A new report on the hospital care of injured patients from the Manchester Arena bombing has been published by BMJ Journals.

The report, “Healthcare system impacts of the 2017 Manchester Arena bombing: evidence from a national trauma registry patient case series and hospital performance data” has been published in the Emergency Medicine Journal. It was developed by Manchester Academic Health Science Centre (MAHSC) collaborators – Paul Dark , Martin Smith, Harry Ziman, Simon Carley, and Fiona Lecky.

It shows, for the first time, that during a civilian major trauma terrorist incident, detailed patient information and routine hospital performance data can be collated and used to examine the demands placed on a region’s healthcare system.

In response to detonation of an improvised explosive device at the Manchester Arena on 22nd May 2017, hospitals across Greater Manchester implemented a pre-rehearsed major disaster plan to receive and treat the injured children and adults. During these responses, hospital data was collected about how, when and where patients attended NHS hospitals, and about the hospital care that they received. The University of Manchester’s national trauma database (Trauma Audit and Research Network – TARN) was pivoted to capture and analyse these data as the hospital responses unfolded. NHS regional hospital emergency system performance data were also reviewed.

The new report identifies:

1. From the perspective of a region’s NHS hospitals, a pre-rehearsed major incident plan appeared effective in delivering the most seriously injured children and adults to hospitals best suited to deliver their care needs.
2. The pattern of arrival of injured patients at emergency departments reflected the constraints at incident scene and provided an opportunity to implement hospital major incident plans to enhance emergency hospital care capacity.
3. The region’s ability to provide networked emergency hospital care for both children and adults was never overwhelmed but was at the expense of a significant loss of planned surgical capacity and a reliance on local community services to help free up hospital capacity.
4. Data arising early from hospitals, particularly on patterns of physical injury, allowed NHS England to anticipate impacts on regional healthcare provision; national supply chains; and the need to deploy national resources including public health services.
5. For individual patients, it was not possible to capture care data recorded at scene and to link these with records of subsequent hospital care. A folding card information system deployed at scene for each patient did not prove robust enough to convey information into hospital care.
6. The report was unable to detail the impact on patients and community-based healthcare services of cancelled elective surgical operations, increased hospital discharges into community care and the sustained reductions in emergency department attendances in the weeks following the incident.

Professor Paul Dark, Professor of Critical Care Medicine at The University of Manchester, said: “This report has shown for the first time how systematic collation of both individual patient hospital data and hospital performance data can be used to examine the demands on a region’s healthcare system during a major terrorist incident. Four years on, the impact of the incident is still being felt, but we recognised that it was important to reflect and use the available data to learn from the event. We would like to thank all of the partners involved in producing the report, particularly for the involvement of patients and relatives.”

The team has worked with a range of organisations in production of the report including: North West Ambulance Service; Trauma Audit and Research Network, University of Manchester; NHS Utilisation Management Unit, Health Innovation Manchester; Greater Manchester Major Trauma Collaborative, NHS England; Humanitarian and Conflict Response Institute, University of Manchester; Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield; Greater Manchester Police; Greater Manchester Combined Authority.

The Emergency Medicine Journal is an international peer-reviewed journal covering pre-hospital, hospital emergency medicine and critical care.

Read the report: https://emj.bmj.com/content/emermed/early/2021/04/21/emermed-2019-208575.full.pdf