"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" "It's our very own human body" "In 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 120 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 I- when I 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" "I'll probably pray for that person for the rest of my life" "I feel like I'm putting a gun- and I'm gonna shoot somebody just so I can live we'll discover the extraordinary courage involved in facing risks" "If 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" "I've just seen the MRI scan and I have to say it's very exciting" "And finally I 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" "I don't remember anything that night" "I realised my arm- my left arm had almost fallen off and was hanging there by the skin" "They had to stop the bleeding" " I was bleeding internally" " they had to remove my spleen 'cause it had ruptured in the accident" "Somebody asked - would I 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 I 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 AIDS, 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..." "In 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" "I want my mum" "As soon as she gets here, we're gonna get here right at your side, OK?" "Yeah, I 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 In this epidemic of trauma is the car" "The Number One cause of death for people under the age of 44 is car crashes" "It'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" "In 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" "I don't remember anything that night" "I don't know how he walked out of that car..." "I don't know But I'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" "It'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" "I don't know if I'm supposed to feel lucky or anything, I just- y'know, because it happened so quickly and I don't remember anything about it, it doesn't feel like anything really happened" "I look at life totally different now" "Show me your left foot" "Things that I used to take for granted before," "I mean I actually concentrate on it now" "No, I mean always loved Corin:" "Corin's my big boy, but I am more focussed on Corin now" "Left foot, see that left foot..." "I'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" "It'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 19,000 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" "If 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" "Injuries 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" "I 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 I'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" "Initially, 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" "If 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" "I 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" "Injured soldiers were often left alone for hours, and Mother Nature was given a chance to work" "In 1982, 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" "I went back for Tony Tye who'd been shot" " he had a gunshot wound in his right arm," "And then I got hit by a mortar round" "Thud" "I can't describe what it was like" "I thought:" "That was very close" "I rolled over and when I looked down I realised that me right foot had gone" "I was probably laying there for three to four hours before I actually was administered with any fluids" "And I was losing blood all the time I was doing it when somebody asked:" "Would I make it?" "It 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 I 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" "I think in this situation - and many people would agree with me" " hypothermia, a mild degree of hypothermia, is positively protective" "I 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" "In view of the fairly gross nature of her injuries," "I felt that probably her survival chances where in the region of perhaps 5%, so I 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 I 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" "If 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" "I've always, always hated the cold" "But now I've been told that as a result of hypothermia, that's one of the things that helped to save me" "I still don't like feeling cold, I must admit" "I don't like the cold, but on this occasion, my goodness me!" "It 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 140-145 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" "I felt helpless, 'cause I couldn't do anything," "I couldn't hold him, I 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" "I 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" "It'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 I 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" "In 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" "It'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!" "It'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" "I'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" "It 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" "It 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" "It wasn't the sort that you and I might recognise perhaps:" "There were no anaesthetics, no antibiotics, nor any doctors with highly specialised training, It was more a temple for healing" "A place where pilgrims could simply come to rest in these peaceful and isolated surroundings" "In Los Angeles, this idea of leaving the body to heal itself has been taken to an extreme even Hippocrates could never have imagined" "11 am, July 6th 1999." "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" "If 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" "Ignoring 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" "I 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 Intensive 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" "It'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" "I 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" "I was riding my street-bike going round a corner, and as I looked up I saw a vehicle sitting right in the middle of the road" "I 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..." "I ruptured my spleen upon impact, I bruised my kidneys..." "I 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 10%" "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" "In 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" "It'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" "It'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 ICU 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" "If 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" "It 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" "I 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"