The North West Ambulance Service response

The North West Ambulance Service response

¶140. The first 999 call to the North West Ambulance Service (NWAS) was the call made by Mr Jonathan Cape which was received by the NWAS Emergency Operations Centre at 11:47:56. This was two minutes and 19 seconds after AR had entered the ground floor entrance to the Hart Space at 11:45:37. During the call, a disturbance can be heard in the background (as I have addressed above, this was Mr Hayes having been stabbed by AR) and the call then cuts out. The call was initially deemed to be a Category 2 – emergency call. The second call was received by NWAS at 11:48:34 and is now known to have been made by the mother of Child C5 (C5-M). C5-M reported stabbing and the call was classified as a Category 1 – life threatening call.²²⁷²²⁷ NWAS received a further eight calls. The later NWAS audit referred to in the Witness Statement of Mr Ainsworth: NWAS001083/§§35-37, found that five of the calls did not achieve a safe standard, in a number of cases because there were missed opportunities for the call handler to gather further information from the caller. However, this did not impact the overall response because resources were allocated to the call made by C5-M which was classed as a Category 1 call.Show full note

¶141. The first NWAS crew that was allocated was Senior Paramedic Team Leader Mr Paul Smith. He was dispatched to the scene at 11:50:09. This was in response to the Category 2 call of Mr Cape, which was to be responded to using blue lights and sirens. He was advised that the incident was for a young person who had been stabbed in the back.

¶142. At 11:50:47, Paramedic Ms Gemma March-Jackson and Emergency Medical Technician (EMT) Ms Katie Johnson were allocated to the attack. At 11:51 Ms March-Jackson’s ambulance contacted the dispatcher via the radio to ask if it was safe to attend the scene. Ms March-Jackson would have been provided information about stabbing or knives on the ambulance’s mobile data terminal. The dispatcher advised that the police were aware of the incident and in attendance, but they should stand off until further information was provided.

¶143. Having been advised to stand off, the expectation was that their ambulance would proceed towards the scene using blue lights and sirens but stop a safe distance from the attack due to the risk presented at the scene. However, it is apparent from the ambulance’s dashcam footage that the ambulance was instead driven toward Hart Street without blue lights and sirens.²²⁸²²⁸ T/S: 12/123/8-18. NWAS’s investigation into why this occurred is continuing. The Inquiry understands, however, that the explanation given for the lack of blue lights and sirens was effectively an oversight while focusing on the immediate response tasks in hand.²²⁹²²⁹ NWAS001340. Given that responses of this nature are time critical, I would have made a recommendation to address the risk of this re-occurring. However, NWAS have recognised that there is an opportunity to state more clearly the standard and expectations in relation to the use of blue lights and sirens. As a result, NWAS is to refresh and reissue operational instructions to staff which clearly require the use of blue lights and sirens, as well as updating the driver training course content.²³⁰²³⁰ NWAS001339. I am satisfied that this addresses the issue and therefore do not make any further recommendations. While it is a matter of concern, this did not in fact have a material impact on the NWAS response because, firstly, the short distances in question meant that the use of blue lights and sirens would not have significantly shortened their travel time and, secondly, this ambulance followed Mr Smith’s vehicle straight to the scene rather than standing off.

¶144. At 11:52, Mr Smith was contacted by the dispatcher and told that the attacker could still be on scene and to stand off. At 11:53, Mr Smith was advised that police were in attendance. This was not actually the case: PS Gillespie was the first Merseyside Police officer to arrive on scene at 11:56. It was not necessary for the Inquiry to determine the exact cause of this miscommunication. However, given the matters set out above, including the confusion between police and ambulance call handlers, it is possible that this is a further demonstration of confusion between NWAS and Merseyside Police in relation to the different terminology used for RVPs, being ‘at scene’ and ‘standing off’.²³¹²³¹ T/S: 12/123/1-7. From NWAS’s perspective, their witness, Mr Daniel Ainsworth (Director of Operations), was not aware of the differences in terminology used by Merseyside Police for the RVP and agreed that NWAS and Merseyside Police should have a common understanding in this respect.²³²²³² T/S: 12/104/3-105/15.

¶145. As Mr Smith was at the junction of St Luke’s Road and Hart Street, he saw a police vehicle behind him. This was the vehicle of PS Gillespie. He pulled over and spoke to PS Gillespie about directions to Hart Street and then decided to follow PS Gillespie to the scene, despite the instruction to stand off. At around the same time, at 11:56, the dispatcher passed further information to Mr Smith stating that there were reports of armed men in the Norwood Business Centre and to stand off. Mr Smith replied confirming that he was already on the scene. He parked his vehicle at the scene at 11:57:25.

¶146. The relevant NWAS policy gave responders a discretion as to whether to move forward to the scene following a stand off instruction. Given the information provided to him, Mr Smith made a brave and commendable decision to go forward to the scene.²³³²³³ Adopting the words used by Mr Ainsworth: T/S: 12/128/9-12. As I have referred to above, Ms March-Jackson’s ambulance crew showed similar courage to go straight to the scene, and they arrived shortly after Mr Smith at 11:58:00.

