|Prosecution Witness: Lt. Brian Dapper|
|Written by Mike Mayleben|
|Friday, 06 May 2011 18:39|
Direct Exam: Travis Vieux
He was certified as an EMT in 1996 and in June 1998, he started working with Hamilton Twp. as a firefighter/EMT. He was certified as a paramedic in 2005 and has worked full-time in this capacity since October. Before that he worked part-time for Hamilton Township and for the City of Milford for 3 years. He said he's not a lieutenant at the moment because in order to accept a full-time position, he had to take a demotion, but that didn't affect his certifications or quality of care.
On Aug. 11, 2008, he was stationed at Maineville Station 76 when they received a dispatch call for a drowning. Max Smith drove Medic 76 and he was in the passenger seat. They arrived on the scene in about 8 to 10 minutes and parked Medic 76 behind Medic 77, which he noticed had it's doors open. There were also a couple of police cars. They did a quick scan to see what they needed, grabbed a pair of gloves and proceeded inside the Widmer home. Care and treatment of the patient is the responsibility of the first on the scene, which was Jason Stevens from Medic 77.
The front door of the house was open and they headed up the stairs and into the master bedroom. The patient was nude and lying on her back with her feet toward the bathroom door. He saw a sheriff's deputy performing chest compressions, Stevens was at her head and Teague was on the right side with the suction unit.
Stevens was preparing to intubate and he asked if anyone needed anything. The cardiac monitor pads were already applied but he didn't remember how they were placed. He didn't see anything improper about Sarah's position or Stevens' technique but noticed that her body was dry.
A photo of the bedroom was on the screen showing the blood stains. Vieux pointed them out and asked him to describe what he saw. One stain was near her head and was the "frothy" material coming out of her mouth. The other stain was near her vagina and he assumed it was her menstrual cycle. Stevens said he was going to the ambulance for IV equipment so Dapper took over placing the bag valve mask on Sarah's face using just enough pressure to get it to seal. He was kneeling, next to her head and noticed her hair was wet and frothy blood and fluid was coming from her mouth. He didn't see any frothy fluid anywhere else on her body and noted again, that her body was dry. His pants and knees of his pants didn't get wet from kneeling on the carpet next her.
They "log rolled" her onto the back board and that was the only time she was moved. She was then secured to the backboard with three straps, one each at her waist, knees and chest, under her armpits. The straps are made of nylon, same as a seatbelt and are about 2.5 inches wide. He said sometimes foam blocks are placed on each side of the patient's head with velcro, and medical tape placed across the forehead to keep the head steady. Chest compressions were momentarily stopped when they brought her down the staircase but he started them up again at the bottom of the stairs and continued out to the ambulance.
In the ambulance he assisted Derek Roat with an attempted intubation by doing the Sellick manuever. He said this moved the trachea more in line to prevent aspiration of fluids coming up from stomach. He was taught to place his index finger and thumb next to the thyroid notch and apply gentle pressure to the back of the throat. That's how he applied pressure to Sarah's throat that night. He said he felt pressure on the top part of his thumb and told Roat he didn't think he got the tube in the right place. He never applied force to her forehead. The intubation attempt failed but they continued chest compressions as Stevens attempted to insert an IV line into Sarah's neck .
He thought they were on the scene in the medic for 10 to 12 minutes before leaving for the hospital. Since the ambulance is an advanced life-support unit, he believed it was better to stay at the scene first to try to establish an airway than to try that en route on the way to the hospital, when the medic is moving. They can also administer IV drugs.
Other than the Sellick maneuver on the thyroid cartilage, he did not apply any other pressure to the left or right side of her neck, the nape of her neck or the front of her forehead. He remembered two intubation attempts while the medic was in the driveway, but neither was successful. He and Stevens then made a joint decision to take Sarah to the hospital but he didn't go to the hospital with them. He took medic 76 back to the station. He didn't participate in filling out the paperwork but he did review the report. He said none of the mistakes on the report affected the patient's care.
Vieux asked if he has ever had to move a deceased person (yes) or a wet deceased person, (no). He explained there are a number of difficulties in moving a non-responsive patient onto a back board. Arms and legs tend to move around so they are usually secured first. It takes more than one person to move a patient; that's why at least two people are sent on medical emergency calls. He didn't see Sarah respond to any treatment and believed she was dead before they arrived. No further questions.
Cross Exam: Jay Clark
Jay Clark began by asking Dapper about his memory regarding the night he responded to the Widmer house. He remembered to the best of his ability but agreed memory gets worse as time passes, and that's why first responders create reports. They are supposed to be accurate and complete to the best of their knowledge.
When asked, he said he didn't remember the time of day it was. Clark then asked if he remembered stating during an interview shortly after Sarah's death, that he thought it was around 8:30 p.m. He said if it was in the interview report, that's what he said.
He recalled coming up the steps, and seeing Sgt. Elliott with a man in the sitting area. It was the defendant, he said, and Sgt. Elliott was "comforting" him. Clark asked if he was visibly upset and Dapper replied that he heard him crying. He then went to the bedroom and, stood in the doorway, to observe what was going on.
A photo of the bedroom was on the screen and Clark drew a stick figure on the scene where Sarah was lying on the floor. He asked Dapper to point out where Teague and Stevens were near Sarah's body. He indicated Stevens at Sarah's head and Teague on her right. Compressions were being done on her left side but the person's back was to him and he didn't remember who it was.
