Coronial

115 results for ambulance transport

SAcommunity2007-12-12

Coroner's Finding: BAUMANIS Bronislawa Sonia

84y · Female·ischaemic heart disease

…rsing home placement. Her GP appropriately obtained a Mental Health Act detention order when she refused transport despite clinical necessity. During transfer to the ambulance, she suffered cardiac arrest, likely precip…

general practiceemergency medicineadrenaline
VIChomePodcast2018-11-09

Finding into death of Hope Carnevali

20y · Female·acute asthma

…sthma event on 21 November 2016. She experienced acute respiratory distress at home around 6:00pm and an ambulance was called at 6:28pm but did not arrive until 7:03pm, during an unprecedented surge in emergency calls. …

respiratory medicineallergy and immunologysystemcommunicationsalbutamol
QLDcommunity2017-07-26

Stephenson, Ethan

14y · Male·Head injuries resulting from a motor vehicle collision (pedestrian)

…ng, lack of speed enforcement capability, no mandatory drug testing for fatal crashes, absence of public transport, and permissive skateboarding regulations. The coroner recommended speed limit reductions, increased pol…

forensic medicinesystemdelay
QLD2009-02-09

Zulpo, Kate Leanne

24y · Female·Head, chest and leg injuries from motor vehicle collision (Driver)

…d truck towing a tipper trailer. She was pronounced life extinct at Nambour General Hospital after being transported by Queensland Ambulance Service helicopter. The coroner examined concerns about roadway conditions but…

VIChospital2014-11-17

Finding into death of Kam Wah Koh

84y · Male·Pneumonia complicating fractured cervical spine in the setting of fall

…ion. The coroner found no medical intervention at an earlier stage would have changed the outcome. While ambulance response time was delayed (one hour), this did not alter the fatal trajectory. The case highlights the i…

trauma surgeryorthopaedic surgerydexamethasone
VIC2010-05-24

Finding into death of Phillip William Banner

79y · Male·Ischaemic heart disease

…y called, and MICA paramedics arrived within 26 minutes. Despite CPR for approximately 20 minutes during transport to St Vincent's Hospital, he did not respond. The coroner found that all emergency response and medical …

emergency medicinecardiology
VIChospital2025-07-24

Finding into death of Shane Michael Kelly

65y · Male·Aspiration pneumonia complicating urosepsis in setting of nephrolithiasis and ce…

…ative care and died on 27 May 2024. The coroner found no preventability issues and noted that a delay in ambulance transport did not contribute to the death. The case highlights the known medical risks associated with h…

infectious diseasesurologyoxygen
NSW2015-12-03

Inquest into the death of Adam Southwick

37y · Male·methyl amphetamine intoxication while being restrained in a confined space; posi…

…tional asphyxia while restrained in a confined space. Critical failures included: police did not call an ambulance at the scene despite obvious signs of severe intoxication (unable to walk, unresponsive); the custody ma…

emergency medicineforensic medicinediagnosticcommunicationmethamphetamine
NSWhospital2020-02-14

Inquest into the death of Tristan Naudi

23y · Male·Acute cardiac arrhythmia in 3,4-methylenedioxymethylamphetamine (MDMA) intoxicat…

…ce appropriately placed him in a police vehicle after finding him violently agitated at home. A delay in ambulance dispatch meant police transported him to hospital instead. While his transfer into the isolation room wa…

emergency medicinetoxicologysystemdelayMDMA
NSW2017-02-03

Inquest into the death of Thanh PHAM

30y · Male·traumatic brain injury

…icate vital head injury information to emergency services—witnesses knew he had hit his head heavily but ambulance operators were not informed, potentially affecting triage decisions; (2) incomplete handover of trauma i…

neurosurgeryemergency medicinecommunicationsystem
VIChospital2026-01-23

Finding into death of Roger Henderson

59y · Male·Complications of epilepsy and cerebral palsy

…ation. On 9 November 2024, he presented with shortness of breath and deterioration. Paramedics initially transported him to Sunshine Hospital but, following GP consultation, redirected him to Bacchus Marsh Hospital wher…

palliative careemergency medicinesalbutamol
QLD2007-11-23

Walker, Nola Jean

66y · Female·Blood loss due to tearing of the spleen and fractured ribs occasioned by a motor…

…rash, assessed by paramedics who found normal vital signs and no obvious injuries. She declined hospital transport. Police then detained her on suspicion of drink-driving (0.198% BAC). Over the next two hours at the pol…

emergency medicineparamedicinediagnosticcommunicationalcohol
SAhospital2015-03-06

Coroner's Finding: SIMOS Theodoras Joannas

48y · Male·undetermined

…cutely psychotic patients face significant complexity; early transfer via specialist retrieval (not RFDS/ambulance) may be preferable; careful medication choice considering respiratory sensitivity is essential; coordina…

psychiatrygeneral practicesystemdelayhaloperidol
VICcommunity2015-07-01

Finding into death of Robert Peter Ferrier

47y · Male·Drug toxicity in the setting of restraint

…amadol) combined with physical restraint. Paramedics provided appropriate emergency care including rapid transport, vital sign monitoring, and resuscitation attempts lasting 36 minutes. The coroner found police restrain…

emergency medicinetoxicologyamitriptyline
VICcommunity2026-04-13

Finding into death of Nikki Maree Francis

40y · Female·Complications of influenza A infection in a woman with Moebius syndrome (palliat…

…, she displayed signs of illness with coughing and chest discomfort; her aunt advised against calling an ambulance due to previous help-seeking behaviour. The next morning she vomited and was hospitalised. Despite antib…

emergency medicineinfectious diseases
VIC2016-05-25

Finding into death of Umut Selek

23y · Male·Unascertained

…aint involving multiple officers at a police station, he was sedated with 5mg intramuscular Midazolam by ambulance officers. He subsequently suffered cardiac arrest during transport to hospital. Despite extensive autops…

forensic medicineemergency medicinecommunicationsystemmidazolam
VIChome2022-08-26

Finding into death of David Patrick Hardisty

32y · Male·Mixed drug toxicity

…nt. Paramedics assessed him as having capacity, appearing alert and denying overdose, and decided not to transport him to hospital. Key clinical lessons: the deceased displayed signs concerning for self-harm (slurred sp…

emergency medicineparamedicinecommunicationdiagnosticoxycodone
VICmental health2015-07-08

Finding into death of David Allan D'Angelo

30y · Male·Heroin toxicity

…ed leave with Associate Charge Nurse Layne, he absconded when left briefly unattended. He was treated by ambulance paramedics for heroin overdose at 12:52pm and declined hospital transport. He died later that day from h…

psychiatryemergency medicinesystemdelayheroin
VICcommunity2019-01-31

Finding into death of Pauline Mary Riordan

61y · Female·injuries sustained in a motor vehicle collision as a passenger

…ue personnel made reasonable decisions about extrication methods. Key lessons include the need for rapid transport of trauma patients to centres with transfusion capability and potential benefits of pre-hospital blood p…

emergency medicinetrauma surgerydelaymorphine
QLDhospital2006-08-10

Casey, Lenard John

39y · Male·Coronary thrombosis caused by coronary atherosclerosis

…t Isa, he became violently agitated despite sedation with diazepam and haloperidol. The pilot refused to transport him on safety grounds, and he was returned to hospital. He subsequently collapsed and died despite resus…

cardiologyemergency medicinecommunicationmorphine

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