Direct Exam – Travis Vieux

He’s with the Hamilton Twp Fire/EMT Dept.   He was certified in CPR around 1984 while in high school and has been continuously certified ever since.   Teague has received ongoing training in emergency medical techniques and was a Lt. for Mason at one time. He explained to the jury that an EMT is trained to a certain level... trauma, basic levels and CPR. A Paramedic is trained in the basics but can also start IVs and give drugs. "Medic 77" is his denotation on the report.

He received the call as a drowning when he was about 2 miles away from the Widmer residence.   He observed a police car as he pulled up to the residence and parked the medic behind the patrol car on the street.   They carried the AED and other gear inside. No one was outside to direct him so he opened the door and yelled "fire dept"!   Someone from upstairs yelled so he entered the home and moved upstairs. Teague did not speak with Ryan. Someone was lying on the floor and there was a deputy there, but he couldn't recall the exact layout of the room.

There was someone in the hallway, but he didn't remember who it was. He observed that the patient was a female, lying on her back, near the bed. The deputy was doing something, but he didn't recall what . As he approached Sarah, he moved to her head and prepared to open her airway. He raised her head into position by lifting the back of her neck.

He brought a CPR mannequin and equipment to show the jury how he worked on Sarah that night. He positioned himself in accordance to Sarah's body and showed how he moved her head and jaw to open the airway and leaned down to the mouth to hear if there is breathing. "She was not breathing and she did not have a pulse," he said. He checked her pulse with his two fingers on her neck at the carotid artery. He placed the ventilator over the nose of the mannequin and began squeezing the bag to demonstrate how he treated Sarah. If he had any resistance to ventilating the airway, he would have to readjust the ventilator mask.

Teague then showed his bag and gear that included the AED and explained how the monitor worked prior to showing how it's used on the mannequin.   The monitor “speaks” to the EMTs/paramedics as they are using it. If it's not being used correctly, it will sound an error. He turned it on for the jury, then demonstrated how it's hooked up to the patient.

When he applied the pad for the AED onto Sarah, he checked her skin. "She felt warm and the pad stuck the way it normally would." If the skin is "overly wet" it won't stick. Vieux asked if it's a problem when someone sweats, and Teague said yes. They had no difficulty placing the pads on her and he didn't have to dry her off, and the carpet didn't feel wet. His first attempt to intubate Sarah failed so he assisted in a second attempt with Mr. Stevens. He performed the Sellick Maneuver by pushing on the thyroid cartilage near her Adam’s apple, trying to expose the vocal chords, while Mr. Stevens tried to open the airway.   He said he never squeezed the trachea area and used minimal pressure doing the Sellick Maneuver so as not to obstruct the airway.    He said he never applied force to the right side of her neck. He also did not apply pressure to the upper part of her collar bone or the lower part of her armpit. He applied pressure to the base of her skull while trying to position her head for intubation, but not on the back of her lower neck area.   During the time that he was doing the intubation,   Deputy Bishop maintained chest compressions and he didn't see the deputy applying improper CPR. He would have stopped him if he had.   There were two intubation attempts at the Widmer home, but neither were successful. He helped with one and EMT Jason Stevens did both of them. They decided to move Sarah to the ambulance because it had better lighting and equipment. He observed two unsuccessful attempts to get an IV into Sarah’s arm but they finally were able to get one into her jugular vein.

He couldn't recall if the monitor was brought into the house, but the pads are left on to reconnect once they are in the ER. Vieux then asked him about the reports that he filled out and Teague said the purpose of writing his report was to show what they did and attempted to do. It is done after the run. It's a compilation of notes and everyone involved. The ER Charting nurse's responsibility is to take notes on arrival at the hospital. He said their report is recorded on anything including gloves or a notepad. They wrote the time based on whoever wrote the note. There is no single source for the report and they are not synced on time. The report he was testifying to was placed on the overhead screen. It's called the "Patient Care Record".

Sarah’s response level was charted at a "0" and Teague confirmed that they did do CPR en route. Her skin was documented as "hot", however, his recollection was that she was "warm to the touch, maybe even warm to hot." There was a lot of discussion when filling out the temperature of Sarah’s body, [hot, warm, warm to hot, etc.] but Teague said her body temperature was not normal.  

Vieux pointed out errors on the report and Teague agreed that there were inaccuracies and mistakes on the report.   Teague said that spaces which should be filled in were not.   The lowest score on the report can be a "6" but the report said "0"... it was improperly reported, but Teague admitted to signing it anyway.   Vieux reviewed a supplement to the report and asked Teague about its accuracy. It said Sarah’s hair was wet and she had no obvious trauma.   No further questions.

