Princess Diana documentary : Channel 4 is right to proceed - update after the programme

The People's Princess

Channel 4 is under fire for insisting on screening the forthcoming documentary on Princess Diana, against the wishes of the Royal Family.

Channel 4 says:

“For ten years conspiracy theories, claims and counter-claims have obscured what actually happened that night. Did the photographers chase Diana to her death in the Pont d'Alma tunnel? Were they too busy taking pictures to call the emergency services and did their presence hinder those services? They had witnessed and recorded one of the most terrible and iconic moments of the 20th century. But for ten years that night has plagued their lives..

…For one night the press photographs became the most expensive ever, but when Diana died they became worthless. Those who possessed them were hounded and for some their careers destroyed. The photographers have never felt able to tell their side of the story... until now.

The balance between freedom of speech and prurient intrusion into people’s private lives is not easy. Dr Crippen's first reaction to this documentary was that it should not be shown, but I have changed my mind. The unexpected death of the then most prominent member of the Royal Family is a matter of legitimate public interest. Princess Diana was a skillful manipulator of the media. That was the game, her game, and it was a game she mastered. She would expect to be pursued by journalists. On many occasions she welcomed the pursuit.

The journalists were blamed for her death. They were scapegoated. The public outcry was led by the very people who bought the tabloid pap from which the paparazzi earned their living. If any one is to blame, it is not the journalists. It is the prurient general public. It is right that we hear the journalists' side of the story.

I sympathise with the Princes, but they do not have to watch the programme.

Let us not forget that for many years, the public blamed Mrs Parker-Bowles for the death of Princess Diana. Had there not been a “third person” in the marriage, who knows what might have happened. Currently, the Prince of Wales is employing some of the most sophisticated media advisers in the world to re-brand the Duchess of Cornwall. As anyone who saw the unctuous "documentary" on her last week, it is clear that the Prince is manipulating a receptive media to make his second wife “acceptable” to the public as a future Queen of England.

This odd, introverted socio-pathic family cannot expect the media only to present issues to their liking. Princess Diana is and always will be in the public domain. They must take the rough with the smooth.

From the medical standpoint, Princess Diana’s tragic death raises a much more important question. The question being, to lapse into jargon, whether the ambulance service should “scoop and run” or “stay and play”.

Princess Diana had sustained catastrophic internal chest injuries. In particular, she had ruptured her pulmonary vein, the vein that takes blood back from the lungs to the heart. It is likely, whatever treatment she had received, that she would not have survived.

A passing doctor was with her within a minute or two, and a fully equipped trauma team was there within fifteen minutes. They “stayed and played”. It was nearly two hours before she was in the operating theatre of a Paris Hospital. Predictably enough, it has been argued that had they “scooped and run” she might have survived. Maybe so. But if they had “scooped and run”, and she had died in the ambulance, the counter argument would have been advanced.

The issue is discussed in detail in:

Death Of A Princess, Did Princess Diana Have To Die?:
A Case Study In French Emergency Medicine

What happens in the UK?

There is an increasing amount of “stay and play” carried out by paramedics well versed in play techniques, but not well enough trained in diagnosis.

Ten years ago, the BMJ reported:

This debate over scoop and run or stay and play serves only to perpetuate the winging of the pendulum. There is likely to be no single answer for the care of the critically injured. Each patient needs individual assessment of his or her needs. Paramedics have been restricted by protocols, which are often inflexible, because their training has not been broad enough to allow more flexible guidelines. Doctors have also tended to overestimate the skills of paramedics.

The involvement of doctors at accident scenes, however, continues to be mostly on a voluntary basis through the BASICS (British Association for Immediate Care) schemes.

We looked at BASICs a while ago. A well-meaning lot, but you have to giggle. What other country would dumb down on site traumatology to a group of amateur volunteers?

GPs are universally hopeless in traumatological “blood, artery, spurt” situations, but they do have diagnostic medical skills. Paramedics have practical skills, but do not have real diagnostic skills and so often underestimate the need for accurate diagnosis. When called to a domestic medical emergency by the family doctor, paramedics can be a real problem. Dr Crippen has had one patient who died as a result of “stay and play” when he had instructed the paramedics to “scoop and run” but was ignored.

Paramedics increasingly now make decisions about who should and should not be taken into hospital. This is all part of the NHS cost cutting and, dear God, they do get called to some nonsense. Even so, sometimes they get it badly wrong. If you are going to “stay and play” you need more skills than the average ambulance brings to market.

Like many family doctors, Dr Crippen has reached the stage that, if he were taken suddenly and seriously ill but was still compos mentis, he would get a family member or friend to drive him to the nearest hospital rather than take his chances with an ambulance full of paramedics who wanted to “stay and play”.

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Follow up at 10.00 pm Wednesday 6th June
This was a responsible and important documentary. It was not primarily about Princess Diana or Dodi Al Fayed. It was about the photographers who were subjected to an authority instituted and media supported lynching. Locked up without charge for over two days. Two years later they were formally cleared. Mohamed Al Fayed pursued an action against them for breach of privacy and was awarded derisory damages.

It seems most likely that the cause of this accident was mundane. A drunken chauffeur driving too fast in a built up area.

Having seen the programme I am convinced that it was reasonable and appropriate for it to be shown. It was carefully edited with nothing prurient or too intrusive. My only criticism is that the photographers, for all their faults, should not have had to wait ten years for their story to be told.

From the medical point of view, I still do not know if "stay and play" was superior to "scoop and run" but I suspect the latter would have had more chance of success. It would be interesting to hear Tom Reynold's views on that.