Commonwealth v. Read — Trial ArchiveTim Nuttall - Direct/Cross/Redirect
534 linesMR. LALLY: Yes. The Commonwealth calls Mr. Timothy Nuttall to the stand.
COURT CLERK: Can you raise your right hand? Do you swear to tell the court and jury of the case now in hearing the truth, the whole truth, and nothing but the truth, so help you God?
MR. NUTTALL: Thank you.
COURT CLERK: You can stand or sit, whatever makes you more comfortable, sir. Just bring that microphone down to you.
MR. NUTTALL: Thank you. How's that?
JUDGE CANNONE: Okay. Whenever you're ready, Mr. Lally.
MR. LALLY: Thank you, your Honor. Good morning, sir.
MR. NUTTALL: Morning.
MR. LALLY: Could you please state your name and spell your last name for the jury?
MR. NUTTALL: Timothy Nuttall. Last name is N-U-T-T-A-L-L.
MR. LALLY: And what do you do for work, sir?
MR. NUTTALL: I'm a firefighter paramedic with the town of Canton.
MR. LALLY: And how long have you been a firefighter paramedic with the town?
MR. NUTTALL: I believe five years, coming up on six.
MR. LALLY: And prior to working in that capacity with the town of Canton, what, if any, other employment have you had within sort of the same field, as far as being a paramedic?
MR. NUTTALL: To back up significantly — I got my EMT certification when I was still in high school through CMTI out of [unintelligible]. They're now owned by Brewster Ambulance. From there I was employed by Cataldo Ambulance. I worked primarily in the city of Chelsea, running BLS transfers and eventually 911 shifts in that city, in that area of the world, if you will. From there I decided I liked it. I decided to enroll in paramedic school. I went to the same school I went to for my BLS certification — back to CMTI. I obtained my paramedic right before I turned 21. I stayed in the same area, primarily in Chelsea, and eventually edged my way into Everett a little bit and worked up there for about seven years. During that time I decided to enroll in the fire suppression side of things.
MR. NUTTALL: So I was hired by the town of [unintelligible]. I was put through the Mass Fire Academy out of Stow — class 268 in Stow — and worked for the [unintelligible] Fire Department for about 18 months, and then transferred to Canton Fire Department in November of 2019.
MR. LALLY: Just a couple questions about what you had just spoken about. When you use the term "BLS," what does that mean?
MR. NUTTALL: So in EMS there are two kind of branches. BLS is basic life support, which is EMT basic — a smaller skill set, if you will. Still running 911 emergencies, but that was kind of the stepping stone to see if you could do the job, if you liked the job, and then you can advance onto ALS — advanced life support — which is the paramedic side of things. That's a broader skill set, many more medications, many more interventions that we can perform in the field. Obviously I enjoyed the BLS side, so I advanced to the ALS side.
MR. LALLY: Now, as far as starting with — becoming an EMT, what if any — I mentioned you went to a CMTI school, but what type of education do you require prior to getting any sort of graduating or certification or something like that? What are the classes like?
MR. NUTTALL: So it kind of runs the gamut for emergency medicine. You start mostly with anatomy and physiology, the human body, progresses down to how those illnesses can progress and the natures of illness. Once that's kind of understood, then we advance on to pharmacology and interventions, just basic interventions that you can do, and then the basic interventions are further progressed into more advanced interventions throughout the program. Once you complete your didactic portion, where all that is kind of in the books, you then progress to clinical time in hospital.
MR. NUTTALL: I can't speak to the hours off the top of my head, I can't remember, but many hours in the hospital, and then you progress to your field ride time where you're in the back of an ALS ambulance with a preceptor, performing those skills, being evaluated, and being watched to make sure you're not causing any harm or going down the wrong treatment pathways. From there, once you complete that, you sit your national paramedic written — I'm a nationally certified paramedic, so I had to sit that written, and then finally a practical examination. And once you pass all that, you're certified to be a paramedic.
MR. LALLY: And so with respect to both your training as far as becoming an EMT and then your training as far as becoming a paramedic, there's sort of a written portion and a practical portion as well — is that correct?
MR. NUTTALL: Correct.
MR. LALLY: You use the term in there as far as a preceptor. What exactly does that mean within your —
MR. NUTTALL: So a preceptor is a senior paramedic who's been practicing for — it varies from place to place, but the standard is usually three to five years — who will watch you to make sure that you're not, like I said, drifting down the wrong path in terms of treatment, making sure that your care is adequate and not doing any harm. My preceptors that I was with, they were medics in the city of Brockton, so they had been around for a little while, and they were excellent at what they did, and they taught me quite a bit. I learned quite a bit in my ride time from them.
MR. LALLY: And in your role post getting your certification, in regard to those — have you acted as a preceptor for other, sort of younger, less experienced —
MR. NUTTALL: Yes. So I was a field training officer for Cataldo for a brief stint right before I left the company, and I am currently a field training officer for the town of Canton.
MR. LALLY: And with respect to those certifications, is that sort of like a one-time blessing in perpetuity, or is there a continuing educational recertification process?
MR. NUTTALL: Right now for the town of Canton, that was a — that's a bid position. I submitted an application in writing and I was selected, so I am currently — I am our field training officer for my group, Group Two.
MR. LALLY: Okay, and my apologies, poor question on my part. I was asking sort of more in general. So beyond the sort of preceptor faction of that, just in regard to in general being an EMT and a paramedic — as far as your certifications are concerned, is that something that you have to continue — is there any sort of recertification process and how often is that?
MR. NUTTALL: Oh, I apologize. Okay, yes. So every two years we are required, both by the national component and the state component, to complete a certain amount of hours per year for your recertification. I actually just recently recertified in March. I can't speak to the exact number of hours, but there's a national component, state component, and a local component, and the trainings are quite in-depth.
MR. LALLY: Now, turning your attention to your work with the Canton Fire Department — how many fire stations are there within the town of Canton?
MR. NUTTALL: We have two fire stations.
MR. LALLY: Okay, where are they located?
MR. NUTTALL: Station 1 is at 99 River Street, and Station 2 is 7 Sassamon Street.
MR. LALLY: And when you're working with the Canton Fire Department, is there a typical kind of schedule or shift schedule that you're working on?
MR. NUTTALL: So my work schedule is I work one 24-hour shift on, one 24-hour off, one 24-hour shift on, and then five consecutive 24s off.
MR. LALLY: And as far as a 24-hour shift, what time to what time does that run with the Canton —
MR. NUTTALL: For us, we report at 0800 to 0800 — 8 a.m. to 8 a.m.
MR. LALLY: Yes. And within both of those station houses, how many different sorts of vehicles and apparatus do you have within each of those stations?
MR. NUTTALL: For Station 1, 99 River Street, we have Car 5 staffed with a captain, we have Engine 3 staffed with one lieutenant and two firefighters, and Ambulance 1 which is staffed with two firefighters. We do have a P/B waiver, so we will run paramedic/basic on Ambulance 1; however, that is primarily a double-medic ambulance. And for Station 2, it's a very similar setup — Engine 4 with two firefighters and a lieutenant, and Ambulance 2 with the same setup as Ambulance 1. Both those stations also have ladders that run out of them — Ladder 1 and Ladder 2 respectively — and the crews from Ambulance 1 or Ambulance 2 will cross-staff those ladders as needed.
MR. LALLY: Now with respect — if I could turn your attention to January 28th into January 29th, sort of Friday into a Saturday — do you recall 2022? Do you recall those days? Were you working one of those two days?
MR. NUTTALL: I was scheduled to work the morning of the 29th, I believe.
MR. LALLY: So you're scheduled to work essentially the morning — 8 a.m. of the 29th until 8 a.m. on the 30th. And prior to the 28th sort of going into the 29th, what if anything were you aware of as far as weather that had been forecasted or that was reported to come?
