Original subtitles

PHONE RINGS

Hello, A&E resus.

After dark and while most of us sleep,

A&E departments across the UK work through the night.

Jack, do you know where you are?

With unprecedented access to the night shift

at one of Britain major trauma centres...

Argh, it hurts!

...this series reveals a working environment

that's not for the faint-hearted.

What you doing? You idiot.

Ow! Argh, get off! All right.

They deserve a medal, what these people have to put up with.

And at night, road traffic collisions are more serious...

I think you got hit by a motorbike. Do you remember that?

...and both drug...

Can you open your eyes for me?

...and alcohol- related admissions increase.

You rascal, you.

We follow the incredible staff of Hull Royal Infirmary.

Morning, sir. Welcome to Hull.

It's a job like no other.

Things affect you more on a night. The job gets to you...

...but it's because you care.

Oh, no, no.

Are you on... Are you on nights?

It's the start of the night shift at Hull Royal Infirmary...

Yeah, that's it.

So it all depends on what your health status is.

...and all is calm.

Shooting straight down there and right up me arm and I can't grip.

But that can quickly change.

A man suspected of taking a drugs overdose

has been brought into hospital by police.

You don't spit at police officers.

You don't spit at anybody. It's disgusting.

Yes, you did. It's on body camera. Yes, you did.

The patient has also been aggressive towards two police officers

and a paramedic.

He was violent towards us.

He wouldn't... Didn't want to come with us

and he had to be arrested for his own safety.

Do you want a glass of water?

I'm not telling ya, I'm asking if you want a drink?

Nurse Jen Whiting is looking after the patient.

Sometimes with a greater police presence, it's more of a challenge.

Sometimes it helps with a female voice or a calmer voice.

But in this case, he wasn't my biggest fan.

So...you can only do what you can do.

I did think I was going to get spit in my face but thankfully, I didn't.

I don't know if he's completely aware of what's going on anyway,

so try and reassure him.

Do you want a cup of tea?

Just go back and sit back.

A toxicology test will determine

if the patient has taken any harmful drugs.

Going to get this blood done, all right?

That's working.

We're not cruel. We're here to help you. Don't shout.

You need to lay back down pal.

We're trying to help you and you're not helping yourself.

If he's medically fit, he's coming with us to custody.

If he's not, he's going to have to stay here.

It must be packed in the unit, then?

I just feel tired.

Just feel like, really tired more than anything.

My head hurts though, not going to lie.

It's just so painful.

Victoria Ashton, please?

It's not just the walking wounded the night shift treat.

Nearly half their admissions are brought in by ambulance.

Can you keep still, darling, for me?

Paramedics have brought in 39-year-old Ricky

with a serious head wound.

Ricky? Hello.

My name is Zac, I'm one of the doctors.

Let's have a look and see what's going on with your head.

As soon as the patient arrives with a head injury,

first thing you check - have they got any significant injuries

that are causing them to haemorrhage?

Could I get a bit of forceps, please?

And have they got bleeding that needs to be stopped

immediately before we even commence the sort of assessment?

Actually, you just need to keep your finger here, where my finger is.

Just that finger there. You just can get...

So it's unlikely arterial.

It's probably venous. And if I press from the top...

Ricky, I'm just going to put some monitoring equipment on you, OK?

I absolutely love my job.

I love looking after people.

If I can make that one person feel better on that shift,

if it's just one person,

then that makes my job worthwhile.

Ricky, are you all right?

What's the matter?

If we need to use anything like that, we'll tell you first,

so stop panicking, we'll sort it out.

You'll get a lot of men that come in that are needle phobic,

but they'll be six-foot men with tattoos everywhere

and then they won't like this tiny little needle.

But then I've had children

that we've had to take blood from repeatedly

that are running around, they don't mind.

They'll sit very still, just waiting to get a sticker.

But then some of the men will end up on the floor.

Ricky?

Ricky?

Sorry, buddy.

Because you've put your head through a window,

you've got a few cuts on your head.

Yeah.

So, one of them is bleeding quite a bit,

so I might have to do something about it.

And, uh, there are two things I can do.

Now, please don't panic.

One - I can suture it. Two - I can put a staple in it.

Which one would you prefer?

You'll feel a bit of sharpness, but that's it.

OK.

OK, Kat, I need two of your hands.

So, I need pressure here, OK.

So, continue like that.

With Ricky refusing stitches...

...the resus team are growing more

concerned about the amount of blood he's losing.

You've lost quite a lot of blood, though.

