[Music] at the heart of our health service hello bounds the emergency department is the overstretched casualty team yeah here it comes now [Music] working around the clock under daily stress and strain i've had 21 patients in the last hour they're on the front line of emergency care we've got a 30 year old overdose right suspected heart attack reliable three minutes on call for our most vulnerable moments you just keep your head nice and still from the lobby and let us do everything okay facing life and death they're just saying that your lungs are packed up and there's nothing that they can do about it sharing trauma and tears what a superhero you were with no time to catch their breath a close-knit team who rely on each other come on out of my way now some of us have work to do to get through the toughest of shifts day in day out anybody want anything doing fetching carrying back massage this is barnsley casualty 24 7. i've got a soft spot for them all although don't tell anybody that will you on shift tonight consultant dr rob jones gonna end up with a really impressive bruise over there volunteer jane allen i see we've got a team on them this morning sarah sister jane horgsworth sometimes they say to me oh you'll talk a bit posh but i don't realize it's just that they talk rough and consultant doctor julian humphrey you're a medical miracle aren't you hi tribute to the nhs so get ready to share a shift with the team at barnsley casualty outside thank you [Music] if you're really happy to be here you know a bit of a spring you know barnsley is ranked in the top 10 for hospital waiting times it's a record they want to uphold but today the casualty team is starting the shift with a backlog of patience we have a very busy department with quite a long document now we're at three hours the clock is ticking as every patient must be treated discharged or admitted within a four-hour target at the moment there are 39 patients wait to be seen with 61 in the department it is busy we want to hand it over in a better state for tonight the 30 bays surrounding the hub are full of people needing treatment and to add to the pressure emergencies keep arriving we've had horrendous weights for beds and that's because the hospital's full pushing the team to hit the four-hour target our consultants dr julian humphrey and part-time comedian dr rob jones so did you do any improv this weekend then rob yeah i must come and see you sometime i really do please do you're more than welcome do you get heckled um like you do here not as bad as here as bad as you our relationships with that team are quite paternal maternal brotherly sisterly everyone wants to look after each other we all have a little hook don't we have a little a little hug out before we go love you it's probably because of the things that we see and the things that we go through and and we're there for each other come and look at mine that's why it's so family orientated i think i'd be the eccentric uncle actually i'd probably be the really handsome good-looking brother i'd definitely be the one in prison i'd be the black sheep of the family clocking on to face another demanding shift is advanced nurse practitioner richard jackson hello good job how are you so bad is it busy it's always busy oh he's busy everyone has outside obvious and for me it's always been star wars and i like dressing up as a stormtrooper that is a little bit of a way of offloading go for it okay so gentlemen it's been there's probably nine am nervous injuries but to arrange parameters you'll be 15 minutes and we'll see you at recess nurse jackson heads to recess bay 1 to treat 82 year old ken he's suffering with shooting pains in his head chest and arm ken's wife joyce is with him [Music] he's had a stroke um six years ago he's so he's already got a weakness in his left side he gets pain in there and tingling in the left arm anyway yeah and it was just more so today and he couldn't put his finger on why and then we've moved him the ambulance and blood pressure's dropped rests are still up and then temperature's just gone up like a whole degree tried cannulating to get some fluids up his veins are awful now you've been getting on oh tell you terrible when did all this start tonight at night and you've been coughing as well have you i've completely eaten yeah are you bringing anything off your chest right approach to the top level and what color was that i don't know i don't know and have you had any pain in the chest at all can yeah [Music] and have you had any headaches yeah you had some headaches and what they're like no no it's like a pig like a beast thing archivising then goes away does it yeah so you felt pretty rotten then have you yeah i was eight year old when i knew my husband and i'm 78. [Music] it's a long time isn't it [Music] hey where's wedding anniversary last week 59 yeah the human nature is just a wonderful thing if you take your time to just stop and watch there's some really tender gentle moments in recess it does make you feel more positive about life you also realize sometimes life is cruel as well [Music] good things will happen and bad things will happen okay i look after you [Music] in the hub of barnsley a e the team are still trying to clear the backlog of patience there's two way to hand over none can sit out in the weight room declared a