MR. NUTTALL: I was aware that there was a significant storm — supposedly there was a significant storm coming through. I woke up very early that morning just to check. I took a peek outside of my house — I live in the city of Brockton — I noticed that the conditions were — it was snowing a little bit. So I got up early and got ready for work and left earlier than I normally do.
MR. LALLY: And about what time — which station were you assigned to on that?
MR. NUTTALL: I was at Station 1, 99 River Street, and I was on Ambulance 1 for the day.
MR. LALLY: And about what time did you arrive at Station 1?
MR. NUTTALL: Due to the inclement weather, I believe I arrived several hours early. I showed up to the station around 5:45, 5:50 that morning.
MR. LALLY: And around the time that you were driving from your home to Station 1 in Canton, what if anything did you note as far as sort of the driving conditions, visibility, anything else?
MR. NUTTALL: The snow was starting to accumulate. The roads — I drove through several towns, but the roads were starting to be treated, but they weren't pristine. There was obviously a buildup of snow starting on my ride, which was part of the reason I left early, just either to relieve people if they needed to get out before the storm really hit, or just to help them with snow removal.
MR. LALLY: And to that point, when it comes to sort of snow removal at the fire station, what if any sort of duties and responsibilities do you and the other firefighters have in relation to snow removal around the station?
MR. NUTTALL: So we're responsible around the station to keep what we refer to as the apron clear of snow. The apron is where we back our fire trucks in and out of the station. So we remove all that ourselves — we have a plow truck — however, we'll also shovel walkways and stuff for the public if they need to get in. So that was one of the primary — the crew was actually outside removing snow when I pulled in to the station that morning.
MR. LALLY: And it may be pretty self-explanatory, but as far as the apron itself, why is it so necessary that the apron remain clear as far as snow is concerned?
MR. NUTTALL: Just to maintain a path for the emergency apparatus to get in and out in a timely manner.
MR. LALLY: Now, beyond sort of the snow accumulation that you noted on your way to work that day, what if anything else did you note as far as the weather conditions — whether it be temperature, winds, anything to that effect?
MR. NUTTALL: They were approaching blizzard conditions. It was windy, it was still very early in the morning so it was quite dark, and it was windy and snowy. So we were approaching blizzard conditions, like I said.
MR. LALLY: And when you arrived there, did a call come into your station sometime around or shortly after 6 o'clock in the morning on the 29th?
MR. NUTTALL: Yeah, I arrived as I previously stated around 5:50. I had put my gear — my firefighting structural gear — out with Ambulance 1, just in the event that there was an emergency. And as I was doing that, the tones — the emergency tones — went off for a medical.
MR. LALLY: If you recall, what was the report in regard to — what was dispatched in regard to as far as the medical was concerned?
MR. NUTTALL: The overhead dispatch came in as an unresponsive male in a snowbank at 34 Fairview Road, outside — unclear any further information. So when that came on, we had one of the paramedics that morning and one of the firefighters, who was a relatively new firefighter. I made the decision to step onto the ambulance to provide an extra set of hands as one of the more senior paramedics in the station at the time.
MR. LALLY: And correct me if I'm wrong — when you step onto the ambulance, you're essentially still sort of getting your gear on and getting dressed?
MR. NUTTALL: Correct. I was — as the tones were going — often because I came in so early, I was still in civilian clothing. I had a Canton Fire t-shirt on, so I actually donned my turnout gear for that call.
MR. LALLY: And as far as the other individuals on Ambulance 1 that were going to that call as well, who were there?
MR. NUTTALL: So it was Firefighter-Paramedic Anthony Flematti and Firefighter-EMT Matt Kelly.
MR. LALLY: And Mr. Kelly, he was sort of the less experienced one at that time. Is that correct?
MR. NUTTALL: Correct.
MR. LALLY: So you get into the back of the ambulance and start going to the scene. Now as far as other sort of vehicles or apparatus, who if anyone, or what if any other sort of vehicles were dispatched on this call as well?
MR. NUTTALL: The initial dispatch was Canton Engine 3 and Canton Ambulance 1. Through the severity of the call, depending on how it comes in, the shift commander, which is Car 5, he will usually respond to any significant incident, so he also added himself to the call, just as a senior officer with us. So the final dispatch I believe was Car 5, Engine 3, and Ambulance 1.
MR. LALLY: You know who was on Engine 3 and who was in Car 5?
MR. NUTTALL: Car 5 was Captain Roby. Engine 3 was Lieutenant Greg Woodbury, Firefighter Frank Walsh, and Firefighter [unintelligible].
MR. LALLY: As far as Ambulance 1 that you were in, obviously there's somebody driving and there's somebody in the front passenger seat. Correct?
MR. NUTTALL: Correct.
MR. LALLY: So who was driving, who was in the front passenger seat?
MR. NUTTALL: I don't want to speak out of turn. I honestly can't tell you who was driving. I was in the back — I was in the back patient compartment of the ambulance — just because there's only two seats up front, so I hopped in the back.
MR. LALLY: Okay, and so when you're in the back of the ambulance and you're going to the call, what is it that you're doing in sort of preparation for arrival?
MR. NUTTALL: As I previously stated, I came in early, so I was donning my turnout gear. I had my boots and structural firefighting pants on, so I finished putting those on and I put the rest of my gear in the back. And as we were driving to the scene of the incident, I started prepping the gear that we were going to need. Off the initial dispatch of an unresponsive male in the snow, I grabbed our first-in bag, which has miscellaneous medical supplies, some IV supplies, and an intraosseous drill kit, the airway bag, which has just a bottle of oxygen and then quite a bit of airway management supplies, and our cardiac monitor. So I had all of those prepped out and ready to go, so as soon as the ambulance was in park we could step right out, ascertain what we had, and go from there.
MR. NUTTALL: So when the ambulance arrived on scene, I had all three of those bags on my person, and the entire ambulance crew was able to step out and provide patient care.
MR. LALLY: And as far as, if you know, approximately how much time elapsed between the time that you hear sort of the tones go off and you get in the ambulance, to the time that you arrive on scene on Fairview —
MR. NUTTALL: I couldn't give you an accurate estimation of the time. Like I said, I was in the back, I was trying to prep everything and get myself kind of prepped just in terms of appropriate attire, so I couldn't give you a fair estimate.
MR. LALLY: And as far as when you arrive on scene, you step out of the back of the ambulance. Is that correct?
MR. NUTTALL: Yes.
MR. LALLY: And as far as the weather conditions, where you were on Fairview, what if any difference was there between the weather conditions there versus the weather conditions when you were arriving at the station?
MR. NUTTALL: I remember — as I previously stated, I remember it was still very dark, the sun was not up yet. I remember the wind — it was quite windy that morning — the wind had, in my opinion, seemed to have picked up since my drive in, and the snow had increased.
MR. LALLY: And so when you step out of the ambulance, can you describe for the jury sort of where you go, and sort of what is it that you first see when you get out there?
MR. NUTTALL: So I stepped out of the ambulance and came around with all three bags. I could hear commotion, I could hear some screaming off in the distance. I couldn't really tell you where it was coming from because it was still quite dark. Came around the passenger side of the ambulance, walked in front of the ambulance, and there was a small huddle of three individuals and what appeared to be a human form laying in the snow, so we made our way over to that and went from there.
MR. LALLY: And when you come around the passenger side of the ambulance and you observe that and start — are you sort of turning left or right, or how are you heading when you come around?
MR. NUTTALL: I came out of the ambulance on the passenger side and I took a left.
MR. LALLY: And you make your way over to the patient on the ground. Is that correct?
