Twenty young women crammed onto a hire bus with pre-mixed vodka and juice in plastic bottles and pockets full of capsules, for what was likely a boisterous 90-minute journey.

That balmy summer's day, January 12 this year, was one Alexandra Ross-King, 19, and her mates had been looking forward to for months.

The night before, several of them bunked together at a sleepover in Gosford on the New South Wales central coast, preparing for the FOMO Music Festival in Sydney's west by buying MDMA from a local dealer.

Less than nine hours after walking into a music festival, Alex Ross-King died in a nearby hospital. Photo / Facebook
Less than nine hours after walking into a music festival, Alex Ross-King died in a nearby hospital. Photo / Facebook

When they woke, some of the girls scoffed down breakfast but Alex, as she was known to her loved ones, decided to skip the meal.

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"One of the young women on the bus told police that since drinks were so expensive in the festival, the group was 'pre-loading' in the bus and many of them, including Alex, appeared to be intoxicated by the time they arrived," state deputy coroner Harriet Grahame said.

On the ride to Parramatta Park, Alex took roughly one-quarter of a capsule of MDMA, and another half about 30 minutes later, washed down with the alcohol she'd prepared earlier.

"About 12.30pm, the bus arrived at the venue (and) Alex was seen to consume a further two capsules, before entering the FOMO music festival," Grahame said.

"She told her friends that because she was nervous about being caught by police, she took the two capsules at once before entering the venue."

That snap decision, based on a fear of being caught by an army of police with sniffer dogs – well publicised in the media after five drug deaths at festivals in the previous 13 months – would prove fatal.

Less than nine hours later, doctors at the nearby Westmead Hospital pronounced Alex dead after multiple attempts to save her.

The circumstances of the tragic loss of a young woman described as a "beautiful soul" by her devastated family and friends is one of six that was examined at an inquest, the findings of which were handed down today.

Among the numerous recommendations was for a rethink of heavy-handed policing at music festivals, including the use of sniffer dogs, which Grahame found contributed to risk-taking behaviour and provided little-to-no benefit.

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"There is clear evidence that Alex took all of the illicit drugs she had with her before she entered the festival in order to avoid detection by police on entry," she said. "Her contemporaneous text messages and the testimony of friends confirm this."

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

The day Alex and her friends had been excited about quickly took a terrible turn, the inquest heard.

About 3pm, she seemed to be in good spirits, having spent a few hours dancing happily while consuming three or four vodka and Red Bull drinks.

At 3.38pm, she sent the first of a series of troubling text messages to her friends, saying that she was sitting beneath a tree and asking them to come and find her.

Twenty minutes later, one of the young women spotted Alex near the main stage.

"She was frantic, but relieved to find her friends," Grahame said.

"She was able to walk but her breathing was irregular and she told her friends repeatedly she was 'hot' and 'really f***ed up'.

"Alex wanted to return to the tree. When they were almost there, Alex stopped following her friend and started to walk very slowly. She said 'my legs aren't working' (and) appeared agitated and had her arms clenched to her chest."

A roving medical officer spotted Alex and was concerned. She approached the group but Alex wandered away, bumping into a group of other festival-goers and falling to the grass.

"The lady in the medical uniform insisted on taking Alex to the medical tent, effectively dragging Alex there with the help of one of her friends."

It was about 4.20pm when Alex got to the tent and by then she was "critically unwell", Grahame said.

A paramedic assessed her and noted that Alex had "spontaneous and uncontrollable large muscle movements, signs consistent with serotonin toxicity".

Her temperature was at 41C so the paramedic applied icepacks. Alex was combative and even abusive – characteristics her friends said were highly unusual.

Her breathing was rapid and irregular. Her pulse was racing. Her jaw was spasming. Her temperature continued to rise despite the ice packs.

Alex was rushed by ambulance to Westmead, losing consciousness on the way, and arrived just after 5pm.

Her temperature was at 42 degrees and her blood pressure was low. Doctors intubated her and she was placed on a ventilator.

"Approximately ten minutes after Alex's arrival at Westmead Hospital, she went into cardiac arrest," Grahame said.

"CPR was commenced and several doses of adrenaline were administered. She continued to have a number of cardiac arrests despite the high doses of adrenaline.

"Around 9.15pm, after around four hours of attempted resuscitation, the decision was made for medical staff to stop mechanical CPR and the time of death was called."

A toxicology report later found an MDMA concentration well in the lethal range.

Alex's friends told the inquest that she had dabbled in recreational drug use a few times that summer, but was hardly prone to taking dangerous amounts.

Like many of her peers, she was naive about the dangers of drug use and had had little exposure to information that might've informed her of the risks.

Alex Ross-King died after taking MDMA just prior to the FOMO Music Festival in January. Photo / Facebook
Alex Ross-King died after taking MDMA just prior to the FOMO Music Festival in January. Photo / Facebook

"Certainly, there is strong evidence that Alex changed her consumption as a result of her fear of detection," Grahame said.

Her death was the final in a spate of fatal drug-related incidents at music festivals that sparked a government crackdown, increased policing and Grahame's inquest.

Her findings identified "practical solutions", including pill testing, improved awareness among young people, the decriminalisation of personal usage and an overhaul of policing.

The report was particularly critical of an approach to drug use by authorities that evidence indicated was flawed and ineffective.

"I find the available evidence establishes that there are inherent dangers and few if any benefits of the use of drug dogs in music festivals," Grahame said.

"In my view there is strong evidence that the operation of drug dog detection programmes may cause significant harm in the music festival environment.

"The presence of police and dogs can be intimidating. More importantly … it can precipitate panic ingestion or dangerous pre-loading which can in turn increase the risk of serious illness or fatality."

The fear of a sniffer dog stopping at her side as she walked in, and the subsequent strip search and interrogation by police that would follow, is likely why Alex decided to down her MDMA capsules in quick succession.

In a statement today, NSW Police Commissioner Mick Fuller rejected that policing played a role in dangerous behaviours at music festivals.

"It is truly tragic for these and many other young lives to have been cut short due to drugs, however any suggestion police were implicit in these deaths will be strongly defended by me," Mr Fuller said.

Before her death, Alex had been working in the family business so she could save money to travel the world.

Her mother Jennie described her as a young woman with a "positive outlook" who was a "strong-willed leader, a good listener and everyone's best friend".