Direct Exam: Travis Vieux

He is a firefighter/paramedic with the Hamilton Twp. fire department  and has had more than 1,000 hours of training as a paramedic and firefighter.   He has worked with Hamilton Twp since 2001, as well as Miami Twp in Clermont County from 2001-06. He was first certified in CPR in 1994, and has been continuously certified ever since.   He also helps instructors train others in CPR.

He has never been disciplined in the treatment of Sarah Widmer as a patient, but he was reprimanded for breaching confidentiality by "venting" to his mother about the case, and his brother overheard and wrote a blog posting some of the information.   He didn’t know his brother had posted it.

He explained the difference between EMTs and paramedics: EMT-B (basic), EMT-I [more hours of training] and paramedics, which is the highest level. He was at station 77 the night Sarah died and arrived in Medic 77 [ambulance] with Jeff Teague.   He explained that a medic is an advanced life support system.  

He was called for a possible drowning with CPR in progress and it took him about four minutes to get to the home.   When they arrived, he put gloves on and grabbed some equipment.    He said that once he arrived inside the home, he had no contact with Ryan Widmer. When he entered the bedroom he saw a deputy performing CPR on the patient who was lying on the floor naked and he observed that the deputy was doing CPR correctly.   He moved to the head of the patient since he was going to be in charge of the airway.  A photo was placed on the screen and he pointed out the position of Sarah’s body. When asked if he changed her position in any way, he replied, “No”.

He knelt down by the mannequin and demonstrated how he would check for a pulse at the carotid artery and then got out a bag valve mask (BVM) to give Sarah oxygen.   Teague got the heart monitor and defibrillator prepared and was using the bag valve mask on Sarah while he got the laryngoscope and tube ready.   He explained how it’s used to clear the airway and is often used with a suction unit to clear fluids out of the mouth and throat. They placed a defibrillator pad on Sarah in front and he held her head while they rolled her over to put a pad on her back. He noticed fluid, blood and vomit ran out of her mouth when they rolled her over and that her body was dry but her hair was wet. He didn’t remember if the carpet was wet or dry.   He told Teague that he couldn’t see the vocal chords so Teague used the Sellick maneuver trying to reveal them.   He attempted to perform the intubation twice, using a 7.5 size tube but was unsuccessful .   He demonstrated on the mannequin.  

Stevens moved back to the witness stand from the courtroom floor.   He said he did not witness anyone else attempt to intubate Sarah.  At that time, Tim Tolliver, Derek Roat and someone else arrived.   He left Sarah with Tolliver, Teague and Dapper while he went downstairs to retrieve medication from the medic to start an IV.

He was not upstairs when the decision was made to put Sarah on the backboard and move her to the ambulance but rejoined them as they were bringing Sarah down the steps. She was secured on a backboard with straps tied across her chest under her armpits, across her knees and her ankles. She was transported via backboard to a cot with wheels and compressions were continued except when they moved her down the stairway.   Chest compressions were started again at the bottom of the steps and continued in the back of the ambulance.

While the ambulance was sitting in the driveway he tried to access a location for an IV.   He explained how there is a proper method for inserting an IV by applying a tourniquet to the upper arm to raise a vein.   He tried both arms but was not successful. He finally got an IV inserted in the external jugular vein and gave her epinephrine.

He said the oral airway [mouth] was cleared but the advanced airway was not sufficient for breathing. After moving Sarah to the ambulance, while it was stationary, he tried again to intubate Sarah. Derek Roat also made an attempt to intubate her, but none were successful. Stevens said it is better to attempt the airway no matter what. At that time they put the bag valve mask back on her face and Teague and Roat took turns bagging her en route to the hospital.   He did not recall how long the ambulance stayed at the scene but said that 8-10 minutes sounded correct. Max Smith was driving the ambulance.  

Upon arrival at the ER, there were nurses and doctors waiting for them and he gave an oral report to the ER doctor which included a summary of the meds given and attempts to save her.   He also assisted the staff by switching the IV bag and then went to a separate room to begin preparing a report.

Vieux then handed a copy of a run report to Stevens and he acknowledged there were errors in the report, and it was his responsibility to see that they were correct.   An incomplete version of the report was given to an investigator at the hospital, but he didn’t tell the investigator the report wasn't complete. Stevens said that Teague, Roat and Smith helped him prepare the run report.   They discussed what each person did and tried to get the times correct but Hamilton Township does not have a charting nurse in the field so they write notes on their gloves or just try to reconstruct the run from memory and write estimates of the times.

