Emergency: Series Synopsis
Category: Press Pack ArticleIn the UK’s capital, a world-first system of hospitals, air ambulances and paramedics provides a safety net for 10 million lives. Known as The London Major Trauma System, it has improved survival rates for major trauma patients by 50%. With access right across this system, Emergency is a present-tense medical documentary box-set - four serial episodes following the minute-by-minute decisions trauma teams make to treat the most serious cases: from life-saving interventions at the road-side to A&E critical care, from cutting-edge surgery to painstaking rehabilitation.
Episode 1
In this first episode, London’s Air Ambulance, paramedics and fire crews are dispatched to 49 year-old Paiwand – a pedestrian trapped underneath a lorry in South London. Medics need to treat his crush injuries, but first fire crews must lift the 29 tonne HGV to get him out. Trauma Doctor, Cosmo, recognises it’s a race against time, “there is always the possibility we may have internal bleeding…and he’s therefore at risk of dying on scene.”
Meanwhile, in Central London, Advanced Paramedic Practitioner Pete is on shift in his fast response car. He is trained to attend the most seriously injured patients. He soon receives a call for a 13 year-old who has ridden an electric scooter into a lamppost. On arrival, he finds Alicia with her distressed mum by her side. She has a large gaping wound on the back of her upper leg. We learn that Alicia had competed in the high jump and won the 100 metres race at her school sports day. Concerned the handlebar of the scooter has penetrated her thigh and she potentially has a broken leg, Pete bypasses the local hospital and rushes Alicia to The Royal London Major Trauma Centre in Whitechapel, “potentially walking, running, high jump…all the things she was doing…could be affected by this injury.”
In West London, 84 year-old Ralph is at St Mary’s after falling at home. He has an obvious break to his leg, but doctors are concerned about Ralph’s complex medical history. He suffers from heart failure, kidney disease, COPD, cancer, and, as Ralph says in his usual good humour, “dandruff.” CT scans confirm Ralph needs surgery but as Consultant Geriatrician Michael explains, “patients like Ralph, unfortunately we lose about 1 in 10 of them” due to complications post-surgery. Michael wants to ensure Ralph is fully aware of the risks. When given the odds at 50/50 as to whether he will make it home, Ralph says “you’ve got to take a chance haven’t you?” But Ralph holds back the reality of his situation from his wife of sixty-two years Jean, “he’s always joking…but I do worry…he’s 84.”
Meanwhile, Paiwand is now at King’s College Hospital with a broken arm and a seriously crushed leg. Orthopaedic Surgeon Ibraheim is preparing for complex surgery to rebuild his leg with rods, plates and screws, “how he will walk again is dramatically impeded if we don’t get this right within a millimetre.” We hear how Paiwand fled Iraq from Saddam Hussein’s regime 23 years ago and just eight days before the accident, he had returned from visiting his family in Iraq for the first time. Ibraheim reflects on the patients he treats “old, young, every gender, every race…that’s something I’m very proud of and something us as a nation should be.”
Episode 2
In this second episode, 84 year-old Ralph is at St Mary’s Major Trauma Centre after falling at home and suffering a fracture down the entire length of his thigh bone that needs emergency surgery. Due to his medical history of heart and lung conditions, Ralph has been given a 50:50 chance of surviving the operation but as Consultant Anaesthetist Ian puts it, “if we don’t fix it, he’ll never get out of bed…that’s a miserable end of life for anyone.” Ralph is keen for some good news and Ian explains that his “heart scans are looking better and I think this is our best shot’. As Ralph heads off to surgery, his fellow ward patient Jamie says he will order his cheese and potato bake for when he comes back; Ralph says “I just want to wake up and be here.”