five hour wait in the hand out there yeah and i think three people have shifted after a week off ill sister benita wainwright is back on shift [Music] chest infection so i went home didn't i two three weeks ago on shift and then come back and then meme yourself poorly again and then come back and tom just looked at me and went what are you doing here but then keeley and that did my abs and my heart rate was 134. my blood pressure relied on 100 sisters i don't have any family support around me so these people they they are actually my family i went home and died for a few days yeah good a lot of them are really close friends and i i wouldn't i wouldn't change any of that [Applause] sister wainwright is pushing to ensure every patient is seen within the four-hour target but all the bays are full you can take cannulas out can't you check canula out for me she's sat in the waiting room she can go home [Music] oh barnsley d a two-year-old boy shorter breath noisy breathing if you come straight to reese's we'll have a team waiting for you okay thank you bye two-year-old thomas is distressed and struggling to breathe [Music] dr caroline bird will assist dr jones in recess [Music] first thing is to realize that you're not treating one person you're treating mum and dad for the child you can put them at ease quite quickly um but you've got to address the anxieties of the people that brought them in as well i think that that balance is quite hard do you have any allergies to anything she giving any medicines regularly he doesn't have asthma it's just the last couple of times he's had this they gave him an inhaler and said give it a couple of puffs so i did that my daughter's nearly four and my son is 15 months when you can easily put the face of your child on that child it's that little bit more difficult it does sound like creep um yeah capricorn time is less than two his heart rate's at about 110. he's probably a moderate proof at the moment and although that's likely to continue to get better his oxygenation and the fact so we're going to give him some medical dexamethasone so that's an all steroid medicine which helps reduce the swelling in his throat and hopefully helps him with that noise and helps with his breathing [Music] oh paramedics are bringing in a fragile 98 year old woman who's had a four tasked with prioritizing new arrivals in the ambulance bay is sister jane hawksworth four minutes ago you arrived [Music] i've done this job for a long time now in a number of years and it's got harder over the years because obviously people are living longer i know yeah 98 year olds it can be the most traumatic time for them um but they come in we look after them we do the best that we can for them she said fall injury on offense so she's going to need scanning she's got it feeling a little bit woozy gone to the excel cup of tea and had a bit of a tumble ink so she's got a big just turn your head down for me lovely and she had alcohol a couple days ago so she's got all that on face she's got pain yeah but in sheltered accommodation have you got a headache no pain no pain anywhere got why was it bigger was it okay we need to get you onto one of these trolleys because you're going to have to go for a scan on your head you know because you're on warfarin so we just need to check that there's nothing wrong doris you know when you fell did you knock yourself out i didn't knock myself out you didn't do you have one of those emergency things that you can pull yeah so that's what you did did you and then they came to get you up okie doke sweetie [Music] cheryl's just requested a ct head on ice for a 98 year old lady called doris bergen all right look i'm just doing some bloods and then i'll bring her out here is that all right thank you bye do you want another blanket all right i'm just going to leave you here while you go for a picture in recess bay one is ken who arrived an hour ago with shooting pains in his head and chest nurse jackson is trying to diagnose his condition ken your observations are showing that you you've got an infection somewhere i just need to have a little tubing so i can give you some treatment and take a little bit of blood from you if that's okay you're not bringing the needles good job into it you're not a typical yacht she'll have with your board are you not tight are you whoa yeah yeah there's no better than yorkshire is the love i don't think so ah there is no has it sounded quite chesty it's not being himself complained about this big heavy pain in his lung yeah yeah just going to listen to your heart just breathe normal for me to click with a patient straight away you just know you're on to a winner really you you get that link up with them it's easy to talk to them they're giving you good information and what's it just oh unsteady what's it like on a good day well you know i watch him yeah do you have any help at home i have carers but i've got family 12 months ken warrell a character with a lovely blog and we we did it off straight away him and his wife or a very nice couple i'm going to treat you with some antibiotics some fluids do some blood tests get a chest x-ray and i think looking at your numbers you'll have to stay in hospital today i'm afraid okay let's get cracking let's get these antibiotics into you [Music] in the hub are two of the longest serving