MR. NUTTALL: Correct.
MR. LALLY: And as far as the other people that you observed around the patient, how would you, or what if any description do you have of those?
MR. NUTTALL: There were three individuals. I believe they were all — all three of them were female. My primary focus was the individual in the snow on the ground. I went right to him, kind of bypassed everybody from there and went directly to that individual.
MR. LALLY: Is that sort of typically how you approach a scene — just sort of tunnel vision right for the patient?
MR. NUTTALL: Typically, on a call like that, where somebody's unresponsive on the ground, typically go directly to the patient and ascertain if they are breathing and if they have signs of life, because that is a time-sensitive matter.
MR. LALLY: And as far as the individual — not then, but at some point subsequent — did you learn the identity of the person on the ground?
MR. NUTTALL: I did. It was, uh, Officer O'Keefe, John O'Keefe.
MR. LALLY: And how was Mr. O'Keefe's body positioned in relation to the ground when you first approached?
MR. NUTTALL: So I found him supine, laying in the snow. Immediately went to him and checked him for signs of life. We found none — we found no breathing, no pulse — so we immediately began performing high-quality CPR. I was at the head of the individual, so I immediately grabbed out of our airway bag a bag valve mask and began ventilating the patient, trying to get some oxygen into him, while the others on scene, like I said, began high-quality CPR.
MR. LALLY: And again, maybe pretty well understood — when you use the term "supine," what exactly do you mean?
MR. NUTTALL: He was laying on his back.
MR. LALLY: Laying on his back, his head sort of facing up. Is that correct?
MR. NUTTALL: Correct.
MR. LALLY: And when you are responding to a call of this nature, there's you and there's other individuals on the ambulance as well. Correct?
MR. NUTTALL: Correct.
MR. LALLY: And is there a certain division, as far as treatment and diagnosis and things of that nature, between you and the other people on the ambulance?
MR. NUTTALL: So typically, just to use the scenario of a cardiac arrest, with two paramedics it's generally split into the airway individual — or the airway monitor — and, for lack of a better term, the code monitor. The airway individual will be responsible for ventilation and eventually advanced airway placement. The other part of that equation will monitor cardiac status, cardiac activity, they will deliver medications and a route for those medications, and they will work together to monitor that patient throughout. As I said, I was on the head — I just happened to fall at the head — so I took the ventilation portion of that.
MR. LALLY: And you use the term — as far as a bag valve mask. Is that correct?
MR. NUTTALL: Yes.
MR. LALLY: Can you explain to the jury sort of what that is?
MR. NUTTALL: All that is, is — for lack of a better term, it's basically a glorified balloon with a mask on it. When you squeeze that bag, that forces air into the airway, so you can ventilate an individual who is no longer breathing on their own.
MR. LALLY: And as far as — obviously with your work with the fire department — there are sort of records or reports that are written in regard to treatment of different individuals on any given call. Correct?
MR. NUTTALL: Correct.
MR. LALLY: Is there an acronym that's used within those reports as far as bag valve masks?
MR. NUTTALL: BVM.
MR. LALLY: And turning back to sort of when you initially approach where Mr. O'Keefe is — if you know, about how far away — where is he in relation to — well, let me back up. Okay, so you arrive at this residence, 34 Fairview Road. Correct?
MR. NUTTALL: Okay.
MR. LALLY: So if I'm standing on the street and I'm facing Fairview Road, is Mr. O'Keefe's body to the left, to the right, center, or something else?
MR. NUTTALL: I would say to the left of center.
MR. LALLY: And what if anything did you sort of note or observe in the general area as far as where Mr. O'Keefe was, in terms of when you got to him?
MR. NUTTALL: Yes, so when I first got to him, we checked for signs of life. And I was, as stated, at the head. There was a small pool of blood that seemed to be underneath him. It was hard to ascertain, again, because of the conditions — it was still very dark, it was snowing, and it was quite windy — so we were able to check the area as best we could with our handheld lights. But that was one of the things that I noted: there was just a pool of blood.
MR. LALLY: Now where Mr. O'Keefe's body was in relation to the roadway — if you know, about how far away — where was it in relation to the roadway?
MR. NUTTALL: I estimated it about where the sidewalk met the front lawn of that residence. That would be my best estimation.
MR. LALLY: Do you have any estimate as far as footage or anything like that?
MR. NUTTALL: I would say about six to eight feet, perhaps — approximately six to eight feet from the curb.
MR. LALLY: Correct. So you indicated that — sort of what — what are the first things ...that you're checking as far as when you first arrive at a patient for this kind —
MR. NUTTALL: I'm sorry, can you repeat?
MR. LALLY: That's okay, that's okay. Um, it's my fault. So as far as when you — let me, let me back you up for just one second. You use the term in there as far as a cardiac arrest. Correct?
MR. NUTTALL: Correct.
MR. LALLY: Can you explain to the jury what you understand that term to mean based on your training experience?
MR. NUTTALL: So cardiac arrest is the cessation of a stable cardiac rhythm in terms of life. Typically it's either asystole, uh, pulseless electrical activity, or uh, V-fib or V-tach. Um, typically you ascertain that but there's no pulse — you check any of the pulses, be it a femoral pulse, a carotid pulse, or radial pulse, you will find nothing. Um, and when that is found you go to life saving measures, which is CPR.
MR. LALLY: And uh, just in reference to one other term you used there — as far as asystole — uh, you could explain to the jury what you understand that term to be, based on your training experience?
MR. NUTTALL: Asystole — to put it as clear as I can — is a flatline. Um, there's no electrical activity in the heart.
MR. LALLY: And um, so you're working sort of at the head of Mr. O'Keefe, is that correct?
MR. NUTTALL: Correct.
MR. LALLY: And sort of while he's still on the ground, what is it that you're specifically sort of doing in reference to your treatment?
MR. NUTTALL: Um, so I was — as we talked about earlier — I had a BVM, bag valve mask, and I had Mr. O'Keefe — I was ventilating him, so I had the mask on his face and I was giving him positive pressure breaths with that BVM.
MR. LALLY: And as you're doing that, what if anything else did you observe beyond sort of the blood pooling you've already talked about — as far as any tactile observations you made of Mr. O'Keefe, any visual observations you made of Mr. O'Keefe at that point outside of the ambulance?
MR. NUTTALL: Uh, he was dressed for the weather. Um, he had several layers on. Um, other than that our primary focus was kind of getting him extricated and out of the elements, just because — as stated — conditions were suboptimal, and uh, we wanted to get him into an environment with better lighting and some heat so we could further assess uh if he had any injuries and go from there.
MR. LALLY: And so the other firefighters — paramedics, excuse me — that are on the ambulance with you while you're doing sort of the bag valve mask at his head, what if anything are they doing?
MR. NUTTALL: Um, I believe the other firefighters that were dispatched, um, they were getting extrication equipment. Um, I believe we put this individual on what we refer to as a scoop stretcher, which is basically a long plastic stretcher that we can roll an individual onto and then just pick him up — just for our safety and the safety of the patient. It's just really just a long board that we can pick up and then put onto our ambulance stretcher. So somebody was grabbing the scoop stretcher, somebody else was grabbing the ambulance stretcher, and I believe that that was a coordinated effort on their part.
MR. LALLY: And, and I apologize, we keep going back and forth, but if I can take you back just one moment before that — so when you first sort of arrived to Mr. O'Keefe, you mentioned that there are three females sort of huddled around, is that correct?
MR. NUTTALL: Correct.
MR. LALLY: What if anything did you observe any of those females doing with respect to Mr. O'Keefe when you first got —
MR. NUTTALL: Uh, that group seemed to be agitated. Um, there was — it was a scene of heightened emotions. Um, as I stated, when I stepped out of the ambulance I could hear screaming, I could hear people yelling. Um, and it was — it seemed just to be that that group was just quite agitated.
