Rescue attempts to save a mother trapped head-first in coastal defence rocks did not adhere to guidelines, an inquest has been told.
Saffron Cole-Nottage, 32, died following a fall in Lowestoft, Suffolk, while walking her dog on The Esplanade on 2 February last year. An initial 999 call was placed at 7.52pm and a paramedic reached the location at 8.10pm. At 8.13pm, police were notified by the ambulance service that it was thought to be a body recovery operation. Her medical cause of death was subsequently recorded as drowning.
Professor Richard Lyon, a consultant in emergency medicine, informed an inquest in Ipswich on Tuesday that a timer should begin on 30 minutes of rescue attempts once a responder arrives on site and confirms an individual is submerged. Prof Lyon, who holds positions with NHS Scotland and the University of Surrey, said: "I do not think the guidance was followed in this case."
He said: "The guidance is quite clear that the clock starts when the responder arrives on scene ... and submersion is confirmed." He questioned "how sure the responders could be that Saffron was actually confirmed submerged when that decision [at 8.13pm] seemed to have been made from above the railings when she [Ms Cole-Nottage] was down in a difficult situation". Prof Lyon said it was "important to have an absolute time that everyone is working to and that time is sure and that's definite". "That's why the guidance is very clear that the time should be from the arrival of the first rescuer - there's no ambiguity about that time," he said. "The whole purpose of the guideline is to maximise the chance of a lifesaving rescue."
He warned that timing information provided by a bystander could be "inaccurate" and should not be relied upon, noting: "This is a stressful situation for a bystander." He also raised the possibility of an "air pocket" being present. "The initial focus is always on rescue, it's always to maximise the chance of a successful outcome," he said.
Prof Lyon explained that how long a person could survive while submerged depended on a range of factors, including age, physiology and environmental conditions. He stated that a submerged individual would initially attempt to hold their breath, which might last "a minute or two". He went on to say the person would then involuntarily inhale, causing water to flood the mouth and upper airway, before eventually ceasing to breathe and suffering cardiac arrest.
Prof Lyon estimated Ms Cole-Nottage's window for "probable survival" was around five minutes after submersion began. He added that being upside down would have made breathing "harder" for Ms Cole-Nottage. The inquest had previously been told that a level of 271 milligrammes of alcohol per 100ml of blood was recorded for Ms Cole-Nottage. This is considerably higher than the legal driving limit in England, which stands at 80 milligrammes of alcohol per 100 millilitres of blood.
Prof Lyon said the effect of the alcohol was "most relevant in terms of it would make her more likely to stumble, more likely to trip". He explained that Ms Cole-Nottage's "protective reflex would have been diminished", suggesting she may not have extended an arm to break her fall. "When she was between the rocks her ability to move ... and try to push herself out would have been impaired as well," he said.
Prof Lyon said: "For Saffron to have had a probable survival, she would have needed to be rescued within five minutes of submersion and, if required, for CPR to start within that time." He further noted that "survival was possible up until about the 15-minute mark", though she may have sustained a brain injury. "In my opinion, beyond 25 minutes, survival would not have been possible," he said. "I should stress, all of these numbers are a best possible expert opinion," he added. The inquest continues.
