The Garden, producers of 24 Hours in A&E, created new series for Netflix, Critical: Between Life and Death.
With exclusive access, 40 cameras were embedded for 21 days across the entire London Major Trauma System. Here, Spencer Kelly, Director of Factual at The Garden and exec producer on the series, explains the complexities of capturing the action in such a fast-paced and sensitive environment.
‘If this were a licensed drug, you would be screaming about it from the rooftops’ said one clinical director about the London Major Trauma System. Since its incarnation after the 7/7 London bombings, this safety net of hospitals, air ambulances and paramedics treating the most seriously injured has improved the rates of survival for trauma patients by over 50%. In its first five years, it saved the lives of 610 people – the equivalent of a jumbo jet worth of passengers. So when Netflix commissioned us to make the series Critical: Between Life and Death, it was a real opportunity to shout about this world-leading trauma system across the globe.
Not only that, a UK access documentary series for Netflix was uncharted waters. We had no idea what would come through the hospital doors and no idea who would say yes to being filmed on the worst days of their lives, but the Netflix commissioners were prepared to take that leap of faith with us supporting every step of the way.
One of the big challenges was how we could elevate the storytelling and visual ambitions that Netflix viewers expect. The latter is no easy feat as anyone who’s filmed in hospitals knows; they’re utilitarian, cramped with very flat lighting, designed for one job only, treating their patients, not to be a film set. With 30 self-shooting directors embedded in six hospitals, air ambulances and with critical care paramedics across London and the South East filming 21 days, 24/7, the trick was how to film in a way that elevated the series with a uniform look.
Series Director, Jermaine Blake, Head of Programmes, Lucie Duxbury and I had regular weekly meetings with Netflix to hone a visual approach. Jermaine created a look-book that laid out a vision for the series, cleverly using the light available and devising a tech list of lenses suitable for PD’s thinking on their feet. There’s no second takes when lives are at stake and speed, nimbleness and coverage are essential for the edit. Most importantly, they needed to film as unobtrusively, allowing the medical teams to do the all-important job of looking after their patients.
Alongside the shooting PDs, we needed approximately 26 Producers and Assistant Producers, hugely experienced in working in sensitive access. They are at the very heart of the story – building relationships with patients and their loved ones and always in the most sensitive circumstances. Before filming, we ran a three day bootcamp that set out how we would work together, including lengthy sessions on consent and compliance as well as support for the crew often dealing with things that are emotionally challenging. Often when dealing with something difficult, hospital staff would invite our team into debriefs or “huddles” as welfare checks and support. Without consent, we have no patients and without looking after the crew, you will have no one to film them.
Crucially, none of this would have happened without a near 20-strong production team led by line producer Charlotte Permutt and supported by Production Executive Jack White. Managing huge kit lists, hundreds of hours of UHD footage – some of the most intensive surgeries are over six hours long – and ensuring the teams are supported is a truly herculean effort. With so many moving parts, the wheels can quickly come off – it’s a testament to production they didn’t.
During the shoot, an editorial team of executive producers, including Becca Arnold, Louise Bartmann, plus support from Rachael Smith and Michael Tuft set up camp in a meeting room at The Garden to work a shift rota 24/7 to keep on top of storylines and be in constant contact with the crews, hospital Comms teams and key medical staff. It’s akin to a pop-up crisis centre with wide-eyed execs fuelled by Colombian coffee from a cafe over the road. As well as driving the narrative, we needed to guide the teams through the consent protocols, patient pathways and often complex compliance. Communication and being calm are key. Access like this is earned through an ongoing trustful relationship and most importantly, realising that the top priority is always the patient and those looking after them.
Finally, we decamped into the edit at Splice in Singer Street. The next stage was how we could turn the dial even further to deliver that essential Netflix visual ambition. Beautifully shot, composed and candid interviews by Jamie Carney and Jean Louis Schuller with the medical protagonists would go some way to meet the bar, but could we shoot bespoke DoP footage without compromising the documentary authenticity? Series Directors Jermaine and Toby Paton devised a DoP shopping list, often filming in the hospitals in the quiet early mornings and late evenings, picking out the macro detail and composition to deliver a more cinematic aesthetic. Toby came up with the idea of shooting monitors in theatres and other areas so that the surgery graphics could be imposed on them, morphing them into the documentary actuality rather than appearing as specialist factual take-out. To marry all these elements together, Jermaine devised another look book for the grade and working with Head of Picture, Adam Dolniak at Splice, they created colour palettes, settling on a look that didn’t distract from the reality of the subject matter but signalled its cinematic intent. Matt Haan picked up the Series Directing duties in the online, ensuring we were consistent with the overall look and tone.
Meanwhile, with many of our patients still poorly and undergoing treatment, Series Producers Andrew Fitzpatrick and Mahi Iftikhar coordinated with medical staff, patients and their families so we didn’t miss a beat of their story. Most crucially, these patients are only consenting to film and consent to broadcast will only happen when they’re in a position and happy to give informed consent – often at the time the films are finished. A series made up of patients who haven’t yet given their fully informed consent can be a nerve wracking experience, but the key thing is patience and understanding and with a brilliant liaison team led by Andrew with Senior Producer Zara Margham in support, you know they are in the best of hands.
Jon Creamer
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