Mr Mascorella said there were no specific guidelines about when paramedics would take over care of patients or assist EMS staff.
He said the lack of leadership made it “extremely difficult” for him to care for Mr Pham, who was suffering the effects of MDMA toxicity, and that the doctors were giving the overdose victim medication at the time of his cardiac arrest that the paramedic wasn’t being made aware of.
“I just felt at the time that nobody was advocating for the patient appropriately,” he told the inquest.
Another paramedic said in a statement the medical tent started to “implode” during the treatment of Mr Pham and Ms Nguyen.
The inquest heard NSW Ambulance staff described the care provided to Mr Pham was “poorly coordinated and indecisive” with EMS staff unable to manage his airway effectively.
Mr Mascorella said it was he who decided to take Mr Pham to hospital under lights and sirens.
The NSW Coroners Court at Lidcombe previously heard Mr Pham arrived in the tent at 7.34pm and was eventually taken to Nepean Hospital at 8.35pm, arriving at 8.51pm. Treatment continued until 9.42pm, when he was pronounced dead.
Ms Nguyen arrived at Nepean Hospital just before 9.30pm and was pronounced dead at 10.17pm.
The inquest is also scrutinising the circumstances surrounding the deaths of Alex Ross-King, 19, Joshua Tam, 22, Callum Brosnan, 19, and Nathan Tran, 18, who all died after consuming MDMA at music festivals between 2017 and 2019.
Dr Andrew Beshara, who was working in the tent, gave evidence earlier in the week he told EMS director Michael Hammond that Mr Pham needed to be transferred to hospital soon after the arrival of Ms Nguyen, who came into the tent within minutes of Mr Pham’s arrival.
The court heard he was one of just two doctors allocated for the 30,000-strong crowd.
The inquest previously heard Dr Beshara had little critical care experience at the time.
Sean Wing, an emergency department registrar also working in the medical tent, told the inquest on Friday that Mr Hammond had described Dr Beshara as an experienced emergency doctor.