Claire Booth was put in the impossible position of having to decide whether to care for her sister or her daughter after the Manchester Arena attack. She understandably chose to look after her 12-year-old daughter, Hollie, but the decision still haunts her. More than anything, she wishes that emergency help had arrived quickly, in whatever form, and that the three of them had been taken to hospital for proper care. Kelly Brewster, her bubbly, music-loving sister did not survive the bombing.
The speed of the emergency response may not have made a difference to Kelly but it may be that two others among the 22 victims could have been saved – eight-year-old Saffie-Rose Roussos and 28-year-old John Atkinson.
Those who lay injured and in immense pain in the City Room foyer where the bomb went off, including Claire and Hollie, wanted help to arrive as quickly as possible. As did Martin Hibbert, whose spinal cord was severed and whose 14-year-old daughter, Eve, was covered up and left for dead, when she was actually still alive.
The reason emergency help did not arrive is because the ambulance and fire services were performing risk assessments before they would go to the scene of the explosion.
Others were not so reticent. At the side of the injured and dying were police officers and first aiders from the arena, who rushed to their help. All were desperately under-equipped to deal with what they were seeing, and all of them were expecting, indeed pleading, for back-up.
Two police officers were heard talking on their body cameras saying: ‘We need ambulances mate massively. We need paramedics like fucking yesterday.’
Claire Booth has sat quietly at the back of the public inquiry almost every day it has run this past 11 months and last week it was finally her turn to give evidence.
Her words are worth reading:
‘I've sat here more or less day since September and I’m completely shocked to have seen that in events such as this, it’s widely known that medical assistance won’t be with you immediately.
‘It’s written into policies, procedures, yet me, as a member of the public, had absolutely no idea that if I was ever in a terrorist attack, I wouldn’t get medical help straightaway.
‘I think that is something that needs to be in the public domain. If you choose to go somewhere public while we’ve got a severe terrorist threat in the country, you’re doing that on the understanding that you’ll have to look after yourself, or it might just be other members of the public that are caring for you instead.
‘I do think it should be publicly known that medical assistance cannot always come to you immediately because if I’d known that, I wouldn’t have just sat and waited, I would have done absolutely anything that I could to get the three of us out of that room.’
Many people reading this will believe they are never going to be involved in a terrorist attack, and they are almost certainly right, but the same ‘stand back’ policies apply to firearms discharges, knife attacks, or any number of other violent incidents.
We know this will happen because the problem is a recurring one.
After the 7/7 bombings 16 years ago, fire fighters delayed going into the tunnels to rescue the injured and dying at the tube sites and the bus because of safety concerns, this time about secondary devices.
At King’s Cross, the ambulance service treated the walking wounded in the ticket office for half an hour while the injured and dying in the tunnels below were being helped by members of the public. The tales of those waiting in those tunnels for help to arrive were as bad as the ones we heard last week.
After criticism at the inquests, the ambulance and fire services introduced hazard area response teams, trained to go into dangerous areas. Nevertheless, concerns remained at the top of government that the emergency services would not treat the wounded quickly enough if the worst happened at the Olympics in 2012. Their concerns proved to be prophetic at the Manchester Arena bombing in 2017.
For the first 43 minutes after the bomb there was only one paramedic in the City Room and he initially triaged but did not treat any patients. The fire service delayed for more than two hours before their officers went in and by the time they did so, the injured and dying had been removed from the City Room on makeshift stretchers made from advertising hoardings and crowd control barriers.
It was an hour and eight minutes before Bradley Hurley, the last casualty, was taken out of the foyer, suffering from two broken legs, having seen his sister, Megan, pass away next to him. As soon as he was at the bottom of the stairs he was put down again, and there he stayed for another three hours waiting for an ambulance.
Greater Manchester Fire and Rescue Service (GMFRS) have made their profuse apologies but North West Ambulance Service (NWAS) insist that the ‘overall operational response to the attack was quick, effective and adequate.’ In other words nothing is likely to change soon.
The problem at the heart of this delay are those risk assessments.
How much risk is acceptable? The fire service routinely conduct risk assessments before they go into burning buildings. Ambulance service paramedics are used to seeing the after-effects of violent attacks but by and large they go into the job to save lives, not to risk their own. Police officers tend to end up in risky situations on a more regular basis and their natural reaction is to rush in where others fear to tread. As a result, they often bear the burden of trying to help the injured.
Ultimately, if the emergency services decide to take no risks, they will never enter the scene of an attack because, put simply, you cannot guarantee there is not another terrorist hiding out or a second bomb hidden somewhere.
Terrorist attacks are chaotic events and they rarely work out like a training exercise. In Manchester, a senior fire officer took an hour to drive from his home in Wigan and a British Transport Police officer took even longer to arrive from Blackpool.
In the aftermath of the attack, Greater Manchester Police launched ‘Operation Plato’, a plan set up for ‘marauding’ terrorist attacks – despite officers on the ground telling them that a bomb had gone off and the attacker was dead. Once Operation Plato kicks in, police have to stop and designate a ‘hot zone’ where the terrorists are still active, a ‘warm zone’ where they have recently left but to which they may return, and a ‘cold zone’ which is safe to enter.
Those zones are easy to determine in theory but impossible in practice. How can you possibly know where the terrorist may return?
And different emergency services often do not see the risk of entering the zone in the same way. The same delays with the ambulance response happened at the London Bridge attacks in June 2017 when it took the ambulance service three hours to go into the scene of the attack. At the Fishmongers Hall attacks in November 2019, firearms officers almost had to drag emergency medics in to help with CPR. Even then medics insisted the casualties were carried down the road instead of being treated at the scene because it was a ‘warm zone’.
Ambulance and fire services have trained special response units with ballistic vests and helmets to enter those zones, but they may be far away from the scene of the attack, and they will still stop to do a risk assessment before entering.
There is an urgent need to speed up our emergency response after terrorist attacks – and to avoid more of what Claire Booth called ‘policies and procedure’.
Emergency responders need to think realistically about the situations they may face and to consider how they would respond as individuals to the unexpected. The danger of a secondary device or another attacker is often slim, and risk assessments and warm zones really are meaningless when there are dozens of badly injured people a short dash away. PC Troy Tyldesley told the inquiry he needed to ‘get help in there for those people’ and that the City Room foyer was ‘as safe as it can be at that time’.
In her evidence Claire Booth drew attention to a scheme called citizenAID, which also gave evidence at the inquiry. Brigadier Tim Hodgetts, who came up with the scheme, made the point that you have normally have ten minutes to save a life: ten minutes to stem catastrophic bleeding and get the casualty stabilised.
‘The opportunity to save a life rests with those who are part of the incident. That is the public,’ he said. Someone needs to pack the wound, apply pressure and put on a tourniquet if possible. Then the injured person needs to get to hospital as quickly as possible. The military has learned this after treating serious injuries in Afghanistan and Iraq. CitizenAID are calling for more of the public to be trained in first aid in the event of a terrorist attack.
As things stand, should you find yourself lying on a cold floor one day waiting for help to arrive, get whoever is nearby to pick you up and carry you out before it's too late, and try to find any way to get to a hospital.
Until our emergency services change their risk assessment policies, this advice may be the only thing keeping you alive.