He said no attempt was made to falsify the report and the existence of an incomplete report had no impact on their treatment of Sarah.   He said, he did not inform anyone that the run report was not complete. One copy was completed for the hospital and one copy was in progress. The incomplete version was not the official copy and he said the incomplete report did not affect the treatment of Sarah Widmer.   There was no response from her during the whole time they attempted to revive her so he believed she was already dead when they arrived.

Cross Exam: Jay Clark

Clark asked Stevens if he was disciplined about this case. He told Clark he was venting to his mother about things that happened in the bathroom and bedroom of the Widmer home because he was upset about Sarah dying. His brother overheard and posted information about Sarah on a blog, which is against HIPPA laws and that's what he was disciplined for. Clark asked if the situation was calm in the bedroom or if there was excitement and confusion. Stevens responded, "We stay as calm as we can". Clark then asked if on Oct. 19, 2008 at 2:45 p.m. he met with an investigator about the case but Stevens didn't remember. He did remember meeting with a female about what happened to Sarah. It was an investigator for Ryan's first trial attorney.   She also contacted his mother and brother.

Clark asked if he tried to intubate Sarah once in the bedroom and Stevens said yes, but Clark told him that in another trial he testified that Roat was attempting to intubate her. He also had testified that Roat had maintained her head while she was rolled onto the back board. He now said he didn't recall who was at Sarah's head while she was being transported down the steps, but is "positive" it was not Roat .

Stevens said he went downstairs to set up an IV and get the drug bag because he was getting ready to transport Sarah. He wasn't planning to get the bag and go back in the house. He did go back in but didn't recall whether Derek Roat was attempting to intubate at that point. Stevens also said he wasn't sure of Roat's training at that time but he wouldn't allow a new EMT who was not certified in intubations to perform one.  Roat was certified at that time and he had witnessed him perform one in the field prior to this incident.

Stevens said that no one performed compressions while Sarah was being carried down the steps but they began again at the bottom of the stairs. They were walking side by side compressing on her chest while taking her to the ambulance.

Clark asked if doing compressions while moving, can injure the patient and Stevens said they can possibly sustain rib fractures if the hands are in the wrong place, but he wasn't aware of any other injuries and he didn't know if doing compressions at an angle can injure the patient.

Stevens said he has done five successful intubations on patients prior to Sarah; two in the field and three in the ER. He can do intubations because of the continuous training he receives.

Clark then asked him about the attempts to start an IV in Sarah's arm. Stevens said only one needle stick is attempted in a particular area. He tried both arms without success but was able to get an IV started in her jugular vein while the medic was still parked in the driveway. He explained how he would puncture the skin, turn the needle at an angle and rotate it into the vein. Blood vessels and veins are different sizes, he said. Clark asked what happened if you clip or nick the vein rather than puncture the vein, will that cause it to bleed?  That is not a successful IV, Stevens said.

Clark then put a sheet of paper on the screen and with a red pen drew a circle, simulating the vein, as Stevens described how to insert an IV. Clark drew a line next to the circle "nicking" it, and one line going through one side of the circle showing the needle going into the vein.   Another line was drawn going into one side of the circle and coming out the other to show a vein being punctured.

Stevens agreed that compressions replace the heart beat that does not exist, therefore the blood is still moving through the body and the IV is pumping meds through the blood with the compressions. Clark asked him if CPR is moving the blood into the arteries and as long as the pump keeps pumping, blood keeps moving through that system. Stevens replied " Yes ".

Clark asked Stevens about the intubation procedure and if that could cause damage to the throat? Stevens said the laryngoscope can cause chipped teeth and lip and mouth lacerations, but he wasn't sure if it could injure the inside of the throat, saying that was not discussed during his training.

Clark showed a model of the throat to the witness and asked Stevens about applying pressure to the thyroid cartilage. Stevens demonstrated and said he was trained to hold onto both sides. Clark put his thumb and forefinger on his Adam's apple, asked Stevens if there is muscle tissue or just skin between the thyroid cartilage and his fingers and Stevens said it depends on the person. He then showed a photo of an intubation and someone doing the Sellick Maneuver and asked Stevens if the hand was in the right place, but Stevens said he couldn't tell because of the angle of the photo.