¶147. Mr Smith arrived at the scene around nine and a half minutes after the first 999 call was received by NWAS. For a Category 1 call, this was within the 15-minute target time for 90% of calls. It was slower than the target average time of seven minutes. However, the first call was correctly classified as a Category 2 call, which has slower response targets. Mr Smith went straight to the scene from the moment of dispatch, save for some short time when he appropriately discussed his attendance with PS Gillespie.

¶148. I am therefore entirely satisfied that the NWAS response time was appropriate.

¶149. In total, NWAS deployed 37 resources to the scene. Apart from the two resources referred to above, and a few justified exceptions, none was given an instruction to stand off or to attend a RVP. All of those resources mobilised directly to the scene using blue lights and sirens.

¶150. Mr Ainsworth, NWAS Director of Operations, stated that it was difficult to ascertain when a Major Incident on Standby and a Major Incident had been declared, but concluded that a Major Incident had been declared by Gary Fitzpatrick, Advanced Paramedic, at 12:25.²³⁴²³⁴ T/S: 12/142/10-14. He accepted that:

¶a. There was a level of confusion about whether a Major Incident had been declared in the documentation;

¶b. While Paul Smith had intended to relay a Major Incident at 12:05, it was not clear that he had done so and no declaration was recorded or taken forward;

¶c. A clear M/ETHANE message was not relayed from the scene during the early stages (The ‘M’ in the M/ETHANE mnemonic stands for ‘Major Incident’. Following this structured approach is intended to focus attention, under the letter ‘M’, on whether a Major Incident should be, or has already been, declared);

¶d. Those at the Emergency Operations Centre could have contacted those at the scene to seek clarity on whether a Major Incident had been declared;

¶e. In any event, there was sufficient information available to the Emergency Operations Centre to declare a Major Incident at an earlier stage;²³⁵²³⁵ T/S: 12/142/22-148/15.

¶f. Once a Major Incident had been declared within NWAS, it was not shared with Merseyside Police by the Emergency Operations Centre (although it was discussed at scene) and nor was a M/ETHANE message sent.²³⁶²³⁶ T/S: 12/142/22-143/16.

¶151. Significantly, the declaration of a Major Incident on Standby and a Major Incident trigger a pre-determined attendance of various NWAS resources. Mr Ainsworth’s evidence, which I accept, was that the resources appropriate for a Major Incident on Standby had been deployed within the first 15 minutes of the first NWAS 999 call and the resources for a Major Incident were deployed within 28 minutes of the first call.²³⁷²³⁷ T/S: 12/146/10-21, T/S: 12/147/14-18. As a result, the dispatchers did deploy appropriate resources to the scene, even in the absence of clear declarations and the NWAS response was not affected by this confusion.

¶152. Nevertheless, the oversight or confusion about whether a declaration has been made could have had a serious impact on an ambulance service response by delaying the pre-determined response. Mr Ainsworth’s explanation for the failure to make a declaration was the infrequency with which paramedics are faced with such a scene. He also noted that the dispatch leadership team felt overwhelmed in the early stages of the response.²³⁸²³⁸ T/S: 12/144/2-21, T/S: 12/148/16-149/11.

¶153. NWAS has introduced duty officers to assist with these issues. It has also revised its incident response plan to reduce the demands on the Emergency Operations Centre duty manager. However, Mr Ainsworth identified exercises as a tool to address these issues.²³⁹²³⁹ T/S: 12/146/2-9. Those in a command role undergo training twice yearly and are required to take part in exercises but NWAS does not have the capacity or the funding to allow all levels of staff to participate in exercises. This is despite the fact that such exercising was a recommendation of the Manchester Arena Inquiry. NWAS had received increased resources since that Inquiry, but Mr Ainsworth stated these those increased resources were to increase the number of ambulances available and NWAS remain in discussions with NHS England in this regard.²⁴⁰²⁴⁰ T/S: 12/156/6-158/24. I recognise that work is ongoing in this area (albeit some time has now passed since the Manchester Arena Inquiry concluded) but I return to this issue in my recommendations at the end of this chapter.²⁴¹²⁴¹ Closing Statement on behalf of NHS England NHS000574/6-8/§23-29.

¶154. Another issue that arose during the NWAS response was the provision of paediatric analgesia. Mr Ainsworth accepted that, in a number of cases after the attack, there was an opportunity to administer stronger pain relief than the oral paracetamol that was given to the child victims, for example orodispersible morphine.²⁴²²⁴² T/S: 12/162/2-21. He noted that NWAS was working to counteract any hesitancy to provide strong pain relief to young children by improving their briefings and guidance.²⁴³²⁴³ T/S: 12/163/19-165/9. As a result of this indication, I do not consider it necessary to issue a recommendation.