MR. LALLY: Now, some point you are able to get him on the scoop stretcher and then over to the ambulance. Correct?
MR. NUTTALL: Correct.
MR. LALLY: And when you get to the ambulance, what if anything did you note — as far as what if any difference was there in the lighting in the back of the ambulance versus on the front lawn?
MR. NUTTALL: The lighting was significantly better. All of our ambulances um have fluorescent lighting in the ceiling of the ambulance, so those were on, and we were able to see that there were some more injuries once we were able to uh get him out of his winter clothing.
MR. LALLY: And so to that point, when you sort of first get into the back of the ambulance, what is sort of the protocol — what is it that each of you are sort of doing with respect to patient care at that point?
MR. NUTTALL: So the biggest um priority is continuous high quality CPR. Um, and that is the biggest thing with any cardiac arrest — is uninterrupted. The — in the ambulance we continued CPR throughout. So while multiple people were performing CPR, and eventually a mechanical CPR device was applied, um, those compressions were uninterrupted, and others were removing clothing — uh, removing — I honestly couldn't tell you the number of articles of clothing, but I believe a winter jacket and a sweatshirt were removed, and then eventually all the clothing was removed. And that's protocol for any cardiac arrest or any traumatic injury — is usually all clothing is removed so we can have unfettered access to the individual, to see if there are any other injuries.
MR. LALLY: And why is that the protocol?
MR. NUTTALL: Uh, just — you mentioned earlier, sir, that there is tunnel vision. Um, the absence of clothing kind of helps to remove that, so you can see everything, you can assess everything.
MR. LALLY: And uh, you mentioned um sort of a mechanical means of CPR — is there a specific device that's used for that?
MR. NUTTALL: Yes, we use a Lucas device, um, manufactured by Stryker. And for lack of a better term, it's basically just a plunger that does CPR. Um, it frees up a set of hands for us, and that can provide CPR uninterrupted as long as the batteries last.
MR. LALLY: Now, at the time that you get him — Mr. O'Keefe — into the back of the ambulance and you're removing some of the clothing, um, what if anything did you note at that time or at any subsequent time in regard to footwear?
MR. NUTTALL: Uh, to be candid, I wasn't really looking at the footwear. Um, I believe it was brought to my attention when we eventually transferred patient care at Good Samaritan Medical Center that the individual was missing a shoe. Uh, however, that wasn't my primary focus at the time.
MR. LALLY: And the items of clothing that were removed uh from within the ambulance — uh, eventually when you transfer that patient care to the hospital, what if anything happens with them in terms of chain of custody of the clothing?
MR. NUTTALL: Um, that is typically brought in either with the individual or after. Um, and that is usually deposited on the floor of the room where that patient is, and then the hospital takes custody of it. Um, occasionally we'll put it in bags. Uh, however, I could not speak to where that clothing went in this case.
MR. LALLY: Um, but fair to say, whatever clothing was taken off in the ambulance left the ambulance at some point? Correct?
MR. NUTTALL: Correct.
MR. LALLY: Went to the hospital? Is that correct?
MR. NUTTALL: Yes.
MR. LALLY: Now, when um you have Mr. O'Keefe in the back of the ambulance and the lighting is better, um, what if anything did you observe uh, following sort of the removal of the clothing — as far as what if any injuries did you observe to Mr. O'Keefe?
MR. NUTTALL: In that sense, he was noted to have — and I was right at the head — he was noted to have a hematoma on the right side of his face, uh, just above — on his forehead. And uh, there were some scratches on the right arm, right, the upper arm.
MR. LALLY: And use a term as far as hematoma — could you explain what you understand that term to mean?
MR. NUTTALL: Uh, for lack of a better term, it's just an egg. He had a pretty good egg on his head.
MR. LALLY: And as far as anything beyond that — did you observe anything, or not anything beyond the egg on the head and the scratches on the right arm?
MR. NUTTALL: Um, as we got further down our treatment model, um, we went to, uh, place an advanced airway. It was noted to have um, some blood, some mucus, and some bile in the back of his airway. Um, that was then suctioned out before we placed our endotracheal tube.
MR. LALLY: And what is an endotracheal tube?
MR. NUTTALL: So an endotracheal tube is basically just a plastic tube that is um, passed through the mouth into the trachea through the vocal cords. Um, it's a definitive airway, if you will. Um, it isolates the trachea so you can better ventilate your patient, um, and you don't have to worry about any air getting into the stomach, any gastric insufflation. Uh, and that is the gold standard for cardiac arrest — is a properly placed endotracheal tube.
MR. LALLY: You mentioned there were some substances that were suctioned from the airway, is that correct?
MR. NUTTALL: Correct.
MR. LALLY: Okay, what were they again? I'm sorry.
MR. NUTTALL: Uh, I believe it was blood, bile, and mucus.
MR. LALLY: And do you have any idea how much of that was suctioned?
MR. NUTTALL: Uh, I couldn't give you an exact number, but it was enough that we needed to set up a suction — uh, suction system to remove it before we intubated.
MR. LALLY: Just turning briefly again to the arm — these were uh injuries that you observed on his right arm, is that correct?
MR. NUTTALL: Correct.
MR. LALLY: What if any injuries did you observe on his left arm?
MR. NUTTALL: Uh, I don't believe I saw any, to my knowledge.
MR. LALLY: And um, as far as — your memory — as far as his right arm, how far did it sort of extend, and where was it located — sort of upper arm, lower, on both, or where was it?
MR. NUTTALL: I believe it was just below his shoulder. Uh, they ran — I would say probably three or four inches — and from I would say about the shoulder right down to maybe two inches above the elbow.
MR. LALLY: And as far as um, Mr. O'Keefe's nose — what if any observations did you make of that?
MR. NUTTALL: Uh, initially it was noted to be very cold. Um, the individual was cold all around to the touch, but his nose was also quite cold — quite, quite white. ...just because he had been in the elements for a little while. There appeared to be a little bit of blood on his nose as well.
MR. LALLY: And through your training and experience, you're familiar with a term or device known as OPA, correct?
MR. NUTTALL: Yes.
MR. LALLY: Can you explain to the jury sort of what OPA stands for and what that device is, what does it do?
MR. NUTTALL: So an OPA, or oropharyngeal airway, is basically a small plastic device that is curved, and when inserted into the mouth, all it does is it prevents the tongue from falling backwards into the airway and occluding the airway. It's relatively simple but it's very effective in keeping an airway open.
MR. LALLY: Just turning back for one moment to the injuries that you observed on Mr. O'Keefe's right arm — were those injuries actively bleeding at the time that you observed them?
MR. NUTTALL: No.
MR. LALLY: What if anything did you observe in reference to those injuries on the arm?
MR. NUTTALL: Those injuries seem to have been congealed. In my opinion it looked like they had been cold, which could have aided in the clotting of those injuries. But when we observed them they were not bleeding.
MR. LALLY: And you mentioned a little bit about Mr. O'Keefe's nose — what if any observations did you make as far as any sort of digits, whether they'd be his hands, his feet, or something else?
MR. NUTTALL: So all of his digits on the upper extremities were noted — they were very cold. They were immobile, they were very stiff. I'm presuming due to the exposure, because when we got him onto the ambulance and were removing clothing, it was noted that all of his digits were very stiff, they were immobile, and it caused a little bit of problems just trying to get clothing off of him, just because they were so stiff.
MR. LALLY: And taking you back outside of the ambulance just for a moment — when you're initially there and you're doing your assessment, and the three females are in your general area, correct?
MR. NUTTALL: Correct.
