A CORONER has ruled a Tamworth man that died in hospital after he was bitten by a snake received adequate care, despite antivenom not being administered until after he lost consciousness.
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Coroner Julie Soars delivered her findings on Friday afternoon in Tamworth Coroner's Court into the 2018 death of Brent Justin Crough, handing down a 40-page judgement.
The 24-year-old was bitten on the finger by an Eastern brown snake in his backyard in West Tamworth on the night of January 10, 2018. He died about two hours later at Tamworth hospital.
Ms Soars found Brent died of a complication of the brown snake bite and ruled it was caused by "misadventure due to picking up an Eastern brown snake whilst separating the snake from his dog". The dog was also bitten, but did not die, the court heard.
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Two family members were in court for the findings where Ms Soars offered her "sincere and respectful condolences to Brent's family".
"It's been a long process, and it's now finished," she told them.
The inquest heard evidence over four days in November last year after it was delayed because of the pandemic.
During the inquest, 14 witnesses gave evidence, and an extensive brief of evidence was tendered that included witness statements, medical documents and expert reports.
The inquest heard Brent was in good health and had no known medical conditions, and he was at home with a family member when he was bitten. The family member drove him to hospital, and took the snake in a large jar with them to hospital, where they arrived at 9.52pm.
Ms Soars said the antivenom was "not administered immediately [when] Brent presented, rather Brent was observed by the treating doctor and nurses in accordance with NSW Health Department Guidelines which cover snakebite".
Ms Soars said the doctor and nurses "had formed the view that Brent was not showing any clinical signs of envenomation at that time and blood was taken for urgent blood tests".
"At about 10.17pm Brent collapsed, was revived briefly and then suffered a cardiac arrest and became unconscious," Ms Soars said.
Shortly after his collapse, antivenom was administered and CPR was applied over an extended period of time, but tragically Brent was unable to be revived despite strenuous efforts.
- Coroner Julie Soars
"Shortly after his collapse, antivenom was administered and CPR was applied over an extended period of time, but tragically Brent was unable to be revived despite strenuous efforts".
No pressure immobilising bandage was applied to Brent's finger or arm at anytime prior to his collapse, the inquest revealed.
The family requested an inquest into his death after one of them, in their evidence, said following the confirmation of death at 11.17pm, "a hospital staff member said to her 'Brent did not present as a snake bite victim'".
The family wanted to explore whether the "care and treatment he received" was appropriate, and whether antivenom could have or should have been administered earlier, and if it would have made a difference.
The inquest examined the care and treatment he received; whether all preventative measures were put in place to give Brent the best possible opportunity to survive; whether the current NSW Health Clinical Management Guidelines are appropriate for a patient with a snake bite; and are there any public health and safety issues that need recommendations to address shortcomings.
Ms Soars said Eastern brown snakes were commonly sighted in Tamworth.
The inquest revealed detailed clinical notes of observations and timings of Brent's condition as it deteriorated in hospital. CPR was started at 10.23pm and the first push of antivenom was also administered at the same time. He died at 11.17pm.
An expert stated Brent's case "was exceedingly rare" and several snake experts had "never seen a case before of a cardiac arrest in hospital from envenomation".
"In Brent's case, there was no precursor before his collapse to suggest he was envenomed," Ms Soars said.
"None of the experts criticised the decision made by [the treating doctor] not to administer the antivenom before 10.23pm on January 10."
She found that there was a "gap or lacuna in the guidelines" used by medical practitioners.
It was said by the experts that Brent's case was unusual, arguably rare, exceptional, particularly for there to be a collapse, cardiac arrest and death in a hospital setting.
- Coroner Julie Soars
"It was said by the experts that Brent's case was unusual, arguably rare, exceptional, particularly for there to be a collapse, cardiac arrest and death in a hospital setting," she said in her findings.
She found the guidelines were followed, and the first hour was crucial, but they had been unable to determine when he had been bitten.
The inquest heard the guidelines were up for a review but had been delayed because of the pandemic, and the inquest.
As part of a series of recommendations, Ms Soars recommended the NSW Ministry of Health consider carrying out an urgent review of the 'Snakebite and Spiderbite Clinical Management Guidelines' and consider establishing an expert review panel.
She said "this case has demonstrated that, without any precursor, a sudden collapse from a brown snake bite can result in death within a hospital setting".
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