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The Kerslake Report: An independent review into the preparedness for, and emergency response to, the Manchester Arena attack on 22nd May 2017

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  • HD Research

Abstract and Figures

The Manchester Arena attack on 22nd May 2017 was the deadliest in the UK since the London bombings on 7th July 2005. Although the Greater Manchester Resilience Forum had done many planning exercises, the events of 22nd May were something none of those involved had ever encountered before. This was a real-world test of the plans and assumptions. This Review has focused on the response to the attack in the nine days that followed it. There is a lot to be proud of in the response, both for the city-region of Greater Manchester and its emergency services. The benefits of investing in collaborative partnership and emergency planning were demonstrated to the full. We set out in the report and summarise below the highlights of what went well. But we are conscious that we are only touching the surface of hundreds if not thousands of acts of individual bravery and selflessness. NB. Hugh Deeming was a panel member and co-author of the review's final report.
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... The global incidence of natural disasters, conflict, and terrorism has risen in the last two decades [1,2]; with over two million people dead, many more wounded, and incurring far-reaching economic and societal consequences [1À4]. In the UK, recent major incidents include terrorist-related combined vehicular and stabbing attacks [2], a shrapnel-laden bomb in a concert hall [4], and a large residential fire [2]. Triage, the sorting of casualties according to priority, was conceived during the Napoleonic Wars [5]. ...
... Globally, natural disasters, conflict, and terrorism pose significant and often unexpected threats, incurring substantial societal and economic impact [1,2,29]. Review of the 2017 Manchester Arena attack highlighted the importance of well-co-ordinated, multiagency collaboration in processing casualties and the negative impacts of an inadequate EMS response [4]. Meticulous disaster planning, including selection of an effective triage tool, is crucial to maximising survival [2,3,8,10,29]. ...
... However, minimising over-triage in the resource-constrained major incident setting is also crucially important as overwhelming medical facilities with patients suffering non-critical injury can impair care for those requiring time-critical interventions[8À10]: a study encompassing 3357 casualties from 220 bombing incidents demonstrated a direct linear relationship between over-triage and critical mortality [9]. Policymakers are therefore likely to favour the clinically relevant measures of under-triage and over-triage over AUC, which offers an aggregate measure of performance, selecting tools that align with local casualty distribution plans and available resources [3,4]. Whilst the need for life-saving intervention is of prime importance in guiding resource allocation in major incidents, predicting all-cause in-hospital mortality in patients with diverse, multi-system injuries is an additional useful measure of tool performance, given that the priority is to maximise overall survival [3,5,12,16]. ...
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Background Natural disasters, conflict, and terrorism are major global causes of death and disability. Central to the healthcare response is triage, vital to ensure the right care is provided to the right patient at the right time. The ideal triage tool has high sensitivity for the highest priority (P1) patients with acceptably low over-triage. This study compared the performance of major incident triage tools in predicting P1 casualty status in adults in the prospective UK Trauma Audit and Research Network (TARN) registry. Methods TARN patients aged 16+ years (January 2008-December 2017) were included. Ten existing triage tools were applied using patients’ first recorded pre-hospital physiology. Patients were subsequently assigned triage categories (P1, P2, P3, Expectant or Dead) based on pre-defined, intervention-based criteria. Tool performance was assessed by comparing tool-predicted and intervention-based priority status. Findings 195,709 patients were included; mortality was 7·0% (n=13,601); median Injury Severity Score (ISS) was 9 (IQR 9–17); 97·1% sustained blunt injuries. 22,144 (11·3%) patients fulfilled intervention-based criteria for P1 status, exhibiting higher mortality (12·8% vs. 5·0%, p<0.001), increased intensive care requirement (52·4% vs 5·0%, p<0.001), and more severe injuries (median ISS 21 vs 9, p<0.001) compared with P2 patients. In 16–64 year olds, the highest performing tool was the Battlefield Casualty Drills (BCD) Triage Sieve (Prediction of P1 status: 70·4% sensitivity, over-triage 70·9%, area under the receiver operating curve (AUC) 0·068 [95%CI 0·676–0·684]). The UK National Ambulance Resilience Unit (NARU) Triage Sieve had sensitivity of 44·9%; over-triage 56·4%; AUC 0·666 (95%CI 0·662–0·670). All tools performed poorly amongst the elderly (65+ years). Interpretation The BCD Triage Sieve performed best in this nationally representative population; we recommend it supersede the NARU Triage Sieve as the UK primary major incident triage tool. Validated triage category definitions are recommended for appraising future major incidents.
