No regulatory body exists to 'identify, specify and enforce' the level of first aid and medical provision at public entertainment events like large-scale concerts, the inquiry into the Manchester Arena bombing heard.
Mark Norris, Principal Policy Adviser for the Local Government Association, the trade body for town halls in England and Wales, said it recognised the 'inevitability of a care gap in the circumstances of a terrorist attack' - a delay in first responders treating the injured after a mass casualty incident like the Arena atrocity.
It comes after the inquiry heard evidence on embedding trained clinicians within police armed response units in the event of a terror attack to help bridge the gap is due to be considered next week.
The terrorist gun attack at the Bataclan Theatre in Paris in 2015 claimed 130 lives.
Paul Greaney QC, counsel to the inquiry, said elite police firearms teams were accompanied by 'highly trained' physicians who 'performed triage in the combat zone' - applying tourniquets, dressings and pain relief, alongside 'specific procedures' - before they managed the evacuation of the injured to waiting medical colleagues.
Counter-terrorism experts said they would support the move in the UK.
Giving evidence at the public inquiry on Wednesday, Mr Norris agreed there 'ought to be a requirement for the availability of medical and first aid services' for people attending a large scale, arena-style concert.
He agreed the standard of medical and first aid services at an arena event with more than 10,000 people in attendance should be 'identified, specified and enforced' - and said 'ideally', there would be a regulator.
"There is no regulator as such, is our view at the moment, and that leaves a gap in this particular area," Mr Norris said.
"It's not clear who has responsibility overall because the legislation is not clear as to whose responsibility it might be."
He agreed with Mr Greaney the situation was 'very far from ideal'.
The inquiry was told the Health and Safety Executive does not consider itself to be the regulator, and Mr Norris said councils through the Licensing Act was 'not an ideal mechanism in which to do it'.
He said the provision of first aid and medical services was sometimes attached to a premises' licence, but not always, and it was often the responsibility of the applicant to arrange.
The inquiry heard regulation in this area was 'light touch' and when local councils grant a licence for an event to take place, the level of provision is left to the event organiser.
The Licensing Act, he added, was designed for the sale of alcohol and entertainment, not as a 'regulatory framework in respect of providing and ensuring there is appropriate medical support at an event, for those people attending, in the event of a mass casualty incident'.
The chairman of the inquiry, Sir John Saunders, said there was 'absolutely no timetable' for when the Government's 'Protect Duty' - Martyn's Law - was due to come into force.
It would place a legal requirement on licensed venues to put counter-terrorism policies in place in the event of an attack.
Mr Norris accepted that now, following Manchester, if a new application for a large arena was made, a local authority would be 'duty bound' to consider terrorism.
Mr Greaney said the chairman 'may find that the provision of medical support on May 22, 2017 was not what it ought to have been'.
Mr Norris agreed licensing authorities 'ought to reflect' upon that when granting licences 'from now on'.
The inquiry has heard many victims at Manchester Arena waited for medical treatment for long periods of time in the aftermath.
Mr Norris said the LGA had 'made the point' to Government about the 'parallels between the regulatory environment in terms of sports grounds and that in relation to entertainment events'.
"And the fact that there is learning that can be drawn from the sports ground arena and applied into the Licensing Act itself and that there might be benefits in doing that," he added.
"Clearly to date we have not been that successful in making that point across to Government."
James Button, President of the Institute of Licensing, agreed it considers that at an arena event with more than 10,000 people present, there 'ought to be a requirement for the provision of medical support for those attending - and the standard for that support should be identified, specified and enforced'.
"It needs to be an enforceable requirement, yes," he said.
Mr Button said there needed to be a regulator, but the institute does not consider that the 'licensing regime is the way in which that area of activity is to be regulated'.
A chief physician with one of the French commando teams involved in the response to the Bataclan attack is due to give evidence.
But Richard Thomas, of Counter-Terrorism Police HQ, said in a statement to the inquiry it was for the Department of Health and Social Care, and the NHS, 'to determine which clinical assets should be deployed to terrorist attacks'.
Police, meanwhile, said policies and procedures in terms of the response to a terror attack have changed 'significantly' since the Arena attack.
Matthew Twist, deputy assistant commissioner for specialist operations at the Metropolitan Police, said where armed officers can't immediately 'neutralise a threat', they are now trained to 'shrink down the hot zone area as quickly as possible' to allow medics access to casualties.
Armed response vehicle officers in Greater Manchester - who would be first at scenes - now all carry first aid bags they can drop for others to use, he revealed, and first aid changes were expected to be approved so all frontline police officers are trained in tourniquet application, wound packing and airway management.
John Cooper QC, for a number of the bereaved families, asked Mark Hardingham, chairman of the National Fire Chiefs' Council, whether attitudes of fire services have changed in terms of 'taking risks and risk aversion' as a result of the inquiry.
Greater Manchester Fire and Rescue Service 'played no meaningful role' in the Arena response as crews took more than two hours to reach the scene, the inquiry has been told.
Mr Hardingham said attitudes were 'better informed' now as a result of the inquiry's findings and the evidence heard, as well as changes made to policies and protocols in terror attack situations.
"The fire service and firefighters are much more aware now of the need to balance public safety/responder safety, of the need to learn from the outcomes and the learning of this inquiry - and also to be able to deploy much more at pace, but safely, than had been the case at this incident," he said.
The Arena bombing after an Ariana Grande concert on May 22, 2017, claimed 22 lives.
A total of 63 people were seriously injured and 111 hospitalised.
The public inquiry continues.