And you're covered in it, as well.

When you're looking after a patient

and they're losing a lot of blood, it can be very worrying.

It can be quite horrific to see.

Are you all right, Ricky?

Ricky? Ricky?

Ricky?

Ricky?

In Majors, four police are guarding a violent patient

while they wait for his toxicology test results.

Selena?

I am.

If the results show he's clear of narcotics,

the patient will be taken into custody.

He went to the toilet and he took that opportunity to try

to spit at me. Hence the reason why he had to be restrained.

A spit guard is used to protect police and the medical team.

It does take up a lot of staff, a lot of resources,

if we have to just focus on one patient that's being aggressive.

The other patients don't get the care they need.

My family do worry, probably, that I'm at work in A&E.

I think it's just the reputation, especially on the weekend.

Were just waiting on your blood test results, aren't we?

That we took earlier.

That's where your training comes in, you've got to be professional

and take into account why they're here.

If they've taken anything, why have they taken it, you know?

Are they in pain, are they scared?

What's going on? You can't judge on what you see.

Ricky, do you know why were applying this pressure to your head?

OK, so you've got quite a nasty cut on your head

and it's bleeding quite a lot

so we're having to do this to stop the bleed, OK?

Matron Kat Henry is struggling

to keep her patient's bleeding under control.

What was it, a window?

What, and you just put head through it?

Do you not like needles?

With a phobia of needles, treating him is proving difficult.

Yeah, it's just there. just, one second.

Oh, it's bleeding.

No, Wendy's not, no.

I told... Trust... Listen to me, trust me,

I'm going to tell you

as soon as we're going to need to use a needle, right? Trust me.

I'm not lying to you.

Zac, the doctor's back now.

So we're going to have a look at it

and we'll let you know what we're going to do, OK?

So we promise you, if we use a needle, we won't show you it. Ready.

And when you have copious amounts of bleeding from the wound,

if it's arterial, so it's coming from the artery,

you have to control this as soon as possible

because even the smallest artery can bleed quite profusely.

I think we should put just a bit of non-adhesive dressing on it

and then head bandage and then CT.

Yeah. First, we're going to make sure there's no glass

and then we'lljust need to clean it up.

So, what we're going to have to do is

we're going to have to scan your head, Ricky.

Yeah, just to make sure everything's all right inside.

Yeah.

Right, Ricky, just move your head first. Perfect.

What kind of window was it?

Was it double glazed, triple glazed?

So, Ricky, do you have any medical problems at all

that I need to be aware of?

Do you take any medications?

OK.

Your heart rate is a bit fast.

I just wanted to make sure we cover all the basics.

Right.

So, what I'll need to do is, because you've lost quite

a bit of blood, I'll need to check to see what your blood count is. OK?

For that, I'll need to pop a small needle into your vein here

and take some blood.

Well, I'll need that for...

OK.

OK.

OK, that's fine.

Um, we'll keep an eye on you.

Obviously, if you show any further signs that you've lost quite

a bit of blood, I'll have a chat with you again, all right?

You sure? OK.

How about you just rest your head back

and we'll get the scan organised?

Shall we take your top off, sweetheart?

Don't rip it.

Ricky!

Don't rip it.

We're there for the patients.

It's about having that relatable interaction with patients.

No, l'lljust pull it up.

I'll pull it over your head. You've just ruined your T-shirt.

I'd of washed that.

It's about how you say things to them...

It's all right.

...which will result in what their behaviour will be towards you.

A CT scan is the only way the team will know for sure

if any glass is buried in Ricky's scalp.

Glass itself can harbour bacteria

and that's why glass has to be taken out

before the wound can be cleaned and closed.

I was, like, licking me lips and I can taste blood,

somethings just not fucking right.

The senior nurse on the ward told me you have had the second most

serious operation there is next to open-heart surgery.

I've had 72 sutures.

I mean, I'm only four foot nine.

It could have been lethal, it could have fucking put me

in here, which it has done.

Are you there, love? Are you there?

She's not listening.

No, she's gone. Anyway, I'm next.

Thank goodness.

It's like a 40 quid T-shirt.

It's a fucking...

It's a Ralph Lauren.

Another patient has been rushed in by paramedics

after a suspected overdose.

Hello.

The patient is in resus, struggling to breathe...

Hello?

Open your eyes.

...and drifting in and out of consciousness.

My names Maddie, I'm one of the staff nurses.

Can you tell me where you are?

Need to pop you on a bit of oxygen.

Right, so a mask going on to your head.