MR. LALLY: And at some point, you or any of the other paramedics or EMTs on scene — did you ask them any questions about what had happened or anything like that?
MR. NUTTALL: So as I was ventilating at the head, there was a small delay in just getting equipment — nothing significant — just enough time that as I was ventilating I was able to ask, "Did anybody see anything, did anybody — what happened?" And there was one individual that replied several times, "I hit him, I hit him."
MR. LALLY: And did you know that individual at that time?
MR. NUTTALL: I did not.
MR. LALLY: Can you describe the individual that said that?
MR. NUTTALL: I would describe her as mid-40s, average build, average height. And the other two, very similar.
MR. LALLY: And with reference to that statement of "I hit him" — is that something that she said once, or more than once?
MR. NUTTALL: It was several times.
MR. LALLY: And as far as the tone or demeanor — how loudly was this being said?
MR. NUTTALL: As previously stated, they seemed to be erratic. There was a lot going on at that scene. It did seem to be said over and over, at varying volumes. And then there was just a lot of — everybody appeared to be quite flustered. And the individual — one of the three females that said that — what if any observations did you make as to her face or anything? The individual that said "I hit him, I hit him" appeared to have some blood on her face, presumably from attempting CPR prior to our arrival.
MR. LALLY: And you say presumably attempted CPR — when you first arrived at Mr. O'Keefe, what if anything did you observe any of the females doing with reference to Mr. O'Keefe?
MR. NUTTALL: Mr. O'Keefe was not being touched by any individual when I first got to him. That whole group was kind of pacing around — for lack of a better term, kind of running around in circles. But Mr. O'Keefe was not — there were no interventions being done to Mr. O'Keefe when I got to him.
MR. LALLY: And to be clear — sort of when you're in the back — fast-forward — you're in the back of the ambulance. You're again focused on the respiratory, on the head, correct?
MR. NUTTALL: Correct.
MR. LALLY: And who if anyone else from your department is in the back of the ambulance, and what if anything are they doing?
MR. NUTTALL: So at that point I had myself and Matt Kelly, EMT Kelly. He was kind of with me for the head. One of the — for lack of a better term — easier operations of a cardiac arrest is ventilation, so Matt Kelly was assisting me with ventilations, just squeezing the BVM to provide ventilation. The lead paramedic for the cardiac arrest was Anthony Flematti. He was running everything else — he was running the application of the cardiac monitor, he was monitoring the status of medications being administered. He was assisted with that by Katie McLaughlin, Lieutenant Woodbury, and Firefighter Walsh.
MR. LALLY: And at some point — Firefighter Flematti — excuse me — at this point that you're in the back of the ambulance, you don't have any sort of demographic information in regard to your patient, correct?
MR. NUTTALL: Correct.
MR. LALLY: So what if anything did Firefighter Flematti ask anybody else to do in order to obtain — ?
MR. NUTTALL: I believe he asked Firefighter McLaughlin to exit the ambulance and gather some information from the bystanders — in terms of name, date of birth, any significant medical history or medications — just so we could further treat the patient.
MR. LALLY: And to the best of your knowledge, Firefighter McLaughlin leaves the ambulance to do that, is that correct?
PARENTHETICAL: [document handling — inaudible]
MR. NUTTALL: Correct.
MR. LALLY: But you weren't present for any of that, correct?
MR. NUTTALL: No.
MR. LALLY: So there's some period of time in the back of the ambulance, and then the transport to Good Samaritan happens, is that correct?
MR. NUTTALL: Correct.
MR. LALLY: Do you recall where different people from your department were in relation to that transport to the hospital?
MR. NUTTALL: So the transport — in the patient compartment — was myself, Firefighter Kelly, and Firefighter Flematti, with Firefighter McLaughlin driving Ambulance One.
MR. LALLY: I have just one moment.
JUDGE CANNONE: Yes.
MR. LALLY: So when it comes to the report that you were testifying about before — there was a report generated in regard to this, is that correct?
MR. NUTTALL: Correct.
MR. LALLY: And who has the sort of duty and responsibility of compiling that?
MR. NUTTALL: That would have been Anthony Flematti.
MR. LALLY: And have you seen Firefighter Flematti's report in relation to this incident?
MR. NUTTALL: I have.
MR. LALLY: Can I approach the witness?
JUDGE CANNONE: Yes.
MR. LALLY: Do you recognize that, sir?
MR. NUTTALL: I do.
MR. LALLY: And what do you recognize that as?
MR. NUTTALL: This is what I believe to be the EMS report written by Captain Roby, and the patient care report written by Firefighter Flematti.
MR. LALLY: Thank you. May I approach?
JUDGE CANNONE: Yes.
MR. LALLY: To seek to introduce and admit the next exhibit — it's already pre-marked.
JUDGE CANNONE: Or you're moving to introduce it now? Is there an objection?
MR. YANNETTI: reviewing — No objection. Patient care report — all right, that will be marked. Madam court reporter, please.
MR. LALLY: Thank you very much. If I could ask for the lights — Miss Gilman, if I could have what's been previously marked as Exhibit Number Nine. Mr. Nuttall, directing your attention up to the screen — what's been previously marked as Exhibit Number Nine — do you recognize what's depicted in that photograph?
MR. NUTTALL: I do.
MR. LALLY: What do you recognize that as?
MR. NUTTALL: I believe that to be 34 Fairview Road.
MR. LALLY: Is that a relatively fair and accurate portrayal of what it looked like around the time that you arrived there, absent lighting conditions and things of that nature?
MR. NUTTALL: Yes.
MR. LALLY: And Miss Gilman, if I could have Exhibit Number 18. May I approach the witness?
JUDGE CANNONE: Yes.
MR. LALLY: All right, Mr. Nuttall — I'd like to ask you, using that laser pointer. Well, first let me ask — do you recognize what's up on the screen as Exhibit 18?
MR. NUTTALL: Yeah, again, 34 Fairview Road.
MR. LALLY: And the area where you first observed Mr. O'Keefe supine on the lawn, and the three females around him — you see that area in this photograph?
MR. NUTTALL: I do.
MR. LALLY: If you could, using that laser pointer, just direct the jury's attention to where in this photograph you see that.
MR. NUTTALL: So sorry — I would say right around this general area, right about here.
MR. LALLY: And lastly, Miss Gilman, if I could have Exhibit Number 14. Do you recognize what's up on the screen as Number 14?
MR. NUTTALL: I do.
MR. LALLY: What do you recognize that as?
MR. NUTTALL: I believe that to be where we found Mr. O'Keefe.
MR. LALLY: And as far as the pooling of the blood that you observed around Mr. O'Keefe's head — do you observe that area within this photograph as well?
MR. NUTTALL: Yes.
MR. LALLY: Could you again, using that laser pointer, just direct the jury's attention to where in this photograph you observed that?
MR. NUTTALL: Stay right around in this general area.
MR. LALLY: Thank you. We can have the lights back up. May I approach just to retrieve that?
JUDGE CANNONE: Yes.
MR. LALLY: I have no further questions for this witness at this time.
JUDGE CANNONE: All right. Cross-examination.
MR. JACKSON: Your Honor. Afternoon, firefighter, sir— how are you? You were coming— I want to make sure I get the timing right— you were coming off of a nearly 24-hour shift when you got the call?
MR. NUTTALL: No, sir. I was reporting for duty that morning, just starting the shift, when you got the call.
MR. JACKSON: Understood. I want to ask one quick question that you mentioned just a couple of seconds ago, under questioning by Mr. Lally, with regard to the clothing. The normal protocol for clothing that's removed from a patient— you said it's often times just sort of discarded onto the floor. In terms of in the ambulance or at the hospital?
MR. NUTTALL: Either one.
