, no, the rest of them
will hold you up for a while.

494
00:27:56,480 --> 00:27:58,040
See, and that's why,

495
00:27:58,560 --> 00:28:02,280
you tell everyone
to wear clean undies. [laughs]

496
00:28:03,040 --> 00:28:05,680
New, clean undies. Just in case.

497
00:28:10,040 --> 00:28:13,080
Jared brings the life in the house.

498
00:28:13,680 --> 00:28:16,280
He's got a beautiful character
that shines.

499
00:28:17,720 --> 00:28:19,600
[woman] Good luck with the procedure.

500
00:28:20,080 --> 00:28:23,680
[Tina] The operation,
it was really, really scary.

501
00:28:25,160 --> 00:28:26,880
He's my baby boy.

502
00:28:33,560 --> 00:28:37,400
[Ibraheim] In the operating theater,
the moment the lights go on,

503
00:28:38,840 --> 00:28:39,800
it's action time.

504
00:28:39,880 --> 00:28:41,680
[dramatic music playing]

505
00:28:41,760 --> 00:28:44,440
You're laser-focused on the task.

506
00:28:45,400 --> 00:28:48,760
[man 1] So, you'll start falling asleep.
Just keep on breathing now.

507
00:28:48,840 --> 00:28:50,120
We'll look after you.

508
00:28:51,000 --> 00:28:52,880
[Ibraheim] The level of responsibility

509
00:28:52,960 --> 00:28:55,560
on the shoulder of a surgeon
is substantial.

510
00:28:56,600 --> 00:28:58,160
Their life is in your hands.

511
00:28:59,240 --> 00:29:00,960
-Okay.
-[man 2] Let's do it.

512
00:29:05,040 --> 00:29:07,080
[Ibraheim] Scans only show us so much.

513
00:29:07,160 --> 00:29:10,960
The only way to really determine
what a patient needs

514
00:29:11,040 --> 00:29:12,680
is once you open them up.

515
00:29:17,120 --> 00:29:18,840
This is a high-energy injury.

516
00:29:18,920 --> 00:29:21,600
So, although the wounds are small
to start off with,

517
00:29:21,680 --> 00:29:25,200
when you get in there, you discover
that the muscle's all been ripped.

518
00:29:26,040 --> 00:29:28,880
You can see, actually,
that the bone is twisted and turned.

519
00:29:28,960 --> 00:29:31,040
That bone is flipped 180.

520
00:29:32,040 --> 00:29:34,200
[man 2] That's a massive
butterfly fragment.

521
00:29:35,680 --> 00:29:37,640
[Ibraheim] Can I have the bone nibbler?

522
00:29:37,720 --> 00:29:41,800
It's shocking just how much damage
that impact has caused.

523
00:29:45,280 --> 00:29:46,440
-[man 2] There you go.
-Wow.

524
00:29:46,520 --> 00:29:49,000
[man 3] So, we need
to remove the necrotic tissue.

525
00:29:49,800 --> 00:29:54,640
[Ibraheim] Leaving any of that dead skin,
muscle, and bone behind

526
00:29:54,720 --> 00:29:56,960
will increase the risk of infection.

527
00:29:57,480 --> 00:29:59,240
There's fragment in the canal.

528
00:30:00,000 --> 00:30:04,320
Because it creates this sort of dead soup
for bacteria to thrive off.

529
00:30:05,200 --> 00:30:08,360
[man 3] There's a chance
that some of this skin might die as well.

530
00:30:09,200 --> 00:30:12,200
[Ibraheim] Jared's extremely
vulnerable to infection,

531
00:30:12,280 --> 00:30:15,200
and this could eventually lead
to him having an amputation.

532
00:30:16,120 --> 00:30:19,120
Gosh. We've got an unstable ankle as well.

533
00:30:19,640 --> 00:30:22,480
So, he's what we call
circumferentially degloved.

