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Special report: Manchester nurses showed 'professionalism, empathy and compassion'

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  • This is the first of four articles on the experiences of nurses in Manchester in the wake of the terror attack on 22 May
  • Three further articles looking in more detail at the nurses and settings featured in this article will be published throughout the week

The health service has rightly been praised for its response to the terror attack in Manchester on 22 May. Nursing Times spoke to seven nurses involved in treating victims and organising care.

“I have never felt prouder to be a nurse”

Rachel Flatley

When staff first received news of a serious incident unfolding at the Manchester Arena, the accident and emergency department at Wythenshawe Hospital was already at record levels of activity.

“Monday was our busiest day ever on record,” recalled senior A&E sister Rachel Flatley, who was on duty. “When we got that call, every area in the department was full and there were patients queuing out the door.

“The most important thing was to keep everyone calm, because we didn’t know what was happening,” she told Nursing Times.

Information was limited, even after a major incident was officially declared. But Ms Flatley and colleagues managed to create the space needed to care for casualties and summon extra staff. “It was about identifying patients who could move – so making sure anyone with an allocated bed went straight up to the ward, but also ensuring that was a safe decision,” she said.

“We made an announcement in the waiting room and quite a few people left, saying they would see their GP or seek an alternative. It was amazing,” she said. “We had some quite sick patients who said they would try and go home but couldn’t, because they needed to stay.”

“The injuries were those you would expect to see in a war zone”

Charlotte Brownhill

In addition, as details emerged about the horrific attack at the Ariana Grande pop concert, scores of off-duty nursing staff phoned in to offer their services or simply turned up in uniform ready to help – alongside doctors, surgeons, pharmacists, lab technicians, porters and other vital support workers.

Those at Wythenshawe, part of the University Hospital of South Manchester NHS Foundation Trust, were told they would be getting 20 “priority one” patients from the incident.

“It was very difficult because we didn’t know exactly what was coming,” said Ms Flatley. “Normally, for injuries that extensive we get some sort of pre-warning – a stand-by call to alert us to what was coming in – but we just knew we were getting multiple casualties.”

By the time the trust’s chief nurse and deputy chief executive, Mandy Bailey, arrived to assume the role of “gold commander”, the major incident plan had been activated and everything was in place.

University Hospital of South Manchester NHS Foundation Trust

Exclusive: Manchester nurses praised for professionalism in wake of terror attack

Mandy Bailey

“The team were fantastic – they had created the bedspace on the wards, the A&E team had called people in and enough staff had come in to run three emergency theatres, because we knew the casualties would probably need a lot of surgery,” said Ms Bailey.

As a result, she was able to start thinking ahead about impending issues such as making space in all three of the hospital’s intensive care units and maintaining the safety of existing patients.

“We have 950 beds and people don’t suddenly become well,” she said. “We needed to make sure we were caring for them as well as the people coming in. It was very calm. I think people just got into their work mode of ‘this is what we need to do’.”

But she said the mood was “very sombre” when the first casualty arrived and staff realised the severity of the injuries they would be dealing with.

“It was the scale of the amount of shrapnel and some of the skin and plastics injuries,” she said. “We needed to stabilise them, as they were very sick, and then get them to theatre, because they had damage to internal organs and some of the shrapnel was in difficult places.”

She highlighted that, since the 22 May, most of the patients had been back for surgery at least once or twice, if not daily for dressing changes and more wound care.

Meanwhile, on the outskirts of the city, nurses at Stepping Hill Hospital, part of Stockport NHS Foundation Trust, were also helping to care for patients with catastrophic wounds.

“They were blast shrapnel injuries, ranging from massive scattered shrapnel across a body to significant, irrecoverable damage to lower limbs – major haemorrhage was our big issue,” said Charlotte Brownhill, matron for the emergency department and acute medicine.

Stockport NHS Foundation Trust

Exclusive: Manchester nurses praised for professionalism in wake of terror attack

Charlotte Brownhill

“The injuries were those you would expect to see in a war zone,” she said, noting that the nurses working in resus that night had limited experience of dealing with “trauma of that size”.

“It was something that if you were at Camp Bastion you might have seen, but this is Stockport and you’ve just come on to work the night shift – that’s what caught people, particularly towards the end of the night,” she said. “It certainly caught me when I got home that evening.

“At the time, there was this adrenaline fuelled ‘keep going’ – you focus on your ABCDE (Airway, Breathing, Circulation, Disability, Exposure) – and you’re not really stopping to think about what you have seen,” she recalled.

Ms Brownhill also said lessons from recent major incident training were fresh in people’s minds, in particular a real-time Greater Manchester-wide training exercise that was based on a scenario involving a suicide bomber in the city’s Trafford Centre.

