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Inquest focus turns to response and policy

NSW Coroner's Court hears detail of ambulance response to Hughes tragedy and changes in policy and procedures implemented by cricket

The fourth day of the Phillip Hughes inquest in Sydney has moved away from analysis of the on-field play leading up to the batsman being fatally struck and onto the medical emergency policies and procedures that were in place.

After three days at Sydney's Downing Centre court precinct where attention centred on the Hughes family's concerns about the NSW Blues' bowling tactics and alleged on-field sledging, the NSW Coroner's Court turned its focus to events off the field.

Read more: Abbott details Hughes incident

Hughes was struck by a bouncer from Blues bowler Sean Abbott on the opening day of a Sheffield Shield match between NSW and South Australia at the Sydney Cricket Ground on November 25, 2014. The 25-year-old died in hospital two days later as a result of a traumatic basal subarachnoid haemorrhage caused by the blow.

Cricket Australia's Sports Science & Sports Medicine manager Alex Kountouris gave detail of a report he prepared that focused on the emergency response on the day, and changes implemented by CA since Hughes's death.

CA now allows State Medical Officers to carry mobile phones in dressing rooms and on the field, where previously this was prevented under anti-corruption regulations, and also a paramedic, in addition to the medical officer and team physiotherapists, is now required to be present at all Shield matches.

Read more: Hughes inquest takes new sledging twist

This is more than what the International Cricket Council recommends, with the game's global body only stipulating a doctor be on call. Kountouris said Australia was the only nation with doctors mandated to be present at first-class matches.

A number of recommendations made in the independent review into the Hughes tragedy have also been implemented. These include the mandatory wearing of a helmet for any batsman facing bowling other than spin, and for close fielders in front of the stumps and wicketkeepers standing up to the stumps.

CA also now has a Concussion and Head Trauma Policy in place, and the use of concussion substitutes is available for the first time in the ongoing Matador BBQs One-Day Cup.

Read more: Cooper testifies at Hughes inquest

The ICC has rejected the use of concussion substitutes in first-class cricket.

It was another traumatic and heart-wrenching day in court for the Hughes family. Parents Greg and Virginia and sister Megan have been present in court for every day of these proceedings, with the late batsman's brother Jason not attending the fourth day of evidence.

The family was moved to tears when NSW Ambulance's Control Division director James Vernon offered his sincere condolences on behalf of the service and attending paramedics from the witness stand.

Vernon was asked to explain why the Triple Zero call was initially assigned a "1C" category. This was later upgraded to a "1A" – the highest possible level – when further information about the batsman's condition became known with a second call to emergency services.

Vernon said NSW Ambulance receives more than 2,500 Triple Zero calls per day and detailed how the procedures they have in place are designed to get information to ambulance dispatchers as quickly as possible.

The court heard NSW Ambulance has since produced information posters specifically for sporting venues, from suburban grounds to international venues, to help those requiring an ambulance provide the information the ambulance service needs as quickly as possible. The information posters are to be circulated to all sporting venues and organisations.

Read more: Warner: Hughes not sledged at all

"It has not been a proactive communication with sporting organisations, but that is something certainly on my mind and will occur," Vernon told the court.

"If we can do whatever we can to ensure sporting bodies, and all organisations, know how to call an ambulance, what information they need to have ... I will do my darndest to ensure that happens."

The NSW Ambulance service information for sporting venues and organisations, which would be useful throughout Australia, can be downloaded here.

The court had already heard that no amount of medical attention, no matter how prompt, would have been able to save Hughes.

"The death of Phillip Hughes ... appears to have been inevitable from the point of impact," Kristina Stern SC, counsel assisting the coroner, said in the opening address on Monday.

The same conclusion was drawn by David Curtain QC, the President of the Australian Bar Association and former Chairman of the Victorian Bar Council, who conducted the independent review into the tragedy that was commissioned by Cricket Australia.

Read more: Bollinger, Haddin on the stand

"I am of the opinion that the attention received by Phillip after being struck had no role whatsoever on his subsequent demise, due to the nature and severity of his injury," Mr Curtain wrote in his review.

"I do not believe any lack of medical attention contributed to Phillip's death."

The inquest will conclude on Friday with final submissions from the army of legal personal involved. The Hughes family, the players, the umpires, Cricket Australia, Cricket NSW, the South Australia Cricket Association, the SCG Trust, the Australian Cricketers Association, helmet manufacturer Masuri, the NSW Police and NSW Ambulance all have legal representation at the bar, with Safe Work NSW lawyers also present.

NSW State Coroner Michael Barnes is expected to publish his findings before the end of the month.