Clark showed Stevens the intubation tube and asked about the suction catheter which is another tool used in intubation.   The suction catheter, which he obtained from his bag, is hard, Stevens said. Clark held it up and whacked it on the podium showing how hard it is. Clark asked him if the laryngoscope could cause lacerations in a patient's throat and Stevens disagreed. Clark asked him if wearing gloves would make his hands sweat and Stevens replied that he's trained to put on gloves as soon as he gets out of the ambulance and hands could get sweaty.

Clark again asked Stevens if he attempted to intubate twice: once in the bedroom and once in the medic and Stevens agreed. He said paramedic Roat attempted two in the driveway in the medic and one more attempt on the way to the hospital.  

Stevens said that as he walked into the bedroom, the person performing CPR had their back to him. He could not see what they were doing until he walked around to the other side of Sarah and saw the person doing compressions. He couldn't recall who was doing what or when. Stevens said there's no difference in doing CPR in the back of a moving ambulance or on the floor of a house. Kneeling on the floor or standing in the ambulance;  both have advantages and disadvantages. It can be difficult in the back of any ambulance if a sharp turn is taken and you lose your balance.  Stevens looked at the prosecutor's table frequently while testifying.

Clark asked if the run report needed to be thorough and truthful and Stevens replied, "Yes". He agreed that according to HIPPA regulations, he must be careful of honesty on the report and he is aware of the procedure for amending reports if mistakes are made.

Clark handed him a paper, with the fire department protocol that was in effect in August 2008, to read to himself. When Stevens was finished reading, Clark asked if it stated that patients have a right to have health information protected and if all reports are to be complete, accurate and thorough. Stevens agreed with the protocols and then the run report was placed on the screen in front of the jury.

Clark asked if someone of authority came to the hospital and asked for the report and he gave it to them. Stevens replied, "That is correct" but agreed it did not have the signatures on it and it wasn't complete. Before it's signed, it must be completed.

Clark handed Stevens a document, and asked him to look it over. Stevens said it may or may not be the incomplete report that he gave the person who asked for it. There were several people asking to look at the report, but didn't remember who because of what was going on at the time. He said they were filling out the report while ER doctors were working on Sarah. He was attempting to share information with the doctors to assist them.

Clark asked Stevens if he recognized his own signature and he replied "yes". Clark then showed him two documents that he agreed had his signature. Stevens said anyone there who is treating the patient can see the patient information. The person he gave his report to, was a "person of authority" that wanted to see the report in question. He looked back at the prosecution table after he made this statement, but didn't name the "person of authority."

Clark showed the witness another report and asked if he recognized it and Stevens answered "yes". Clark put both reports up on the screen side by side and they began to go over the blank spaces. Nothing is marked for many spots but his signature is on the report. Stevens agreed it wasn't complete but it was signed by him. He said reports are not always done in chronological order. But Clark insisted he was supposed to record important information and review the entire report before signing it. Stevens agreed.

Asked about the relevance of the report, Stevens replied that hospital staff get verbal and written reports once they arrive at the ER. This gives the ER doctors an idea of what's going on and what's been done so far for the patient.

Clark asked Stevens to demonstrate how he does an intubation. Stevens stepped down from the stand to demonstrate on the floor. "Tilt the head..." he said as he grasped the neck and forehead, "When you go in, you use this part of your forearm to support your hand."

Stevens said he couldn't recall how long it took him to get to the Widmer home but Clark reminded him that in previous testimony he said three minutes. Clark then asked him about his report where he said that he saw "six legs" not including Sarah's. Stevens replied that he wasn't paying attention to who they belonged to. Deputy Bishop was one, and while he was intubating he noticed four other legs. He saw the deputy when he arrived, but after that more arrived.

Re-Direct: Travis Vieux

Vieux asked about the latex gloves Stevens wore and if they would show moisture. Stevens said that wearing gloves could affect temperature and feeling wetness but he never saw moisture on his gloves when handling Sarah that night.

Vieux then asked if he recalled any rapid turns during the medic's route to the hospital and Stevens replied that there were only two turns but didn't remember any problems.

Asked about the intubation procedure, Stevens said the laryngoscope he used that night was a little different from the one displayed in the court room. His left arm would have been on the left side of Sarah's head trying to keep it steady. He said he didn't apply too much pressure and affixing the bag valve mask was the most pressure that would have been applied to her head.

Stevens also said that the veins of an asystolic patient would be flattened and that's why blood pressure was needed to insert an IV. Stevens said the veins on Sarah's body were flattened out. Nothing further.

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