534
00:30:23,000 --> 00:30:24,800
He's taken off his ATFL

535
00:30:25,480 --> 00:30:27,320
and stripped off all the ligaments.

536
00:30:28,040 --> 00:30:31,840
The muscle has been ripped off the bone
360 degrees.

537
00:30:31,920 --> 00:30:35,280
So, there's no longer any muscle
in contact with the bone.

538
00:30:36,680 --> 00:30:38,720
There's a saying that states,

539
00:30:38,800 --> 00:30:41,280
"A good surgeon knows how to operate,

540
00:30:41,960 --> 00:30:44,640
a better surgeon knows when to operate,

541
00:30:45,840 --> 00:30:48,680
and the best surgeon
knows when not to operate."

542
00:30:51,720 --> 00:30:54,960
It's gonna be ex fix, guys.
Can we get the Hoffman ready?

543
00:30:57,240 --> 00:30:59,720
Given the complexity of Jared's fracture

544
00:30:59,800 --> 00:31:01,720
and the soft tissue damage,

545
00:31:01,800 --> 00:31:04,280
we can't permanently fix
Jared's leg today.

546
00:31:05,640 --> 00:31:07,880
-Can we get a Langenbeck, please?
-[man 3] Yep.

547
00:31:07,960 --> 00:31:09,520
[Ibraheim] We need nine liters, guys.

548
00:31:10,360 --> 00:31:13,200
So today, I'm doing an external scaffold

549
00:31:13,280 --> 00:31:16,000
to temporarily hold the bones
out to length.

550
00:31:16,600 --> 00:31:19,440
We're using pins to drill
into the patient's leg.

551
00:31:20,560 --> 00:31:23,480
These pins provide
a strong hold in the bone

552
00:31:23,560 --> 00:31:26,120
to allow us to then put rods across

553
00:31:26,200 --> 00:31:28,080
to hold the bones stable

554
00:31:28,680 --> 00:31:31,400
so that it doesn't move
and cause the patient any pain.

555
00:31:34,680 --> 00:31:36,000
Shall we start the pins?

556
00:31:36,080 --> 00:31:37,280
[man 4] Yeah, ready. I'm ready.

557
00:31:38,680 --> 00:31:42,600
[Ibraheim] Let's look at the angle,
straight up and down, pop onto the bone.

558
00:31:43,120 --> 00:31:44,240
That's it. Go for it.

559
00:31:47,080 --> 00:31:48,360
We're a teaching hospital,

560
00:31:48,440 --> 00:31:51,760
so we get a lot of trainees
coming through our doors,

561
00:31:51,840 --> 00:31:54,880
and these are the future surgeons.
They will look after me one day.

562
00:31:55,480 --> 00:31:56,880
Maybe one more turn.

563
00:31:58,080 --> 00:31:59,400
That's perfect.

564
00:31:59,480 --> 00:32:00,920
So you have to ensure

565
00:32:01,000 --> 00:32:03,440
that you pass on your knowledge,
your skill set.

566
00:32:03,520 --> 00:32:04,640
Go on, drive it in.

567
00:32:04,720 --> 00:32:05,840
It's a duty.

568
00:32:05,920 --> 00:32:06,840
Just go there.

569
00:32:08,000 --> 00:32:10,920
You keep the finger on the trigger.
You don't let go.

570
00:32:11,000 --> 00:32:12,080
You're gonna hear "nyeh!"

571
00:32:12,160 --> 00:32:15,120
As it goes through the first cortex,
you're gonna feel the torque

572
00:32:15,200 --> 00:32:17,160
on your wrist. The pitch is gonna change.

573
00:32:17,240 --> 00:32:19,920
You're gonna hit the next cortex,
and then you let go.

574
00:32:20,000 --> 00:32:22,920
Once the pitch…
You understand what I'm talking about?

575
00:32:23,560 --> 00:32:24,720
Go for it.

