|Prosecution Witness: Derek Roat|
|Written by Mike Mayleben|
|Friday, 06 May 2011 18:39|
Direct Exam: Travis Vieux
He is a firefighter and basic EMT for Hamilton Twp. He’s been continuously certified in CPR since he was 14 yrs. old. He enlisted in the military on August 8, 2008 and was enrolled as an E4 specialist rank. During the first trial, he was in basic combat training in Missouri, then moved to Houston where he was in advanced training as a combat medic. He was deployed to Iraq in Operation Iraqi Freedom and is now a combat medic in the National Guard. He's been with Hamilton Township since 2004 and also works for Patient Transport Services.
On Aug. 11, 2008, he was on duty at Station 76 and was the driver of medic 76. He was one of the responders to the Widmer home and it took about 5-6 minutes to get there. It was a drowning call with possible CPR in progress. Police and medic 77 were already there when he arrived. The house was in a subdivision with a dead-end cul-de-sac. He and his partner, Tim Tolliver went inside, straight upstairs to the bedroom. He saw firefighters Teague and Stevens and saw that CPR was being performed. Sarah was lying on the floor with her feet towards the threshold of the bathroom doorway, head towards the bed. He noticed a milky, bloodstained froth between her legs. He recalled seeing Ryan, in the room but then turned his attention to Sarah.
Her body was "completely dry but her hair was damp." Since it was a drowning, "I expected her to be wet." Defibrillator pads won't stick to a wet body, not even a sweaty one. He wasn't there when the pads were applied. He wasn't involved in any treatment of Sarah, but helped to carry her downstairs. She was place on the backboard and three straps, like seat belt buckles, were used to strap her on. There was one at the armpit area, one at the hip level and one at the ankles. There was a cushion to secure her head in position. CPR was continued while she was being moved from upstairs to the medic and she was never dropped or banged into the wall. Roat said he did chest compressions and applied a bag valve mask using the EC method and minimal pressure, which he demonstrated to the jury. He's done about 12-15 intubations in a hospital environment and 7 or 8 in the field.
He had a difficult intubation prior to Sarah's and he detailed hanging upside down to perform a successful intubation on a car-wreck victim. He did an intubation on Sarah while the medic was stationary, but had difficulty. He attempted to intubate her twice but there was a lot of fluid in the airway and he couldn't see the vocal chords.
Vieux put a photo on the screen of a 3-person CPR technique, but Roat said this wasn't the procedure he did on Sarah, but rather him alone doing intubation. Another photo was shown to Roat then put up on the screen and Roat said this was not the intubation (2 person) that he did either.
Roat said he never applied pressure to Sarah's left or right side of her neck, the base of the neck, or the front of her neck from the cricoid cartilege to the clavicle area. The only pressure applied to her neck was when another medic performed the Sellick maneuver.
He said Medic 77 is an advanced life support unit and it's better to wait and try to start an airway instead of trying to transport the patient immediately to the hospital. An attempt to intubate while the medic is stationary is better than trying it while moving. He was in the ambulance when Sarah was transported and he tried one more attempt to intubate while en route but was not successful. He said there weren't many turns on the way to the hospital; "It's a pretty straight route."
He was still doing compressions when they arrived at the hospital. They came straight in the doors and went to trauma room 3. Sarah was moved with the back board from the medic cot to the bed. The charting nurse began writing everything down, what was already done, what was being done then, etc. He stayed and did chest compressions and then helped Jason Stevens with the EMS run report. He said he's aware of the mistakes in the report, but none of them affected Sarah's care. They were interrupted by the coroner's investigator for a version of the report. They weren't finished yet, but he insisted on having a report.
He said there was never a response from Sarah, and he believed she was dead when responders arrived at the house. Nothing further from Vieux, but the Judge has a question. He wants to know more about the straps and pads used to secure Sarah's head to the backboard and Roat said she was strapped on the board the way he described it, but couldn't remember if she had a brace on her neck.
Cross-Exam: Jay Clark
He saw no intubation attempts inside the house but saw someone doing chest compressions when he arrived. There was a Hamilton Twp. police officer in the room, as well as a sheriff's deputy. The highest certified medical person at the scene would have been in charge. In this case, either Jason Stevens or Brian Dapper.
He made two intubation attempts in the medic before leaving the house and another en route. He had done 7 or 8 intubations in the field but this was the first time he attempted to intubate a drowning victim. Stevens was attempting to insert the IV and Teague was doing chest compressions. After leaving for the hospital, no one helped him manage the airway or the position of her head. Once compressions are started they don't stop. Doing compressions or intubation in a moving ambulance isn't ideal, but it's manageable. Even when an intubation is done properly it can cause damage to vocal cords, teeth, mouth, lips and jaw. The thyroid cartilage can be damaged if it's squeezed too hard.