MR. JACKSON: Yes, okay. Both?
MR. NUTTALL: So typically, when we remove clothes in the back of the ambulance, it's generally done with trauma shears. So we will expose and then kind of fold over. That clothing is then usually left in place. We'll do a quick roll just to check the back of the patient, and then he's usually rolled back if there's nothing found, and it's typically left there. In terms of like big puffy jackets— if you cut a puffy jacket, it just makes quite the mess—
MR. JACKSON: Yeah, exactly.
MR. NUTTALL: It just— it's a disaster. So typically those bigger jackets are just removed, and that is when we— when we removed that type of article of clothing, that's when we noticed that his hands were quite rigid.
MR. JACKSON: So that's what happened in this case, correct? You removed a big heavy jacket, discarded it, got it away from the body so you could better assess the injuries, correct? And it was only then, after you removed this big heavy winter coat, that you could assess that his hands were stiff and cold?
MR. NUTTALL: We noted the hands, but it came more into light, if you will, when we removed that coat.
MR. JACKSON: Got it. And you have as good a memory about that as you do the rest of the scene that morning, in terms of removing the article of clothing, correct?
MR. NUTTALL: I did not remove any article of clothing— I was ventilating.
MR. JACKSON: But you remember him having the big jacket on, correct?
MR. NUTTALL: Okay.
MR. JACKSON: And you remember that as well as you remember the other specifics of the incident?
MR. NUTTALL: Yes.
MR. JACKSON: Okay. When responding to a scene— I want to dovetail on the same subject but just come at it a little bit different way, if you would indulge me. When responding to a scene, one of your jobs has to be to sort of immediately take note of and assess the situation of the patient that you're dealing with, correct?
MR. NUTTALL: Correct.
MR. JACKSON: Motorcycle accident is going to be very different than a drowning.
MR. NUTTALL: Exactly.
MR. JACKSON: Someone in this case, exposed in a snow bank— you're going to deal with, or assess, the weather. Is that right?
MR. NUTTALL: Yes, yes.
MR. JACKSON: You're also going to note and assess the condition of the patient, correct, as it pertains to the weather?
MR. NUTTALL: Yes.
MR. JACKSON: So someone, for instance, that's in a snow bank— naked, no clothes on at all— is going to be a little bit different assessment than someone who's completely dressed for winter, correct?
MR. NUTTALL: The initial assessment with every patient is automatically going to be circulation, airway, breathing.
MR. JACKSON: Understood. We approach this individual the exact same way— automatically went directly to cardiac— make sure— I guess what I'm asking is: your attention is focused on some of those details, for sure, correct? And that's how you remember that big heavy coat that he was wearing, correct?
MR. NUTTALL: I remember he was appropriately dressed.
MR. JACKSON: Correct. Okay. As a matter of fact, you testified to that in the grand jury— that, quote unquote, he had a heavy coat on?
MR. NUTTALL: Yes.
MR. JACKSON: Consistent with how you're testifying today, is that right?
MR. NUTTALL: Correct.
MR. JACKSON: All right. Your Honor, I'd like to mark two photographs as next in order.
JUDGE CANNONE: Not yet.
MR. JACKSON: I believe it would be 160— it doesn't matter so much the number— but why don't you just show the prosecutor the photos, 161 and 162, in order. May I approach?
JUDGE CANNONE: Yes.
MR. JACKSON: I'm going to ask you first of all whether or not you recognize what's depicted in those photos.
MR. NUTTALL: Honestly, sir, I couldn't recall the exact— but yeah.
MR. JACKSON: You do recognize them?
MR. NUTTALL: Yes.
MR. JACKSON: Does that appear— what appears to be what John O'Keefe is wearing when found?
MR. NUTTALL: I don't recall, sir, to be perfectly honest.
MR. JACKSON: May I approach?
JUDGE CANNONE: Yes.
MR. JACKSON: Do you recall this being part of— let me ask you a different way. Do you remember somebody cutting this off of John O'Keefe at the time?
MR. NUTTALL: I remember the clothing being removed.
MR. JACKSON: Okay. But you don't remember this clothing?
MR. NUTTALL: I could say that he had clothing removed, but I couldn't tell you exactly what it was.
MR. JACKSON: And you've just looked at this— what I'm holding in my hand appears to be the front and back of a—
JUDGE CANNONE: So— don't hold it up to him from that distance where he said he doesn't recognize it. You can put it back in front of him. Don't hold it up for the jury, please.
MR. JACKSON: May I?
JUDGE CANNONE: Yes.
MR. JACKSON: You— that appears to be a thin cotton hoodie?
MR. NUTTALL: Yeah, that appears to be a thinner layer of clothing.
MR. JACKSON: Okay. May I approach?
JUDGE CANNONE: Yes.
MR. JACKSON: Not a heavy coat, fair?
MR. NUTTALL: Fair.
MR. JACKSON: Not a winter jacket, fair? Is it fair to say you had a lot on your mind when you were out at that scene, correct? In terms of just— saving a man's life— correct? Your credentials are impressive. You were there focused on one thing, and that is trying to make sure that a man did not die, right? Would you agree that that was your primary concern and your primary focus the entire time you were at the scene?
MR. NUTTALL: Correct.
MR. JACKSON: You weren't necessarily worried about what other individuals were doing, correct?
MR. NUTTALL: No.
MR. JACKSON: If I asked you right now, off the top of your head, tell me exactly the number of law enforcement officers that were there at the scene— probably couldn't tell me, could you?
MR. NUTTALL: No.
MR. JACKSON: If I asked you whether or not you remember every single civilian that was at the scene— probably couldn't tell me, correct?
MR. NUTTALL: Outside of the three.
MR. JACKSON: Outside of the three, correct. Any other civilians?
MR. NUTTALL: Not that I noted.
MR. JACKSON: Okay. As a matter of fact, you can't even identify the three civilians other than generally middle-aged 40s, Caucasian female, correct? You said all three of them sort of looked alike, right?
MR. NUTTALL: Without the— the only defining feature on one of the individuals was, one of the individuals did have blood on their face.
MR. JACKSON: So some of the specifics of that scene you didn't pay special note to, correct?
MR. NUTTALL: No, we were focused on patient care.
MR. JACKSON: Is it fair to say that specifically, as it pertains to what the victim was wearing, your memory might be a little faulty where that's concerned?
MR. NUTTALL: Sure.
MR. JACKSON: Okay. I mean, nothing wrong with that— you were focused on something completely different, correct? You did notice certain injuries on Mr. O'Keefe's person, correct?
MR. NUTTALL: Correct.
MR. JACKSON: And you indicated on direct examination that, once you got him into the back of the ambulance, you— as you put it— had a quote unquote "much better picture" of what you were dealing with. Is that right?
MR. NUTTALL: Correct.
MR. JACKSON: You testified at the grand jury that you noted that, once he was in the back of the ambulance, under better lighting, you were able to tell that he had trauma to the right side of his head, correct? Is that right?
MR. NUTTALL: Yes.
MR. JACKSON: Are you talking about the major trauma he suffered to the back of his head, or the egg that you earlier described?
MR. NUTTALL: I was more— just because it was directly in front of me— it was on the front side of his head.
MR. JACKSON: Okay. So it wasn't the right side of his head. If you said "right side of your head," you might point above your ear, right? That's not what you're talking about.
MR. NUTTALL: I would— and if— to use my person— I would say right here.
MR. JACKSON: So more towards the right, above his right eye, right of center, but still on the front of his head, correct? And you did not make any note of another injury on the back of his head?
MR. NUTTALL: No.
MR. JACKSON: You talked about the injuries to the right side of his arm, correct?
MR. NUTTALL: Correct.
MR. JACKSON: You noted that those injuries appear to be scratches?
