A senior doctor who tried in vain to save teenager Alex Ross-King's life at a Sydney festival had been there to observe, not care for patrons, an inquest has been told.
Westmead Hospital emergency medicine specialist Kavita Varshney on Thursday said she realised she was the most senior clinician at January's FOMO Festival soon after arriving at the medical tent.
She told the NSW Coroners Court the only doctor employed by medical contractor EMS Event Medical was a recent university graduate.
Dr Varshney attended FOMO at the request of NSW Health to observe medical procedures after four NSW festival patrons within five months died after taking MDMA.
"I was asked by the emergency care provider that should he (the doctor) have any questions, queries and concerns, could he come to me," she said.
"Of course, I said yes."
About 4.30pm, Ms Ross-King arrived at the medical tent agitated and with a very high heart rate and extreme hyperthermia - all signs of MDMA toxicity.
She'd taken a cocktail of MDMA caps, alcohol and energy drinks on the day of the festival, headlined by Nicki Minaj.
Dr Varshney said she led the care for the 19-year-old, who was sedated, cooled and put in an ambulance within 20 minutes.
But performing a rapid sequence intubation - used to ensure a clear airway for a patient at high risk of choking - wasn't possible due to a lack of equipment, the drug rocuronium and a second emergency specialist doctor, she said.
Dr Varshney was initially surprised the medical contractor didn't have the equipment or drugs on site, she told the inquest.
"But once I saw the qualification of the staff, I wasn't surprised because it wasn't safe to have those staff (doing that procedure)."
Experienced emergency specialist Anna Holdgate, who reviewed the six MDMA related deaths subject of the inquest, said there was nothing that could have been done to prevent Ms Ross-King's death once she arrived at the medical tent.
Under questioning from EMSEM boss Mike Hammond's lawyer, Dr Varshney said she deferred to Associate Professor Holdgate's opinion.
Deputy state coroner Harriet Grahame is examining the deaths of six young people who died from MDMA toxicity or complications of MDMA use after attending NSW music festivals between December 2017 and January 2019.
The inquest on Thursday heard from a Queensland forensic psychiatrist who wants governments to make anti-drug advertisements resembling the Grim Reaper bowling ball campaign from the height of the AIDS epidemic.
The 1987 ad helped Australia communicate safety messages about sex and illicit drug use and reduce the spread of HIV, Russ Scott said.
"Australia led the way in reducing AIDS," he told the court.
"We've not seen anything like that recently, warning young people about the harm of pills.
"Many, many people with that information will decide 'I'm not using that drug'."
Social worker Cameron Francis told the inquest pill testing venues offered a chance to talk to young drug users who had forgotten or ignored messages delivered by schools or government.
"They valued what they'd heard off their friends, which was at most times not correct," he said.
© AAP 2019