Finding into death of Hope Carnevali

Contributing factors

• thunderstorm asthma event with pollen exposure
• high sensitivity to rye grass pollen
• hay fever and seasonal allergic rhinitis
• sub-optimal use of preventer medications
• lack of written asthma action plan
• probable lack of awareness of high-dose reliever paradigm
• absence of objective lung function testing
• outdoor exposure during storm event
• use of evaporative cooling drawing outside air
• sensibility to Alternaria mould (possible co-factor)
• unprecedented surge in emergency call demand limiting ambulance response

Coroner's recommendations

1. Further research into meteorological, biological and aerobiological factors that combine to create thunderstorm asthma events to improve prediction and forecasting
2. Verification and development of the thunderstorm asthma forecasting system to provide more accurate and meaningful public warnings
3. Continue public awareness campaigns by DHHS about thunderstorm asthma, asthma action plans, and the link between hay fever and thunderstorm asthma
4. Further medical, allied health and community education encouraging hay fever sufferers to undergo allergy testing and develop management plans
5. When thunderstorm asthma warnings are issued, those at risk should remain indoors with windows and doors shut, turn off evaporative cooling systems, and avoid travel during peak pollen/storm periods
6. Address the existing issue that callers during high demand periods cannot access estimated ambulance arrival times to make informed decisions about self-transport to hospital