members of barnsley casualty team volunteer jane allen and dr joe bien it's been 10 years since i started in a couple of months it only seems like two minutes i think i look younger my first introduction to jane was um you just had a party you just had your mother's way her mum decided that she was gonna die soon and that she should have awake before she died yeah that was ten years but she's still here she had a big party with vicar and everybody it's time she had another one because she might know differently well she's 85 this year so i think it's with about you for another week but she said she'll not be when she dies well she said she'll not know what anybody's got to say about it that's what she wanted to know she wanted to know what they were going to say about it now so we had a party for him some of the consultants there started out when they were registrars etc and dr b and she were a young woman and you know 12 15 years she's just gotten older i'm getting younger obviously but they're getting older dr bien is treating the walk-in patients today next to be seen is james who's been in the department for almost two hours okay that looks fine so no sign of any glass we'll just get him stitched when he comes back my hand pitch is really bad [Laughter] it's not good it's better if it's the front of the hand because i can draw the nails on so at least that looks more more realistic you're coming in then [Music] no glass in it no glass so that's a good thing so you've had stitches before haven't you yeah so just pop a little bit of local anesthetic in it numb me up in just a couple of stitches and i'll be good to go so definitely feel normal there it feels okay there yeah feels okay and okay there so tell me what happened it was putting the glass down on the table the it broke next thing you know nice piece of glass sticking in the end just checked no signs of tens and damage you can't see any signs of that so okay just a sharp scratch that stings a bit yeah right needles as well oh you're a man [Music] i don't think anyone likes needles you'd be a bit strange [Music] how long you done the job for i've been in a e since about 1998 so it's been a long time it's a lot more busy than on the wall didn't you i draw the bbc well that's it oh i should be bored on the job weren't you really yeah because when i first worked in any there wasn't the four hour top you know now we're meant to get everyone in and out yes in that time limit the weights used to be awful so i think people do forget what it was like before we had that my parents were quite horrified when i first suggested i might be a doctor they thought it was a really difficult career to go into the hours are quite long the pace that i work at now can be pretty intense [Music] right so that looks better oh it does an hour i can't feel it it feels going [Music] stitches will be out about next tuesday or wednesday if it bleeds through then get us coming come back and we'll change it for you it should be fine okay hold on there because i'll get the nurses to come and give you a clean all right okay thank you just another start scar to add to the collection [Music] [Applause] in the hub the team are pushing to get more patients treated and discharged within the four-hour target so there's 30 patients in the department at the minute there's a couple in recess and quite a few in majors and the hub is just flooding this guy here aiden and rob jones is going to pick him up because he's had a weight fall on his head and he's a bit of a mess at the minute okay he looks really bad [Music] from the door dr jones is treating aidan who was admitted to bay eight three hours ago right i'm gonna inject that now so this is the worst place probably your head is it such a blood supply it bleeds a lot that's why i love bed so much trying to distract you from what i'm doing it doesn't help i think the first time i dealt with head injuries you feel like someone's bleeding stuff in front of you as you get more experienced and quicker at closing them you know you can mitigate that by just pressing on it but equally you just need to get it closed quickly and then it'll stop bleeding this should be the last bit okay let's just give that a pressing there you go is that as painful to press on as it was a bit better yeah i could still feel it but yeah just turn your head slightly towards me i can't see anything deeper damaged than the skin so that's good how's that i can't feel anything stitches you think it's always one of those things you don't really know until you start getting away with five or less i'd be surprised i've never really been squeamish i don't mind blood i don't mind well better don't mind a bit of poo even it's probably the emotional stuff that that worries me a bit more you're right if i yeah yeah just carry on yeah it's fine it's less than that needle so okay [Music] i think we're done actually i think you you got away one two three five you're gonna end up with a really impressive bruise a scar as well yeah is it anytime you get a cut you get a scar that's done the trick nice one thank you very much okay and then we'll sort your mouth out okay so i'll be hitting that for me halfway through the tooth is a clear crack and whether that extends into the roots or not i'm not sure then you've got a cut on your lip probably pretty easy to