A haunting photo from the night of the Manchester Arena terrorist attack shows the first paramedic on scene unaware of the carnage that lay ahead.
Patrick Ennis, who is giving evidence as part of an independent inquiry into the 2017 bombing at an Ariana Grande concert, said it wasn't until he entered the City Room did he realise the "true scale" of what he was dealing with.
Salman Abedi detonated his home-made rucksack bomb at 10.30pm (local time) on May 22, 2017, killing 22 bystanders and injuring hundreds more.
Mr Ennis said just before he entered the City Room he was aware it was likely an explosion and there were a number of casualties.
"But it wasn't until entering the City Room that I had any idea of the true scale of the incident," he told the inquiry.
"There were a number of casualties, including very, very serious casualties, but being able to estimate initial numbers was quite difficult."
Paramedic 'didn't realise scale' of bombing
Mr Ennis said the reason he was unprepared for the atrocities in the arena was not because of inadequate training, but rather the people who were the victims. Among the dead were seven children, the youngest aged just eight.
"Until I saw it myself, saw the City Room, I hadn't realised just the scale of the incident. So nothing that anybody had said to me before that had really prepared me for what a large scale and awful incident it was," he said.
"I think until I saw it, I hadn't been able to really visualise it.
"It was more the age of those that were injured that I hadn't prepared myself for."
Mr Ennis said from the beginning he was aware of a potentially serious incident and was responding to a call that could be of an extremely serious nature. However he was open to all possibilities.
"A member of the public calling 999 for an emergency isn't necessarily medically trained... isn't necessarily able to judge when something is serious or not," he told the inquiry.
"What may appear to be very serious may not be to somebody who's trained to respond to serious emergencies.
"So I had in the back of my mind other possibilities that this could be.
"That's not to say that in any way I assumed it would be less serious, but I just kept open to the possibility that it might be and hopefully would be not as it was."
Paramedic on scene 19 minutes after explosion
Mr Ennis was the first North West Ambulance Service (NWAS) officer to arrive on scene, about 19 minutes after the bomb exploded.
After arriving, Mr Ennis relayed back to NWAS control he received reports of a nail bomb, "possibly with shooting".
When asked during the inquiry whether Mr Ennis had the adequate training to respond to the major incident, the paramedic said he could perform his role.
"I think it's fair to say that regardless of the amount of training received, one could never be adequately prepared to deal with an incident of this type," he said.
The Manchester attack injured 264 people in addition to the 22 killed and 670 people have since reported psychological trauma.
The inquiry continues.
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