A seven-month-old baby choked to death on a pistachio nut as paramedics did nothing to try to remove it.
An inquest heard that Gauravdeep Bassi had been crawling on the floor in the living room on March 17 last year when he accidentally picked up the dropped nut and put it in his mouth.
The baby's frantic mother Rajwinder Kaur, 37, immediately called for an ambulance as her son struggled for breath at the family home in West Bromwich, West Midlands.
But when paramedics arrived after three minutes, they didn't attempt to remove the shell, which was lodged in the child's throat, Smethwick Coroner's Court heard.
Gauravdeep died after being transferred to Sandwell General Hospital with the object still obstructing his airways.
An inquest heard the shell from the pistachio nut had been lodged in the baby's throat for more than 21 minutes before he died.
Pathologist Tamas Morton said Gauravdeep's life could have been saved if an emergency tracheotomy had been carried out while en route to the hospital.
Giving evidence on Monday, Mrs Kaur said she had been in the house with her sister and nephew and they were all in the same room together.
She added: "I was cleaning away toys at the time and I do not know when the baby got down on the floor.
"No-one saw him pick up the shell. I heard his breathing and knew something was wrong.
"I did not know it was a nut shell I just knew he had put something in his mouth. I called for an ambulance."
Mrs Kaur said before crews had arrived, she and other members of the family had tried to dislodge the object by patting her son on the back.
On the advice of ambulance service staff on the phone they had also carried out chest compressions until paramedics had arrived.
She added: "When they arrived they checked his breathing and his neck and took him straight away."
The inquest was told crews may 'not have been fully aware of the situation' and the shell had not been removed until arrival at hospital.
But attempts to revive the boy were unsuccessful and he was pronounced dead at Sandwell Hospital.
Mr Morton told the hearing: "All of my observations show there was no underlying medical condition.
"However any findings in cases such as this are not specific so in this case I have to rely on circumstantial evidence. I would give the medical cause of death as accidental airway obstruction."
Senior coroner for the Black Country Mr Robin Balmain adjourned the inquest to hear from a representative from West Midlands Ambulance Service.
Mr Balmain said he wanted to know if crews were trained to give this procedure and to hear more about how paramedics responded in this case.
He added: "I am not going to conclude this case today. I want to hear from the ambulance service."
The inquest will resume at a date still to be set. West Midlands Ambulance Service has declined to comment until the conclusion of the inquest.