A delay in the response by ambulances to a terrorist attack is "almost inevitable" and would leave the public having to fill a "care gap" while they wait for the emergency services to arrive, the Manchester Arena Inquiry has been told.
This means that if a terror attack like the one at the Arena were to happen again, the public are effectively on our own because it will take time for emergency services to arrive and there may then be limitations on whether its deemed safe for them to enter to treat casualties.
On the night of the Arena attack in May 2017 only one paramedics went into the scene for the first 44 minutes, and only three went in all night which meant some casualties waited more than an hour for medical treatment
How do we speed up the medical response?
One idea the inquiry has heard is to embed medics into the armed police teams who are often first on scene.
This is what happened after the Bataclan attack in Paris in 2015. However the UK National Counter-Terrorism Police do not currently support the idea of placing civilian medics within armed teams.
There are however plans to train front line police officers in advanced first aid.
Indeed many of the police officers who did their best on the night have made the point that the basic first aid training they’d had wasn’t enough to deal with catastrophic the injuries they were faced with.
In terms of the ambulance service – the inquiry has heard how there are plans to make more use of the air ambulance as a resource.
The North West Air Ambulance was not used during the emergency response to the arena attack.
More funding is also being made available to train specialist HART paramedics (Hazardous Area Response Team) who have the skills to work in hazardous environments like the blast zone.
However while the numbers of expected casualties in terror attacks has increased, staff numbers have not.
Nationally there is a shortage of HART paramedics and the National Ambulance Resilience Unit admit that is an issue.
Will there still be delays in the Ambulance response?
The inquiry heard how there remains "unacceptable delays" in getting specialist paramedics to treat casualties in some major incidents due to the reluctance of commanders to deploy these teams.
Keith Prior from the National Ambulance Resilience Unit told the inquiry that ambulances did not arrive quickly enough at the scene of the bombing and that had they known it was safe, there is no reason why regular paramedics couldn't have gone into the blast zone.
Paul Greaney QC said: "You have a very strong view personally and as an organisation that if have you have unprotected members of the public and police officers providing treatment, your resources should be in there too?"
Keith Prior, Director, National Ambulance Resilience Unit replied "Yes, if it is unsafe, those people in the forward position should be moved out.
"I think the overriding factor should be at the welfare of the patients and the public caught up in the incident."
The North West Ambulance Service stands by its decision not to deploy regular paramedics into this area.
What role do the public have to play?
Members of the public are likely to have to treat traumatic injuries from a terrorist attack while they wait for paramedics to arrive and there are calls for us all to be better first aid training and for training to be rolled out in schools.
In the first ten minutes after an attack it could be that members of the public have to triage, clear airways and apply tourniquets themselves.
A charity called Citizen Aid (https://www.citizenaid.org/) has launched an app which gives step -by-step advice on what to do.
Then comes the question of the public having the appropriate first aid kits available to use.
There is currently no official body checking that large public entertainment venues have proper medical and first aid equipment available, a situation described by the inquiry legal team as "far from ideal."