576
00:32:26,920 --> 00:32:29,040
-Stop. That's it. Did you hear that?
-[man 5] Yeah.

577
00:32:29,120 --> 00:32:31,520
[Ibraheim] "Nyeh!"
Yeah, that's it. Wicked.

578
00:32:32,280 --> 00:32:35,080
I find a deep sense of pleasure

579
00:32:35,160 --> 00:32:40,120
when a person who I've shown something,
they can actually then do it.

580
00:32:40,200 --> 00:32:42,040
It's like a success story.

581
00:32:43,080 --> 00:32:45,520
Shot there. See where we are. Boom!

582
00:32:46,360 --> 00:32:48,080
Well done, yeah? That's very good.

583
00:32:50,560 --> 00:32:54,360
Today, we've debrided,
and we've put a scaffold on.

584
00:32:54,440 --> 00:32:56,680
This is a journey, you know,

585
00:32:56,760 --> 00:32:59,520
but I think the first step is
to make the right decision,

586
00:32:59,600 --> 00:33:03,000
which is what we've done today,
which is, we're gonna hold our nerve,

587
00:33:03,080 --> 00:33:05,240
we're gonna wait, we're gonna come back.

588
00:33:05,320 --> 00:33:07,360
And the next stage is the bigger stage.

589
00:33:08,400 --> 00:33:11,720
It's the stage which is
sort of, I'd say, highest risk.

590
00:33:11,800 --> 00:33:13,880
You know, he could still lose his leg.

591
00:33:14,640 --> 00:33:18,560
[woman] Jared, stay nice and still for us.
You're just waking up from your operation.

592
00:33:21,920 --> 00:33:23,480
[Ibraheim] See you later, dude.

593
00:33:25,560 --> 00:33:28,560
From the moment a patient
is picked up from the roadside

594
00:33:29,080 --> 00:33:30,960
to the moment they're discharged,

595
00:33:31,480 --> 00:33:35,000
several hundred hands have been involved
in the care of that patient,

596
00:33:36,360 --> 00:33:37,800
and everyone leaves their mark.

597
00:33:37,880 --> 00:33:43,000
And that's where the trauma system
works perfectly.

598
00:33:46,240 --> 00:33:49,760
Hands down, we outbid the world
when it comes to that.

599
00:33:59,720 --> 00:34:01,040
[sirens blaring]

600
00:34:03,600 --> 00:34:07,000
[man] …airborne on the hour.
We'll be there in two minutes.

601
00:34:07,080 --> 00:34:08,520
[intense music playing]

602
00:34:15,400 --> 00:34:17,120
[Fiona] How was your night?

603
00:34:17,200 --> 00:34:19,800
Yeah. I was a bit tired this morning,
but it's all right.

604
00:34:20,440 --> 00:34:22,640
-Tired, but not sleeping. Yeah.
-Yeah.

605
00:34:23,640 --> 00:34:26,520
[Jack] I've started having
very vivid dreams each night.

606
00:34:27,480 --> 00:34:30,000
Dreams where I was sort of being attacked.

607
00:34:31,640 --> 00:34:33,920
[Fiona] You are
in the best possible place.

608
00:34:34,000 --> 00:34:34,840
-Yeah.

609
00:34:35,360 --> 00:34:40,240
I think the next major step forward
is the appointment that we're going to.

610
00:34:42,560 --> 00:34:44,320
[intriguing music playing]

611
00:34:44,400 --> 00:34:46,040
-[woman] Good morning, Prof.
-[man] Hi.

612
00:34:46,800 --> 00:34:48,720
My job is to fix facial bones.

613
00:34:49,560 --> 00:34:53,440
Historically, we've been known
as tooth fairies, but that's derogatory.

614
00:34:53,520 --> 00:34:57,760
But these days, just "max fax"
is kinda the label that we adhere to.

615
00:35:01,560 --> 00:35:05,680
The thing about facial trauma
is that often it's initiated by violence.

