THE ambulance team which treated Diana, Princess of Wales, was following standard French practice when it chose to treat her at the scene.
But it was a choice that may well have cost her life, investigations by The Scotsman have discovered.
Contrary to impressions given to the British Embassy in Paris that she had been trapped in the wreckage, it is now clear that the decision to treat her on the spot was made by the emergency services, not dictated by circumstances.
British policy advocates that patients are moved to hospital immediately as long as they are not trapped in wreckage or so ill that movement will kill them, while French accident victims are routinely treated at the scene of a crash.
As French officialdom is maintaining absolute silence on the precise details of her treatment, The Scotsman has established that there was a gap of at least 95 minutes between the first call to the emergency services and Diana's arrival at the La Pitié Salpêtrière hospital.
Diana not only stayed in the tunnel for too long, but was driven to hospital pitifully slowly at 25 miles per hour, while losing blood from a crucial vein. When the vein was eventually repaired at the hospital, it was too late to restore effective circulation.
From the start, official spokesmen in Paris have encouraged journalists to believe that the delay was caused because Diana was trapped in the twisted wreckage of the Mercedes and that she had to be cut free before she could be moved.
But that explanation is false. A police source has now confirmed that Diana was treated at the scene of the crash not because it was impossible to move her but because "that's perfectly normal" in France.
More than a week later, The Scotsman's detailed chronology of the events immediately following the crash suggests disturbing consequences of that policy.
The first doctor to treat Princess Diana in the tunnel under the Pont de l'Alma believed her condition was not desperate and later told a French medical magazine: "I thought her life could be saved."
Dr Fréderic Mailliez said that when he chanced on the accident he was surrounded by photographers and bystanders who told him: "She's had an accident. You mustn't touch her."
Dr Mailliez retorted: "I'm a doctor. I know what to do. If someone doesn't touch her she's in danger of suffocating."
Dr Mailliez was well qualified to treat the injured princess. Associates say he worked as an emergency doctor with SAMU (the French emergency ambulance service) for nearly three years before starting his current job with the medical call-out service SOS Médecins.
Dr Mailliez lifted Diana's head to allow her to breathe properly.
Sources say that the princess did speak a few words to him before lapsing into unconsciousness. She said: "Oh my God" and "Leave me alone".
Malo France, 41, from Paris is another eyewitness who watched the tragic events unfold. He said: "I was driving past the scene of the accident and as I stopped I could hear the victims screaming from the car. They were still in the car at that point but I had no idea it was Princess Diana or even that it was anyone famous."
It was not until 8am on Sunday morning that he realised who was in the wreckage. He was shown photographs of the car but says he was not interviewed by police.
"Even though I could see the photographers taking pictures I was so overwhelmed by everything that I just didn't take it in," said Mr France.
In the midst of the chaos, after supporting Diana's head, Dr Mailliez went straight back to his own car to call the ambulance service and give them a first medical report.
He told them there were two dead and two seriously injured and that he needed two emergency ambulance teams. The control centre told him ambulances were already on their way. Dr Mailliez assumes they were called by another driver who had passed the accident.
Dr Mailliez returned to the crashed Mercedes where he gave Diana oxygen and moved her into a position in which her tongue could not block her airway.
He did not try to get her out of the car, not because that was impossible but because "I don't have the right to do that without first giving the patient an intravenous drip and making sure they're conscious".
By this time Diana was not conscious although she was moaning and moving her hands. Dr Mailliez says Diana became a bit more agitated and slightly more responsive once she was able to breathe better. He said he was not competent to attempt to remove her from the wreck while she was in this condition.
Dr Mailliez followed the correct procedure. Although Diana was not physically trapped she could have been suffering from spinal injuries. All doctors know that moving an accident victim without special equipment creates a serious risk of exacerbating any spinal fractures. That can cause irreversible paralysis.
Emergency ambulance teams carry the equipment required to strap a patient's back so that no damage is caused when they are lifted clear. Doctors explain that the accident paramedics in the SAMU teams are experienced in the use of the necessary stretchers, braces and boards. When SAMU arrived at the accident Dr Mailliez left. He insists he was no longer of any use.
The Scotsman understands that Diana was removed from the wrecked Mercedes soon after the arrival of the fire brigade. The rear passenger compartment in which she was lying was intact.
One of the ambulance crew told the Paris newspaper Le Parisien that when he arrived Diana was lying with most of her body out of the car and her legs resting on the rear seat.
"She was very agitated, semi knocked out but conscious ... she was groaning and struggling feebly. She murmured: 'Oh my God' several times," he said.
According to one doctor, Diana's last words, just before she lost consciousness, were: "Leave me alone." She repeated the phrase several times. Then an oxygen mask was fitted over her face and a catheter was inserted into a vein.