sort out but they may as well see to sort out the whole thing aidan can now be discharged from a e and transferred to a clinic for further treatment jones moves straight on to his next patient joshua moore please [Music] in front of me right i'm dr jones nice to meet you um just start from the beginning if that's okay uh yeah about so we go underneath my nose i'm getting any excited pretty much every day from then but but not constant but ever since sunday afternoon we've just gone uh should've been constantly quiet every day um day and night it's working through night as well so okay this morning how many times do you think you've been sitting now just twice and today's the first time you got to be instead yeah yeah okay no no speeds or anything okay we'll have a good look at you and then it sounds like probably need to get a scan sorted with your head there are always those patients that you're um the moment you meet them they're very very high risk the nuances of it sometimes just prick your ears and make you stop to think josh's parents wait anxiously for a diagnosis it's not it's not a nice experience and hopefully get results if that's what's causing pain i have two concerns one that you've you've hit your face in your head um and then got progressive headaches and whether that's caused anything and the other concern is that actually there was quite a distance between your hitting your nose and then that sudden headache and we don't want to be missing something else that's happening so if you have bleeding inside the head for for medical reasons then that can be a sudden onset headache and we don't want you know the red herring of your nose injury to sort of mask that okay so you hold hold tight here i'm just going to organize that scanner for dr jones it's not just the four-hour target adding pressure if josh has a bleed on the brain every minute is critical most people with a headache will feel disorientated drowsy unwell but vomiting in particular um concerns me and the fact that his traps headaches come on so so rapidly and a distance after the injury there's just a couple of a couple of symptoms that make you a bit more alert quite worried just want to get salted and find out we know why he's having these headaches [Music] after a manic start to the shift the team at barnsley casualty have managed to clear the backlog of patients there's really not much for me to do danny and it's uh it's that word what we're not going to say so quiet today you dare why would you do that why would you do that when i'm in resource that is not quiet is that word we don't say quiet no can't never say that word i mean you've already said it now so i know it just came out that we don't use the q word here no way do not say the q word yeah if you're in trouble because odds once you've said it doors will fling open and there'll be 18 ambulances stood outside all waiting to come in as soon as you said quiet that's it sod's law hello braziliani yep 90 year old male 1 chest pain all right if you want to bring to the hub and we'll go from there all right cheers within minutes of saying it's quiet the casualty bays start filling up again dr julian humphrey is called to the assessment bay to treat year old jack who has symptoms of a heart attack did your daughter ring the doctors and tell them that you've been having chest pain yeah the chest pain that you've been having when did you have it today or yesterday yeah yesterday it was likely yesterday and does it feel like a pressure on your chest that's it right i've got off the side laid on my back right and laid on the other side because it failed were you a miner that's the other thing i need to know right you were a minor okay yeah right how many years were you down the pitch going into [ __ ] years and did you get any compensation for your chest or anything like that no no just for your back right we see a lot of miners that ethic that hard working you know yorkshire grits i think comes across in in the way that these patients talk to you or have this sort of very stoical attitude this this group slowly but surely are actually dwindling down now as well right you're a medical miracle aren't you you're you're a tribute to the nhs right how many layers of clothes have you got on there i've got a [Music] right well that scar's healed up quite nicely isn't it just relax let me have a quick listen to your heart [Music] now this pain that you're getting does it feel like it's across your chest like a pressure there and does it deny above later does it hurt when i press on your chest at all keep brushing right with your heart being a little bit diseased we're going to just check it over okay that's what your doctor wanted i would imagine we'll do another tracing of your heart and we'll take some blood from you okay he's a carrying [Laughter] i don't know if you saw but he put his fists to his chest and that's that's one of the classic signs that it's it's pressure there and that's possibly from an angina type [Music] doris scan's fine so what i think she can be discharged once that's been started [Music] in recess bay 4 dr jones is assessing thomas's response to medication to help him breathe hey dude what toys have you managed to pilfer what smiles that's good is he as noisy as he was at home no no no no no sorry can you just lift your head up for me