Paddy told how the devastating scale of the bloodshed slowly dawned on him with each step he took towards the arena foyer. Photo / AP
The first paramedic to arrive at the Manchester Arena bombing recalled last night hearing "screams from all directions" as he entered a foyer full of the dead and dying, including children.
Nothing in his training could have prepared father-of-three Paddy Ennis for the carnage he would witness as he reached the blast zone.
But fighting his instincts, the paramedic had to ignore those casualties who were pleading for help because, however horrific their injuries, their airways were clear and they could breathe, reports Daily Mail.
"The quiet ones were my first priority," he said. "Many others, tragically, were beyond any help."
Paddy, 38, an advanced paramedic with North West Ambulance Service, was racked with emotion as he spoke exclusively to The Mail on Sunday to give a moving account of the night's events.
He told how the devastating scale of the bloodshed slowly dawned on him with each step he took towards the arena foyer where crazed suicide bomber Salman Abedi blew himself up on Monday evening.
Because of fears of another device, Paddy and two colleagues who arrived later were the only paramedics allowed into the 'hot zone' where the bomb was detonated.
As Paddy put it: "It was worse than any of us could have imagined."
Paddy was on duty at Central Manchester Ambulance Station, near the city's Royal Infirmary, when the first calls came in shortly after 10.30pm.
He said: "It was already a busy evening for us, with about 40 999 calls waiting to be answered. Then all of a sudden the screen displaying those calls just lit up with alerts all saying the same thing - 'Manchester Arena'. The only one I saw said, 'Explosion.'"
Paddy jumped in his ambulance car and, slipping behind a police car with its lights flashing, headed for the arena, just over a mile away.
"All the way there I was trying to prepare myself mentally for what this could be, but as I got closer to the arena there were large crowds of people who seemed remarkably calm.
"When I saw their demeanour, I began to hope this was not going to be a serious incident after all."
However, any such optimism dissipated as he approached Victoria Station, which has a link to the arena: "I could see the mood of the crowd was different, partly from the speed at which they were moving. There was a level of panic, but it still didn't alert me to how horrendous the scene was going to be.
"As I approached the station I could see there was a group of people who looked as if they could be injured, so that seemed the right place to assess them. I got basic equipment out to be able to render aid to a small number of patients.
"I was directed by police towards a group of four or five people who were clearly injured. They were saying they thought they'd been shot or there was an explosion, and their injuries were consistent with either scenario.
"Then I could hear myself being shouted to by another group of people 20 or 30 yards closer to the station and the arena.
"The injuries were similar - lacerations possibly from glass or shrapnel to arms or legs, but thankfully without massive haemorrhages or underlying fractures, chest or abdominal injuries.
"It was a really rapid assessment: checking they were conscious, breathing and that their pulse rate was within an acceptable limit. But my brief assessment told me they were walking wounded.
"Presumably that's why they were able to get so far away from the station in such a small amount of time - about 50 yards from the foyer. At that point I realised there would be at least ten casualties so I radioed my control to say this was a potential major incident."
Paddy admits he had no idea what he was walking into.
"I reassured the people I saw that I would be back or my colleagues would be coming behind me, and as I made my way out further towards the building entrance, I was met by people sitting down.
"They had more serious injuries but incredibly they had been able to make their way down there, presumably on pure adrenaline. People were helping them but everyone was conscious and stable."
But with each step forward it began to dawn on Paddy that the closer he got to the arena the more severe were the injuries he was encountering. As he feared, the worst was yet to come.
"The police officers I met told me there were multiple serious casualties upstairs in the foyer and confirmed it was an explosion of some sort," he said.
"While all this was going on, people were running, screaming and terrified, and as I got closer the degree of fear from people was far more palpable.
"I made my way up the stairs. I was still the only paramedic there but I knew my colleagues would be coming soon. At that stage, I still didn't have a handle on what had happened or where, or how many people were involved.
"Just outside the foyer there were some people with very, very serious injuries, consistent with a bomb - severe impact and shrapnel wounds to multiple parts of their body.
"There were bystanders there helping them who were doing an incredible job. I learned later that these were ordinary people who had run into the scene to help straight afterwards.
"I can't imagine how people could do that, but it was amazing to see and what they were doing was everything that could be done: stemming any blood loss, reassuring people and keeping airways open.
"After a quick assessment of these patients I made my way in and that's when the scale of the incident really came home. It was surreal to walk into that scene.
"I'm an experienced paramedic and we have training for this kind of situation, but I don't think you could ever be prepared for seeing anything like that. I certainly didn't feel prepared for what I saw when I walked in there - just the scale of it was overwhelming.
"I'm sure there was a split-second when I took the scene in and froze, but there was no time for a thought process.
"I was just hit by a wave of devastation and then realised I was being shouted and screamed at. People had seen me and they obviously wanted help.
"There were people screaming in pain and people terrified. But you have to ignore them because if they're screaming the airways are open and you know they can breathe, so you are reassured by the fact they are relatively OK for now, although they had horrendous injuries.
"The first priority was the quiet patients and my initial assessment was there were around ten people who were not moving, but that changed as time went by.
"Unfortunately for some, my assessment was they were beyond any help we could provide. They were already dead.
"In any other situation there would be a massive ambulance response for each individual person and we would do everything possible to get them to a trauma centre.
"I had to make the very, very difficult decision that we needed to concentrate on the people who were critically injured because they could still be helped - the others could not.
"There was a huge number of injured people, probably between 30 and 40 who were clearly injured or worse in that scene.
"But there were also a lot of people who I could tell were professionals and I was incredibly reassured to see them - a number of police officers, first-aid staff and medics who had been at the event, along with the event security staff.
"People had improvised tourniquets, in some cases using belts or T-shirts to stem the blood.
"It's a big area and trying to prioritise was extremely difficult. I needed to gather information to pass back to my control because this was something far bigger than we could possibly have expected.
"The next person on scene was my colleague, consultant paramedic Dan Smith, and there couldn't be anybody better to arrive at an incident like that."
But because the police feared other bombs or attackers, Dan and other paramedics who were arriving were not allowed into the "hot zone" where Paddy was.
Two paramedic colleagues from the specially trained Hazardous Area Response Team (HART) were allowed through after a time.
"I cannot tell you how grateful I was to see them," Paddy said. "This is what their unit was designed for, so they came in with the equipment for full major incident triage such as blast dressings."
The three paramedics then set about dividing a pack of triage cards marked in red, yellow and green for priorities one, two and three respectively, attaching them with elastic to the casualty to flag them up for colleagues outside at the clearing station.
"It became apparent quite early on that were there were a lot of young people but it was a while after I arrived that I learned who had been playing at the concert - I saw a T-shirt with Ariana Grande's name on it.
"I have a nine-year-old who loves Ariana Grande and it just hit me that the people attending would have been very young.
"I can't tell you how long it took for everyone to be moved but when they had been, there was just an eerie silence.
"It was a very strange and awful experience. It's really difficult to express how awful it must have been for everybody who was there and utterly terrifying for the people and the families."
Now back at home with his wife Lucy and three sons - Sol, 15, Zac, nine, and five-year-old Sam - Paddy has tried not to dwell on what he saw on Monday. It's clear that even this interview has been a harrowing experience for him.
Apart from being presented to the Queen when she visited Manchester, Paddy has tried to stay out of the limelight.
"I have struggled the past few days," he added. "The fact that people were so young and the attack was so senseless. Those are my abiding thoughts."
The site was used by Hezbollah to plan attacks on Israeli civilians.