Take some big, deep breaths for me.

Over half of suspected drug overdoses are admitted at night.

He was OK in the ambulance initially, fully awake

and now he's become a lot more drowsy.

So we're giving some fluids, I'm trying some naloxone

and see whether we can get his breathing bit faster.

Can you just check this for me? I will.

So, we've got naloxone, 400.

And it expires 20/22. Mm-hm.

It is quite, quite quick.

The trauma team now wait to see if the antidote takes effect.

All right, Ricky?

You got any pain at the minute?

OK.

Have you had pain relief?

Ricky's been joined by his partner.

Two hours ago, he arrived in resus with lacerations to his head

after falling into a window.

CT scan results will indicate

whether he needs the attention of a plastic surgeon.

Ricky is stable. We've managed to control his bleeding

with just a bit of pressure.

His laceration is here.

So you can actually see the dressing

and there's something here. This might be a bit of glass here.

Because if it is, we'll need to call the maxillofacial surgeons

to see if we can fish it out and, obviously, close his wound for us.

What you doing?

You're not, you're getting back in that bed.

Ricky's fear of needles becomes too much.

He decides to discharge himself.

Get in there now.

The patients do have a right to say no.

You're getting back in that bed now.

It's incredibly frustrating

because as a doctor you're always trained to help, fix, cure.

Get in that bed now.

Coming back in?

Come back in.

Get in there now.

Get in there now.

Get in there now.

Get in there.

Can you come back in? I ain't got time for...

I've got sick people to look after.

No, you need to come in.

You need to get your head sorted out. Get in there!

You are not going home.

Get in there now. Get in there.

Get in there. No, you can't go home.

Get in there now. Get in there now.

Get in there now!

It's a head injury so...

In there, now.

OFFICER:

Come on, now.

When a patient's refusing treatment, it is frustrating

when it's obvious that the patient needs the treatment.

Yeah, exactly.

So, get your arse back in there now.

Now!

Right, Ricky, come on.

Stay in here, mate, and get seen to. All right?

After earlier refusing treatment for deep lacerations to his head

and face, Ricky reluctantly returns to A&E.

Come on.

HE RETCH ES

Do you want to swap it?

It'll all be from your head.

Your nose looks like it's been bleeding.

But just try and concentrate on your breathing.

That's it, just concentrate on your breathing.

Ricky?

Brain looks OK. OK?

Skull's all right.

You had a CT scan, man.

Yeah.

How did you manage to do all this to yourself? I don't know.

Cos he's a lunatic.

Usually, you need to get some help from someone to do it for you.

It's usually someone who doesn't like you very much.

Well, it looks like just vomit for now.

Obviously, let's see, if you're going to start vomiting blood,

we'll have to do something about it.

Ricky must now wait for further treatment from plastic surgeons

before he can return home.

The CT scan has confirmed that he has got a foreign body

in his wound which is most likely glass from him hitting the window.

So that wound will need to be explored

to get that foreign body out.

And obviously, Ricky is not particularly keen on needles

and he doesn't really want to have anything done

under local anaesthetic, so the maxillofacial surgeon's just going

to speak with a senior to see if they need to admit him to take him

to theatre and have this done under general anaesthetic.

In resus, the team are still trying to get their overdose patient

to regain consciousness.

Can you open your eyes for me?

I'm just going to shine a light into your eyes.

He's been given an antidote, but concerns are rising

that there may be another reason why he's not yet responding.

Um, apparently, he had a knife

and I think he was threatening some self-harm.

He has got previous self-harm.

I saw him on Wednesday, he originally presented on Tuesday,

with laceration to his right arm

but there's no injuries, apparently.

Do you want to do a top-to-toe at all,

just because he did have a knife on scene?

I know there's no obvious signs of any bleeding,

but I'm just thinking any other injuries, really.

I think the most worrying thing about a patient who's unconscious

is not knowing what's going on.

You just have to be like medical Sherlock Holmes and start searching.

No signs of head injury or anything.

And there's always that pressure of will I find the answer in time?

Will I be able to do enough to keep them safe while I find the answer?

PATIENT COUGHS

Hello.

Are you all right? Sit up.

You're OK. Sit up.

There you are.

Have you got a spittoon?

There we go.

There you go. Spit it out.

That's it.

There you go. Wipe your mouth, that's it. Spit it all out.

I'm Audrey by the way. I'm one of the A&E doctors, hello.

Can you open your eyes now for us?

You're in hospital.

Do you remember what happened today?

No.

Have you just been taking tablets all in one go today?

