Over the past two weeks, deputy state coroner Harriet Grahame has heard harrowing details about the drug-related deaths of six young people at music festivals across New South Wales.

On Saturday she will visit Splendour in the Grass at Byron Bay to observe a pill-testing trial in action, after hearing experts express support for broader drug-testing measures in Australia.

But the inquest has shown that pill testing is not the sole answer to festival deaths, with multiple issues identified as having let young revellers down.

The inquest revealed the ratio of on-site doctors to festival patrons could be as low as one doctor for 15,000 people.

At December’s Defqon.1, where Diana Nguyen, 21, and Joseph Pham, 23, died, two doctors served the 30,000-strong crowd.

The Defqon.1 festival at Sydney International Regatta Centre in Penrith. Photo: Facebook

But according to Dr Sean Wing of medical service provider MRA, those common ratios are based on risk profiles from previous experience.

The bigger concern is the qualifications of the staff, who are also supported by NSW Ambulance paramedics.

Dr Wing’s Defqon.1 co-contractor Dr Andrew Beshara had never intubated a patient unsupervised – something both Ms Nguyen and Mr Pham required when they arrived in the medic tent within six minutes of one another.

NSW Ambulance paramedic Timothy Mascorella called the lack of leadership there “completely abhorrent” and said the main service provider, EMS, was “overwhelmed”.

EMS serves many large events and festivals, including December’s Lost Paradise in the Glenworth Valley where Josh Tam took MDMA before his death.

Josh Tam died after taking MDMA at the Lost Paradise music festival. Photo: ABC

The only doctor contracted for the festival, GP Dr Krishna Sura, expressed reservations to EMS that not only could he not manage patients’ airways, but was “not equipped” to deal with life-threatening MDMA reactions.

Two festival directors, Defqon.1 promoter Simon Coffey and Simon Beckingham of Lost Paradise, told the inquest the ratio of medical staff and their qualifications was a matter for EMS.

Policing

Policing at Australian festivals reflects a hardline “zero tolerance” approach to drugs, but the inquest heard of its unintended consequences.

A young woman who attended 2017’s Knockout Circuz, where 18-year-old Nathan Tran died, said she wouldn’t go to another festival due to the “drama” and “anxiety” heavy policing created.

Nathan Tran died of MDMA toxicity after attending the Knockout Circus dance party. Photo: ABC

She sobbed recalling being “humiliated” during two strip searches, after which police came back empty-handed.

The court heard research showed 10 per cent of people who encountered sniffer-dog operations simply swallowed their drugs.

Alex Ross-King was among that group. She told friends she was “nervous” entering FOMO in January and “double-dunked” two MDMA pills, having already ingested one other.

The 19-year-old died in Westmead Hospital that night.

Alex Ross-King died at the FOMO Festival in Sydney. Photo: Facebook

Even coroner Ms Grahame said she found the entry point “intense” and felt “nervous” attending a June music festival.

Researcher Dr Caitlin Hughes cited 2014 data that found sniffer dogs had a “negligible deterrent effect” on festival patrons, adding their perverse effects include patrons opting to buy drugs inside events from unknown sources.

Mr Coffey defended security measures at his event, saying there were hundreds of “eyes on the ground”, including security officers and police, to oversee patron safety.

Intense policing has come into question at music festivals. Photo: AAP

Resources

Summer music festivals are inherently uncomfortable and hot places, but this can exacerbate overdoses and the court heard some of the young people had temperatures soaring past 40 degrees.

The mosh pit at FOMO was “like an oven”, according to one of Ms Ross-King’s friends.

At Lost Paradise, Mr Tam’s friends sought cool showers, but according to one they were “about a thousand degrees”.

“It actually hurt to put your head under the shower,” he said, recalling there was nobody handing out water.

The coroner was told FOMO patrons in the main chillout space were complaining of heat exhaustion and a lack of fans and water.

Mr Coffey said he was aware of the high temperatures and ordered an extra 10,000 litres of water and extra sunscreen in the lead-up to Defqon 1.

Education

The coroner heard drug education presented researchers with a catch-22.

Director of Drug and Alcohol Research and Training Australia Paul Dillon was “baffled” one in 20 year 10 students had already tried MDMA.

He said if education was delivered too early there was a risk of introducing drugs to new users, but if it was too late, no young person would believe the dangers once they’d had positive experiences.

The young people who have given evidence had varying understanding of drugs.

Alex Ross-King’s best friend remembered the “don’t do drugs” message in primary school, but experienced nothing in high school and didn’t think death was a possibility.

Mr Tam’s close mate said his friendship group knew of the dangers, but “did it anyway” and didn’t think anyone would die.

Witnesses have repeatedly pointed to the trusted Drug Information and Monitoring System operation in the Netherlands as a system that can assist with not only harm minimisation through drug testing, but data collection that will inform festival planning and more-targeted education.

Many witnesses called to the inquest believe the Netherlands is one place Australia desperately needs to learn from, with a trusted drug-testing operation and lighter security.

The motivations of these witnesses vary from social to commercial to academic, but the value of their shared goal is indisputable: preventing further loss of life at music festivals.

The inquest has adjourned until another two-week block of evidence in September, with the aim of delivering findings in October before the next summer festival season begins.

-ABC