Cross Exam:   Jay Clark

Clark began by asking Teague about the ABC’s of CPR, which is a training guideline for providing care: Airway, Breathing, Cardio. Without “A” there is no “B” or “C”.   Teague said the guidelines have changed since the last trial.   Clark asked Teague if he could provide good care without an airway and reminded Teague that yesterday he said there was so much resistance forcing air that the bag valve mask kept popping off the ventilator.   Teague agreed that something was probably blocking the airway.  

Clark asked if he’s been taught triage on a patient and Teague replied “yes”.  The most critical patient got first attention and the most care.   He agreed that having no pulse or respiration was critical and the paramedic with the highest level of training was in charge of directing the care. In this case, it was Jason Stevens.

Clark put a copy of the run report and a supplemental report on the screen and began to go over it with Teague.   Teague said he witnessed two attempts by Jason Stevens to intubate Sarah at the house. He [Teague] assisted Stevens in one of those attempts at the house by doing the Sellick Maneuver.   Clark then asked Teague about the written report and it’s supplement, which showed there were five attempts to intubate Sarah.   The first attempt at 22:58, the second at 23:02; both done in the bedroom, but the second wasn’t listed on the report.   The third attempt was done at 23:05 in the bedroom.   Teague admitted there were mistakes on the report about the number of intubation attempts.   The report said they were in the house for 18 minutes, in the driveway for 12 minutes and then it took 7 minutes to reach the hospital. At 23:20 there was another intubation attempt in the ambulance.   The report showed the times entered by hand onto the report and they were aided by the computer dispatch logs.   The report showed that medics left the home at 23:15 and arrived at the hospital at 22:54. Teague said that must be a mistake, but he agreed they must have sat in the driveway for about 12 minutes.

Clark directed Teague’s attention to testimony from the previous trial, pointing out that there was a discrepancy between who he recalled doing intubations then, and who he recalled now.   He forgot an attempt by a Mr. Dapper but Teague said he was doing compressions in the life squad so he might not have seen that. He recalled that he also saw one done by Derek Roat, which he helped with by holding Sarah's head firmly at her neck and forehead. He said he applied pressure at the thyroid cartilage and testified to this when questioned by the prosecution. He admitted there are risks for injuring a patient while doing an intubation in a moving ambulance, because it’s more difficult.   He also said that doing CPR in a moving ambulance can be more difficult because you can lose your balance.   Doing just one wrong compression can cause injury to the patient.

Clark then asked him about his previous testimony when he walked into the bedroom and saw only one other person in the room with Sarah.   He now said that other people were around, but he couldn't remember. He also couldn’t remember if he did compressions in the bedroom.   Clark handed him the page with the previous trial testimony and asked him if he’d like to read it to refresh his memory, which he did.  After he finished reading it to himself, he was asked to read it aloud.   At the second trial he testified that when he arrived at the Widmer home, he saw a sheriff’s deputy doing CPR, two other deputies and two other police officers.

Clark handed Teague a laryngoscope and asked him to describe its use.   He explained that it has a #4 Macintosh blade which is curved and it moves the back of the tongue down when doing an intubation. Clark showed him a tube which Teague said was 8.5 in diameter and was inserted into the trachea to aid breathing.   He admitted that the laryngoscope can injure lips, the inside of the mouth and even break teeth, if not inserted properly. Teague agreed it was an invasive procedure. The tube is made of plastic and it gave a loud cracking sound as Clark hit it repeatedly on the podium to demonstrate. The end has an angled rough edge and it’s very sturdy Teague agreed, as Clark continued to hit it on the podium.

Clark softly clapped his hands together, over and over, to simulate compressions as he asked Teague how he would be positioned when he did chest compressions in a moving ambulance.   Teague said there is a grab rail that EMTs can grab onto if they lose their balance so they don’t fall on a patient. Clark asked him about the placement of hands while CPR is given. Teague said hands should be placed on the sternum for compressions, but people of different heights have different length sternums. They have landmarks that they look for on different sized people.

Clark asked Teague what should be done if you find someone unconscious?   Should the patient be moved?   Teague agreed that non-trained personnel should check for a pulse on the carotid artery, check if the patient is breathing and then call 911. They can give attention to the patient if they know how.

