An inquest into the death of 17-year-old James Tsindos, a Cypriot living in Australia, has begun in Melbourne.
James died in May 2021 after eating a burrito bowl he ordered online via the now-defunct food delivery app Deliveroo. He was unaware the dish contained cashews to which he was allergic.
After eating the dish, James’ lips began to swell, his throat began to tingle, and he suffered abdominal pain — telltale signs of anaphylaxis. He called the restaurant and was told the dish he ordered contained cashews.
His father called emergency services, who arrived within 11 minutes. Paramedic Jonathon Hammond administered two doses of epinephrine five minutes apart, which eased James’ symptoms.
“He appeared comfortable (during the ambulance ride) and able to speak in clear sentences about school and interests,” Hammond told the Coroners Court in Melbourne.
As James was wheeled through the Holmesglen Private Hospital doors at 3:44PM, he told the paramedics he felt “wheezy” and proceeded to administer his asthma puffer 15 times.
“It was one of the first things I [told the hospital staff] and that’s why the nurse left to get the puffer spacer,” Hammond said.
At 4:10PM, James was given oxygen and administered epinephrine but began having trouble breathing.
He was transferred to the resuscitation ward and — within a minute — became unresponsive before suffering cardiac arrest.
Medical staff spent the next 40 minutes trying to resuscitate James to no avail. He was eventually transferred to another hospital but never recovered consciousness and was removed from life support on June 1.
The inquest is hearing whether James received appropriate care.
He was admitted to the hospital as a category 3, which signaled an urgent case requiring medical care within 30 minutes.
Renowned intensive care clinician Warwick Butt told the court James’ initial condition warranted an emergency category 2 response requiring medical care to be provided within ten minutes.
He testified:
The moment that he got a wheeze, that was not a new symptom, but it was a progression of the disease signaling the adrenaline [Epinephrine] wearing off.
That was a huge red flag, a sliding doors moment.
Counsel asked him whether an earlier shot of epinephrine at a higher dose at the hospital would have led to a better prospect for survival.
“It’s more likely than not,” Butt responded. “This event was preventable.”
James may have suffered a biphasic reaction, a potentially life-threatening recurrence of symptoms after the initial resolution of anaphylaxis without re-exposure to the trigger.
The infrequent nature of these reactions has made them difficult to study and predict. A study found that, on average, 8.9% of adult reactions were biphasic.
Should anaphylactic symptoms resolve after administration of epinephrine, be vigilant and call emergency services immediately if symptoms reoccur.