... The operational landscape and responsibilities of International Fire Services have changed dramatically over the last fifteen years, with terrorist attacks (Deeming, 2018), extreme weather events and complex fire prevention strategies, all greatly affecting the scope, severity and, importantly, numbers of incidents attended (Home Office, 2019). This dynamic operating landscape challenges fire services to implement change, adapt, innovate and evolve to maintain service levels commensurate with community risk. ...
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Purpose The study aims to determine if the application of a systematic command training system (Effective Command) could influence the organisational competency profile, through the identification, training and assessment of key behavioural markers. Design/methodology/approach The Effective Command framework is aligned to UK National Fire Service role-maps and is routinely used in both development and assessment of Fire Officers worldwide. Data from 1,261 formal assessments were analysed and descriptive statistics performed. Findings Structured analysis of incident command assessment data should inform subsequent training cycles of individuals, organisations and procedures. Key behavioural markers were identified in Level 1 (L1) and Level 2 (L2) commanders which influence assessment outcomes. Reduced competence scores between L1 and L2 officers were recorded, providing a strong argument for a supported development process for L2 officers. Practical implications Six key behavioural markers were identified in L1 commanders, all were associated with information comprehension and evaluation, which ultimately impacted the outcomes of formal assessments. This study provides empirical evidence that frequent incident or scenario exposure, coupled with metacognitive understanding of the decision rationale could reverse these weaknesses and turn them into individual strengths. This in-depth analysis of data generated in individuals who pass or fail these assessments should strengthen organisational learning. Originality/value The use of a structured command training framework contributes significantly to operational assurance by providing a robust assessment and training methodology, which ensures that organisations can appoint, train and assess their incident commanders.
... Additionally, emergency response organizations have to deal with terrorist attacks like the Manchester Arena attack on May 22, 2017, in which a suicide bomber detonated an improvised device and killed twenty-two people and physically wounded over one hundred people (Kerslake, Deeming, Goodwin, Lund, & Wahlström, 2018). All these hazards are fully capable of disrupting society on a local, national, or global scale (Tierney, 2014). ...
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enAn emergency response organization is resilient when it learns from and is well equipped to handle (potential) risks and hazards. In this paper, we will address the organizational resilience fit for Dutch emergency response organizations (safety regions) in relation to various types of crisis. The approach presented in this paper is based on a quantitative organizational resilience model. We validated the model by means of a survey conducted among the employees of Dutch safety regions. In this survey, we queried how the employees perceive the different attributes related to a set of crisis types. We used the results to calculate the quantitative representation of organizational resilience. We found that the presence of a Quality Management system or a Safety Management system does not significantly influence the organizational resilience of the organization. However, a statistically significant difference for organizational resilience was found in the type of staff assignment: volunteer, professional, or volunteer and professional. The volunteers rated the organizational resilience lower. We recommend to increase a safety region’s organizational resilience by enhancing communication and organizational engagement of volunteers, stop pursuing a Quality/Safety Management program and perform further research on (international) emergency response organizations. 组织弹性及其与六种主要危机类型之间的关系——以荷兰“安全区域”为例 zh 一个应急响应机构是具备弹性的 ,如果它有能力应对其所必须面临的(潜在)风险和危害,并同时从危机中吸取经验。笔者研究了荷兰应急响应机构(被称为安全区域)的设计方式和在应对不同(潜在)危机时的建构方式,二者之间可能存在的(非)适应。首先,本文提出的方法基于一项模型,这项模型定义了一组用于弥补组织弹性的性质。通过对荷兰安全区域中就职的员工进行调查,笔者证实了该模型。调查中,针对员工如何看待与一组危机类型有关的不同性质,笔者提出了疑问。笔者将调查结果引入上述模型,并计算了组织弹性的定量代表。笔者发现,质量管理体系或安全管理体系的存在并不会显著影响一个组织的组织弹性。然而,笔者在员工任务类型中找出了组织弹性的显著区别,员工任务类型分为:志愿者、专业人士、以及志愿者和专业人士。其中志愿者对组织弹性的评级较低。笔者建议,应通过以下方式增加一个安全区域的组织弹性:聚焦于提升沟通、促进志愿者进行组织参与、停止追求质量管理或安全管理计划、以及对(国际)应急响应组织展开进一步研究。 