Concerns about ambulance staff being held back from casualty scenes have been raised by the coroner who held inquests into the deaths of mass killer Derrick Bird and the 12 people he shot dead.
West Cumbria Coroner David Roberts said there were clear concerns of national importance which came out of the four-week hearing involving communications between the police and the ambulance service, and he added that he would write to the Home Secretary and the Health Secretary expressing his views.
Confusion reigned as the 52-year-old taxi driver went on a 45-mile shooting rampage around West Cumbria on June 2 last year, then turned his rifle on himself.
The police airwave system nearly collapsed as armed officers were swiftly deployed to hunt down the killer and there was a lack of communication at strategic level between Cumbria Constabulary and the North West Ambulance Service.
Ambulance crews and paramedics refused to attend shooting scenes until areas were declared safe as they followed their health and safety protocol which the police in Cumbria were not even aware of and had not been consulted on.
After the jury at the Energus centre in Workington recorded verdicts of suicide for Bird and unlawful killings on each of his 12 victims, Mr Roberts said: "Clearly there are issues regarding the question of safe rendezvous points (with police) and whether these are going to be practicable in similar circumstances involving mass fatalities.
"It does not take a leap of imagination to see a situation where, if this incident was replicated, it may be the ambulance service or paramedic assistance would be needed for someone to survive who otherwise would have died."
Following the inquests, director of emergency service for North West Ambulance Service Derek Cartwright said: "The role of the ambulance service is to save life and I stand here proud of every one of the ambulance staff who were involved in this tragedy.
"It is my belief that the ambulance staff fulfilled their duties to the best of their ability, but we accept that, as often happens in cases such as this, there are lessons to be learned, albeit on a national level, and we need to reflect on the helpful comments made during this inquest."
Bird shot his twin brother David; solicitor Kevin Commons, 60; taxi driver Darren Rewcastle, 43; mother-of-two Susan Hughes, 57; retired security worker Kenneth Fishburn, 71; retired Sellafield worker and part-time mole-catcher Isaac Dixon, 65; retired couple James and Jennifer Jackson, aged 67 and 68; farmer and rugby league player Garry Purdham, 31; estate agent Jamie Clark, 23; retired Sellafield employee Michael Pike, 64; and pensioner Jane Robinson, 66.