i won't tickle you i promise that's a good boy yeah that's all right isn't it that's doing well can i ever listen to your chest mister did you have any dinner tonight thomas not much i didn't really want to eat much did you there's nothing in this belly just got a few bits of sausages in there this morning i can feed a sausage so i think we're all a bit less worried about him yes i enjoy looking after kids um i enjoy the fact that most of them seem to like me some of them are better judges of character than others and don't like me but um but yeah no on the whole i think it's a good thing to be doing given that he's you can still hear a bit of that strider when he's not doing anything at the moment we're probably looking at keeping hold of him overnight but if the strider goes away and he's really really happy and you're all really really happy more importantly [Music] you got joshua moore's notes somewhere dr jones is busy with thomas but his other patient josh has been in the department for nearly four hours with the results of his head scan back doctor bien takes on josh's case is it joshua hi let's just pull you into here the doctor who saw you earlier was a bit worried that the severe headache might be related to a small bleed in your brain we can't see that on the scan but that doesn't rule that out so the plan is now is to get you admitted up onto the medical ward upstairs and then we'll probably want to do a lumbar puncture just to double check so that should be happening fairly soon okay sorry josh will be admitted to another department for further treatment i've had a longer punch before it's not nice it's just like a lot of your spine a needle your pizza [Music] in recess bay one ken is still in the critical condition [Music] ken i'm going to i've arranged for a chest x-ray they'll come and do that now i have some antibiotics and fluids i'm just seeing a patient out in the department i want to finish off with them then come back write your notes and have a look at you and see how you're feeling after some treatments connie okay we've just come to do a chest x-ray on your tennis i'm just gonna push you up [Music] my job is to hunt for the life threatening conditions to find the diseases that are going to affect life falling and that's that's the driver for us if you like puzzles and games then emergency medicine is probably for you really the chest x-ray does suggest you might have a bit of infection yeah the antibiotics i've given you will cover chest urine a few other places as well okay but we'll keep an eye on you and get you up to the ward as soon as we can all right all right ken i'll see you in a bit [Music] in the hub sister rachel wilkes is halfway through her shift are you squeamish rachel not really the thing that i don't like is uh sputum you know when they're coughing coughing up dark greens fuel to make things sister wilkes is monitoring steve and his wife gail in recess bay 3 following a high-speed road crash all right let's stephen steve was admitted three hours ago and is waiting for x-ray results of his chest and legs started off uh we're just off to the shops just normal sunday food shopping and normal we go down that route every time and this vehicle just come from nowhere we're going at speed and just hit his head on and roll the car three times i think he's just shocked that now that we have actually survived it but we're here to self-tale it's very important to listen to patients because they've just gone through a road traffic accident it's not an everyday occurrence for them they are scared they are shocked let them get it off the chest thankfully then people pulled [Music] thank you it shows you the good people of barnsley there there's only a couple of hours left of what has been a very demanding shift hey john how are we doing the team have pulled together to treat over a hundred patients all within the four hour target time next to be seen is mrs brown in bay three is it mrs b in there for you mrs b in room three mrs b round three well mrs brown is a term that's used when um the tea trolley has been admitted to one of the cubicles [Music] [Music] i didn't know what it was though when i first come to barnsley i was like when they were like mrs brown's moving through i'm thinking what does she need some set of bobs do it i had no idea like it actually meant a cup of tea that's the best that's best thing mrs brown cheers [Music] in the hub dr doverick hughes is reviewing the scan of 60 year old steve who arrived in recess over three hours ago he had quite a bit of pain in his neck to ct he's checking the scans for any fractures after steve was involved in a high-speed car crash i think it looks fine it's been reported i've scanned his abdomen and his pelvis as well i think the radiologists have said that's fine i think he's been been quite lucky we've seen your scans everything's fine little bits of glass to get out i just need to have a good look at your back it's it's my knee it's absolutely killing me nothing on the back there that's fine okay back here yeah okay so we've not found anything wrong inside your head nothing wrong with your neck chest looks fine your chest x-ray's fine the scan of your belly's fine there's that bruise surgeon have another look yeah um your arms are fine yeah so it's just that leg so yeah and we haven't found