616
00:35:06,400 --> 00:35:09,000
Knife wounds,
fisticuffs, and baseball bats.

617
00:35:10,080 --> 00:35:12,040
I've treated all sorts, good and bad.

618
00:35:13,600 --> 00:35:15,000
I've had a patient saying,

619
00:35:15,080 --> 00:35:18,120
"If you need anyone beaten up,
let me know. It would be a pleasure."

620
00:35:18,200 --> 00:35:19,440
"Here's my card."

621
00:35:19,520 --> 00:35:21,240
Which I declined, by the way.

622
00:35:24,600 --> 00:35:28,240
Most people, if they've had an accident,
would regret getting on the e-scooter.

623
00:35:28,320 --> 00:35:32,920
Would regret getting on the bike.
Would regret getting involved in fights.

624
00:35:33,800 --> 00:35:35,480
But there is an element of fate.

625
00:35:36,000 --> 00:35:38,920
It's important to understand
that you're not always in charge

626
00:35:39,000 --> 00:35:40,160
of your own destiny.

627
00:35:41,280 --> 00:35:43,400
My mission is to see people
come back to life,

628
00:35:43,480 --> 00:35:44,800
and come back to health.

629
00:35:45,320 --> 00:35:47,400
Come back to who they used to be.

630
00:35:51,000 --> 00:35:54,360
Jack has bits of broken face
that are all over the place.

631
00:35:54,880 --> 00:35:57,960
He has demolished
the roof of the eye socket,

632
00:35:58,040 --> 00:35:59,840
and his cheekbone is broken.

633
00:36:00,520 --> 00:36:03,720
So there's a definite risk
that his face can collapse.

634
00:36:04,760 --> 00:36:08,800
He has a problem with his eye movements
because there's damaged muscle and bone,

635
00:36:08,880 --> 00:36:11,760
which could cause significant damage
to his vision.

636
00:36:12,480 --> 00:36:14,240
But probably most important is,

637
00:36:14,320 --> 00:36:16,880
because of the immense force
that he experienced,

638
00:36:16,960 --> 00:36:20,000
there is a hole
between his brain and his nose.

639
00:36:20,880 --> 00:36:24,360
So, there's a definite risk
of complications from brain infections

640
00:36:24,440 --> 00:36:25,960
if this is left alone.

641
00:36:27,320 --> 00:36:29,800
We need to make sure that we seal the hole

642
00:36:29,880 --> 00:36:32,040
between his brain and his nose

643
00:36:32,120 --> 00:36:35,080
with his soft tissue,
and we have to rebuild his eye socket

644
00:36:35,160 --> 00:36:38,800
using bone fragments and titanium mesh.

645
00:36:41,880 --> 00:36:43,840
So, you'll be seeing
Professor Holmes today.

646
00:36:43,920 --> 00:36:45,280
-[Jack] How are you doing?
-Hello.

647
00:36:45,360 --> 00:36:47,160
If you want to come in and take a seat.

648
00:36:47,240 --> 00:36:50,000
So, first of all, I'm sorry
for what's happened to you.

649
00:36:50,080 --> 00:36:51,080
-[Jack] Thank you.
-Okay.

650
00:36:51,160 --> 00:36:56,600
And I'm very aware of
just how awful it's been for you.

651
00:36:56,680 --> 00:36:58,360
Do you remember it happening to you?

652
00:36:58,440 --> 00:37:00,760
I can remember the first blow, and then…

653
00:37:00,840 --> 00:37:02,640
-That was it? Okay.
-That was it.

654
00:37:03,360 --> 00:37:07,120
[Simon] All right. Rest your head back.
So, I'll just have a little look at you

655
00:37:07,200 --> 00:37:08,240
to start with.

656
00:37:08,320 --> 00:37:11,440
Your eyebrow's distorted
because the bone is out of the way.

657
00:37:11,520 --> 00:37:13,520
Open your mouth for me. Bite hard.