Quite a lot of them? Do you remember that?

Yeah? Have you taken or had anything else at all?

Smells like you've had some alcohol?

Yeah.

There was also a knife found with you.

Now, I know this one was from earlier this week.

Have you hurt yourself at all with the knife today?

No? Were you planning to?

Right, OK.

Well, who rang an ambulance? Was that you? Yeah.

So you'll need to stay here for now.

All right.

I'm just going to take this mask off.

The patient will be kept in overnight for observation.

Dr Fox's concern now centres on providing the patient

with access to the mental health team.

Yeah, hi, it's Audrey.

I have an adult patient to refer to you.

He's a bit of a regular attender in the department.

When I see a patient who comes in with mental health problems,

I do tend to feel very sorry for them

because I know it's a difficult road.

It's a very long road to try and get somewhere.

Depression is difficult for other people to understand.

Like, if you break your leg, you walk around in a cast,

then everybody understands, you'll get lots of sympathy.

You all right there?

Whereas with mental health, it's invisible

so people get less sympathy from people around them.

In Majors, the aggressive patient

is waiting for his toxicology test results.

Right, your bloods are all hunky-dory, OK?

The police officers will take you to custody

and you can sort your business out there, all right?

The test results show the patient is clear of drugs,

allowing the police to finally take him into custody.

PHONE RINGS

Resus.

The red phone rings signalling a blue light emergency.

No idea of speed?

OK, see you soon. All right, thank you. Bye.

A teenager has rolled his car four times

after swerving to avoid a deer.

Right, this is 19-year-old Ryan.

Ryan has been the single driver of a medium-sized car

down a country lane in the dark

A deer has pulled out in front of him.

So, he's reared to the left

and his car's rolled, probably about four times.

He believes there hasn't been a loss of consciousness.

When we got there, he was face down in the car.

Extracted him using the spine board.

He's complained of C-spine tenderness.

Just found a radial pulse.

It's 1:30am.

An ambulance has rushed in another patient with a head injury.

Shut your eyes. Lay back and shut your eyes.

It just hurts.

I know, just... just lay back.

56-year-old Colette is with her husband, Tony.

The cut, it hurts.

It just hurts.

Chill out, will ya?

Yes.

Here.

I believe so, yeah.

Oh, stupid. Slipped on pizza on the laminate flooring.

Pizza. On the floor.

My husband decided to have a piece of pizza

and threw the crusts on the floor to the dog.

I didn't see it.

He went to bed, I took a walk on the wooden floor,

went flying, hit me head on the table.

Yeah.

About midnight-ish.

Yeah, I managed to grab me phone cos Tony had already gone to bed.

And, uh, I rang 999.

I heard you shouting though from upstairs.

I was just on the verge of going over and I thought,

"Who's that shouting?"

Well, who else would it be apart from your wife? Idiot. Well...

And eventually, he heard me and come down to let the paramedics in.

Yeah, it's...

Yeah.

Have you found it?

Thank you very much.

You're a star. Thank you. Bye-bye.

No more... Argh! ..pizza.

You'll be in the doghouse for months.

I quite like diamonds.

We'll make it right. I'll make it right.

Chill out, will ya?

We're going to keep your head still until we know it's fine.

Whilst that's going on, nurse is getting the pain relief.

So, if we can get some more morphine, that'd be great.

Emma's going to get that line in.

I'll speak to scan.

After rolling his car four times, 19-year-old Ryan urgently needs

a CT scan to check for any internal injuries.

That's all good. Scanner ready.

Might as well take him round.

Let's go.

Right, so we're just going to drag you across.

You're still on a board. OK, on you. Yep.

We'll be back in in a minute.

Keep an eye on his obs,

cos his saturations did drop down to 93% there,

which I can't work out.

But just be aware we've obviously taken him off the oxygen.

The CT findings can range from being quite catastrophic

and life-threatening

to, hopefully, no injuries identified.

If anything comes screaming out,

we need to get the neurosurgeon down straight away.

Colette is being treated for a deep gash to her head

after slipping on a pizza slice at home.

My husband owes me a spa.

That's the last time he's feeding the dogs pizza in my front room.

Yeah, that's fine.

OK.

I'll try not to.

I trust you, you're a doctor.

Ooh, aye, aye.

No, no, that was fine.

Thank you very much. And you was very gentle.

You was very gentle.

Obviously.

Thank you. You're a gentleman.

I will. Thanks very much. Thank you.

You can come in now, sweetheart, it's all done.