Clark reminded him that during trial no. 2 in May 2010, he said he took over chest compressions for the deputy sheriff. In an interview with investigators in Oct. 2008, he also said he took over chest compressions. But today he said he didn't do chest compressions in the bedroom, he attached the bag valve mask. Dapper agreed that he reviewed his prior testimony from both trials and changed his testimony.
Clark asked where the pads were when he saw them and he explained pad placement was right upper (below the clavicle) and left lower (on her side), not on her back. That was the proper placement, but the back is also correct placement. He didn't see a pad placed on her back. Clark reminded him that in a previous trial he said right upper and right lower.
Dapper said that Teague had his fingers at the back of Sarah's neck to hyper-extend it during the intubation attempt. This is continuous to keep the patient's airway open. He didn't recall Stevens attempting to intubate. When reminded that he just testified on direct exam that Stevens prepared to intubate, he said that inserting the laryngoscope into a patient's mouth to look around is classified as an attempt but he didn't see Stevens attempt to insert the trach tube. He couldn't recall if Stevens said he couldn't visualize Sarah's vocal cords.
In a previous trial, Dapper testified that he grabbed sarah's right shoulder and elbow to help roll her onto the backboard but in this trial he stated that he steadied her head.
Clark asked if the airway is the no. 1 priority in emergency care and Dapper replied "yes". Any situation that is more critical than a person with no airway, no heartbeat, and no respiration? Dapper replied, "no".
Asked if he remembered what he said in the Medic, he said they needed to get Sarah to the hospital when she was in the back of the medic. Clark asked him to explain "load and go" to the jury. He said in the past, when they didn't have equipment and advanced life-support facilities in Medics, it meant hurry up and get the patient to the hospital. The urgency isn't as great now because the ALS allows more time to stabilize the patient. Staying and playing is a basic run such as a broken finger for example. There's no rush to get to a hospital.
Referring to an investigative report in 2008, Clark asked if he remembered saying, "Heck with it, we need to get to the hospital. We need to stop dicking around on scene, let's go." in the back of the medic? He said he didn't remember saying it in the back of the medic or in his October interview with investigators but agreed that the statement meant it was important to get immediate care. He couldn't remember how long medics sat in the driveway with Sarah loaded into ambulance. The dispatch report didn't show the time, but the run report did.
Placing the run report on the screen, Clark asked about the times entered. 23:03 placed in squad. 23:15 en route to the hospital. Clark asked if paperwork is to document what happened on a run and Dapper replied, "To the best of our ability, yes."
Dapper agreed that chest compressions continued as Sarah was taken from the house, except when they took her through the front door and again to get her into the Medic. He testified that he did not go back into the house but Clark called his attention to the investigator's report of 2008 where he said he went back into the house to make sure they didn't leave any equipment behind.
Asked about doing intubations, he agreed that even if done accurately, they can still cause injuries. The risk of injury increases when the vehicle is moving, and when the Sellick maneuver is being done in a moving vehicle. Derek Roat attempted to intubate Sarah in the back of the Medic and he assisted. He said this was his first drowning experience with the "frothy" fluid. He didn't see any sign of trauma on Sarah except for the blood by her vagina and near her head.
Clark asked, where the tube was, when he said to Roat, "I don't think you're in"? Dapper pointed to the model and said the tube must go into either the esophagus or trachea but it was a little to the right. He felt the end of the tube poking under Sarah's skin. Asked if he had to have a lot of pressure on the thyroid cartilage to feel that the tube was moving in the wrong direction, Dapper replied, "Not necessarily sir, no". He agreed that the run report didn't indicate he used the Sellick maneuver during that intubation attempt but he said that was an oversight and the only thing he left out.
Clark asked if doing CPR in the back of a moving vehicle is more difficult? Dapper said it's possible to be thrown off balance and lose your land line, or compress in the wrong place. Asked if the chest could get slippery from vomit or fluids, Dapper replied he never had that happen. Referring to his statement “the body was dry—her hair was wet” Clark asked if he remembered telling investigators her forehead was wet, but Dapper didn't remember.
Asked how supplies are maintained in the medic, Dapper said they do a check but don't replenish the Medic at the hospital. Clark asked what size tube was used to intubate Sarah? "7.5" he said. Any size 7 used? "No sir" replied Dapper. With the supplement report on the screen, Clark zoomed in to where it stated the endotracheal size tubes used were 7.5, and 7.0. Clark asked if the tube is too big, it won't fit? "Yes, that's correct," said Dapper.
Dapper said he's done "multiple" intubations prior to 2008 and Stevens would have also done multiple intubations to become a paramedic. Their training was done in a hospital operating room but he has done several in the field too. No further questions.
Re-Direct: Travis Vieux
Dapper said he didn't assist with placing the defibrillator pads on Sarah. Vieux asked about his statement "dicking around" and did he think that standing there in the Medic was a waste of time? Dapper replied, "No sir", but in the interview with the investigator he felt, "we should go ahead and get going". In the back of the Medic, if you can't get the intubation and IV in, then go ahead and transport. He said he didn't think the time spent trying to intubate or start an IV were "dicking around". Nothing further.