The dying Diana, Princess of Wales was so agitated as doctors attended her in the wreckage of her car that she tore out a drip they had inserted, her inquest heard today.

Shouting incoherently and thrashing her arms, the princess had to be restrained and sedated before it was possible to administer treatment and extract her from the mangled Mercedes, the High Court jury was told.

Dr Jean-Marc Martino, the emergency specialist who responded to the crash in Paris' Pont d'Alma tunnel, recalled Diana “shouting and saying things in English which were comprehensible yet incoherent”.

The inquest, investigating the deaths of Diana and her boyfriend Dodi al-Fayed on August 31 1997, also heard of the unusual nature of the Princess’s injuries, which suggested her heart had been thrust violently forward in her chest by the force of the crash.

There were no recorded cases of patients with such injuries arriving at hospital alive, said Professor Andre Lienhart, who probed all aspects of Diana’s treatment for a French investigating magistrate and related Dr Martino’s account by videolink from Paris.

Dr Martino, of France’s Service d’Aide Medicale d’Urgence (Samu), directed efforts to save the Princess’s life from shortly after the crash to her arrival at the Pitie-Salpetriere Hospital at 2.06am.

Though emergency services arrived shortly after the crash, which took place just before 00.25am in the Pont d’Alma tunnel, it was a further half an hour before Diana could be removed from the wreckage. The court has previously heard that this delay was due to difficulties in keeping the Princess’s condition stable.

Professor Lienhart said an assistant had to forcibly grip the Princess’s arm to insert a drip but she immediately pulled it out.

“That’s true,” he said, in response to questioning. “Due to the agitation, the first line, the first drip was removed.”

“She was agitated, she refused treatment,” he continued. “He decided to inject some drugs to reduce the agitation, for her to accept treatment.”

The court has previously heard that the Princess suffered severe internal bleeding from a ruptured blood vessel attached to her heart – the superior left pulmonary vein – as well as the pericardium, the casing of the heart.

Professor Lienhart said he concluded that the Princess, who was not wearing a seatbelt, might have been sitting sideways when the car ploughed into a pillar in the tunnel.

“There was a very strong and brutal rotational movement,” he told the jury.

Nicholas Hilliard, counsel to the inquest, asked him: “In other words, that on impact the heart had been projected very violently to her right hand side?”

The professor replied: “Yes, that’s true.”

The court also heard from witness Sarah Culpepper, who reported seeing a man talking on a mobile phone while walking out of the tunnel shortly after the crash.

She had assumed that the man, who she described as well-dressed, in his early 40s and Caucasian, was “on the phone to an ambulance,” she told the court.

The hearing is expected to last several months.

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