|Defense Witness: Max Smith|
|Written by Mike Mayleben|
|Friday, 06 May 2011 18:28|
Direct Exam: Jay Clark
He has worked for Hamilton Twp Fire/Rescue for about four years. In Aug. 2008 he was an EMT and firefighter, but he's now been a paramedic/firefighter for about a year.
He was at Station 76 when the call came in on Aug. 11, 2008 and he was assigned to drive the fire engine. Lt. Dapper was with him. When they arrived at the home on Crested Owl Court there were a lot of police, sheriff's vehicles and Medic 77 with Jeff Teague and Jason Stevens, was on the scene. When he arrived, he went inside to see if anything was needed. He didn't take any equipment with him because the only information he had was a possible drowning.
He went upstairs, and at the top of the stairs, he saw Ryan sitting in a little seating area. It looked like Ryan was alone and he was very upset and crying. He found Stevens and Teague on the floor working on the patient trying to resuscitate her. Someone was doing chest compressions but he couldn't remember who it was. He couldn't recall who was doing what on Sarah so Clark handed him a statement he had filled out that night and after looking it over, he said he still couldn't recall who was doing what.
A photo of the bedroom was put on the screen and Smith touched the screen showing the door where he entered the room . "She was lying on her back on the floor. Her hair was damp," he said. He didn't recall if the defibrillator was hooked up. He asked what equipment they needed and then went down to the medic to get the backboard and straps. He didn't recall if anyone went with him. He moved the cot to the bottom of the stairs inside the house, and took the backboard and straps upstairs. He helped move Sarah onto the backboard using the log roll method. He was down by her legs and he said he saw a little blood by her vaginal area.
He helped carry her downstairs to the cot so they could get her to the medic. The stairs were difficult to navigate, because of being split - there were a few steps, a landing and a turn, then up more steps. He said the stairwell was also narrow. Clark put two photos on the screen showing the staircase from the top and bottom of the steps and Smith explained how they carried Sarah down. He didn't recall if they used head blocks for stabilization, but said they usually do. CPR was stopped while they were going down the steps, but once they got to the bottom CPR was restarted. He didn't think she was covered with a sheet yet, but she was strapped to the backboard with seat belts to secure her.
She was moved into the medic at that time and he was told to drive the medic. He said it's not unusual to arrive in one vehicle and leave in another. He said when he went into the back of the medic, he remembered seeing someone doing chest compressions on Sarah, but didn't recall if they were doing an intubation attempt. They didn't leave immediately, they continued to work on her.
Ryan was in the passenger seat of the medic; "He was very upset" still sobbing and crying. He spoke to Ryan to make sure he had his seatbelt fastened. He didn't observe any injuries or marks on Ryan. They sat there for a few minutes because he thought some vehicles had to be moved around. "He [Ryan] was very upset and still crying." He asked Ryan if he had a cell phone to call his family, if not he would loan him his phone. Ryan said he had a phone and had made several phone calls but couldn't get a hold of anyone. Smith said it took about 7 or 8 minutes to get to Bethesda Arrow Springs. He said if medics are trying to establish an IV, on a rough road, they may ask him to pull over but he didn't pull over that night.
He said he’s had experience inserting an IV, doing compressions and doing an intubation in the back of a moving medic and it's not very easy. If you move around, it's easy to lose the physical landmarks you need on a patient's body or your hands can slip if you're doing chest compressions. It's easier to do compressions when you're stationary.
He said he wasn't able to successfully intubate a patient on two different runs, due to the moving ambulance. A vehicle in front of the ambulance stopped suddenly and caused him to lose his proper positioning. It's possible to injure soft tissue doing an intubation in a moving ambulance.
He said Ryan was able to contact two people on the way to the hospital; he wasn't sure who the first person was, but thought the second person was Sarah's mom. Ryan was very upset while making phone calls and was still upset when they arrived at the hospital. He asked Ryan if her family or her mom had arrived, once they got to the hospital. His demeanor never changed. "He was upset the entire way."