Showing the diagram of the two-handed intubation, Clark asked if pressure is put on the cricoid cartilage; Roat replied it would not because cricoid cartilage is not the landmark you look for in the Sellick maneuver. During the time, he was with Sarah, he never saw anyone use any other method of intubation on Sarah. When asked if other EMTs have been trained in other methods, he replied this is the only method he has seen used.
When he attempted to intubate the first time, there was some fluid in Sarah's throat. He could see the top of the vocal cords as he proceeded but then lost sight of them and pulled the tube out. Clark asked
if he used a new tube each time and he replied no, he used the same one all three times. He's not sure if he's supposed to use a new one with each attempt, but to save time he would use the same one again because it's clean and individually wrapped.
While en route, the medic unit called the hospital to let them know they were coming and what the status of the patient was. It was Stevens' responsibility to contact the hospital and Stevens was also the one who got the IV in Sarah's jugular after he failed to get it inserted in her arm. His best memory is that it only took one attempt to get the IV into Sarah's jugular.
Roat was serving in Iraq while the case was going on. When he returned, prosecutors asked him what he remembered and gave him and the other EMTs transcripts from the previous trials. He and his crew have talked about that night and he talked with the prosecutor twice, about what happened that night.
Clark put up the photo of the bedroom scene showing blood stains on the carpet and asked Roat about his earlier testimony when he noticed blood between the legs, below the vagina. Clark circled a blood stain and asked if people were standing around that area, but Roat couldn't remember.
Arriving at the hospital, Sarah was taken to trauma room 3. He assisted in compressions but doesn't remember how long he did them, but knows he didn't do them the entire time he was there.
After the doctors and nurses took over Sarah's care, he and the other medics created their run report. Clark showed him a copy of the report and Roat said it should be thorough, complete and accurate before they all sign it and his signature was on the report. When asked if he'd sign a report that wasn't complete, Roat replied that it would depend on the situation. "Even though policy required that those who sign must make sure of its accuracy?" asked Clark. Roat said if he was filling out the form, he'd sign as he goes, but if it's someone else, he would sign only after reviewing it.
Clark put the report on the screen and began to go over it's details. He pointed out the portion of the form where level of responsiveness was indicated by the Glasgow coma scale. The numbers refer to eye opening, verbal response and motor response and the numbers range from 3 to 15, 3 being the lowest response. The scores state 0, but Roat said they should be 3; the times and scores are both incorrect and the checked boxes are also wrong, he testifies.
Roat said he was wearing gloves while treating Sarah so her skin and his skin never touched, but Clark pointed out that on the report the temperature for Sarah said hot. Clark also pointed out that there is no notation that Sarah's body was dry. Clark then handed Roat another incomplete run report from that night and Roat said it's before the data was entered into the computer with the times missing.
Clark asked, when someone came in and asked for a run report, in accordance with patient privacy laws, what type of ID did they give? Roat replied he didn't remember but it was someone who worked for the county. He said he's never had someone come in and interrupt EMS workers filling out a run report, like he did that night.
The witness said he didn't recall where Ryan was in the house, what he was wearing or what his demeanor was.
Clark asked if it's easier to cause injuries in a moving vehicle and Roat replied that he positions himself in a certain way so he can move with the ambulance but that movement doesn't affect his ability.
If the patient has a lot of blood and fluids coming out of the mouth, it's suctioned. Clark asked if it ever ended up on the skin or neck area and Roat replied not in his experience.
When he was deployed to Iraq, he didn't get to take his paramedic test, which he took a class for, so he will have to retake the class before he can take the test.
Roat said compressions would have stopped while coming down the stairs. Since he's tall, he had the backboard lifted high above his head. Compressions continue at all points unless it's physically impossible. He transported patients to Bethesda Medical Center at Arrow Springs once or twice a week. Nothing further.
Re-cross: Travis Vieux
Vieux asked the witness how he maintained a patient's head while trying to intubate in the moving ambulance and Roat replied that it depended on the patient, whether he had to maintain the head or not, but he didn't have any trouble with Sarah's head moving.
If he ever needed to keep the head still, he would use his knees at the top of the head to stabilize it. The ambulance has suction equipment to help medics visualize the vocal cords, but he can't recall if suction was used before he attempted to intubate in the ambulance. He could see the vocal cords on his first attempt to intubate Sarah in the ambulance, but then they disappeared because of the fluid and he had to stop. He couldn't see them on his second and third attempt.
Roat said the coroner's investigator doesn't typically ask for the run report, but he never had a patient involved in a homicide investigation. Nothing further.