anything there's nothing terribly out of place on the x-rays if you're comfortable we can get you home if you're in just too much discomfort to manage then we'll keep you until you're a bit more comfortable yeah could have been worse could be dead thanks a lot i'm gonna head home shortly and uh lucky you are as well you should be okay for your holiday that's what i thought well i'm going to get off from the 60th but should we do now so i'm just going to give you a face and add a little clean it's still stuck around the top just tell me anything it's a very vulnerable time for patients because it's always unexpected why they've come in you know it's nothing that they've planned and probably got up that morning and didn't expect to attend any that day that's all you need uh five days before your 60th i remember it weren't yeah obviously something like that you just think i'm lucky to be alive definitely could have been a lot worse couldn't take they're definitely being a different story you'd all look a bit better now you've got all that blood off your face i mean yeah it's still really painful is it right okay so it's going to be quite somewhat then into it for a for a little while definitely burning my body aches i've dislocated my finger that's how my wedding rings cut off and everything is yeah it's a good job we did it because the young's look at mars wallet they can be mended love be like you steve is discharged just before breaching the four-hour target right okay okay then thanks a lot all right gail take care of and enjoy your birthday and benny darm i will [Music] people involved are funny though they are oh they're so funny they're a they're funny they're so dry and they can just just take you out with one little comment i think i have a very yorkshire sense of humor actually and the yorkshire you can the orchard are quite mocking of each other but i haven't developed a yorkshire accent i don't think i've developed a yorkshire accent anyway eight hours in and a dozen patients seen nurse catherine ravensdale is treating the walking wounded as quickly as she can forgot neville smith come around take a all seat then so i'm catherine and one of nurses hey i am right there what's brought you here today yesterday and fighting with muscle and his stamps on my collarbone okay i don't think he's meant to do it i think he's blushed out and just you know is it more like a heat or this patch on you with his foot it's like a stamp out of it felt i wasn't cut out with the floor we got really out for a couple but ended up getting right on it it feels like it's crunching and cracking and i think it's definitely broke just undress you well yes that feel okay it's not good it's your face it's just you can see it brings it here on your chest every day is always different i just think to myself all right you think you've heard it oh but then [Music] [Music] reference this morning and what time did you take care of yourself it was about seven o'clock are you wanting any further apparently from yourself today you're just trying to pick out the facts of what actually happened because then facts are what you need and a doctor looks at that and they don't want to know that they've been involved with their altercation at home they just want to know the simple facts on what's actually being injured rather than anything else really he's 20 i'm not sure for 321 you don't normally not lash out no no another coupler [Music] neville will be scanned and treated before being discharged as dr humphrey's shift nears its end he's keen to get 90 year old jack home as soon as possible right so uh he's got trifosicular block on there which is first degree heart block plus left bundle branch block normally patients who have that rhythm need a pacemaker but um he's not describing any syncopes right young man why don't you come back and sit down and i'll have a little chat with you you're watching the world go by are you sorry you can sit on that chair if you want it definitely isn't your heart all right as i say if it's not your heart then it what we call is is not specific so we don't know quite what it is so we're going to let you go home all right i'm going in and i'm a daily baby yeah and i'm just going to speak to the nurse and we get you up to the discharge lab right thank you very much okay one of the things about mine and in general balancing people is they're extremely respectful to doctors thank you for helping me thank you doctor that's one of the things that does make me proud to work in barnsley actually that recognition of what you do as jack is discharged the day shift ends for the team of barnsley casualty this hospital is very very very good the staff the staff you know on the amenities of it's very cool i haven't got all you know a a millimeter of regret no regret at all about choosing emergency medicine as a career the good points to annie are you can make such a massive massive difference and be part of that relationship you can't put into words it's it's brilliant this department is not about any single person we are a team i couldn't do my job if it wasn't for every single one of them it can be so rewarding to work in a e and if i can make a little difference to somebody then that's that's my reward thank you for the day shift it's home time but the doors of barnsley casualty stay open 24 7.