A teenager who died of an MDMA overdose at a Sydney music festival, panicked and swallowed three pills to avoid being caught in a police search, a court has heard.

The NSW Cornoner's Court in Lidcombe this morning heard that Alexandra Ross-King, 19, became unwell after taking three MDMA pills at Sydney's FOMO music festival in January.

Counsel Assisting Peggy Dwyer told the court that she had stayed with friends at a mate's house on the Central Coast the night before the festival where they agreed they would take the drug - before sourcing it from a local supplier.

On the morning of the festival, the friends mixed vodka and juice in bottles and set off on an organised bus journey to Sydney.

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Dwyer said the girls were told drinks were expensive at the festival so they should "pre-load" on the journey down.

The court heard that Alexandra took a quarter and then half a pill on the journey.

But when the bus arrived at the event, Alexandra told her friends she was worried about being caught with the remaining pills and took them in one go.

It wasn't long after that the teenager began to feel unwell. It was a 31C day and one friend said they were all dripping with sweat.

Alexandra's mates said she was sweating heavily and was told to stop drinking vodka.

She was taken to the festival's medical tent where she was "combative" towards staff trying to help her – a trait that Dwyer said was "completely out of character".

Medics took her temperature and found it to be 41C. Her breathing was rapid and she had an irregular pulse.

She was given sedatives, but they were ineffective and she wasn't responding to the cooling ice packs.

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It was then that she was taken to Westmead Hospital and she lost consciousness – with a body temperature of 42C.

Just ten minutes after she arrived, she went into cardiac arrest and didn't have high enough blood pressure to pump to blood to her organs.

After her life-support machine was turned off, an autopsy found her death was caused by MDMA toxicity.

Dwyer said Alexandra's family was not aware of her drug use as she was "responsible beyond her years", with her parents describing her as "mature".

Alexandra Ross-King, 19, was rushed to hospital after attending the FOMO music festival in Parramatta on Saturday, January 12, 2018. She later died. Photo / Facebook
Alexandra Ross-King, 19, was rushed to hospital after attending the FOMO music festival in Parramatta on Saturday, January 12, 2018. She later died. Photo / Facebook

Her family said she was respected by her peers and a hard worker who got a job at a chicken shop at 13.

She then worked in the family butchers, but in her spare time, she was saying out late with her friends, as many teenagers do.

The court heard she was taking MDMA on some weekends with mates, sometimes taking one or two pills at a time.

Alexandra's family were among heartbroken relatives of six young people gathered in court this morning — on the first day of an inquest into a series of suspected drug-related fatalities at NSW music festivals.

Deputy State Coroner Harriet Grahame, who is presiding over the week-long search for answers, started proceedings with a powerful opening statement.

She began by explaining how the inquest would look at the deaths of Diana Nguyen, Joseph Nguyen Binh Pham, Callum Brosnan, Joshua Gerard Tam and Ms Ross-King at NSW festivals between September 2018 and January 2019.

Their deaths are being considered alongside the death of Hoang Tran — known to his family as Nathan — who died after attending Knockout Circuz in December 2017.

Hoang Tran, 18, died after attending the knockout Circuz festival at Homebush in December 2017. Photo / Supplied
Hoang Tran, 18, died after attending the knockout Circuz festival at Homebush in December 2017. Photo / Supplied

"I offer you my sincere condolences," Grahame said, addressing the families in the courtroom. "I understand how difficult these proceedings can be.

"Your grief must be profound and ongoing. They could have been the children of friends of anyone in the courtroom you have my sincere condolences but also my respect."

She said the inquest would look at "genuine ways" of stopping similar tragedies taking place in the future — which could include "drug checking".

The court heard how the young people who died were "beautiful souls" and they were all deeply loved by their families and friends.

Sydney man Joseph Pham, 23, and Victorian woman Diana Nguyen, 21, collapsed at the Defqon. 1 festival in September and later died in hospital.

Joseph Pham, 23, (left), collapsed at the Defqon Festival last September and later died in hospital. Photo / Facebook
Joseph Pham, 23, (left), collapsed at the Defqon Festival last September and later died in hospital. Photo / Facebook

Two other festivalgoers were flown to a hospital in a critical condition, while an additional 13 people attended Nepean Hospital for drug-related issues during and after the festival.

Callum Brosnan, 19, died after attending the Knockout Games of Destiny in December — which is billed as the southern hemisphere's biggest indoor dance music festival.

Callum Brosnan, 19, who died after attending Knockout Games of Destiny dance party in December was described as a 'beautiful soul'. Photo / Supplied
Callum Brosnan, 19, who died after attending Knockout Games of Destiny dance party in December was described as a 'beautiful soul'. Photo / Supplied

The Baulkham Hills teenager was found at a train station near the festival at Sydney Olympic Park and was taken to Concord Hospital, but died in the early hours of the following day.

He was remembered as a "beautiful, thoughtful, honest and intelligent" man in a Facebook tribute posted by his mate Bianca Douglas.

There were several drug-related illnesses at the festival, and more than a dozen people were taken to hospital.

Brisbane rugby player Josh Tam, 22, died from a suspected overdose at the Lost Paradise music festival on December 29, 2018. Photo /Facebook
Brisbane rugby player Josh Tam, 22, died from a suspected overdose at the Lost Paradise music festival on December 29, 2018. Photo /Facebook

Twenty-two-year-old Brisbane rugby player, Joshua Tam, died in hospital on December 29, after attending the Lost Paradise music festival on the NSW Central Coast and taking an "unknown substance".

Alexandra's grandmother Denise Koig told The Daily Telegraph the family have been left shattered by the loss.

Diana Nguyen, 21, died from a suspected overdose at Defqon 1 in Penrith in September 2018. Photo / Facebook
Diana Nguyen, 21, died from a suspected overdose at Defqon 1 in Penrith in September 2018. Photo / Facebook

"She was the most loving child you could ever want," she told the paper. "An absolutely gorgeous child."

Hoang Tran, 18, died after falling over and hitting his head at the Knockout Circuz music festival in Homebush in December 2017.

The inquest is set to run all this week with further hearing dates possible.