AAB, a 26-year-old man with a history of substance abuse and mental health issues, died from acute cocaine and alcohol toxicity while in police custody. He presented to a hotel with agitated, paranoid behaviour and was detained by NSW Police after cocaine was found on his person. He then experienced seizures followed by cardiorespiratory arrest. Expert evidence confirmed the police officers' response was exemplary and appropriate throughout, including seizure management, airway positioning, and timely resuscitation. The death was not preventable—it resulted from acute toxicity from self-administered cocaine combined with alcohol, with no identifiable failures in police or emergency medical care. The case demonstrates the challenges in recognising acute cocaine toxicity in non-clinical settings.
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