On May 22nd 2017, a suicide bomber detonated an explosive device at the Manchester Arena, injuring many. Patients were taken to nearby hospitals including the Manchester Royal Infirmary, Royal Manchester Children's Hospital, and Wythenshawe Hospital. The incident had profound impacts on hospital staff both professionally and personally. Immediate psychological support was provided by various organizations working collaboratively. Support included debriefings, counseling sessions, and peer support groups. This response helped staff process their experiences and maintain morale in the aftermath of the traumatic event. Lessons were learned about including mental health provisions for staff in major incident plans to help address needs over both the short and long term.

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22nd May 2017 Arena Event – Workforce Resilience
Professor Cheryl Lenney
Chief Nurse Manchester University NHS Foundation Trust

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On Thursday the 22nd May 2017 at 22:31 hours a suicide bomber detonated an
improvised explosive device, packed with nuts and bolts to act as shrapnel, in
the foyer area of the Manchester Arena
Patients with life threatening and life changing injuries attended:
Manchester Royal Infirmary (MRI) Emergency Department
Royal Manchester Children's Hospital (RMCH) Emergency Department
Wythenshawe Hospital Emergency Department
Arena Attack

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The Ask Of Our Staff

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Impact on Staff
• Listening to ‘stories’ or narratives of the event experienced by families
• Supported parents who were injured to be cared for/nursed with their children
• Helping families talk to children and involvement in breaking bad news
• Longer stay patients and staff developed a camaraderie
• Affected some staff both professionally and personally
• Prolonged impact of the event through media coverage and high profile Hospital visits
• Symptoms of Post-Traumatic Stress (PTSD) may manifest six weeks after event
• Recognition that staff already had challenging and stressful jobs
• Staff encouraged to ‘normalise distress’, look after each other and seek support from
peers / personal support networks
• Provision of Psychological Support First Aid information to promote self help

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Psychological Care: RMCH
• Immediate response from CAMHS to Paediatric Emergency Department to support
parents/children and staff
• Value of providing a space for separate staff teams as their experiences vary
• Senior staff being available for containment and clear message of importance
• Paired up to deliver support – providing continuity
• Making good use of available resources i.e. senior CAMHS staff to augment existing
services
• Peer support provided within CAHMS team

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Psychological Care: MRI /Wythenshawe
• GMMH immediately provided Consultant Psychology and nursing team support
• GMMH worked in collaboration with CMFT staff support and multifaith service
• 90 minute Post Incident Briefing offered for key areas
• 10 days of intensive support including a 7 day self referral service to responsively
meet the psychological needs of staff
• Debriefs, one to one sessions and ward walks
• ED delivered internal briefing to staff involved
• Major Incident debrief 1 month after event Employee Health and Wellbeing (EHW)
service engaged early with affected staff
• Psychology led debrief sessions for affected staff groups
• Debrief sessions positively affected staff morale

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Support Following The Incident

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What Worked Well
• Immediacy of response offering support to staff on shift
• Provision of a collective safe space for discussion
• Separating requests for patient and staff support
• Recognition of when to handover to staff support
• Staff appreciated positive feedback and reinforcement that what many were
experiencing was a normal response
• Liaison between GMMH and CAMHS with referrals between services
• Clear and visible managerial support and leadership
• Improved relationships between physical and mental health teams at RMCH
• Manchester Resilience Hub

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Psychological Support Response
• Omission of robust mental health planning within Major Incident Plan
• Differing response across former CMFT and UHSM for patients and staff
• Welfare of staff remained Trust key priority
• Early recognition to distinguish between patient and staff support
• Commitment to avoid staff becoming secondary victims of the attack through
an experience of prolonged fear, stress and anxiety
• Partnership working with GMMH
• Coordinated approach between GMMH and CMFT/UHSM CAMHS, staff
support / employee health and wellbeing / multi-faith services

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Reflections & Action
• Inclusion of mental health provision in the Major
Incident Plan for patients and staff
• Investment in psychological support services /
training:
• PICU business case 1.0 wte Clinical
Psychological to support patients, families and
staff
• Schwartz Round December 2017
• Strong response from staff who were not involved
• Unintended consequence of staff feeling angry,
guilty and a sense of being left out
• Consideration in future for those delivering
‘business as usual’
• MRI Nurses’ Fellowship
• Funded four workshops: Learning From
Experience The Psychological Impact of Trauma
• Funded cognitive behavioural therapy training for
staff support service

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The Spirit Of Manchester