Smith said getting a medical history of a patient is very important when going to a medical emergency. Sometimes they are unable to get that history, or sometimes it is incorrect because the family member is so upset they're not thinking clearly or remembering correctly.
When they got to the hospital, he pulled the medic up to the door and parked. Ryan asked if he could get out of the medic, which he did, and came around to the back. Ryan didn't help with Sarah but Smith said he wouldn't have allowed him to help because he wouldn't know how to operate their equipment. Smith helped remove Sarah from the back of the medic. They were told there was a room waiting for them. He said they try to maintain CPR at all times, but didn't remember if anyone was doing compressions on Sarah when they were moving her into the hospital trauma room.
He went back to the medic to clean up after Sarah was inside the hospital. He said the suction equipment on board the ambulance is about as effective as the device used at the scene. It's used to suction out the patient's mouth or throat. The medical waste is usually disposed of at the hospital, but Hamilton Township Police asked Smith to save it for police. He couldn't recall if Braley asked him to save it.
He said he was interviewed once about the events of that night, and there was a meeting about "possible information that was leaked out." He said the meeting was with the Warren County Sheriffs and Lt. Braley.
After cleaning up the ambulance, he, Stevens, Roat and Teague met in the EMS room at the hospital to write their run report. "We're all kind of responsible" for what is put in the report, he said. He didn’t know Doyle Burke or Dr. Uptegrove. He didn't recall anyone coming in and asking for a copy of the report and he didn't get any phone calls from Dr. Uptegrove or Doyle Burke asking him about the events of that night. No more questions.
Cross Exam: Travis Vieux
Smith said he didn't perform any medical treatments on Sarah that night such as compressions or intubation. He's been certified in CPR since 1988 and has maintained his certification since then. He didn't recall seeing anyone do any improper treatments on Sarah. Emergency workers are trained to handle stressful situations like this one even if it's a difficult rescue. Everyone knew their job and everyone was doing their job. Asked if it was chaotic, Smith replied, "No, it just looks like chaos to the average person, but there was no confusion."
He was certified as an EMT basic in 1997 or 1998 and at the time of this run, he had 10 yrs experience. Others on the run were fairly experienced as well. He's worked with them on other calls and trusts their experience.
Asked what Sarah's appearance was when he saw her, he said he remembered her hair being wet, but didn't recall anything about her skin and didn't notice if she had pruning on her fingers or toes. They did the log roll to put her on the backboard. The patient's arms are usually placed across the chest and several medics stabilize the body. He held her thighs near the knee and someone stabilized her head and feet. He agreed there would have been no reason to touch her armpit. Once she was on the backboard, she wasn't dropped or bumped as they carried her out to the ambulance.
He said the road they took wasn’t rough and didn’t have any sharp turns, or sudden stops. He said he couldn't give any testimony about what was being done in the back of the medic while on the way to the hospital because he was driving, but Stevens is an experience paramedic along with Teague and Roat, so he had no concerns about their ability to treat Sarah.
He said there is no single person responsible for keeping times on a run. Everyone is responsible for taking their own notes from their own watches which aren't synced with the computer-aided dispatch. They record times to the best of their ability, he said, but they are more concerned with treating the patient and less concerned about the times being correct. No further questions.
Re-Direct: Jay Clark
Clark wanted to clarify the log roll procedure again so asked, if the patient's arms are crossed over the upper body, does that expose the arm? He put his arms up and crossed, pointing to his under arm. Smith replied, yes. Asked what Sarah was wearing, Smith said she was naked. Clark then asked, when she was rolled onto the backboard and had no clothes on, could her skin have been exposed to injury from the belts or someone's hands. Smith replied "yes". Clark pointed out that he told Vieux that her hair was wet, but in his statement he said "It looked like someone, ya' know, got out of the shower." He agreed that was what he said but he didn't recall it. Whether she was wet or dry wasn't his primary concern. Nothing further.
Re-Cross: Travis Vieux
Asked if anyone had their hand on the sternum to do chest compressions, that would be obvious, and Smith said "Yes". When he stated, "It looked like someone got out of the shower, he agreed that he was not referring to her skin, just her hair.