For thousands of years we've tried to tame nature
to control the forces that drive life itself
We've built machines of great power
and created barriers to protect us from the elements
and in doing so we've transformed the world
Today we can go almost anywhere we want,
and we're making new discoveries at a breathtaking rate
Already our accomplishments in engineering and construction
have gone way beyond what our grandparents could ever have imagined
Sometimes it seems we can create anything
But the most stunning piece of engineering on the planet
is something we've inherited, not something that we've made
And in contrast to all the changes that have occurred,
it's one thing that in the last few thousand years,
hasn't really changed at all
lt's our very own human body
ln this series, we'll rediscover the body
- its untold powers to heal and renew
We'll meet Penny
whose last steps were captured on this home Video
When her parachute failed, she hit the ground at 1 20 mph
Her spine was severed
but now after four years, she's started to regain some feeling
Medically, there is no explanation
why this should start happening five years after my accident
We'll show you how doctors studying tissue regeneration
follow nature's example in the salamander, whose severed limb will re-grow
But when re-growth isn't possible, new transplanting techniques can help
Clint Hallam had the world's first arm transplant
My first thoughts when l- when l saw my hand was that it was a miracle
We join him as he struggles with his new, unfamiliar limb
No, no, no
We take intimate journeys with people having pioneering operations
Hear how it feels to have another person's body part in your own
l'll probably pray for that person for the rest of my life
l feel like l'm putting a gun- and l'm gonna shoot somebody just so l can live
We'll discover the extraordinary courage involved in facing risks
lf it goes in, and it does happen,
he's gonna be able to hear but he's not gonna be able to smile
We'll watch infection as it spreads
and discover the defences the body has evolved to fight back
We'll meet people trying new cancer treatments,
including one designed to help the body fight its own battle
l've just seen the MRl scan and l have to say it's very exciting
And finally l want to show you what's happening in my own area;
reproductive medicine, where some of the most exciting research is going on,
but where we are also taking nature into strange uncharted territories
Here, too, we are learning how to tap into the innate powers that our bodies possess
Thanks to all that we're learning about ourselves,
something remarkable is happening
For the first time in history,
we're able to do more than just wonder at the body's ability to heal itself
- we can actually change that ability and improve on nature itself,
and in doing so we're beginning to understand
just how superhuman the body really is
Nowhere is the superhuman nature of the body
more starkly revealed than in trauma medicine; the treatment of injury
l don't remember anything that night
l realised my arm- my left arm had almost fallen off
and was hanging there by the skin
They had to stop the bleeding - l was bleeding internally
- they had to remove my spleen 'cause it had ruptured in the accident
Somebody asked - would l make it? And it was - no way
The number one public health issue in the world is injury, is trauma
on the scene on the South West Freeway at West Park, acknowledge
Every day, all over the world,
thousands of people will be rushed to hospital as a result of trauma
Trauma is kind of interesting;
Everybody in the world is scared to death of having a cancer,
and l would make a point of the fact that if you look around the room
a lot of folks ought to be scared of having a heart attack or a stroke,
you can tell what they're eating
People are hysterical about getting AlDS,
but nobody thinks they're gonna get hurt
Trauma outstrips heart disease, stroke and cancer combined
This little boy has been in a traffic accident
OK, this is four-year-old Dmitry
He was down there in West Columbia riding his bicycle,
when he was struck by a motor vehicle travelling around 25 miles per hour
They're gonna look after you, Dmitry, there's your lion, buddy
Dmitry, we're gonna be doing a lot of things to you
We're gonna be taking some pictures
- it's real important that you lie still while we do it,
OK? Then we'll get you off this board....
ln an emergency room, trauma teams are faced with endless questions
Dmitry, Dmitry, that's not gonna happen yet, Buddy
Bones may be broken, there may be internal bleeding
What about right here?
He was complaining about pain in the....?... area
His sensation's pretty much intact
With the help of technology like X-ray and ultrasound
each potential problem can be discovered, addressed or, hopefully, ruled out
l want my mum
As soon as she gets here, we're gonna get here right at your side, OK?
Yeah, l want .......?........
You want .........?.......
Fortunately for Dmitry, he survived his trauma without serious consequences
But trauma is a massive problem, and it won't just go away
We are a nation in denial of an epidemic that's running wild
And denial ain't a river in Egypt!
