Krishna Sura treated Joshua Tam before the 22-year-old died of complications from using MDMA at Central Coast festival Lost Paradise attended by 11,000 people.

Dr Sura hadn't worked in an emergency department for eight years and was "not at all" capable of putting tubes down someone's throat unsupervised or dealing with other elements of a life-threatening MDMA overdose.

He told the NSW Coroner's Court on Monday he raised his limitations with the boss of the festival's medical services provider, Mike Hammond.

"(He told me) that won't be required as there will be intensive care paramedics on site," Dr Sura said.

"I think they were struggling to get doctors ... (as) he requested I work at this festival."

Co-founder and festival promoter Simon Beckingham told the inquest Dr Sura's abilities surprised him and he had an expectation patrons requiring drug-related emergency treatment would receive critical care on-site.

He said planning for the 2019 festival had gone to "a higher level".

Intensive care paramedic Mark Wheatley, who began a shift about 4.15pm - two hours before Mr Tam arrived - said it was immediately clear to him resources were lacking.

He pointed to risk factors including patrons being mostly young adults, the party environment, the event's remote location 20km west of Gosford and temperatures approaching 40C.

But partly due to poor mobile reception and the private contractor not organising an onsite ambulance supervisor, he said he didn't raise the risks with his superiors before Mr Tam presented about 6.15pm.

When he arrived in company of an unknown woman, Mr Tam was combative, had a temperature of 43C and a heart rate of 190, the court was told.

Mr Wheatley, an intensive care paramedicine since 1986, said he took over and sedated the agitated man.

Mr Tam went into cardiac arrest en route to Gosford Hospital where he died about 7.50pm.

One of Mr Tam's friends told the court they lost contact with the man he called "Bobby" before 5pm and spent the next hours trying to locate him.

"I would call Bob's phone as I was only one with reception," the friend who cannot be identified told the inquest.

Eventually, police found and told him to go to the medical tent, where little information was offered on Mr Tam's condition.

"Given how they were acting, I basically thought he was in a stable condition and he was ok," he said.

"Then (police) came and got his bag and that's when everyone starting fretting."

He said drug-checking at festivals was a no-brainer.

"Having experienced it now and how much his death has affected myself and everyone, if we can save one person (with pill testing) then we've done our job," the friend said.

"I think we need to drill into them the actual effect those particular substances do to your bod, what will actually happen."

Australian Associated Press