Key findings
- The Purple Guide provided guidance to those providing healthcare services at events.
- The outline guidance for an event of the size of that which took place on 22nd May 2017 was: 1–2 doctors; 2–4 nurses; 2–4 paramedics; 11 first aiders;
- 1 ambulance crew.
- It advised that a comprehensive risk assessment was required to identify the number and skills of those providing healthcare services at events.
- It advised that a first aid at work certificate was insufficient qualification on its own for those acting as first aiders at events.
- It advised that during an event there should be clear lines of communication between those running the event and the local ambulance service.
- It advised that, once a Major Incident is declared, it is important that the arriving ambulance staff know with whom to liaise from the event healthcare service.
Introduction
In 1993, the Health and Safety Executive (HSE) published The Purple Guide to Health, Safety and Welfare at Music and Other Events.101 It was substantially updated by the HSE in 1999.102 The HSE began work on a third edition, but this was never published.103 In 2013, the HSE stopped regulating first aid and ceased to be responsible for publishing the Purple Guide.104 Responsibility for it was handed over to the Events Industry Forum.
The edition in force in the period running up to and including the Attack was published in November 2015 by the Events Industry Forum.105 I shall refer to this edition as ‘the Purple Guide’.
I will rehearse without commentary the relevant parts of the Purple Guide. In Part 16, I shall consider SMG’s and Emergency Training UK’s preparedness for and response to the Attack by reference to its content.
Status of the Purple Guide
The introduction to the Purple Guide stated:
“This guide aims to help those who organise music or similar events, so that the events can run safely. As an employer, the event organiser … has a general duty to ensure, so far as reasonably practicable, the health, safety and welfare of their employees. They also have a duty to ensure, so far as is reasonably practicable, that others – including volunteers and spectators – are not exposed to risks to their health and safety arising from the operation of the event.”106
It went on:
“This guide goes beyond the compliance with the Health and Safety at Work Act and covers not only legislation and good practice for Health and Safety, but other legislation and good practice across the industry including the Licensing Act 2003, the Civil Contingencies Act 2004 the Regulatory Reform (Fire Safety) Order 2005 … The contents are not designed to be prescriptive but simply seek to highlight legal criteria and non-legislative good practise.”107
Chapter 4: Contingency & emergency planning
Chapter 4 began by identifying a number of “key points”. Among these were that being prepared for the initial response to an emergency may be the responsibility of the event safety management team. The importance of risk management and having plans in place was also identified, along with testing the plans “in the most practicable way”.108
A list of hazards or threats that might result in an emergency were listed. This included “bomb threat”.109
Chapter 5: Medical
Chapter 5 was titled “Medical”. As the introductory remarks made clear, the chapter was not confined to care provided by doctors, but also that provided by paramedics and first aiders.110 To avoid confusion, I shall use the term ‘healthcare services’. I intend this to include all care directed at a person’s health and wellbeing by an appropriately qualified person or people. This will range from care which can only be competently provided by doctors through to the initial assessment and treatment of minor physical and mental health issues.
The chapter began:
“The aim of this chapter is to set out the responsibilities of an event organiser to ensure appropriate medical, ambulance and first aid provision is available to all those involved in music and similar events, whatever their type and size.”111
Event pre-planning
The Purple Guide stated that it was important to undertake a healthcare services resource assessment in order to determine “the skill mix and how many personnel will be appropriate”.112 As part of that review, the organiser should have considered a number of factors, including the number of attendees, what might cause injuries and the likelihood of such risks eventuating.113
It went on to state:
“It is important to ensure that the spectrum of care is available, commensurate with the size of event. This may encompass the competencies of doctors, nurses, paramedics, ambulance and first aid staff who bring different skill levels to the event.”114 The Ambulance Service Experts, Christian Cooper and Michael Herriot, stated that the guidance expected a comprehensive risk assessment.115 They explained that this should identify
the “right skills” required to anticipate the type of conditions that may be encountered.116
Once the risk assessment was completed, the Purple Guide expected that a “medical plan” would be produced. This was to set out the details of the event and, among other things, the numbers and skill mix of the staff and the intended receiving hospital(s) for casualties. The expectation was that the receiving hospital(s) would have been pre‑notified of the event.117
The medical plan was to be communicated to the regional ambulance service, even if it was not involved. It should also be made available to the licensing authority.118
There was an expectation that all details of cover being provided should be made in writing.119
RVPs should be shared with staff within an event to “assist a smooth flow to any incident, whether major or not”.120 The Purple Guide advised that ambulance control rooms and Area Managers surrounding the event “should be aware of these areas prior to the event, as should the other emergency services, where appropriate”.121
During an event
The Purple Guide advised that the medical control should have clear lines of communication to the event organiser and the NHS ambulance service. A communications plan detailing the medical communications links should be produced and held at both the medical control point and incident control room, and shared with the NHS ambulance service for the area.122
In the event of the NHS ambulance service being requested or the declaration of a Major Incident, the person with overall responsibility for healthcare provision would be the liaison point between the site medical provider and the NHS ambulance service.123
Competence of personnel
The Purple Guide identified a number of categories of person who might provide healthcare: first aiders, doctors, nurses, paramedics, emergency care practitioners and ambulance personnel.
In relation to those termed first aiders, it stated: “A first aider is a person who holds a current certificate in first aid competency, issued by an organisation that meets the HSE guidelines on first aid training.”124 However, it went on: “The holding of a Health and Safety at Work, or three-day First Aid at Work certificate does not in itself qualify a person as competent to administer first aid to the public at events.”125 The Ambulance Service Experts confirmed that this level of qualification had not been designed for first aid given to others at public events. The Purple Guide did not specify what the minimum standard was.126
Number of personnel
A table setting out “outline guidance” as to the number and skill mix of healthcare services required was provided by the Purple Guide. The table was introduced with a repetition that the level of provision needed to make an event safe can only be determined after a comprehensive risk assessment.127
The entry from the table for a “medium”‑sized event is shown in Table 2.
| Medium Event | 10,000–50,000 attenders | |
| Doctor‑led cover | 1–2 doctors | Consider: |
|
2–4 nurses or ENPs [Extended Nurse Practitioners]
2–4 paramedics or ECPs [Emergency Care Practitioners]
|
Specialist doctors, pit crews, substance abuse team etc where indicated | |
| 10 first aiders or first responders for first 10,000 attenders + 1/5,000 above 10,000 | ||
| Ambulance(s) and crew for on‑site service and transfers to hospital (minimum 1 ambulance) | ||
| 1 Rapid Response Vehicle |
Major Incident
The Purple Guide explained that once a Major Incident is declared, it is important that the arriving NHS staff are aware of key personnel on site with whom to liaise and whether the event medical provider has commenced effective triage and initial casualty management. Clear communications between the on‑site provider and the NHS ambulance service is key to ensuring effective handover and co‑ordination of the incident.129