In her expert report to the inquest, Associate Professor Anna Holdgate said the medical team at the the Defqon.1 festival near Penrith had been quickly overwhelmed, ran out of basic resuscitation equipment, did not have sufficient medical expertise and made poor decisions in September last year.
Dr Holdgate, a senior staff specialist in emergency medicine, said it was clear that festival-goer Joseph Pham, 23, needed to be sent to hospital immediately when he arrived at the medical tent with signs of “significant MDMA toxicity” but staff had waited until he had a cardiac arrest.
“If Joseph had received immediate treatment to lower his body temperature and had been promptly transported to hospital by appropriately skilled NSW Ambulance intensive-care paramedics, he would have arrived at hospital prior to his cardiac arrest and may have been effectively resuscitated,” she said.
“While it is by no means certain that this would have prevented the fatal outcome, it would certainly have significantly improved his chances of survival.”
Mr Pham died less than an hour after arriving at Nepean Hospital.
Dr Holdgate’s report described his medical care as “poorly co-ordinated and indecisive” with staff “apparently unable to effectively manage his airway”, not recognising the significance of his elevated temperature and delaying a handover to NSW Ambulance so he could go to hospital.
“NSW Ambulance report that even after they had taken over care, Dr [Andrew] Beshara [who was working for Event Medical Services or EMS] continued to independently administer drugs to Joseph without any co-ordination with the ambulance crew.”
Dr Holdgate said it took 70 minutes to transport the critically ill Diana Nguyen, 21, to hospital with incomplete resuscitation, which was “below the standard of care”, and she was given “entirely inappropriate treatment” for her slow heart rate on the way.
Ms Nguyen died 35 minutes after Mr Pham at the same hospital.
Dr Holdgate’s report added to criticism of EMS during the first week of the inquest into six MDMA-related deaths.
Ms Grahame is also examining the deaths of Joshua Tam, 22, Callum Brosnan, 19, Nathan Tran, 18, and Alex Ross-King, 19.
In the case of both Mr Pham and Ms Nguyen, Dr Holdgate criticised EMS, which had emergency department registrar Sean Wing and the more junior Dr Beshara working in the tent, for how it simultaneously treated the two critically ill patients.
“They were clearly rapidly overwhelmed,” she wrote. “They apparently rapidly ran out of basic resuscitation equipment.
“The skill set of the medical staff was not adequate to manage critically ill patients. The decision-making as to what treatment should be provided on site and when patients should be transferred to hospital was poor.
“It seems Dr Wing attempted to treat both patients as if he was in a well-supported hospital environment rather than a relatively isolated facility with limited physical and human resources. NSW Ambulance resources were apparently readily available but the decision to use these apparently required initiation by EMS staff and they did not request this early enough.”
Dr Beshara gave evidence during the week that he had told EMS director Michael Hammond that Mr Pham needed to be transferred to hospital soon after the arrival of Ms Nguyen. “There should’ve been a lot more staff,” he said.
Dr Wing told the inquest that he had reflected on the situation but was unable to determine how Ms Nguyen’s situation could have been improved.
Mr Hammond is due to give evidence on Thursday.
The inquest resumes today with witnesses focusing on the death of Mr Tam, who took MDMA at the Lost Paradise festival on the central coast just before New Year.
Dr Holdgate also raised the prospect of public health messages advising about the specific dangers of MDMA for people of south-east Asian heritage, who might be genetically “poor metabolisers”, and for anyone significantly overweight, who were more prone to extreme body core temperatures.
After a call by Jennie Ross-King, Alex’s mother, for the NSW government to implement all the deputy coroner’s recommendations before the summer festival season, Ms Berejiklian said it depended on what they were.
“I don’t think anyone can accuse the government of not taking a strict approach to music festivals,” the Premier said. “We want to get the balance right, we want people to enjoy themselves, we want those festivals to continue and increase in number, but we also need to ensure that lives are not lost when that could be prevented and the strongest message to anybody is ‘don’t take illegal substances’.”
A spokeswoman for next weekend’s Splendour in the Grass festival said its extensive medical services, under provider Emergency Medics Pty Ltd, included an emergency consultant, resuscitation doctor, orthopaedic doctor, eight emergency nurse specialists, 11 advanced care paramedics, critical care paramedic, eight medics with at least two years of a paramedics degree and 70 harm-minimisation and crowd-care staff and it would also have the NSW Ambulance Service on site.
A medical facility covering 270 square metres included six acute beds, eight short-stay beds, two resuscitation bays, two isolation rooms and a chill-out room, and there was also a secondary treatment post.
With Deborah Snow
Garry Maddox is a Senior Writer for The Sydney Morning Herald.
Angus Thompson is a court reporter for the Sydney Morning Herald.