Coronial
VICcommunity

Finding into death of Omar Jamil Moujalled

Deceased

Omar Jamil Moujalled

Demographics

18y, male

Date of death

2016-11-21

Finding date

2018-11-09

Cause of death

acute asthma

AI-generated summary

Omar Jamil Moujalled, 18 years old, died from acute asthma during the unprecedented thunderstorm asthma event in Melbourne on 21 November 2016. He had pre-existing asthma and severe hay fever with exceptionally high sensitivity to ryegrass pollen (>100 kUA/L). He developed acute respiratory distress around 6:00 PM, attended Greenvale Medical Clinic where CPR was commenced by attending physicians, and an ambulance arrived approximately 16 minutes later. Despite paramedic support and intubation, he could not be resuscitated. The coroner found that while there was a delay in ambulance dispatch due to unprecedented call surge, this was not inordinate and unlikely to have materially altered the outcome. Key clinical lessons include: better identification and management of at-risk individuals (those with asthma and hay fever), importance of asthma action plans, optimization of preventer medication use, and staying indoors during TA warnings.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.

Specialties

emergency medicinerespiratory medicineallergy and immunologyparamedicine

Error types

systemdelay

Drugs involved

salbutamolseretide accuhaleradrenalineoxygen

Clinical conditions

acute asthmasevere allergic asthmahay fever (seasonal allergic rhinitis)asthma with seasonal exacerbationsrespiratory arresttonic-clonic seizure (due to hypoxia)ryegrass pollen allergyalternaria mould sensitisation

Procedures

cardiopulmonary resuscitationendotracheal intubationdefibrillation

Contributing factors

  • thunderstorm asthma event with severe allergic reaction to ryegrass pollen
  • sub-optimal use of preventer medications
  • severe sensitivity to ryegrass pollen with elevated IgE
  • hay fever and seasonal asthma exacerbations
  • lack of documented asthma emergency management plan
  • outdoor exposure during thunderstorm with gust front dispersing pollen
  • unprecedented surge in emergency call demand overwhelming ambulance dispatch capacity
  • possible Alternaria mould sensitisation as co-factor

Coroner's recommendations

  1. Further research into the specific meteorological, biological and aerobiological factors that combine to create thunderstorm asthma events to improve prediction and forecasting accuracy
  2. Continued verification and development of the thunderstorm asthma forecasting system
  3. Continuation of public awareness campaigns linking hay fever and thunderstorm asthma with escalated preventative therapy
  4. Further medical, allied health and community education encouraging hay fever sufferers to undergo allergy testing to understand susceptibility and inform clinical management
  5. When thunderstorm asthma warnings are issued, those at risk should remain indoors with windows and doors shut, turn off evaporative cooling and external air systems, and consider travelling outside peak exposure times
  6. Continued testing and refinement of new ambulance dispatch scripts (surge script and updated Priority 0/1 exit scripts) to provide callers with more accurate information during high-demand periods
  7. Further work to configure emergency response systems to provide callers with estimated arrival times of ambulances where feasible
  8. Continued collaborative work between DHHS, ESTA, Ambulance Victoria, Bureau of Meteorology and other agencies on emergency preparedness for thunderstorm asthma and other surge events

Further listening

Coronial podcast — Episode 93

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