@article {Dark746, author = {Paul Dark and Martin Smith and Harry Ziman and Simon Carley and Fiona Lecky}, editor = {, and , and Dark, Paul and Smith, Martin and Ziman, Harry and Carley, Simon and Lecky, Fiona and Davis, Naomi and Eddleston, Jane and Parr, Victoria and Berry, Karren and Wafer, Michael and Ratcliffe, David and Edwards, Antoinette and Young, Mike and Bouamra, Omar and Lawrence, Tom and Islam, Maydul and Mullarkey, Andrew and McGirr, Seamus and Wong, Jason and Reid, Adam and Jenner, Rachel and Gleeson, Anthony and Davenport, Matthew and Carlson, Gordon and Smith, Stella and Murphy, Fiona and Holsgrove, Daniel and Windle, Jill and Rennie, Alistair and Shoaih, Amer and Kamaly-Asl, Ian and Coats, Timothy and Moran, Christopher and Willett, Keith and Bartolucci, Andrea and Redmond, Anthony}, title = {Healthcare system impacts of the 2017 Manchester Arena bombing: evidence from a national trauma registry patient case series and hospital performance data}, volume = {38}, number = {10}, pages = {746--755}, year = {2021}, doi = {10.1136/emermed-2019-208575}, publisher = {British Association for Accident and Emergency Medicine}, abstract = {Introduction In response to detonation of an improvised explosive device at the Manchester Arena on 22 May 2017, we aimed to use detailed information about injured patients flowing through hospital healthcare to objectively evaluate the preplanned responses of a regional trauma care system and to show how routinely collected hospital performance data can be used to assess impact on regional healthcare.Methods Data about injury severity, management and outcome for patients presenting to hospitals were collated using England{\textquoteright}s major trauma registry for 30 days following hospital attendance. System-wide data about hospital performance were collated by National Health Service England{\textquoteright}s North West Utilisation Management Unit and presented as Shewhart charts from 15 April 2017 to 25 June 2017.Results Detailed information was obtained on 153 patients (109 adults and 44 children) who attended hospital emergency departments after the incident. Within 6 hours, a network of 11 regional trauma care hospitals received a total of 138 patients (90\%). For the whole patient cohort, median Injury Severity Score (ISS) was 1 (IQR 1{\textendash}10) and median New ISS (NISS) was 2 (IQR 1{\textendash}14). For the 75 patients (49\%) attending a major trauma centre, median ISS was 7.5 (IQR 1{\textendash}14) and NISS was 10 (IQR 3{\textendash}22). Limb and torso body regions predominated when injuries were classified as major life threatening (Abbreviated Injury Scale\>3). Ninety-three patients (61\%) required hospital admission following emergency department management, with 21 (14\%) requiring emergency damage control surgery and 24 (16\%) requiring critical care. Three fatalities occurred during early resuscitative treatment and 150 (98\%) survived to day 30. The increased system-wide hospital admissions and care activity was linked to increases in regional hospital care capacity through cancellations of elective surgery and increased community care. Consequently, there were sustained system-wide hospital service improvements over the following weeks.Conclusions The systematic collation of injured patient and healthcare system data has provided an objective evaluation of a regional major incident plan and provided insight into healthcare system resilience. Hospital patient care data indicated that a prerehearsed patient dispersal plan at incident scene was implemented effectively.All data relevant to the study are included in the article or uploaded as online supplemental information. Individual patient data are not available due to the sensitivity of the incident and the HRA ethical framework. Please contact the Trauma Audit and Research Network (TARN) registry by email (support@tarn.ac.uk) for more details about the available Major Incident audit module.}, issn = {1472-0205}, URL = {https://emj.bmj.com/content/38/10/746}, eprint = {https://emj.bmj.com/content/38/10/746.full.pdf}, journal = {Emergency Medicine Journal} }