Coronial findings in thunderstorm asthma inquest

Monday 11 February 2019
Paula Shelton

On Monday, 21 November 2016 Melbourne experienced an unprecedented meteorological event which sadly saw ten people lose their lives.

The temperature peaked at 35° before high levels of pollen from plains to the north and west of Melbourne and a cool stormy change combined to produce a thunderstorm asthma event. Whilst the precise mechanism of a thunderstorm asthma event is not clear, it is generally understood that the moisture from the storm breaks pollen particles down to a size capable of being breathed deep into the lungs, resulting in breathing difficulties in people sensitive to the substance, in this case rye grass.

The ten deaths occurred because of respiratory complications which related to acute thunderstorm asthma. An inquest was held into the deaths before Coroner Paresa Spanos who has now delivered her findings.

The findings

One of the major issues examined in the inquest was the response to the overwhelming number of calls for ambulances.

The Emergency Services Telecommunications Authority (“ESTA”), who takes calls for Ambulance Victoria (“AV”), received an unprecedented surge of calls requesting ambulance assistance for people suffering shortness of breath or asthma.

The 12 hour period from 6pm on 2 November to 6am on 22 November 2016 saw the greatest single volume of calls received by ESTA in its history. A total of 2332 calls were received during this period, an increase of 73% on what was expected.

Requests for ambulances were prioritised according to clinical need, with the most serious category being told “the ambulance is on its way”. Evidence was given that normally this would be correct and an ambulance would be dispatched immediately or diverted from another event, however during the thunderstorm asthma event ambulances were not available for dispatch to these high priority events, and would not be dispatched for some time.

This meant that what callers were told was inaccurate and possibly, misleading. Patients complained that, had they known that an ambulance was not on its way they could have used alternative transport to get to hospital rather than waiting for ambulances that would not arrive.

AV’s performance targets require that 85% of high priority events within 15 minutes. On the day of the thunderstorm asthma event only 57.1 of priority cases were attended in the target period.

The outcomes

Following the thunderstorm asthma event AV and ESTA have changed the advice given to people calling for ambulances during high demand events. Now callers are told that there is an extremely high for ambulance resources and that if they can access health services another way they should do so.

The aim is to better equip callers to make appropriate decisions about their health emergency during periods of high demand for ambulance services.

AV and ESTA have also implemented changes to permit public warnings about higher than normal demands on ambulance resources, establish better communication with the Department of Health and Human Services and the Bureau of Meteorology and recall staff for surge events.

 

Coroner Spanos praised the actions of ambulance and medical staff for their extraordinary efforts to help patients in the face of an unexpected and rapidly evolving medical crisis.

This tragic incident shows the necessity to be cognisant of the changing natural disaster risks that we face and the challenges to emergency medical services that this creates.

If you require further information about Coronial Investigations or Inquests, call (03) 9321 9988.

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