And the biggest killer ln this epidemic of trauma is the car
The Number One cause of death for people under the age of 44 is car crashes
lt's hard to imagine the massive deceleration forces of a car crash
So how about this?
With collisions like these, it's amazing any of us survive car crashes at all
ln the fraction of a second during impact
the huge G-forces involved
can mean that the human body weight can multiply up to 60 times
And these same huge deceleration forces are
what the driver of this car experienced when he crashed headlong into a bus
Every year, millions of people around the world are injured in car crashes
Michael Sharp had been driving home from seeing his sister
when his car collided with a bus
l don't remember anything that night
l don't know how he walked out of that car...
l don't know But l'm glad he did
He says he's got no back pain No back pain
When Michael was removed from his wrecked car, he was in a bad way
He soon began to show classic symptoms of traumatic shock
He's confused and aggressive
No, stay stay stay stay, No, don't do it, don't do it, Stay there, stay there
His pupils dilate, and he starts to sweat
His blood pressure rises and his heart beats faster
Soon his veins start to constrict
and redirect the flow of blood away from his skin to his vital organs
His breathing becomes fast and short as his lungs
work to capture as much oxygen as possible
Armies of white blood cells are mobilised to the site of injury
This is the body's standard way of coping with its injuries
The trauma team are also going through their standard response
- they're following three life-saving principles known as the ABCs
Firstly, 'A', they check Michael's airways making sure
they're clear without which 'B' for breathing wouldn't be possible
And if you can't breathe
you can't get life-sustaining oxygen into the body,
and without that there would be no oxygen for the circulation,
'C', to carry around the body
The brain in particular is very sensitive to even a short while without oxygen
Within as little as three minutes, you could suffer permanent brain damage
When they got Michael into hospital he started to fit
lt's distressing but quite common after a severe blow to the head
OK, somebody stabilise his neck for me please
He says he's got no pain in his chest or neck
l don't know if l'm supposed to feel lucky or anything, l just- y'know,
because it happened so quickly and l don't remember anything about it,
it doesn't feel like anything really happened
l look at life totally different now
Show me your left foot
Things that l used to take for granted before,
l mean l actually concentrate on it now
No, l mean always loved Corin; Corin's my big boy,
but l am more focussed on Corin now
Left foot, see that left foot...
l'm lucky to be here
Treating a seriously injured patient is not just a race against the clock
There's blood there, can't see an obvious laceration...
Call Anaesthesia
He's got a big haemotoma,
it's hard to feel if there's a bony thing under there or not...
Every doctor, faced with a trauma victim, has to make precise decisions,
and each one of them can have consequences
...that was the second, this is the first...
Yeah, let's get anaesthesia, this is awfully weird breathing...
So doctors have to be ready to vary their game-plan
Jose. Hold on anaesthesia for a second
Get a staple remover - roll him back and get a staple remover
lt's like a ......?.... don't know what that is - roll him back
...there's nothing on the outside...
And trauma medicine is going through some quite revolutionary changes;
changes driven by our increased understanding of the ways
the human body tries to preserve itself after injury
And the thing the body tries to preserve above almost everything else is blood
One drop of blood contains about five million red blood cells
Red blood cells make up just under half the total volume of blood,
and their main function is to carry oxygen from the lungs to the rest of the body
We produce two hundred billion new red cells every day,
and in twenty four hours the blood in our bodies travels
a total of 1 9,000 kilometres; that's four times across the USA
We tend to take this precious liquid for granted
Our bodies cope pretty well with large blood losses,
but we don't have an unlimited supply
What's surprising is how much can be lost in an accident
without there being any external bleeding
lf you broke your leg for example,
you could lose a third of your blood supply into your thigh
These sorts of internal injuries can lead to a massive fall in blood pressure,
and the standard medical response has always been to try
and correct it by replacing the blood fluid as fast as possible
But standard medical responses can be wrong
And nowhere has this lesson been better learned than in war
OK. One zero zero metres...
