A paramedic told an inquiry how he found a woman “writhing in pain” after the car she was in with her partner crashed off a motorway and lay undiscovered for days.
Lamara Bell, 25, and John Yuill, 28, died after the car they were in left the M9 near Stirling on July 5 2015.
The couple had been on a camping trip with friends to Lochearnhead, Stirling, and were making their way back to Falkirk.
They lay in their Renault Clio for three days before being discovered, after a police control room operator failed to log a 101 call reporting the crash.
A missing persons investigation was launched after the families of Mr Yuill and Miss Bell reported them missing when they failed to return home.
James Stewart, 55, was one of the first paramedics at the scene when the couple were discovered on Wednesday July 8.
Giving evidence at the Fatal Accident Inquiry at Falkirk Sheriff Court, he said Miss Bell seemed “confused and incomprehensible” and had been “writhing in pain”.
Mr Stewart, then a service area manager for the Scottish Ambulance Service, assessed Miss Bell, putting her at a nine on the Glasgow Coma Scale and said she would only move after stimulus had been applied.
The paramedic, who retired from the ambulance service in 2018, also said Miss Bell seemed “hypothermic”.
Advocate depute Gavin Anderson KC asked Mr Stewart how he knew Miss Bell was hypothermic, as he was not able to check her temperature.
Mr Stewart said: “It was touch really. To touch her skin – it was cold. That was one indication.
“It could (also) have been the colour of her skin as well.”
On Friday, the inquiry heard how witness Robert Findlay had climbed down a motorway embankment and called the emergency services upon discovering that Miss Bell and Mr Yuill were trapped inside the car.
The FAI comes after the family of Ms Bell was awarded more than £1 million in damages from Police Scotland in a civil settlement in December 2021.
Three months previously, the force was fined £100,000 at the High Court in Edinburgh after it pleaded guilty to health and safety failings which “materially contributed” to Ms Bell’s death.
Police Scotland Chief Constable Sir Iain Livingstone apologised to the families following the court case.
The inquiry before Sheriff James Williamson continues.