Next month we will mark the fourth anniversary of the Manchester Arena Bombing on the 22nd May. As you will remember Salman Ramadan Abedi detonated an improvised device in the foyer of an Ariana Grande concert in Manchester resulting in the deaths of 23 people (including the attacker) and injury to many more. The attack changed much about the city and the emergency services who responded that night. Three years on many are still affected by the event and for some the event is far from resolved as a public enquiry is currently ongoing. The enquiry is focusing on the emergency services response at scene where concerns have been identified about the care and transportation of patients. The Guardian and the Manchester Evening News newspapers have collated articles that paint a picture of the event and subsequent concerns. I believe that the enquiry will also take evidence from hospital staff.
The level of scrutiny is forensic and a reminder that in the event of a major incident everything will be looked at in retrospect. Even issues such as whether individuals were up to date with mandatory training has been examined and in the modern age with automatic recording of all messages, CCTV and mobile device recording it is possible to piece together incredibly detailed analysis of events. As an example (and if you can get past the advert) have a listen to the initial radio conversations between control and the first paramedic on scene here.
EMJ paper published this week
Soon after the event we recognised that it is important to learn from the event and to collate data on what happened such that others can learn from the event. A small group was identified to look at hospital data on behalf of the MAHSC (Manchester Academic Health Science Centre) using hospital and TARN data to generate a picture of what happened on the night.
That paper is now published and is available as an open access download here. I hope that you get time to read it and to consider the event and how it would impact your health and emergency services if it happened near you.
The abstract is shown below. As the paper is open access I’m not going to reproduce the data here as I’d prefer you to read and digest it yourself.
It has taken a long time to get this paper to publication. Whilst there was a general consensus that sharing information after a major incident is important, the very nature of these unique events means that patient confidentiality is difficult to maintain. The names of the victims are in the public domain, but what actually happened to individuals is not and it is therefore important to respect this when reporting events. This was a significant challenge in this paper and we have detailed how we addressed this in the main article. The issues and actions can be summarised as follows.
- We sought advice from editors and staff of journals
- We got great advice from the BMJ ethics committee and followed their recommendations
- We were supported in hearing the patients voice through contact with Manchester City Council and Greater Manchester Police who remain in contact with those involved in the incident
- We removed some data from the paper that would have been identifiable to individuals. For example we were able to track accurate times for patients in their hospital journey by extracting data from admission, discharge, radiology, clinical notes etc. On an individual basis we could track the patient journey through the system and present this in graphical form (almost like a GANTT chart), but this would have identified individuals and was thus not suitable for publication in line with the agreement reached with patients and families
- We wrote to all identified individuals to explain the purpose of the publication and to ask permission to publish. We have published that letter with the main paper
- We have published the response from one individual who raised concerns about the content of the paper
- We repeatedly sought advice from the ethics committee who, together with the editor, had the final say over whether the paper should be published
- The paper and data have been made available to the public enquiry
We believe that this is a model that could and should be repeated in future major incident reporting where patient anonymity cannot be maintained.
The Trauma Audit and Research Network is a long standing project that records data on all hospital admissions with major trauma. It’s an invaluable tool to improve UK trauma services. In an incident such as this, those patients admitted to hospital would be included in the database, but those discharged with minor injuries would not as TARN does not ordinarily collect data on patients who die at the scene, during transfer or those discharged in under three days. Following the arena bombing TARN rapidly developed and deployed a major incident module that allowed the inclusion of patients who would not normally be recorded into the database. This module can now be deployed at future major incidents.
The Manchester Arena Bombing was a terrible event that changed the city of Manchester. The enquiry into the events continues three years later. We have learned a lot about how to report such incidents and also how to record them in trauma databases.
We should all seek to learn from this event, and from other major incidents, in a way that respects patients and staff.
- Manchester Arena Enquiry https://manchesterarenainquiry.org.uk/
- Manchester Arena Enquiry YouTube channel https://www.youtube.com/channel/UCdWYYDnEbLUOyFsCaVhqlxw
- Guardian pages on the arena bombing https://www.theguardian.com/uk-news/manchester-arena-explosion
- Manchester Evening News pages on the arena bombing https://www.manchestereveningnews.co.uk/all-about/manchester-terror-attack
- Dark P, Smith M, Ziman H, et alHealthcare system impacts of the 2017 Manchester Arena bombing: evidence from a national trauma registry patient case series and hospital performance data Emergency Medicine Journal Published Online First: 22 April 2021. doi: 10.1136/emermed-2019-208575
- Trauma Audit and Research Network https://www.tarn.ac.uk/
- MAHSC https://healthinnovationmanchester.com/partnerships/manchester-academic-health-science-centre/