On November 21, 2016, 10 people in Victoria died from thunderstorm asthma attacks, a rare condition that results from a freak series of coinciding weather events.
The coroner's findings from an inquest this year have been released, detailing the events that led to the deaths.
Epidemic thunderstorm asthma is triggered by a combination of uncommonly high amounts of ryegrass pollen (an introduced grass species), strong winds, high humidity and high temperatures. Thunderstorm asthma events are extremely rare globally but Melbourne is particularly vulnerable because of the vast grasslands that surround the city.
Grass pollen, which contains starch particles, is picked up and carried by the winds, and when the pollen absorbs moisture from humidity or rain, the pieces explode, sending these starch particles deep into the lungs and causing extreme breathing difficulty.
The dangers of thunderstorm asthma are exacerbated when people are outside and breathing in more pollen particles.
A history of asthma increases the risk of suffering from thunderstorm asthma, as does hay fever, but it can also strike in people who have never experienced respiratory issues before.
The coronial inquest into Melbourne's asthma thunderstorm deaths was told that ambulance requests stretched the emergency system to breaking point, with over 2,300 calls for medical help across the city.
1,400 people also presented independently to emergency rooms across western Melbourne.
The people who died in the Melbourne thunderstorm from asthma attacks were:
- Omar-Jamil Moujalled, 18 years-old
- Hope Marsh (also known as Hope Carnevali), 20 years-old
- Min Guo, 29 years-old
- Apollo Papadopoulos, 35 years-old
- Clarence Leo, 37 years-old
- Le Hue Huynh, 46 years-old
- Ling-Ling Ang, 47 years-old
- Thao La, 48 years-old
- Hoi-Sam Lau, 49 years-old
- Priyantha Peiris, 57 years-old
Professor Jo Douglass, an allergy specialist from the University of Melbourne, told the coroner that for those who died, there was an average of 15 minutes from the onset of severe symptoms to when the patients entered cardiac arrest.
Victorian coroner Paresa Antoniadis Spanos said in the hearings that many people suffering from asthma attacks were assured that the ambulances were on the way, when many were not. Hope Marsh's father told Seven News that the family wishes they had driven his daughter to the hospital themselves but instead the 20 year-old had died on the front lawn waiting for the ambulance.
The coronial report released today explores the series of events that led to the death of Moujalled, who had just completed his Year 12 studies and lived with his mother and three sisters. Moujalled was diagnosed with asthma at four years old.
The final report, written by Spanos, states that Ambulance Victoria have already made recommendations relating to public forewarning, preparation of the Emergency Services Telecommunication Authority (ESTA) or 000 phone line, and public hospitals.
For example, the script for 000 phone respondents has now been changed from "the ambulance is on its way" to "help is being arranged" with the intention that this will "better equip callers with information to enable them to make independent decisions" during these surging periods of callers.
However, Spanos notes that the emergency system phone response needs to be more individualised and give callers an accurate estimation of ambulance arrival time.
While Victoria now has an early warning system in place for thunderstorm asthma conditions, the report notes that this is a relatively new and untested system, and that it should be used sparingly so as not to desensitise the public.
Spanos suggests that further research into thunderstorm asthma needs to be undertaken "to improve our understanding of the phenomenon" and "our ability to predict which particular weather event has the potential to produce Thunderstorm Asthma".
The report also notes that there needs to be more community understanding about hay fever, so that people can submit themselves to testing and be aware of their susceptibility to thunderstorm asthma.