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As the NSW deputy state coroner examines the MDMA-linked deaths of six young music festival-goers, security precautions, pill testing and overdose procedures come under scrutiny. By Drew Rooke.

Music festival deaths inquest

Joshua Tam, who died at the Lost Paradise music festival in December 2018.
Credit: SUPPLIED

Among the nearly 17,000 people at Sydney’s Knockout Circuz music festival on December 16, 2017, was 18-year-old Hoang Nathan Tran. Known to friends and family as Nathan, he was a quiet and gentle young man who had only recently finished high school and dreamed of joining the police force.

At the festival, he bought and consumed what he believed to be capsules of MDMA. Friends saw him smiling and having a good time for most of the day, but shortly after 10pm, Nathan was spotted in an outdoor area of the festival acting strangely and aggressively to staff and other patrons. Nathan started running through the crowd, tripped and fell face-first on the ground.

He was motionless until paramedics and security guards arrived. According to one of the guards who testified at a coronial inquest currently being held into six drug-related deaths at New South Wales music festivals between late 2017 and early 2019, Nathan then became “agitated” and “started lashing out with his hands”. He was forcefully restrained while paramedics assessed his condition. After he had calmed down, the guards started helping Nathan towards the medical tent for treatment.

But the teenager could not walk unsupported and dropped to the ground many times. Police standing nearby stepped in. Nathan grew agitated again and one of the officers put him in a headlock-like hold. He was then forced to the ground, handcuffed and carried to the medical tent by police and security guards. Medical staff noted his breathing was short and shallow. He started to lose consciousness and was urgently transferred to Westmead Hospital.

Nathan arrived at 11.28pm with a body temperature of 41 degrees. His condition continued to deteriorate. At 12.50am, he was pronounced dead.

 

During the past fortnight, the deputy state coroner, Harriet Grahame, has heard disturbing details about the recent deaths of five other young people at NSW music festivals.

On September 15, 2018, Diana Nguyen, 21, and Joseph Nguyen Nhu Binh Pham, 23, both died at Defqon.1 near Penrith. On December 8, 2018, Callum Brosnan, 19, died after attending Knockout – Games of Destiny at Sydney Olympic Park. Joshua Tam, 22, died at Lost Paradise on the Central Coast on December 29, and on January 12, 2019, Alexandra Ross-King, 19, died at FOMO Festival in Parramatta.

The main drug under the spotlight at the coronial inquest is MDMA – or 3,4-methylenedioxymethamphetamine. All six people died as a result of MDMA toxicity or complications resulting from MDMA use. Others were lucky to escape the same fate. According to NSW Health, at 25 NSW music festivals in 2018-19 there were 29 pre-hospital intubations, 25 drug-related intensive care admissions and at least an additional 23 drug-related hospital admissions.

MDMA is the active ingredient in ecstasy but is also sold on the street in the form of crystals or powder. As with all illegal drugs, its purity varies dramatically. It is sometimes cut with other substances, greatly increasing the risk of harm or death. A common contaminant is paramethoxyamphetamine (PMA), traces of which were found in Hoang Nathan Tran’s bloodstream.

Dr David Caldicott is an emergency medicine consultant and a clinical senior lecturer in the Australian National University’s College of Health and Medicine. He told the inquest that PMA is “far more dangerous” than MDMA. It is known to accentuate hyperthermia and in 2013 was directly implicated in a spike of drug-related deaths across Britain.

Mixing MDMA with alcohol – as three of the six young people whose deaths are being examined are known to have done – also significantly increases the risk of harm.

But even those who just consume alcohol are taking a risk. According to the Australian Bureau of Statistics, 1366 people died as a direct result of alcohol in 2017, with a total of 4186 cases where alcohol contributed to a death. A study published this month in the Journal of Psychopharmacology, which reviewed the harm to users and others of legal and illegal drugs consumed in Australia, found that, overall, alcohol was “the most harmful”.