OK, bring him back, bring him back here Remember to stop the bleeding
lnjuries in the Vietnam War were horrendous,
but what was unique was the speed at which medical help arrived;
helicopters were able to reach the injured within minutes
At that time, the standard treatment was to replace lost blood
and to raise the blood pressure as quickly as possible
Blood or other fluids were poured in before soldiers even got off the ground
Many of the injured went on to die
Doctors have begun to wonder if sometimes this treatment did more harm than good
l am sure that a number of these people this century
have actually probably been killed by their treatment
Someone's come up - particularly in wars like Vietnam
where they had medical support in close - put lines up,
raised their blood pressure, didn't stop the tap,
and l'm sure they've made them re-bleed
The way the body responds to bleeding is by forming a clot
Platelets in the blood rush to the injury site
and are cemented together by fibrin
lnitially, the clot is quite delicate and easily blown
apart by a change in blood pressure
A blood clot is a dam; it plugs the flow of blood
lf the blood pressure is low, there's less for the clot to hold back
But increase the pressure, and the dam could burst,
and that could be disastrous
And that's exactly what happened to many of the soldiers in Vietnam
Suddenly, They're pulled into a helicopter
lines are put in, blood pressure's driven up - they bleed
l think Mother Nature's built in a mechanism to take care of us
- it's centuries-old, if not millenia-old
- we've got to be damn careful that any treatment we devise does not upset that
Jim Ryan was a surgeon in the Falklands,
where medical circumstances were very different
Unlike Vietnam, night battles and bad weather meant
quick helicopter recovery was impossible
lnjured soldiers were often left alone for hours,
and Mother Nature was given a chance to work
ln 1 982, David Gray was in the 2nd Battalion of the Parachute Regiment
He was just eighteen years old
when he suffered appalling injuries in a mortar attackat Goose Green
We broke the brow of the hill,
so of course you had your rear echelon at the back,
your front-line blokes going into Goose Green
and then everybody that was injured on that slope going down,
were exposed
- and under sniper fire as well
l went back for Tony Tye who'd been shot
- he had a gunshot wound in his right arm,
And then l got hit by a mortar round
Thud
l can't describe what it was like
l thought; that was very close
l rolled over and when l looked down l realised that me right foot had gone
l was probably laying there for three to four hours
before l actually was administered with any fluids
And l was losing blood all the time l was doing it
When somebody asked;
would l make it? lt was; no way
Soldiers with injuries as bad as David's were not expected to survive,
yet many of them did
We were shocked - pleased and shocked to see
people still alive having waited six, eight,
ten hours with dramatic amputations, multiple injuries -
many of them should have died, but some of them didn't
Jim Ryan believes that the long wait before fluids
were administered may actually have saved these men's lives
They probably fell down, lay very quiet, they will have bled out significantly,
but not to the point of death
They'd clot- they'd form a good clot,
no one gives them fluids to raise their blood pressure
and they- they just hang in there
really quite ill but hanging in there, low blood pressure, high pulse
breathing rapidly, getting cold, but lying quietly and resting
As a result of observations like this,
the routine giving of fluids to all trauma victims is being questioned
Paramedics now watch and wait before trying to raise blood pressure
But there was another vital factor at work in the Falklands; the cold
The cold l can remember probably more than anything; numbness, fingers, face...
Profoundly cold.
Y'know, un- we didn't have really low-reading thermometers,
but these were off the values of the thermometers that we had
- certainly below 30
Almost looking like corpses
But rather than doing any serious harm,
Jim Ryan feels the cold may actually have helped survival
l think in this situation -
and many people would agree with me
- hypothermia, a mild degree of hypothermia,
is positively protective
l think it just slows the whole thing down
What war has revealed
about the human body is that sometimes cold can be a life-saver
And this knowledge is now being used to save accident victims
On a freezing November day,
Kate Close was thrown from her horse
Paramedics didn't reach her for nearly two hours,
by which time she was extremely cold
The main concern was her massive head injury,
and she was rushed to the Royal London Hospital
Her doctor, Alastair Wilson, was also extremely worried about her head injury
He ordered an urgent CT scan and the results were horrific
Oh, crikey, O'Reilly!