A French witness said Diana was removed from the wrecked Mercedes and placed on the road where she was treated for about 30 minutes by doctors from a SAMU emergency ambulance.
One French report that Diana was given a blood transfusion at the scene was not accurate, The Scotsman understands.
SAMU ambulances do not carry blood transfusion equipment or the stock of matched blood required to use it. Diana received intravenous infusions to maintain her fluid levels. Blood transfusion was not attempted until she reached hospital.
Thierry Meresse said last night: "We cannot give blood transfusions at the scene because the medics don't know the blood type of the patient."
Yet The Scotsman has learned that the first medical personnel to reach the scene of the crash realised very quickly that Diana was bleeding internally. A doctor said: "She was sweating and her blood pressure had dropped. She had the external signs of internal haemorrhage." British medical experts say that if this assessment is accurate it is increasingly difficult to understand why Diana was not taken to hospital immediately.
Even when the ambulance carrying Diana finally began its journey to the hospital it was moving at snail's pace. It is a short journey but doctors on board demanded that the driver should not exceed 40 kilometres per hour (25 miles per hour).
At the hospital the French interior minister, Jean-Pierre Chevenement, and the police chief, Philippe Massoni, were in a state of panic, fearing the ambulance had disappeared.
The motorcycle riders sent to escort it had lost contact when the ambulance stopped to let doctors use emergency resuscitation equipment.
Diana's heart had to be restarted twice before she reached La Pitié Salpêtrière. The ambulance crew used powerful electric shock pads and massive doses of adrenaline as they battled to keep her alive. On the second occasion the ambulance halted mere yards from the hospital.
Diana was losing huge quantities of blood which was draining from her torn left pulmonary vein into her chest cavity. Any possibility of saving her life depended on repairing the torn vein, but that work could not be attempted at the accident scene or in the ambulance. It could only be done by the hospital surgery team led by Professor Riou at the world- class operating theatre only minutes away. In fact Prof Riou and his colleagues did make a repair but it was too late to restore effective circulation.
What is puzzling about the treatment offered to Diana is that she was not hospitalised until her condition had deteriorated to a critical extent. She suffered a series of heart attacks in the tunnel and on the way to hospital, and had a massive cardiac arrest within minutes of arriving at La Pitié Salpêtrière.
The truth is that she was dead on arrival in the operating theatre although the surgical team battled against all the odds to revive her.
No convincing explanation has been offered for the delay. The surgical team at the hospital had a long time in which to prepare for the arrival of their patient. They were in telephone communication with the doctors in the tunnel from the very beginning and were on formal alert from 1am. Diana did not arrive until at least one hour later, although here too there is confusion over the chronology.
Reports on the night of the crash said Diana reached hospital at 2:30am. French authorities now say she arrived at 2am. A hospital spokesman told The Scotsman: "The initial reports were mistaken, like so much that was said that night. She arrived here at exactly 2am."
Asked why Diana's arrival at hospital was delayed for so long he said: "I think it took a long time to get her out of the car. I think she was trapped and had to be cut out by the fire brigade. What do the fire brigade say?" The fire brigade refused to confirm any details.
The emergency teams treating Diana had a range of options. They could have summoned a helicopter to transfer her to hospital immediately. They chose not to. A spokesman for the fire brigade in Paris said: "It is normal practice to treat the patients at the scene. There are three options, either you treat them at the site of the accident, you transfer them to hospital by ambulance, or in certain circumstances when time is of the essence you can dispatch a helicopter. This is only in exceptional circumstances when you cannot afford to lose time."
Asked whether Princess Diana's was an exceptional case, he said he could not comment on individual medical cases or anything which occurred on the night of the accident.
The purpose of treatment at the scene is to stabilise a patient's condition. This is sometimes effective and can save lives. In Diana's case the medical team in the tunnel failed to stabilise her. Indeed, her condition seems to have deteriorated dramatically and rapidly before she was moved. When Dr Mailliez arrived she was semiconscious and obviously in extreme pain. By the time she reached hospital her condition was hopeless.
Asked whether Diana would have survived if she had reached hospital earlier, Dr Mailliez said: "That's very controversial. It's impossible to say. I don't want to be drawn on that. I've already said too much and I don't want to say any more."
The French authorities are extremely sensitive about the suggestion that the princess should have received hospital treatment earlier than she did.
Yesterday, neither the fire brigade nor the ambulance service would comment on suggestions that her move to hospital was delayed for too long. The hospital and the police refused to comment on any of the circumstances following the accident, insisting that these are matters for the judicial investigation.
In fact, that investigation is concerned only with the causes of the
crash. No inquiry is examining the nature of the medical care provided
to the dying princess.