MR. NUTTALL: Yes.
MR. JACKSON: That's your word, not mine, right?
MR. NUTTALL: Correct.
MR. JACKSON: You didn't say that those were blunt force trauma.
MR. NUTTALL: No.
MR. JACKSON: You didn't say that there were abrasions?
MR. NUTTALL: Scratches and abrasions, in my point of view, seem to go hand in hand, but the word that I used was scratches.
MR. JACKSON: Yes.
MR. NUTTALL: They were like— furrow—
MR. JACKSON: Say that again?
MR. NUTTALL: Furrow, if you will, for lack of a better term.
MR. JACKSON: Just— I don't understand that word. So if you remove something— like you create a furrow in the skin— is that—
MR. NUTTALL: Yes, there you go. Sorry— excuse my accent. I'm on your turf.
MR. JACKSON: It's my accent, I'm so sorry! Boy, that one— it's gonna be a meme somewhere. Hey, "My Cousin Vinnie"— yeah, got it. All right. So when you said "furrows," you made your hand in an O—
MR. NUTTALL: Almost like a claw and dragged it against his right biceps.
MR. LALLY: Objection.
JUDGE CANNONE: Sustained.
MR. JACKSON: Can you repeat the movement that you did for the jurors when you said furrow—
MR. LALLY: Objection.
JUDGE CANNONE: Sustained. Just move on to the next question, please.
MR. JACKSON: You would agree that a very common cause of a hematoma over one's eye is being hit or punched? Correct? Is that right?
MR. NUTTALL: Yes.
MR. JACKSON: You said that Mr. O'Keefe did have such a hematoma over his right eye. Correct?
MR. NUTTALL: Yes.
PARENTHETICAL: [sidebar]
MR. JACKSON: Did you also see a laceration under the eyebrow but above the lid on his right eye?
MR. NUTTALL: I don't recall.
MR. JACKSON: Did you see a laceration on Mr. O'Keefe's nose?
MR. NUTTALL: I don't recall.
MR. JACKSON: You did note that there was some blood on his nose. Correct?
MR. NUTTALL: Correct.
MR. JACKSON: Is it possible that came from a small laceration?
MR. NUTTALL: Yes.
MR. JACKSON: In your experience — well, let me ask another question. Did it look like he had, in addition to the egg on the right side of his head in the front, did he also have a black eye on the left side?
MR. NUTTALL: If memory serves, correct. Yes.
MR. JACKSON: So both eyes were blackened?
MR. NUTTALL: Primarily the right side, if memory serves.
MR. JACKSON: Okay. And the laceration on the right side — of the right eye — are those injuries that you just described consistent or inconsistent with some sort of physical altercation?
MR. LALLY: Objection.
JUDGE CANNONE: Sustained. Next question, please.
MR. JACKSON: Did it appear to you, just from your initial assessment given your experience, training, and background, that those injuries looked like he had been in a fight?
MR. LALLY: Objection.
JUDGE CANNONE: I'll see counsel at sidebar.
MR. JACKSON: Thank you, sir. Little break. In your experience as an obviously trained firefighter — someone tell me the word again that you used — field training officer, or preceptor. Thank you. As a field training officer, have you seen in your experience the injuries that can be produced from fistfights?
MR. NUTTALL: Yes.
MR. JACKSON: Injuries to the face?
MR. NUTTALL: Yes.
MR. JACKSON: Injuries to the mouth? Injuries to the nose?
MR. NUTTALL: Yes.
MR. JACKSON: The ears?
MR. NUTTALL: Yes.
MR. JACKSON: To the eyes? Defensive wounds on the hands?
MR. NUTTALL: Yes.
MR. JACKSON: Did you note — you've already noted what the injuries to the face were that you saw Mr. O'Keefe having suffered.
MR. NUTTALL: Yes.
MR. JACKSON: Were those consistent or inconsistent with a physical altercation?
MR. NUTTALL: I couldn't say.
MR. JACKSON: Were they consistent or inconsistent with being in a fight?
MR. NUTTALL: I couldn't say.
MR. JACKSON: Was that egg over his right eye consistent or inconsistent with him having been punched or hit?
MR. NUTTALL: I couldn't say.
MR. JACKSON: I thought you said that one of the common causes of an egg like that — a hematoma, as you put it — over someone's eye is being hit or punched.
MR. NUTTALL: There's quite a few reasons that somebody could get an egg such as that over their head. I mean, you can get hit with a golf ball, of course, for instance.
MR. JACKSON: I'm not asking you to the exclusion of everything else. I'm asking you, is it consistent?
MR. NUTTALL: It's consistent. It could be.
MR. JACKSON: Okay. And the other injuries as well?
MR. NUTTALL: Correct.
MR. JACKSON: Okay. Did you see bruising to the back of one or both of his hands?
MR. NUTTALL: His hands were, as stated, very cold and very white. They were not well perfused, and when you don't have adequate perfusion, swelling and smaller injuries don't typically present themselves, if you will.
MR. JACKSON: So you may not have seen that. Correct?
MR. NUTTALL: Bruising may have been there. It might have been there. It just wasn't observable, just due to the condition of his hands — just made it overlooked.
MR. JACKSON: Yes. Okay. You indicated that you were not present when your colleague Katie McLaughlin was questioning anybody at the scene. Correct?
MR. NUTTALL: Correct.
MR. JACKSON: She was tasked with that responsibility, but you did not engage with her. Correct? Meaning, when I say "engage with her," you weren't standing there with her.
MR. NUTTALL: No, I was — no, I was in the back of the ambulance.
MR. JACKSON: Okay. You claim to have heard this statement — "I hit him, I hit him" — yes, several times, from the woman with blood on her face. Correct?
MR. NUTTALL: Correct.
MR. JACKSON: You indicated that she was erratic. Correct?
MR. NUTTALL: Correct.
MR. JACKSON: Hysterical?
MR. NUTTALL: Correct.
MR. JACKSON: You said, for lack of a better term, running around in circles?
MR. NUTTALL: Yes.
MR. JACKSON: She seemed despondent or distraught?
MR. NUTTALL: Very distraught. Very upset. Yes.
MR. JACKSON: Was she saying anything else that you recall?
MR. NUTTALL: To me, I heard "I hit him, I hit him," and then I went back, obviously — continuing on, focusing on patient care.
MR. JACKSON: Did you hear her say "could I hit him"?
MR. NUTTALL: I heard "I hit him, I hit him."
MR. JACKSON: That's what you believe at this point?
MR. NUTTALL: That's what I heard.
MR. JACKSON: Okay. Where exactly were you?
MR. NUTTALL: I was crouched at the head of Mr. O'Keefe.
MR. JACKSON: Okay. You were asked that exact question at the grand jury — correct — to describe where you were and who was doing what?
MR. NUTTALL: To my knowledge. Yes.
MR. JACKSON: Okay. You were asked the question, "When you spoke to her and she said 'I hit him, I hit him,' were you — the other — sorry — were you with the other representatives there at the time? Were there other people around you?" You remember being asked that question by a grand juror?
MR. NUTTALL: I don't recall.
MR. JACKSON: Do you remember answering, "No — there were other people around me. I had paramedic Flematti with me. I believe firefighter Kelly was there as well. Correct? So the three of us were all providing patient care." Around Mr. O'Keefe. And you indicated that you were all there together. You were kneeling and you were doing the airway. Well, you called him Tony?
MR. NUTTALL: That's — yes. That's Anthony. Tony. Yes.
MR. JACKSON: All right. He was doing the CPR?
MR. NUTTALL: Correct. Correct.
MR. JACKSON: And it's absolutely clear in your mind that when that statement was made, you were knelt down over Mr. O'Keefe, Flematti was doing CPR, Kelly was with you guys, and you posed the question to her, "Do you know him"?