Do you not want your dressing gown off? No.

I've got no clothes on under it, no.

You all right there? Yeah, thank you. Good.

I think your girlfriend's outside. Are you happy for her to come in?

Yes, that's fine. OK, I shalljust go and get her.

Ryan is waiting for the results of his CT scan

after rolling his car, leaving him trapped upside down.

You Ryan's partner? Partner's mum?

Do you want to come through and see him?

Have you been told what's happened so far?

Cos he's had a car crash, we've got a collar on him.

His heads tied down, he's on a board,

it all looks really serious, so...

His girlfriend, Jasmin, has arrived with her mum for support.

And I shall leave you be.

Don't worry.

I think it was a little deer, I'm not sure, but something ran out.

I only did, like, a quarter-turn of the wheel,

but then I hit the grass and then it just rolled and rolled and rolled.

And here I am.

I was upside down. Three cars went past and didn't stop.

I had my hazards on and I kept beeping my horn,

so they knew there was someone in there.

The ambulance? Yeah.

Then someone else stopped and pulled over.

I'm sure if I end up in a wheelchair,

you'll push me around, won't you?

Part of the job of being a doctor is communicating with patients.

As good as it would be to always give a really positive outlook,

you know, sometimes we do need to be very honest, uh, and explain,

you know, these injuries are life-threatening or life-changing.

Got the scan results. Cool.

Absolutely fine. Good.

Your brain's fine, your neck's fine, your back's fine,

your tummy's fine, your chest is fine, your pelvis is fine.

What we can do is start taking some of these contraptions off.

Now everything's starting to settle in

I'm just... I feel like... Well, I feel like I've been hit by a bus.

I feel really achy and...

Keep your head nice and still just for the time being.

I still need to check your bones out.

The CT's fine, but we just want to be 100% sure.

OK. Sore?

Really sore but not, you know, like... Yeah.

I feel so much better.

Now, do you want the bad news? Yeah.

Usually after these sort of incidents

what happens is, you can seize up.

Usually, it's about 48 hours afterwards,

when it gets to its worst. Yeah.

So we do warn you of that now,

but we'll get you off this hardboard, as well,

and get things moving and get you up and about.

Excellent, thank you. All right, won't be long.

My back.

That's fantastic. At the end of the day, the patient's had a near miss.

No injuries sustained which is ideal.

Oh, oh, that's sore.

Oh, Jesus Christ, that hurts.

I feel good.

I'm in a fortuitous position that when patients come to me

in pain, I'm able to make that difference.

Yeah, slow. I'm all right.

Sure? just give it a minute or two.

If that was a member of my family or someone I knew,

I know what I would want happening

and I try to do that day-to-day for the patients that I see.

All right, no problems, all the best.

Cheers. That's all right.

God, they put this on hard, didn't they?

Just relax your arm for me.

You all right? Uh-huh.

Three hours ago,

this patient attempted to take his own life with an overdose.

He's now conscious,

but the trauma team continue to closely monitor him.

You keep going a bit light-headed when you're sitting up, aren't you?

So, there's no point even attempting to go outside.

I'm funny? Why am I funny?

I am a happy individual.

Is there not?

Is that a good thing, then?

Oh, well you're not doing that tonight.

So, can I just have a quick look?

Well, I'm not going to touch the actual wound,

I'm just going to clean the area.

It's going to be, cos you've gone out and...

I think there are people who basically just want attention.

So the classic cry for help, so people who don't actually want

to die who just want someone to take them seriously, to listen to them.

People who do overdoses, it does seem to happen more in the evening.

I don't know whether that is because people feel, maybe, more alone

or it's dark and it makes you feel even more depressed. I'm not sure.

No.

You need your hands. Use your hands for everything.

So, what we're going to do now is going to pop you some antiseptic on.

I sometimes find myself looking at patients

and thinking what's really the different between them and me?

What really sets me apart from them?

Is it just a roll of the dice, it's just luck of the draw?

So, that makes you sometimes more appreciative of the people

in your life who do support you

and the chances you've had, lsuppose.

Get in there now.

Oh, Jesus Christ, that hurts.

Is there not?

You was very gentle.

Next time...

Do you think you can get us some help for CPR?

When it comes to cardiac arrest,

you are trying to bring them back to life.

There is a pulse, I can feel a pulse.

Shut the fuck up.

I don't give a fuck. What you doing?

So, it's a visitor, not a patient? Absolutely, yup.

You can't be smoking in here.

Cos you could have blown everybody up in this hospital.

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