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The Welsh Ambulance Service has issued a stark warning that its ability to respond to major incidents such as terrorist attacks could be severely hampered by hospital handover delays.

It follows a report being published that highlights the risk of “catastrophic harm” to members of the public if crews are tied up outside emergency departments during serious incidents.

The service has raised concerns after carrying out a mass-casualty simulation exercise, which found it would have failed to provide an adequate response in three out of four scenarios.

The tests were conducted in the wake of the public inquiry into the Manchester Arena bombing, which identified a catalogue of failings by emergency services in the aftermath of the attack.

The warning also comes after the service claimed some medics were unable to respond to an explosion at Treforest Industrial Estate at the end of last year due to being stuck outside Morriston Hospital in Swansea.

A major incident was declared after the blast on the evening of December 13, 2023, in which one woman died, but a report being presented to ambulance service board members next week alleges hospital officials failed to release crews from the site.

This has been denied by Swansea Bay University Health Board, which said it did free up ambulances to attend and took its responsibilities “very seriously”.

However, the ambulance service has questioned the effectiveness of release procedures after its chief executive, Jason Killens, wrote to health boards across Wales to seek assurances.

The Welsh Government has also said it expects health boards to reduce handover delays “as a priority” in response to the concerns.

The ambulance report states: “If a major incident or mass casualty incident is declared, then there is a risk that the trust cannot provide its pre-determined attendance as set out in the incident response plan and provide an effective, timely, or safe response to patients due to vehicles not being released from hospital sites.

“(This would result in) catastrophic harm (death) and a breach of the trust’s legal obligation as a category one responder under the Civil Contingency Act 2004.

“Despite the controls listed, the single most limiting factor in providing a pre-determined response in line with the incident response plan is the lost capacity due to hospital handover delays. In this area, WAST has no control.

“The trust is not assured that hospital sites have plans in place that are trained and tested to release ambulances effectively and immediately in the event of an incident declaration.”

In a statement, Lee Brooks, executive director of operations at the Welsh Ambulance Service, said it had plans in place to provide an “effective, timely and safe response” to major incidents.

These set out the minimum ambulance response level which needs to be sent to the scene in the event of a large-scale emergency.

He admitted that hospital handover delays were one of the main factors which could restrict its ability to send crews.

Mr Brooks said: “The consequence of delays to transfer patients from ambulances to emergency departments is well-documented, not just in Wales, but across the UK and beyond.

“Our ability to send a large-scale response to an incident may be hindered if our people and vehicles are not immediately released by emergency departments.

“We take our legal obligation under the Civil Contingency Act 2004 very seriously, which is why we continue to work with partners, including health boards, for tested frameworks to release ambulances in a major incident.

“Learning from other incidents, like the Manchester Arena Inquiry, is also taken seriously and our work to fully incorporate recommendations into our service continues.”

He said the future delivery of ambulance services was also being considered, with an emphasis on keeping more patients at home to “alleviate pressures” on hospitals.

The report also highlights two further incidents where the service was left concerned over ambulances not being released.

These include a fire on board a ferry off Fishguard Dock in February 2023 and a gas explosion which happened in Swansea the following month.

A Swansea Bay University Health Board spokesperson said: “We can give assurances that we take our responsibilities very seriously and have major incident plans which are tested and reviewed regularly.

“These include agreed protocols to enable the rapid release of ambulances from the emergency department in the event that a major incident is declared.

“We can confirm that on the evening of the Treforest Industrial Estate fire our major incident plan was invoked and that we did release ambulances as a result.”

The issue of handover delays was raised in the Senedd last week after health committee members were told ambulance crews are often only able to see one patient per shift.

The ambulance service’s chief executive said that up to 30,000 hours of emergency response time are lost every month in Wales due to long waits in transferring patients to hospitals.

Mr Killens said it was causing harm to patient safety, with average handover times standing at more than two hours, compared to the target of 15 minutes.

Responding to the concerns, a Welsh Government spokesperson said: “All health boards have urgent and emergency care improvement plans in place, and we expect them to reduce ambulance patient handover delays as a priority over the next six months.

“Despite continued budget pressures, we are investing over £180m in additional funding this year to support health boards and regional partnership boards to safely manage more people in the community, avoid ambulance transport and admission to hospital, and deliver integrated solutions with social care services to improve patient flow through hospitals.”