Clark questioned Teague about the IV that was placed in Sarah’s neck and Teague agreed that veins in the arms are closer to the surface than in other areas, but he's not trained in IVs, so he can’t answer the questions.  Clark then asked him if Sarah was throwing up a lot?   Teague said there was some fluid in her throat, but he wasn’t there when she was throwing up.

A photo given to Teague showed a patient with an EMT touching their neck. Clark asked if that’s where he placed his fingers on Sarah’s neck while doing the Sellick Maneuver, but Teague said he couldn’t tell from the photo where the Adam's apple was, and if the patient was having pressure applied to the thyroid cartilage. Clark asked him to explain thyroid cartilage pressure and he said the purpose is to put pressure on the vocal cords, pushing them so they can visualize how to insert the intubation tube. Teague said he asked paramedic Stevens if he could see the vocal cords before beginning the Sellick maneuver as he applied very light pressure

Clark returned to the run report and asked Teague if he knew of any other version of this report. Teague said he didn’t understand the question but there are no other official reports. Clark then showed him another document which Teague didn’t recognize except to say its part of a copied sheet. Clark handed the run report and the new document to Teague and asked him to read both narratives to see if they’re identical. Clark pointed out the area that said CPR was started by ______. The initials CP are there.   As they continued to compare areas that were filled out and not filled out, Teague replied that there were only parts of the narrative on one so they are different.   They were both signed by Jason Stevens but not all signatures were on there. Clark reminded Teague that he testified there was only one run report but now asked Teague how there can be two? Teague replied that the incomplete one was not a run report for this call, but looked at the prosecution table and frowned.

Clark pointed out a blank on the form that said "Time of onset 22:53."  Teague agreed that he can’t be dispatched to a medical situation until the condition occurs and that they arrived at 22:53, so onset must have been earlier and this was another mistake.   Clark continued to point out discrepancies in both reports such as scores on the chart listing the level of response and the times listed.   Teague said the times can’t be correct as listed.   Clark then asked him if he was present with all the people who signed the report when they signed [there were four].   Did they all review the report, and then sign it with all the mistakes while they were all in the same room? Teague replied "Yes" and also agreed that they all reviewed and signed the supplement to the report with the mistakes on it.   Clark pointed out a signature and asked if it indicated the form was checked for quality control, but Teague said all the signature meant was that the form was logged but he wasn't sure if it was checked for quality. Clark pointed out that Teague's initials were on the form along with the initials of four other medics. Teague agreed that all four reviewed the report and signed off, despite “all those mistakes “ on it.

Clark asked him about Hamilton Twp. emergency protocol on the night Sarah died and Teague said the protocol has been changed since then. Clark gave him a copy of the protocol from August 2008 for him to look over.   It said, ‘in the EMS incident reporting protocols and standing orders, all patient care reports shall be checked for completion and accuracy, and thoroughness prior to final submission'. Furthermore, errors can be fixed after the fact and they are given instructions on how to do so. Teague said that amendments can be filed to the report and are to be submitted on a supplemental form. When Clark asked him if the supplemental report was ever submitted, Teague replied, “No”.

Clark asked Teague again where he had his hands on Sarah’s head during an intubation attempt. He had one hand on Sarah's forehead and the other on the back of her neck, trying to keep her immobilized during the intubation attempt.   Clark used his own head to show where Teague’s hands were when pushing the neck up to open Sarah's airway.   Clark pushed his own head back on his forehead and up on his neck as he questioned the EMT about how he attempted to open her airway. Clark then asked, "Her hair was wet, her body was dry" is your testimony?   “Correct”, Teague replied. Clark reminded him that previously, he testified that her body was "not overly wet."   “Correct,” he said, "The pads stuck to her."

Clark then asked Teague about the term "staying and playing" which he used in the last trial. Teague said that would mean providing more care to a patient on the scene, but sharply asked Clark if he's insinuating that's what they were doing? Clark replied, "Well you were sitting in the driveway for 12 minutes." Clark then asked about "load and go," and Teague said it meant loading a patient right away on the scene, and getting to the hospital. Teague said his understanding about "staying and playing" is different now than it was in the second trial.

Clark concluded his cross exam by asking Teague if he was disciplined for the inaccurate run reports, and he replied “no”.

Re-Direct: Travis Vieux asked Teague if he ever used the grab rail and did one-handed compressions and he replied “No”.

Re-Cross: Jay Clark then asked Teague if he knew someone who was disciplined for the inaccurate reports and he replied, “yes, one person”.