Triple-zero delay ‘eliminated’ Preston father’s chance of survival

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A Preston father who died following a lengthy delay connecting to Victoria’s triple-zero service hadn’t yet gone into cardiac arrest the first time he called for an ambulance.

However, the wait of more than 16 minutes to reach an Emergency Services Telecommunications Authority (ESTA) call taker encountered by Nick Panagiotopoulos and others who rang trying to get him help “eliminated his chance of survival”.

Nick Panagiotopoulos, who died last year waiting for an ambulance, and his wife Belinda.

This was the evidence given to the Coroners Court by cardiologist Associate Professor Nicholas Cox, who said if emergency services had arrived even seven to 10 minutes after his cardiac arrest, Nick’s chances of surviving would have been good.

“I think the [triple-zero answering] delay and the result that emergency services didn’t arrive was contributory to his death,” Cox told the court. “Had he been treated, had he survived, I would expect that he is someone that with appropriate medical therapy could have otherwise had a normal quality of life, and indeed probably a long life, with appropriate care and follow-up.”

Nick’s death from a heart attack on October 16, 2021, was first reported by The Age in December the same year, sparking a review by ESTA’s regulator, the Inspector-General for Emergency Management. But many more deaths would follow in the months to come as the answering crisis worsened.

It took revelations by The Age of another 11 deaths linked to ESTA call-answering delays, reported in March the following year, for the Victorian government to announce a $115.6 million reform package for the service battling “unprecedented demand”. Still more deaths would follow.

The court heard on Monday that the coroner’s investigation may include an assessment of the adequacy of the 2022 inspector-general’s review of emergency ambulance call answer performance, and whether it properly considered how the pandemic-related surge in calls was identified, who was responsible for responding to that increase, and what was done in response.

The Panagiotopoulos inquest was scheduled to run all week but was adjourned on Monday afternoon until March because the court recently received a “considerable amount of information” from ESTA and Telstra, which directs Australians’ triple-zero calls to the appropriate emergency service.

“The volume of that material was more significant and complex than initially anticipated,” said barrister assisting the coroner Georgina Coughlan, KC.

Before the adjournment, the court heard from forensic pathologist Dr Hans de Boer, who said toxicology results showed evidence of cocaine in Nick’s system before his death. Although he wasn’t under the influence of the recreational drug at the time of his death, Nick probably consumed it within a couple of days prior, de Boer said.

Cox said cocaine could have contributed to the 47-year-old’s heart attack but wouldn’t have influenced his chance of survival.

He said the father of three had other risk factors that would have been more significant in the fatal cardiac episode, including a family history of heart disease, hypertension (high blood pressure) and hypercholesterolemia, and his status as an ex-smoker.

Nick, a civil engineer, first called for an ambulance at 12.34pm after complaining of being sweaty and clammy, but no one at ESTA was available to accept the call. Further calls were made by Nick, his daughter, his sister-in-law and a bystander.

It took 16 minutes and 26 seconds for an ESTA operator to be reached. From then, it took only four minutes for paramedics to arrive.

The court heard the long delay getting through to ESTA may have hampered the start of effective CPR, as initial resuscitation attempts “involved pumping of the stomach, rather than the chest”.

Cox said he had listened to Nick’s call made at 12.34pm, which suggested he had yet to go into cardiac arrest. Bystanders noticed he wasn’t breathing by 12.41pm, indicating he’d then had a cardiac arrest.

“Had the emergency services arrived before he had his cardiac arrest, I think almost 100 per cent he would have survived,” the cardiologist said. “Had the emergency services arrived … within seven to 10 minutes [of his cardiac arrest], then I think his chances of survival were very good.”

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