Diana, Princess of Wales, might have survived the car crash in which she died had French medical staff not squandered vital time, her inquest was told yesterday.

Thomas Treasure, a leading British surgeon, told the inquest that a “window of opportunity” may have existed to get her to hospital half an hour before she was taken there. Professor Treasure, a former president of the European Association for Cardiothoracic Surgery, said that medics had done “very substantial good” in the initial period after the accident but that once the Princess was in the ambulance time began “slipping away”.

The professor, who was asked to review records of the treatment given to the Princess for Lord Justice Scott Baker, the coroner, conceded that the combination of her internal injuries was extremely rare and serious but said it was theoretically possible that she might have been saved.

The inquest heard of a sharp divide between the French approach to multiple-injury patients — which favours treatment by doctors at the scene — and the “scoop and run” approach taken in Britain. The jury has been told that the Princess was freed from her Mercedes within 35 minutes of the crash on August 31, 1997. She suffered an apparent cardiac arrest and had to be given heart massage and stabilised on the road before being put inside the ambulance, where she was intubated and ventilated and given a fuller examination.

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At one stage the Princess shouted out, pulled out her drip and was so distressed that she had to be restrained, the inquest was told. It was not until 1.40am that she was judged sufficiently stable to be taken to hospital.

Dr Jean-Marc Martino, the emergency resuscitation specialist, then told the ambulance driver to go slowly so as not to destabilise the Princess further. At one point the vehicle had to stop for about five minutes near the hospital entrance when her blood pressure dropped to perilously low levels and she needed stabilisation.

A series of senior doctors have told the inquest that if she had not had such intense treatment on the way she would have been dead on arrival.

The jury has been told how she suffered massive internal bleeding because of a rupture to one of her pulmonary veins — attached to her heart — as well as the casing of the heart itself. Once in hospital just after 2am, an X-ray showed massive internal bleeding on the right side of her chest.

A surgeon opened up her thorax to search for the source of the bleeding but could not immediately find the ruptured vessel.

Professor Alain Pavie, one of the top cardio-thoracic surgeons in France, who had been called in from home, then took over, extending the cut to find that the rupture was on the left rather than the right where the bleeding was. He sewed it up but, despite prolonged resuscitation attempts with oxygen, heart massage, electric shocks and massive doses of adrenalin, doctors finally gave up the battle at 4am.

Professor André Lienhart, who reviewed the case for a French investigating magistrate, told the inquest yesterday that there were no recorded cases in medical literature of patients with the same combination of ruptures arriving at hospital alive.

Professor Treasure said: “They had done some very substantial good relatively quickly — stabilising the neck, getting her out of the car — with just a brief episode when they lost the pulse, they got things going again and produced a normal blood pressure.”

But, describing the further treatment at the scene and the subsequent journey to hospital, he said: “That’s where the time was slipping away.”

He went on: “That’s my analysis, they had done a lot of good in that first half hour but from there, the next big amount of good that could be done required a surgeon.”

Nicholas Hilliard, counsel to the inquest, asked: “Is it your view that part of that time, the essential period, was squandered?” Professor Treasure replied: “It’s a hard word, isn’t it, but I think opportunities were lost.”

He went on: “At the point at which she was in the ambulance and that initial assessment had been done pretty accurately and the neck was stabilised and the circulation . . . I’m not quite sure what happened after that, that they didn’t have her in hospital and Professor Pavie alerted rather sooner.”

He added: “When I pick through this with the benefit of hindsight [and ask] ‘was this recoverable?’ the answer is, ‘Yes, it just about was’.”

He also questioned the large doses of adrenalin given to the Princess at the hospital. “They ran out of syringes of adrenalin. It’s quite extraordinary,” he said. “They didn’t lose for the lack of trying but it was not necessarily productive trying.”

Professor Treasure, who is this week due to publish a study on how best to treat multiple-injury patients, also questioned the decision to stop so near to the hospital to stabilise the Princess when her blood pressure dropped.

The inquest continues.

What went wrong

Professor Treasure suggested that:

— A ventilation tube might not have been needed en route

— He questioned the decision to stop so close to the hospital rather than speed up; the Princess might have survived if the journey to hospital had been short

— A specialist team should have been on standby in advance

— Her chances would have been helped if a surgeon had opened up her chest from the front rather than the side

— The amount of adrenalin that she was given during surgery may have been counterproductive

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