Look at that, look at all that air as well
ln view of the fairly gross nature of her injuries,
l felt that probably her survival chances where in the region of perhaps 5%,
so l wasn't being very hopeful at that stage
Alastair Wilson then made an extraordinary decision;
he decided not to warm her up
Her temperature was very low
- it was just- initially l think just under 34 degrees,
and then we felt well, this is probably a good thing on the one hand
because it's going to reduce the oxygen requirements of the brain,
which means that it's less likely to become hypoxic;
to get into a state where it's doing damage to itself
When Kate fell off her horse and injured her brain,
it set off a dangerous chain reaction
Any injury to brain cells can trigger the release of destructive chemicals
lf they're not stopped, these chemicals cause other uninjured brain cells to die
Although we don't know precisely why,
we do know that cooling the brain
by just a few degrees can stop further widespread damage happening
Still cold, Kate was rushed to surgery,
where the blood clot that had formed on her brain was removed
Amazingly, she suffered no brain damage
l've always, always hated the cold
But now l've been told that as a result of hypothermia,
that's one of the things that helped to save me
l still don't like feeling cold, l must admit
l don't like the cold, but on this occasion,
my goodness me! lt did me a lot of favour, it really, really did
Research into the benefits of being cold
is now at the cutting edge of trauma medicine
Trauma isn't just war and car crashes
- it can be part of our first moments in this world; being born
For many of us, being born is the most dangerous event we'll ever experience
The journey down the birth canal may be short but it can be very hazardous
During his delivery, Ross Walker was starved of oxygen
The chance of surviving without severe brain damage was extremely low
The first thing that struck me was the fact that he was quiet,
and there was no particular movement from him
The heart-rate should have been around 1 40-1 45 beats per minute,
and he'd gone down to about 80 beats per minute
Once he had fitted for the second time,
they realised that there was something worse than what they first thought
They told us
that it was 94% chance that he could have severe brain damage
Lack of oxygen had begun the chemical chain reaction in his brain,
and now some of his brain cells were starting to die off
Ross was rushed to the Hammersmith Hospital in London
where they were trying a radically different treatment
To prevent brain damage, babies like Ross were cooled down
He was in a like a paddling pool without the bottom or the top,
and he was in the centre and the cold air was blowing across him
So that was cooling him down by two degrees below the body temperature
And he was cold to touch, and dry as well,
and, yeah, it seemed an odd thing to do
And your natural reaction is to cuddle them and keep them warm-
Wrap him up- That's right, wrap him up,
so once they'd explained
why the reasons why they thought that would help,
well obviously we knew it was probably for the best
and y'know had to cope with those sort of feelings
until we could give him a proper cuddle later on
l felt helpless,
'cause l couldn't do anything,
l couldn't hold him, l couldn't do anything to help him
When he first arrived at the Hammersmith,
Ross's brain-wave output was virtually zero
As he became cooler and cooler,
his parents simply had to wait to see what might happen
We just sat by the bedside,
didn't we, just watching and willing this machine
to show us some brain waves that were showing signs of activity
As the hours- minutes, hours and days
went by we could see the brain waves picking up,
we could see that there was a light coming on and we had something to aim for
Over the following two years, successive brain scans revealed that
Ross was developing into a normal, healthy toddler
He's a very happy boy,
he's very lively, he's jumping around and he enjoys playing
He's good fun
l don't know what kind of boy Ross would have been without this treatment
He's right where he should be for a normal two year old
lt's the best bit, isn't it?
We could say that he may have got better on his own- of his own accord,
but at the end of the day l feel that in our heart of hearts
that we can say that without the treatment
that he would have been severely brain-damaged
Although it does seem rather odd, being cold can actually be good for you
Doctors are now trying it in a variety of circumstances,
from heart attacks to head injuries
After trauma, the body can become cold naturally
ln fact, cooling is often the end-point of the process we call shock
And the often strange ways people behave when they're in shock
can be traced back to our evolutionary origins
As far as our bodies are concerned,
we're still just animals fighting for survival,
struggling to escape and find a safe place to hide
lt's called 'Fight or Flight'
The body is flooded with adrenaline
Adrenaline makes the heart beat faster;
The lungs work harder;
The body is shouting; Escape! Escape!
lt's why victims often struggle with people trying to save them
You can't, Kate, don't fight now Don't fight now....