Una organización de respuesta a emergencias es resiliente si está bien equipada para lidiar con riesgos y peligros (potenciales) y para aprender de las crisis es En este documento trataremos el tema del posible (des)encaje de la forma en que las organizaciones de respuesta a emergencias en Países Bajos (las regiones de seguridad) están diseñadas y estructuradas para lidiar con una crisis (potencial) en relación con varios tipos de crisis. Primero, el enfoque presentado en este documento se basa en un modelo con un conjunto definido de atributos que conforma la resiliencia organizacional. Validamos con la ayuda de una encuesta llevada a cabo entre los empleados de las Regiones de Seguridad de Países Bajos. En esta encuesta preguntamos cómo perciben los empleados los diferentes atributos relacionados con un conjunto de tipos de crisis. Introdujimos en el modelo los resultados obtenidos y calculamos la representación cuantitativa de la resiliencia organizacional. Hallamos que la presencia de un sistema de gestión de calidad o un sistema de gestión de seguridad no tiene una influencia significativa sobre la resiliencia organizacional de la organización. Sin embargo, una diferencia estadística significativa de la resiliencia organizacional fue encontrada en el tipo de tarea del personal: voluntario, profesional o voluntario y profesional. Los voluntarios asignaron un valor menor a la resiliencia organizacional. Recomendamos aumentar la resiliencia organizacional de una región de seguridad con un enfoque en mejorar la comunicación, incrementar la participación de los voluntarios en la organización y dejar de buscar un programa de gestión de la calidad y / o seguridad y realizar investigaciones adicionales sobre organizaciones de respuesta a emergencias (internacionales).
... The UK experience has mirrored this, and responders to Manchester Arena bombing stated this occurred once again, with many patients being moved by improvised means such as crowd barriers. The Kerslake report (Deeming, 2018), completed in response to the bombings, highlighted this issue as the following quotes from bystanders show: "Metal railings were used to carry out all the injured people from the Arena. Me and six police officers carried X to the station. ...
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Prehospital terrorism response in Australia has been bolstered significantly in the past couple of years, however there are still large capability gaps. International best practice and identified lessons from previous attacks can provide guidance on moving forward, with a systems approach to robust high threat medicine provision. This Scholarship report identifies lines of action for local and national level enhancements in response capacity.
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Objectives Post-traumatic stress disorder (PTSD) is commonly experienced in the aftermath of major incidents such as terrorism and pandemics. Well-established principles of response include effective and scalable treatment for individuals affected by PTSD. In England, such responses have combined proactive outreach, screening and evidence-based interventions (a ‘screen-and-treat’ approach), but little is known about its cost-effectiveness. The objective of this paper is to report the first systematic attempt to assess the cost-effectiveness of this approach. Methods A decision modelling analysis was undertaken to estimate the costs per quality-adjusted life-year (QALY) gained from a screen-and-treat approach compared with treatment-as-usual, the latter involving identification of PTSD by general practitioners and referral to psychological therapy services. Model input variables were drawn from relevant empirical studies in the context of terrorism and the unit costs of health and social care in England. The model was run over a 5-year time horizon for a hypothetical cohort of 1000 exposed adults from the perspective of the National Health Service and Personal Social Services in England. Results The incremental cost per QALY gained was £7931. This would be considered cost-effective 88% of the time at a willingness-to-pay threshold of £20 000 per QALY gained, the threshold associated with the National Institute for Health and Care Excellence in England. Sensitivity analysis confirmed this result was robust. Conclusions A screen-and-treat approach for identifying and treating PTSD in adults following terrorist attacks appears cost-effective in England compared with treatment-as-usual through conventional primary care routes. Although this finding was in the context of terrorism, the implications might be translatable into other major incident-related scenarios including the current COVID-19 pandemic.
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