Meanwhile, in the Tactical Operations Centre at London’s Ambulance Service, Flight Paramedic Jason is dealing with an influx of trauma calls. He reflects “some are predictable and some are completely random acts.” 33 year-old Zoltan is one of those in the wrong place at the wrong time and is in St Mary’s Hospital after he was hit by a van whilst walking along a pavement, being crushed against metal railings then thrown into the basement of a Mayfair property. His fiancée Julia admits “at first I didn't really want to believe it”. She has tried to explain everything to her two daughters and to remain strong but “for him and for the girls … it is difficult. It's a life-changing accident”.
Orthopaedic surgeon Chris explains that his leg “was so badly damaged it was unsalvageable” and they had to amputate his leg below the knee. In order to give Zoltan any chance of walking on a prosthetic limb, the team need to stabilise his pelvis, which is fractured on both sides. In the same operation, plastic surgeons examine the remaining tissue, cutting away any infected muscle and skin, and trimming the bone to give them the best chance of saving what is left of Zoltan’s leg and fitting him with a prosthetic leg. In the words of orthopaedic surgeon Chris, “this is where the trauma system really shines ... having all those specialties in one place and working together for the good of the patient”.
At King’s Major Trauma Centre, a call is put out for an adult ‘code red’ trauma as a 42 year old-man is being flown in by Kent Surrey and Sussex Air Ambulance after a collision on the M25. Father-of-two Karl was trapped in the vehicle for over two hours. Emergency Medicine Consultant George leads the trauma team and quickly gives Karl a transfusion to replace the blood he has lost to prevent him going into cardiac arrest. CT scans reveal significant fractures to both legs and also his elbow. The radiographer is particularly concerned that there may be a vascular injury to Karl’s arm, and Consultant George says “the lack of blood flowing to his arm…could result in…having his arm amputated”. Meanwhile, Karl’s wife Lulu and his son Brendan arrive at King’s to hear the devastating news that Karl will need emergency surgery to the break in his femur. Orthopaedic Surgeon, Ibraheim will carry out the operation and is worried about the crush injuries to his chest and his ability to breathe whilst under anaesthetic. As he finishes the operation, Anaesthetists become concerned about Karl’s breathing and refer him to ICU where he will be kept on a ventilator to help him breathe.
Over at the Royal London, 13 year-old Alicia is about to have surgery after she collided with a lamppost when riding an e-scooter and suffered a deep wound to her thigh. A talented athlete, Alicia and her mum are concerned about how her injury could impact her sporting future. Orthopaedic surgeon Anouska explores the wound and is concerned about the damage to her hamstring. She says it’s “much worse than I expected” and how “you do feel a certain pressure when you're operating on children because what you're doing can impact the rest of their lives”.
Episode 3
In this third episode, 42 year-old Karl is in Intensive Care at King’s College Hospital following a high-speed motorway accident where his van collided with an HGV. His wife Lulu is coming to terms with the fact that he is being kept alive by a ventilator following traumatic chest injuries. Consultant Surgeon, Ibraheim, and Intensive Care consultant, Sancho, meet her to give her an update. She asks them “you’re not giving up on him are you?” and Sancho explains he is critically ill but in the best place.
Meanwhile in South East London, Advanced Paramedic Practitioner James is dispatched to 87 year-old June who has lost her balance stepping into a taxi. On arrival, he finds June, lying on the road, supported by her neighbour with an open ankle fracture - “one of the worst” he’s ever seen. James tries to restore blood flow and rushes June to King’s Major Trauma Centre where specialist surgeons need to work quickly to try to save her foot.
In West London, at St Mary’s Hospital, 33 year-old Zoltan is recovering from several traumatic injuries and an emergency amputation below his right knee after being crushed between a van and railings. After complex surgery to his pelvis and amputated leg, the hospital physio team have been working on his rehabilitation so that he can get out of bed and into a wheelchair to see his young daughters for the first time since the accident.
“Zoltan’s been on an emotional roller-coaster" says physiotherapist Kirsty and after an emotional family reunion, he again faces more surgery to his amputated leg to ensure they can fit him a prosthetic limb to get him on his feet. Surgeon Kshem is worried that “if there’s infection or if the skin doesn’t heal Zoltan may still need an amputation at a much higher level and this can have a huge impact on his ability to walk.”