At the same time, the brain releases a surge
of pain-killing hormones; endorphines
These are so powerful
that you can have a limb blown off and feel nothing
l'd literally gone numb from the waist downwards
You'd just gone through your pain barrier
After a while, however, the effects of these hormones start to wear off
The heart slows down, blood pressure drops
Clots form
Blood drains away from all but the most essential organs
The body cools and starts the long process of self-repair
The idea of trying to work in harmony with the body is hardly a new one
This is the Greek island of Kos
lt was once home to the ancient world's most famous doctor, Hippocrates
Hippocrates taught his followers that it was vital to observe
and listen to what the body was trying to say
lt may not look much, but this is where modern medicine really began
Two and a half thousand years ago,
these ruins form one of the earliest kind of hospital
lt wasn't the sort that you and l might recognise perhaps;
there were no anaesthetics, no antibiotics,
nor any doctors with highly specialised training, lt was more a temple for healing
A place where pilgrims could simply come to rest
in these peaceful and isolated surroundings
ln Los Angeles, this idea of leaving the body to heal itself
has been taken to an extreme even Hippocrates could never have imagined
1 1 am, July 6th 1 999.
A factory in downtown L.A. exploded
The man on this stretcher Kiomo Vasques suffered horrendous injuries
and was rushed to L.A. County Hospital
When he arrived in the emergency room,
doctors had little hope that he would survive;
Kiomo had a broken neck, a fractured skull and a huge bleed into his abdomen
With so many terrible injuries, his surgeon,
Dr. Demetriades, had to make a very brave decision
Because of the severity of the patient,
we decided within a matter of minutes
that we should follow a different approach, an unconventional approach,
the so-called 'Damage Control Procedure'
After multiple injury, the body is in an incredibly fragile state
Damage control recognises that in this state it takes very little to kill the patient
The human body has certain physiological reserves
lf the physiological reserves become exhausted
and it tips over the cliff, this is the end of patient's life
So they did the bare minimum necessary to keep their patient alive
lgnoring his other injuries,
they glued his liver together and packed it with gauze
And then, instead of sewing him back together,
they covered his guts with plastic and left him,
in the hope that he would heal himself
Kiomo was left to stabilise for three days in intensive care
Only then did Dr. Demetriades attempt to perform further surgery
They removed the outer plastic cover
To their relief, his liver was now healing
and his internal bleeding had stopped
The bowel looks nice...and healthy; it's good news.
After checking his bowel for further injuries,
they reconstructed his abdominal wall with a special membrane
made out of pig's intestines
And then, at last, they sewed him up
His chances of survival-
you can ask any surgeon anywhere in the world
will tell you they are near zero
l am certain that without this Damage Control Procedure
he would have died on the table in the operating room during the first operation
The more and more experience we get, you realise that
the less you do the better will be for the patient, sometimes
But after everything that has happened to Kiomo,
it is the next few weeks in intensive care that could well kill him
This is the lntensive Care Unit,
where it takes around a hundred nurses to look after just thirteen people
That's because every patient is given life-support;
machines breathe for them, feed them and remove waste products
Every vital organ can be carefully monitored around the clock
What everyone is hoping for is any sign of recovery
But the staff know that they need to look out for something else
20% of patients who die from injuries
die in the intensive care unit
approximately two to three weeks after their injury
Just when you think they're getting better,
organs like the liver and kidneys start to fail
They die because sometimes the body over-reacts to trauma
lt's called Multiple Organ Failure
And it's what should have happened to Peter Blaud and Jennifer Vaughn,
both of whom suffered horrific multiple injuries
My car was hit on the driver's side door...
which was then pushed...into a fence on the opposite side of the road
l was bleeding to death from the lower base of my spine
They had to remove my spleen, 'cause it had ruptured in the accident,
my liver also had a tear in it,
and my pelvic bone was broken in six places
She had severe extensive injuries from a motor vehicle crash
and at the time of evaluation,
she had intra-abdominal injuries to her spleen and liver that were both bleeding,
she had a severe injury to her pelvis with fractures
and she had bleeding into both of her lungs from hitting her chest during the crash
Peter Blaud also suffered massive injuries during a motor-bike crash
l was riding my street-bike going round a corner,
and as l looked up l saw a vehicle sitting right in the middle of the road
l had a broken wrist in a couple of spots,
broken collar-bone, both front and back,
ten broken ribs...