658
00:37:14,520 --> 00:37:16,160
Back teeth. Okay.

659
00:37:16,880 --> 00:37:19,640
And you've got an issue here, haven't you?

660
00:37:20,680 --> 00:37:23,640
You can see there's missing bone
just at the front,

661
00:37:23,720 --> 00:37:25,640
and there's a break at the back.

662
00:37:25,720 --> 00:37:27,440
So you were hit really hard.

663
00:37:29,880 --> 00:37:32,000
Your cheekbone has been pushed back.

664
00:37:33,160 --> 00:37:35,280
That's a marker of how bad that was.

665
00:37:36,440 --> 00:37:39,360
-Is it possible to get a glass of water?
-[Simon] Of course it is.

666
00:37:39,440 --> 00:37:41,840
[Jack] Starting to feel myself
start sweating all over again.

667
00:37:41,920 --> 00:37:42,760
[Simon] Okay.

668
00:37:49,080 --> 00:37:51,040
-Want me to lie you back?
-Yes, please.

669
00:37:51,120 --> 00:37:54,240
[Simon] What I'm gonna do
is just lift your legs up for you, okay?

670
00:37:54,320 --> 00:37:55,600
[emotional music playing]

671
00:37:58,440 --> 00:38:02,080
The psychological impact of trauma
cannot be underestimated.

672
00:38:04,960 --> 00:38:10,040
What can happen in a split second
can have ramifications that go on forever.

673
00:38:10,920 --> 00:38:12,600
-Feel better?
-A bit. Yeah.

674
00:38:13,360 --> 00:38:14,400
[Simon] Okay.

675
00:38:15,200 --> 00:38:16,400
Are you reliving it?

676
00:38:18,280 --> 00:38:20,760
-This is crap. I'm sorry.
-[Jack] Yeah, it's okay.

677
00:38:22,520 --> 00:38:24,320
[Simon] It's such a lot to take in.

678
00:38:25,600 --> 00:38:27,680
-We'll get you back.
-[Jack] Yeah, thank you.

679
00:38:31,880 --> 00:38:34,880
Jack has a complex operation ahead of him.

680
00:38:36,000 --> 00:38:38,920
I want to put him back together
physically,

681
00:38:39,000 --> 00:38:42,040
but also I want
to build him psychologically up as well.

682
00:38:42,560 --> 00:38:43,800
-Appreciate it.
-Sure.

683
00:38:44,720 --> 00:38:46,360
Trauma can happen to everyone.

684
00:38:48,080 --> 00:38:51,160
And I have my own experience with trauma.

685
00:38:53,400 --> 00:38:57,560
Dad was a dentist in Leicester
and a very kind man.

686
00:38:58,560 --> 00:39:00,040
[emotional music playing]

687
00:39:00,120 --> 00:39:03,680
He married the love of his life,
and they had an amazing marriage

688
00:39:04,240 --> 00:39:05,840
until they had a car accident.

689
00:39:10,560 --> 00:39:14,200
It was terrible coming to terms
with two amazing people

690
00:39:14,280 --> 00:39:17,240
who were suddenly torn from you,
potentially both of them.

691
00:39:19,040 --> 00:39:21,880
Dad didn't make it. Mum was badly injured.

692
00:39:26,720 --> 00:39:29,640
They preserved her life,
but she had a damaged eye

693
00:39:29,720 --> 00:39:31,680
and had terrible facial scarring.

694
00:39:34,120 --> 00:39:35,720
Which she has

695
00:39:36,960 --> 00:39:38,080
always remarked about.

696
00:39:39,280 --> 00:39:42,360
Mum's injuries very much cemented
the thought in my mind,

697
00:39:42,440 --> 00:39:44,000
"I must make this better."

698
00:39:49,520 --> 00:39:53,360
I want to give the patients
the chance that she never had.

699
00:39:57,360 --> 00:39:58,840
[Jack] I'm in the best place.