Former soldier Joe, 61, arrives at St Mary’s having fallen down an escalator at King’s Cross station and losing consciousness. He was at an army reunion earlier that day and drunk half a bottle of vodka. Trauma Consultant Dan quickly sends him for CT scans that reveal a potential skull fracture and bleed on the brain, “people can rapidly deteriorate from brain injuries... talking and walking one moment and then collapse the next.” With Joe’s potentially life-changing head, pelvic and wrist injuries, daughter Kerry is worried most about the head injury “cause everything else is repairable”.
In South West London, 20-year-old motorcyclist Daniil, arrives at St George’s by air ambulance after he collided with an HGV. As he’s brought out of the helicopter, he has a seizure on the roof and Emergency Medicine doctor Rich suspects a traumatic brain injury, “a leading cause of death amongst injured patients”. Doctor Rich sends Daniil straight to the CT scanner, alerting neurosurgeons in case he needs an emergency brain operation.
Episode 4
In this final episode, 61 year-old Joe is at St Mary’s Major Trauma Centre. A former soldier, Joe had been at an army reunion where he had drunk half a bottle of vodka. On his way home, he tripped and fell down an escalator at King’s Cross station. Hospital scans revealed a fractured skull, a small bleed in his brain and a fractured wrist. Best friend and ex-wife Jacky worries about the extent of his injuries, saying, “all these years he served in the army and... he didn't even get a paper cut.” Neurosurgeons rule out surgery on the brain but orthopaedic surgeon Dylan must urgently operate to put the protruding wrist bone back in place before fixing it with a plate whilst protecting the radial artery that runs alongside the bone. Despite potentially life-changing injuries, Joe’s desperate to attend his grand-daughter’s 18th birthday. “She's only 18 once ...don’t know if I'm gonna make it”.
In South-West London, Advanced Paramedic Practitioner Steve is dispatched to Jacob, a 25 year-old who, whilst playing for his vegan rugby team, suffered a severe femur injury and leg deformity after being tackled. On arrival, Steve assesses his leg and rushes him to St George’s Major Trauma Centre while Jacob asks, “I’m not going to lose my leg am I?” Orthopaedic surgeon Tim looks at Jacob’s injury and reveals the extent of the injury is rare, admitting that Jacob “might not be playing rugby again … ever, unfortunately.”
46 year-old Jorge (pron. Hor-hay) has arrived at North Middlesex University Hospital – a trauma unit in North London. Still in shock, Jorge’s son Juan explains he found his Dad on the floor, at home, unconscious with a lot of bleeding. When Jorge’s CT scan shows a broken bone in his neck, Emergency Medicine registrar Allam explains “it's a serious injury. It can lead to stroke and paralysis... so we need to act fast”. He sends him for an MRI scan and refers Jorge to the neurosurgery team at Royal London Hospital. Spinal surgeon Brett, and spinal fellow, Daniel, analyse the MRI scans. Fixing his unstable neck and spine is complex and a delicate operation and as Brett explains “there’s a danger of paralysing him or worse” but “Jorge’s 46. He's got forty, fifty years of living with whatever we give him now, so it's important to get it right”.
Back at St George’s, motorcyclist Daniil has been in intensive care for five days after colliding with an HGV. Following a seizure on arrival, doctors were concerned the 20 year-old had bleeding in the brain and a brain injury. His worried Mum, Dasha, is with him and explains “every day when he go to work with his bike, every time I'm thinking ‘please not today’ and finally ... it happens.” Daniil has an uncertain and long recovery ahead, but his Mum is still grateful it’s not worse. “This is not [a] miracle you know? The guys just know what to do and they saved my son.”
Finally, we revisit the patients filmed across the series to reveal the outcomes after their traumatic injuries.