Couple of those ribs actually punctured my lung...
The bottom rib severed my lung...
l ruptured my spleen upon impact, l bruised my kidneys...
l realised my arm- my left arm
had almost fallen off and was hanging there by the skin
His injuries were so extensive that his probability of
surviving was probably less than 1 0%
Multiple injuries like Jennifer's and Peter's are common in car accidents,
because in a car accident, several different
collisions happen at the same time
Metal crashes into metal
Organs crash into skeletons, or get ripped from their moorings
Flesh is pierced and punctured
The human body just hasn't evolved to cope with injuries as dreadful as these
ln the wild, animals who are injured beyond the point of self-repair simply die
There are no medical systems to keep them alive
Death is part of the natural order of things
But we, of course, are different
These patients basically are surviving injuries that
evolution did not plan on them surviving
Technology means we now keep people alive,
even when their injuries are well beyond the normal limits
of the body's ability to heal itself
Kept alive by machines, the body is understandably in a state of confusion,
and it responds by over-compensating
Severe injuries trigger the release of huge numbers of white cells,
called Nutrofils into the blood
Their job is to kill bacteria, but they can end up killing you
lt's like cars in the rush hour; in response to injury,
millions of Nutrofils all trying to get to work at the same time
They're all heading in the same direction towards the injury site
where they're trying to kill any invading bacteria
But sheer weight of numbers can lead to disaster
The trouble is when there's been really serious trauma,
you get too many of them,
and then they all stick together, which is what they're designed to do,
and then a jam starts and in the end you get gridlock
A gridlock of nutrofils will eventually block normal blood flow
Without blood, the oxygen supply to vital organs is cut off
One by one they shut down and die
And the very cells which should be saving life actually end it
lt's kind of an insidious process
that tends to get worse and worse over time, can affect
any organ system of the body,
and in general kind of goes from one organ system to the other, you know,
the body works as a very fine-tuned mechanism
and when part of that over-
that very complex mechanism gets out of balance
it leads to imbalance in the other systems
When Peter Blaud and Jennifer Vaughn arrrived at hospital,
Dr. Maier anticipated both would have a long stay in the lCU
and develop multiple organ failure
Even though we were able to stabilise her initially,
her risk of developing multiple organ failure and
even having a high risk of dying from multiple organ failure was significant
To try to prevent this happening,
Jennifer and Peter were rapidly
given an experimental drug called Lucarest
Kind of like Velcro; there's little hooks on one side
and the fuzzy stuff on the other side,
and the white blood cell will - will stick as a result of this
And a number of antibodies
- which is what Lucarest is
- have been developed that bind to these adhesion molecules,
it's kind of like coating the Velcro so that it doesn't stick any more
By using these anti-bodies, we can prevent the white blood cell from sticking,
and as a result of preventing it from sticking
can prevent it from causing injury
lf they don't stick, free-flow of blood is possible,
so oxygen can reach vital organs,
and in theory multiple organ failure can be avoided
Whether or not it was thanks to the drug,
both Peter and Jennifer made extraordinary rapid recoveries
Although we cannot prove definitely that the drug is what did it,
it was a remarkable recovery
and we've seen this in other patients that have received the drug also
Just two months after her accident, Jennifer was back at work
lt changed my outlook on life a lot,
You know, it taught me a lot about life, and about people and about friends
and just to enjoy it while you're here, 'cause so quickly you can lose it
The opportunity and chances
that we get sometimes are taken away from us really quickly,
and so you need to take advantage of life and live it to your fullest
Three months after his damage control surgery,
Kiomo was out of intensive care and out of danger
Good morning, Kiomo, how are you?
Are you all right? Si
Tell him that he'll recover- Well, he'll be stronger than before
Gracias
l also want him
Once a year, at Christmas, during Christmas-time,
to send me a card and tell me how he is doing
The ancient Greeks were the first to really emphasise
the importance of listening to the body, and in a funny sort of way,
after centuries of making huge technological strides,
we've managed to come full circle
Modern medicine is undergoing a revolution
But it's a revolution that harks back to the ideas
of the people that built this temple
We're now learning that as well as exploiting our strengths,
we can work with our body to overcome its weaknesses