700
00:39:59,760 --> 00:40:03,200
I'll be asleep. Fingers crossed,
I don't wake up halfway through.

701
00:40:03,280 --> 00:40:04,760
[dramatic music playing]

702
00:40:10,000 --> 00:40:12,840
[Simon] The sort of surgery
that I perform takes a long time.

703
00:40:13,600 --> 00:40:15,440
And attention to detail is key.

704
00:40:17,240 --> 00:40:20,440
So, my presurgery drill
is a cup of coffee.

705
00:40:20,960 --> 00:40:25,320
And then another cup of coffee.
Usually Italian and usually very strong.

706
00:40:30,960 --> 00:40:34,320
What we're gonna do is we're gonna expose
his hole in his skull,

707
00:40:34,400 --> 00:40:40,120
and then my neurosurgeon will come in
and seal the brain from the nose.

708
00:40:42,040 --> 00:40:43,400
If we don't treat it,

709
00:40:43,480 --> 00:40:46,640
there's a definite risk of a serious
life-threatening infection.

710
00:40:47,960 --> 00:40:50,880
Then we'll remove
all the bits of damaged bone

711
00:40:50,960 --> 00:40:54,360
and build him
a new eye socket out of metal and bone.

712
00:40:58,600 --> 00:41:00,680
Well, I hope you've had your breakfast.

713
00:41:01,400 --> 00:41:02,920
This could take quite a while.

714
00:41:03,000 --> 00:41:04,560
[dramatic music continues]

715
00:41:06,440 --> 00:41:07,400
Okay.

716
00:41:08,000 --> 00:41:10,800
We start by separating the face
from the muscles underneath

717
00:41:10,880 --> 00:41:12,760
so we can get access to the fracture.

718
00:41:14,160 --> 00:41:16,040
You have to have a steady hand.

719
00:41:17,160 --> 00:41:20,120
We have to be very careful
that we make the depth of cuts

720
00:41:20,200 --> 00:41:22,080
at the right point at the right time.

721
00:41:23,680 --> 00:41:26,200
If you get it right,
it's like peeling an orange.

722
00:41:27,080 --> 00:41:29,520
You hear the rasp as the skin pulls away.

723
00:41:31,240 --> 00:41:32,960
I'm lifting the scalp off it.

724
00:41:37,000 --> 00:41:39,080
Until I see inside Jack's face,

725
00:41:39,760 --> 00:41:42,360
I don't really know what I'm gonna find.

726
00:41:43,640 --> 00:41:44,560
That's it.

727
00:41:45,600 --> 00:41:48,760
Okay, now, peel his face off.

728
00:41:54,400 --> 00:41:57,120
So we start to see the fracture
for the first time.

729
00:42:02,280 --> 00:42:04,760
It's so smashed.

730
00:42:08,840 --> 00:42:11,480
This is where we're all
gonna have to work as a team.

731
00:42:14,120 --> 00:42:17,000
Before I can do my job
to rebuild his eye socket,

732
00:42:17,720 --> 00:42:22,480
I need a neurosurgeon
to join us to seal the fracture.

733
00:42:24,120 --> 00:42:27,360
[Chris] The frontal air sinus,

734
00:42:27,440 --> 00:42:30,360
which is around here, has been fractured.

735
00:42:30,440 --> 00:42:34,000
Which means there is a very high chance

736
00:42:34,080 --> 00:42:38,800
the lining of the sinus
will start producing snot,

737
00:42:39,400 --> 00:42:43,640
which will press on his brain
and potentially be life-threatening.

738
00:42:46,800 --> 00:42:49,440
Can I turn his head a tiny bit towards me?

739
00:42:50,200 --> 00:42:51,400
That's great.

740
00:42:53,760 --> 00:42:57,840
[Simon] He's now gonna take away
through the hole all of the frontal sinus.