“A lot of nurses looking after these patients are mums themselves with teenagers who go to pop concerts”

Judith Morris

She said: “There was a sense of faith in the system – we knew we had tested this and that was reassuring and helped people stay calm.”

In fact, the system appeared to work smoothly across the board, according to Judith Morris, Stockport’s director of nursing and midwifery. “One of the things that worked well from an organisational point of view was the flow of casualties across Greater Manchester,” she said.

In total, 119 patients were treated at eight hospitals across the city, of which 59 were taken by ambulance and 60 made their own way.

“In the old days, with something like this, casualties would have gone straight to the Manchester Royal Infirmary and Central Manchester University Hospitals NHS Foundation Trust,” said Ms Morris. “It would have got jammed up, while the rest of us would have been business as usual. What actually happened was very effective.”

Stockport NHS Foundation Trust

Exclusive: Manchester nurses praised for professionalism in wake of terror attack

Judith Morris

While more experienced nurses rotated in an out of resus, emergency department sister Harriet Deighton described how junior staff rallied round.

“We had some staff nurses who were relatively newly-qualified and not as experienced in trauma, so they stayed with the majors patients who were already there,” she told Nursing Times.

“It was amazing the way those guys rose to the challenge – they didn’t question or say they couldn’t deal with anything – they just stayed focused and looked after the medically unwell patients with the best care they could give,” she said. “To me, it shows the true essence of emergency nursing – we’re part of one large team and everybody in that team is vital.”

Mari Hopley, a senior staff nurse in anaesthetics and recovery, normally works mornings but phoned in to offer her services, after realising casualties were likely to come to Stepping Hill.

“I was apprehensive driving there,” she said. “I have worked in theatre for many years and seen many distressing things, but had never experienced a major incident. When I got there my colleagues were very calm and everything was under control; we just got on with the job, basically.”

Ms Hopley added: “I’m getting older and coming to the end of my nursing career and sometimes you think you are losing your skills, but that night I realised the skills, training and professionalism are all still there.”

She admitted she “cried for most of the day”, after getting home at 7am on Tuesday. “My sympathies are for the victims and the people who have to deal with the aftermath for the rest of their lives – the patients we saw will all stay in my head,” she said.

Stockport NHS Foundation Trust

Exclusive: Manchester nurses praised for professionalism in wake of terror attack

Mari Hopley

Theatre lead Victoria Dale said she believed the experience had brought teams and whole departments closer together at Wythenshawe.

“It wasn’t just the people that were on that night, it was the people who took over the next day and the people who have been on the lists every day since,” she said. “It feels like a different department and that we’re all very much united.”

She added: “It is just so busy still. We have put on extra lists just so we can try and get these people back to some kind of normality and home to their families, and are all working a lot of extra shifts and extended shifts.”

Ms Dale noted that some hospital staff had donated their pay to one of the charities set up to support those affected by the terrorist attack.

Taking stock, the two nursing directors were unanimous in their praise for the way nursing staff dealt with the event and its aftermath.

“My sympathies are for the victims – the patients we saw will all stay in my head”

Mari Hopley

Ms Bailey said she felt the professionalism displayed by her team “showed nursing at its best and the NHS at its best”. Ms Morris agreed, stating: “I am totally and utterly proud of my team. They were shining examples of professionalism, empathy and compassion.”

Both said they have been overwhelmed by the support from the public and local businesses who continued to bring in food and gifts for staff.

As well as ensuring the best ongoing care and support for the patients involved in the tragedy, their focus is also now on supporting staff.

“The day after, as soon as I got in at 7am, I went straight to the emergency department,” said Ms Morris. “I caught the tail end of some of the night staff – I think they were proud of what they had achieved but fragile in terms of just having got through it, really.

Stockport NHS Foundation Trust

Greater Manchester trust plans to cut workforce by 7%

Source: Gerald England

Stepping Hill Hospital

“Part of being a nurse is that the professionalism just kicks in and you do what you are trained to do,” she said. “A lot of nurses looking after these patients are mums themselves with teenagers who go to pop concerts.

“The minute you take away the pressure and they are left to get themselves home or make a cup of tea, that was when it hit for a lot of them,” she said. “They had coped all night, but then they felt a bit wobbly.”

She acknowledged that it may take a while for the full impact to sink in. At University Hospital of South Manchester, Ms Flatley was among those who attended a multi-disciplinary debrief.

She said: “There will always be lessons learned and things we can do better, but it was very positive. I have never felt prouder to be a nurse.”

University Hospital of South Manchester NHS Foundation Trust

Exclusive: Manchester nurses praised for professionalism in wake of terror attack

From left to right: Victoria Dale, theatre lead, Mr David Jones, consultant general surgeon, Rachel Flatley, A&E sister and Janet Brennan, head of nursing

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