 

EMS Event Medical (EMS) was formed, according to its website, “in an effort to meet the growing demand for professional quality event medical services”. Throughout the inquest, the “professional quality” of its work at music festivals has come under serious fire.

EMS provided medical care at Defqon.1, where Joseph Pham and Diana Nguyen died. The company contracted two doctors to work at the 30,000-person event. There had been a number of critical incidents at the festival in previous years but the doctors were carrying only one dose of succinylcholine and one of rocuronium, critical life-saving medications that assist with patient intubation. One of the pair was a junior doctor who had never performed an unsupervised intubation in an emergency setting.

A NSW Ambulance paramedic, who was at the festival and gave evidence at the inquest, described the onsite care provided to Joseph and Diana, who arrived at the medical tent within minutes of each other, as “completely abhorrent”. It was a sentiment echoed in an independent expert report prepared for the coroner by emergency medicine specialist Associate Professor Anna Holdgate. Joseph’s treatment was “poorly co-ordinated and indecisive”, according to Holdgate, while Diana’s was “disorganised, delayed and incomplete, and further reduced her chance of survival”.

At Lost Paradise, where Joshua Tam died, EMS contracted only one doctor, a general practitioner, to provide critical care at the 11,000-person festival. He told the inquest he was “not at all” equipped to treat adverse reactions to drugs or perform emergency medical procedures.

The aggressive nature of policing at these festivals is another issue that has attracted intense scrutiny during the inquest. It emerged that Alexandra Ross-King consumed more than two MDMA capsules in quick succession before entering FOMO Festival, because she was scared of being caught by police. A short time later, she became critically unwell and died.

Other evidence has suggested strip-searching and the large presence of sniffer dogs at festivals traumatise patrons and even deter them from seeking medical help.

One young woman who attended Knockout Circuz, where Hoang Nathan Tran died, tearfully recounted to the coroner how she was taken into a room by police after a sniffer dog indicated she was carrying drugs. She was ordered to strip naked then to repeatedly “squat and cough”. She was “humiliated” by the search, which failed to uncover any drugs.

Even the coroner said that on a recent research trip to a music festival in the lead-up to the inquest, she felt “nervous” seeing the “lines and lines of police and dogs” at the gates.

 

“There are days when you find yourself on the ground crying uncontrollably for no apparent reason,” says Julie Tam. “Then there are other days when you feel half-normal, because you know you’ll never feel completely normal when your child has died.”

Tam is sitting with her husband, John, in the sun outside the Coroners Court during a lunchbreak. Six months have passed since their son Josh died after taking MDMA at Lost Paradise.

“Nothing really takes the edge off it or softens it in any way,” she tells The Saturday Paper. “You literally just have to go with the flow, let the grief wash over you, and hope you come out the other side.”

She would love if young people just listened to the “Say no to drugs” message. But she knows that “there will always be people who want to take drugs, who will test the waters and push the boundaries”.

In the wake of Josh’s death, Julie and John launched Just Mossin – an organisation that advocates improved drug harm-minimisation measures. They have a suite of ideas for how to reduce the chance another family will be forced to live through the pain they’re experiencing, including better onsite medical care at music festivals, improved drug education that is relevant to young people already interested in taking drugs, and pill testing.

Even if a pill test doesn’t detect dangerous substances such as PMA, they believe it is worthwhile for the opportunity it creates for a health professional to inform a young person about the risks of consuming drugs. And what to do if they, a friend or someone they see at the festival has an adverse reaction. John believes it could be “the last-minute intervention” that might just prevent another tragedy.

The inquest will resume in September, with a final report due before the summer music festival season begins. The Tam family is hoping the NSW government will heed the coroner’s recommendations. As Julie told the inquest on its first day: “Six kids can’t die at music festivals without the rules changing.”

This article was first published in the print edition of The Saturday Paper on Jul 20, 2019 as "A testing inquest". Subscribe here.

Drew Rooke
is a freelance journalist and the author of One Last Spin: the power and peril of the pokies.