Casualties from the Manchester Arena bombing placed on the “ever so cold” floor at the city’s Victoria railway station were at risk of hypothermia, a public inquiry has heard.

John Atkinson, from Radcliffe, suffered catastrophic blood loss in the explosion when terrorist Salman Abedi blew himself up in the City Room foyer at the end of an Ariana Grande concert in May 2017.

The 28-year-old healthcare worker lay in agony in the foyer for 47 minutes before police officers carried him on a makeshift stretcher and placed him on the ground near the station entrance, while another 30 minutes passed until he was taken to hospital, where he later died.

Senior paramedic Philip Keogh had taken over the care of Mr Atkinson on the station floor from a member of the public who had held an improvised tourniquet of a belt on the patient’s leg for nearly a hour.

The former reservist Army medic, who was deployed to Afghanistan in 2010, told the inquiry into the terror attack that blood loss is the biggest cause of death in trauma patients, with hypothermia the second biggest killer.

He said Mr Atkinson had little or no clothing on when he first approached and he quickly assessed that he needed urgent transfer to hospital as his appearance was pale, which indicated massive blood loss.

Giving evidence on Monday, North West Ambulance Service (NWAS) employee Mr Keogh said: “If you think of Madame Tussauds before they put the make-up on the dolls, that’s the colour that John was.”

He attended other casualties as an ambulance crew came over but said he was “surprised” that, when he returned about 15 minutes later, Mr Atkinson was still lying there uncovered.

Shortly afterwards, Mr Atkinson went into cardiac arrest and Mr Keogh said he started chest compressions and helped load him into an ambulance – the furthest vehicle away – before returning to assist more casualties.

He said: “I had just been with a patient who had asked me not to let him die. At the time when I said I wouldn’t I thought then his chances were absolutely slim but I wasn’t going to tell him the truth because it’s not what you do, you provide comfort to people like that.

“Losing John had a profound effect on me that night in terms of just walking away from that vehicle and having him gone into cardiac arrest changed my perspective … I wanted to get people off the floor and I wanted to get them where they needed to be.

“We had patients that were all over the Victoria train station floor, a marbly floor, I believe, which is ever so cold, and we have got patients who have suffered traumatic injuries.

“Literally we needed to get them off the floor and at least provide that level of protection from hypothermia.”

Mr Keogh said he took it upon himself to arrange for ambulance stretchers to be then taken to casualties.

He admitted he was “overwhelmed” as patients outnumbered paramedics at the scene and he agreed with John Cooper QC, representing Mr Atkinson’s family, that more were “desperately needed” to help perform the job he was doing.

An independent cardiology expert has told the inquiry that Mr Atkinson might have survived if he had received hospital treatment before his cardiac arrest.

Following Monday’s hearing, Richard Scorer, of law firm Slater & Gordon, read out a statement on behalf of Mr Atkinson’s family who paid tribute to a “kind, intelligent” man who worked with young adults with autism and planned to be a foster father.

They said: “We lost our beloved John to an appalling atrocity while on a night out, an atrocity which could and should have been prevented by proper security.

“To compound this, John was badly let down by some from the emergency services. Mistake after mistake was made, and precious time was allowed to ebb away whilst John needed urgent hospital treatment.”

The family said they could not accept an apology made last week by Dan Smith, the NWAS operational commander on the night.

They reiterated their thanks to those who tried to help Mr Atkinson, including Ronald Blake, a member of the public who stayed with him for nearly an hour.

The family said: “Hearing about the kindness of strangers on the night has offered us a small glimmer of hope in our darkest moments.”