MR. NUTTALL: Correct. Correct.
MR. JACKSON: Okay. So I want to make sure I understand this. You said, as you're knelt down, "Do you know him?" — directly to the female — and she answered your question with "I hit him, I hit him"?
MR. NUTTALL: Yes.
MR. JACKSON: But that's not what you told Trooper Proctor in a February 8th interview.
MR. NUTTALL: I don't recall what I told Trooper Proctor.
MR. JACKSON: Let's start at the beginning. Do you remember having a conversation with Trooper Proctor on February 8?
MR. NUTTALL: I do.
MR. JACKSON: That was obviously much closer in time than your grand jury testimony. Correct?
MR. NUTTALL: Correct.
MR. JACKSON: And years closer in time than your testimony now. Correct?
MR. NUTTALL: Correct.
MR. JACKSON: Do you recall on February 8th telling Trooper Proctor that while you were rendering aid, you heard Karen say "I hit him" to another female on the scene?
MR. NUTTALL: To another female — as I stated, I heard several times "I hit him." In terms of who that was directed towards, I mean, again — focused on patient care.
MR. JACKSON: Understood. My question was a little bit different. Do you recall telling Trooper Proctor specifically that while you were rendering aid, you heard Karen say "I hit him" to another female on the scene, and the other female told Karen to be quiet?
MR. NUTTALL: I do recall that.
MR. JACKSON: Okay. That's not what you testified to today, though. Okay? Matter of fact, that story has changed to: you posed a question and she answered your question. Correct?
MR. NUTTALL: Correct.
MR. JACKSON: So which is it?
MR. NUTTALL: So when ventilating a patient, typically that is also used to gather information from bystanders, because as I'm ventilating, I can real quick look around — "Do you know this individual? Do you know anything about this individual?" — that's fairly typical for any scenario. This is just a very quick information gathering strategy.
MR. JACKSON: But you will agree that your testimony today has changed from what it was — from your statement to Trooper Proctor on February?
MR. NUTTALL: I don't know if I would so much say "changed," sir. To be honest, I don't fully recall that meeting with Mr. Proctor.
MR. JACKSON: You don't?
MR. NUTTALL: Sorry — I remember meeting with him, however I don't fully remember what was discussed.
MR. JACKSON: So it's fair to say that your memory is a little bit faulty as it pertains to that time frame?
MR. NUTTALL: Absolutely.
MR. JACKSON: Okay. When you went to the hospital with the patient, did you ever inform any of the doctors or nurses or medical professionals at the hospital that you had heard a female claim to have hit John O'Keefe, and that's the reason for his injuries?
MR. NUTTALL: I did not give the report to the hospital, so the answer to that is no. Did not.
MR. JACKSON: As a first responder and a medical professional yourself, obviously you know that the cause and manner of a victim's injuries are incredibly important as it pertains to assessing how to treat that patient. Correct?
MR. NUTTALL: Correct.
MR. JACKSON: Once you got back to the station, and to take a brief breath, did you write any report?
MR. NUTTALL: I did not. No. I did not write the patient care report.
MR. JACKSON: So you didn't write a report — just to finish my question — you didn't write a report that said, "By the way, while I was out at the scene, I heard a female say 'I hit him,' and that's the cause and manner..."
MR. NUTTALL: ...of the injuries, not to my knowledge.
MR. JACKSON: Well, you would know if you wrote a report that said that, correct? And you did not.
MR. NUTTALL: I did not write the patient care report.
MR. JACKSON: Okay. At any time that day, or any day subsequent thereto, did you contact the Canton Police Department, which were the first responders — I did not — let me finish my question — and say, "By the way, just so you know, I heard this woman say 'I hit him' out at the scene"?
MR. NUTTALL: I did not.
MR. JACKSON: Did you ever, on that day or any day subsequent thereto, contact the Massachusetts State Police and say "I heard this person say 'I hit him'"?
MR. NUTTALL: I did not.
MR. JACKSON: So the first time you ever repeated that statement was on February 8th, with Trooper Proctor, correct?
MR. NUTTALL: Correct.
MR. JACKSON: And by the time we've come full circle to today, that statement has now pivoted — in that you didn't overhear the person say it to a female. Now she's talking directly to you.
MR. NUTTALL: Now she spoke directly to me, yes.
MR. JACKSON: Have you — just one last point — you've obviously noted that this case has gotten an enormous amount of notoriety, correct?
MR. NUTTALL: Correct.
MR. JACKSON: How many times would you say that you have discussed this case and this incident with your fellow firefighters?
MR. NUTTALL: It's brought up around the station semi-frequently. However, being involved in it, we try to stay clear of it, just because we are involved in it.
MR. JACKSON: So the answer is there have been many discussions — yes, probably daily, frequently. Have any of those discussions helped you with what you earlier described as a little bit of a faulty memory around that time frame?
MR. LALLY: Jackson, he can have that.
MR. NUTTALL: Have they — repeat the question for me, sir.
MR. JACKSON: Sure. Have any of those discussions helped you with what you earlier described as a little bit of a faulty memory?
MR. NUTTALL: The memories that I have and the ones that I'm bringing up — I don't believe that they've changed. You know, I've played them over in my head to the best of my ability, and I don't believe my story is swayed. If they've been enunciated incorrectly on my part, it wasn't intentional.
MR. JACKSON: Understood. And nobody's casting aspersions. Yeah, memory is a funny thing. So your memory is as good about that as it is about that winter call.
MR. NUTTALL: Yes, sir.
MR. JACKSON: Thanks. That's all I have.
MR. LALLY: Mr. Nuttall, when it comes to you being asked about the consistency of causality, as far as the different injuries that you observed on Mr. O'Keefe — correct — rephrase that for me.
MR. NUTTALL: Sure.
MR. LALLY: Poorly phrased on my part. So you would have been asked on cross-examination about some things — the injuries you observed on Mr. O'Keefe — could those be consistent with, as far as having been the cause of those injuries, correct?
MR. NUTTALL: Correct.
MR. LALLY: And how many myriad of other things — how many myriad of other sorts of things — could have also been a cause of the injuries that you observed?
MR. NUTTALL: As stated, a lot. It's not typically just physical altercations. It could be — again, a golf ball could hit you in the head, that could cause similar injuries.
MR. LALLY: And just for clarity purposes — when you were asked about a time frame, were you talking about the time frame of January 29th, or were you talking about the time frame of February 8th when you met with Trooper Proctor? Sorry, I'll rephrase that. Let me withdraw that and move on to something else. So, again, just for clarity purposes — when you were asked about some statements that were attributed to you to Trooper Proctor during the interview, correct?
MR. NUTTALL: Correct.
MR. LALLY: Okay. And so with regard to what you recalled differently — is it the statement that the person, the female with the blood on her face, made to you? Or is it the statement of the other female telling that person to be quiet?
MR. NUTTALL: So as stated, real quick, down and dirty — I asked, "Do you know this person?" to which I got, "I hit him, I hit him." And then in the background, I remember hearing over and over "I hit him, I hit him" — that was kind of pushed towards the back, and patient care took priority. If that answers your question.
MR. LALLY: Do you recall specifically, at this time, the other statements that you were asked about — as far as whether or not the other female told that female to be quiet?
MR. NUTTALL: I do remember that, correct.
MR. LALLY: And the other statement — as far as the female with blood on her face — and again, that was the differentiating characteristic between the two females that you observed there, correct?
MR. NUTTALL: Correct.
MR. LALLY: And your memory of that statement is "I hit him, I hit him, I hit him," correct?
MR. NUTTALL: Correct.
MR. LALLY: Nothing further.