Coronial

536 results for trauma assessment

VIC2022-07-28

Finding into death of Master S

17y · Male·Unascertained in the setting of volatile substance abuse

…ly; (2) multiple systems (child protection, youth justice, health) operated in silos without coordinated assessment or intervention; (3) suicidal ideation expressed repeatedly in 2016-2017 was not comprehensively assesse…

paediatricspsychiatrycommunicationsystemrexona deodorant
QLDhome2019-10-02

Banjo, Neil Richard

53y · Male·Traumatic brain injury sustained from police use of force on 25 February 2016, t…

Neil Banjo, a 53-year-old Aboriginal man, died from traumatic brain injury sustained during a police confrontation on 25 February 2016 in Normanton, Queensland. Offi…

trauma surgeryemergency medicinesystemdelay
TAS2015-08-01

Coroner's Finding: Leemhuis, Leah Maree

46y · Female·Multiple severe trauma suffered in a motor vehicle accident

A 46-year-old woman died in a head-on motor vehicle collision after her car drifted across the centre line on the Bass Highway. She had reported feeling tired earlier that morning and had intended to pull over to sleep. …

psychiatrygeneral practicecommunicationdiazepam
SA2024-12-20

Coroner's Finding: Huddy, Kobee Michael David

20y · Male·gunshot wound to the chest

…found the shooting legally justified. Critical clinical lessons include: ensuring adequate mental health assessment and follow-up in young people with BPD and multiple suicide attempts; managing acute mental health crisi…

psychiatryemergency medicinecommunicationsystemcannabis
NSWhome2021-03-10

Inquest into the death of Z

2y · Male·traumatic head injury

A 2-year-7-month-old boy died from traumatic head injury inflicted by person(s) unknown after experiencing severe and escalating physical abuse over…

paediatricsemergency medicinediagnosticcommunication
NSW2021-05-26

Inquest into the death of Liam WOLF

19y · Male·unexpected arrhythmogenic event leading to a fall from height, blunt force head …

…) that could not have been identified pre-training. Key preventable factors included lack of proper risk assessment of the tunnel obstacle, absence of timely defibrillation (delayed by water hazard), and difficulties ext…

emergency medicinecardiologysystemdelay
QLDhospital2018-09-26

Mann, Renae Jean

43y · Female·acute toxic effects of amitriptyline

… overdose. After 11 hours of ED monitoring, she was medically cleared and transferred to a mental health assessment pod, despite abnormal ECG findings with T-wave changes not fully investigated (troponin test ordered but…

emergency medicinepsychiatrydiagnosticcommunicationamitriptyline
WA2019-08-20

Inquest into the Death of Judy Sonia BOLTON

44y · Female·acute myocardial infarction due to coronary thrombosis

…etected until November 2016 due to missed appointments and failed testing attempts. Nurse Owen's initial assessment was reasonable given the deceased presented with subtle symptoms typical of female presentation (no cold…

cardiologyemergency medicinediagnosticsystemmetoprolol
QLDhospital2026-01-20

Non-Inquest findings - DUCHATEL Daniella Jade

26y · Female·Pulmonary thromboembolism due to deep vein thrombosis (left leg) due to fracture…

… (obesity, oral contraceptive use, vaping, leg immobilization, prolonged immobility), no formal VTE risk assessment was conducted at emergency presentation or fracture clinic. Blood-thinning prophylaxis was not prescribe…

orthopaedic surgeryemergency medicinediagnosticcommunicationaspirin
WAhome2017-03-30

Inquest into the Death of Troy William MURRAY

34y · Male·ligature compression of the neck (hanging)

…zepines in at-risk populations given risk of disinhibition and overdose; and importance of mental health assessment following episodes of self-harm (he presented to hospital after wrist laceration in November 2011). The …

psychiatrygeneral practicecommunicationamphetamine
QLDhome2019-04-04

Blackmore, Rinabel Tiglao - Non-inquest findings

44y · Female·Head injury sustained when exiting a moving vehicle

…ates the importance of recognising non-lethal strangulation as a major homicide risk factor, proper risk assessment alignment with response, support for CALD victims, and cultural competence in police responses to domest…

forensic medicineparamedicinecommunicationsystem
SAhospital2010-12-06

Coroner's Finding: GEORGE Irene Thelma

84y · Female·septicaemia secondary to septic arthritis of the left knee

An 84-year-old woman presented to hospital with acute left knee swelling and pain. Initial assessment at Ashford Hospital ED reasonably excluded septic arthritis based on borderline blood tests and absence …

emergency medicinegeneral medicinediagnosticcommunicationmorphine
QLDPodcast2006-12-04

Jones, Katherine Alison

54y · Female·Severe multi trauma due to gate falling on deceased

Katherine Alison Jones, a 54-year-old cleaner, was fatally crushed by a 900kg automatic sliding gate that fell from its track at a shopping centre on 10 December 2005. The gate had a broken safety stop that had not been …

systemprocedural
VIC2015-05-03

Finding into death of Courtney Faith Keast

12y · Female·Head injury

Courtney Keast, age 12, died from catastrophic head injury sustained in a boat collision at Lake Eppalock. She was struck by another vessel while sitting in the back of a ski boat. Both operators were experienced, licens…

QLDcommunity2023-12-21

GREER, Tina

32y · Female·Unknown

…d Safety (failure to assess DV risk adequately when Lili self-placed with Tina in 2011, lack of holistic assessment despite awareness of DV pattern). While preventative interventions cannot be confirmed to have altered t…

paediatricsaddiction medicinediagnosticcommunication
VIC2010-04-27

Finding into death of Trevor James Day

42y · Male·Head injuries sustained in motor vehicle accident (passenger)

… safety information cascades effectively to all drivers, and implementing driver training and competency assessment systems.

emergency medicineforensic medicinecommunicationsystem
QLDcommunity2024-10-11

Findings of the inquest into the death of Luke Brian Gilbert

24y · Male·Gunshot wounds to the chest

Luke Gilbert, 24-year-old male, died from gunshot wounds after approaching two police officers in Airlie Beach's Safe Night Precinct while carrying an illegal Category M folding knife and heavily intoxicated. He produced…

emergency medicinepsychiatryalcohol
TAS2022-04-21

Coroner's Finding: Beesley, Nathaniel Owen

32y · Male·crush injuries sustained in a rock fall

… evidence of negligence, procedural failure, or preventable error by the scalers or site operators. Risk assessments were thorough and documented; the team held appropriate IRATA rope-access qualifications; work protocol…

occupational and environmental healthforensic medicinesystem
VIC2012-03-23

Finding into death of Shane Bennett

19y · Male·Closed brain injuries sustained in motor vehicle accident

…suit despite speeds vastly exceeding the zone limit and approaching a busy intersection; inadequate risk assessment by both officers; and post-incident investigative delays and discrepancies in police statements.

emergency medicinetrauma surgeryproceduralcommunicationcannabis
WAhome2007-07-27

Inquest into the Death of Chubby

64y · Female·Acute bronchopneumonia in a woman with liver failure

…d no ambulance was needed, believing her condition unchanged from discharge. The A&E nurse accepted this assessment without directly evaluating the patient. The granddaughters were told to bring her to hospital at 9:00am…

general medicinecardiologycommunicationdiagnostic
122232427

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