741
00:43:00,240 --> 00:43:04,560
[Chris] Okay. So, we're starting to see
the lining of the brain.

742
00:43:05,960 --> 00:43:09,200
Could I have bayonet forceps, please?

743
00:43:10,000 --> 00:43:13,600
[Simon] This tissue here
is the lining of his skull,

744
00:43:13,680 --> 00:43:15,680
and that's going to be pushed in the hole

745
00:43:15,760 --> 00:43:20,440
to seal the link
between the brain and the face.

746
00:43:22,040 --> 00:43:24,200
[Chris] Just watch your hand
because we can see light

747
00:43:24,280 --> 00:43:26,160
through the translucent skull.

748
00:43:27,520 --> 00:43:28,840
[man] This is his eyeball.

749
00:43:31,360 --> 00:43:32,840
[Simon] One of the major concerns

750
00:43:32,920 --> 00:43:35,960
about operating
close to a patient's eye sockets,

751
00:43:36,480 --> 00:43:40,200
we're right on the optic nerve,
the nerve that makes the eye see.

752
00:43:42,480 --> 00:43:43,800
If you get this wrong,

753
00:43:45,080 --> 00:43:47,520
then you could jeopardize
the person's vision,

754
00:43:47,600 --> 00:43:49,240
and they can go blind.

755
00:43:56,760 --> 00:43:57,920
[high-pitched drilling]

756
00:44:00,360 --> 00:44:01,440
[Chris] It's really good.

757
00:44:02,080 --> 00:44:04,080
We've taken the lining of the head

758
00:44:04,760 --> 00:44:09,520
and put it over the top of the nose
and the frontal sinuses.

759
00:44:11,160 --> 00:44:12,880
-Okay, perfect. Good.
-[Simon] Thanks, Chris.

760
00:44:12,960 --> 00:44:14,640
[Chris] That all looks good.

761
00:44:14,720 --> 00:44:15,960
-That's my part done.
-Yeah.

762
00:44:17,000 --> 00:44:18,600
Right, let's change place.

763
00:44:20,800 --> 00:44:23,240
[Simon] Right, Zeeshan.
We'll need two plates.

764
00:44:25,280 --> 00:44:28,320
What we have to do
is reconstruct Jack's forehead.

765
00:44:28,400 --> 00:44:29,800
Seven-hole, please, Captain.

766
00:44:31,600 --> 00:44:32,960
The fracture's difficult to repair

767
00:44:33,040 --> 00:44:36,360
because the bone fragment's
been shattered into microscopic pieces.

768
00:44:37,880 --> 00:44:41,920
There is no bone between the middle
and the side of his eye socket

769
00:44:42,000 --> 00:44:43,400
to hang anything on.

770
00:44:44,720 --> 00:44:48,200
So, we need to graft
a new three-dimensional shape.

771
00:44:51,640 --> 00:44:54,440
This is where it starts
to get a bit difficult.

772
00:44:57,640 --> 00:45:01,240
One of the things we're taught is,
"Treat the patient, not the X-ray."

773
00:45:01,320 --> 00:45:04,400
Now, with Jack,
never is there a more true thing.

774
00:45:04,480 --> 00:45:06,600
-[music intensifies]
-Screw, please.

775
00:45:08,760 --> 00:45:11,880
One must never assume
everything's gonna run smoothly.

776
00:45:12,720 --> 00:45:14,200
Don't go in there. Go in there.

777
00:45:14,280 --> 00:45:15,720
Zip, zip. Yeah.

778
00:45:17,760 --> 00:45:19,800
Any mistakes that we make here

779
00:45:19,880 --> 00:45:22,720
would have life-threatening
and serious complications.

780
00:45:25,240 --> 00:45:27,680
-[Zeeshan] Ready?
-[Simon] Ready to go.

781
00:45:31,880 --> 00:45:33,200
[thrilling music playing]

781
00:45:34,305 --> 00:46:34,235
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