Commonwealth v. Read — Trial ArchiveTim Nuttall — Direct/Cross/Redirect
695 lines(Whereupon, the defendant was escorted from the courtroom and a brief recess was taken.)
(Court resumes at 11:19 a.m.)
(Defendant present. Jury present.)
JUDGE CANNONE: Your next witness, please, Mr. Lally?
MR. LALLY: The Commonwealth calls Timothy Nuttall.
Whereupon, TIMOTHY NUTTALL having been first duly sworn, was examined and testified under oath as follows:
JUDGE CANNONE: You can stand or sit, whatever makes you more comfortable, sir.
MR. NUTTALL: All right.
JUDGE CANNONE: Whenever you are ready, Mr. Lally.
MR. LALLY: Thank you, Your Honor.
DIRECT EXAMINATION BY MR. LALLY:
MR. LALLY: Good morning, sir.
MR. NUTTALL: Good morning.
MR. LALLY: Could you please state your name and spell your last name for the jury?
MR. NUTTALL: Timothy Nuttall. My last name is Nuttall, N-U-T-T-A-L-L.
MR. LALLY: And what do you do for work, sir?
MR. NUTTALL: I am a firefighter/paramedic with the town of Canton.
MR. LALLY: And how long have you been a firefighter/paramedic with the town of Canton?
MR. NUTTALL: I believe five years and 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 Weymouth. They are 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 and 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 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 into the fire suppression side of things. So I was hired by the town of Scituate and was put through Mass. Fire Academy out of Stowe, Class 268 in Stowe, and worked for the Scituate Fire Department for about 18 months and then transferred to Canton Fire Department in November of 2019.
MR. LALLY: Just a couple of questions about what you had just spoken about. So when you used the term sort of BLS, what does that mean?
MR. NUTTALL: So in EMS, there's 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 a stepping stone to see if you could do the job, if you liked the job. And then you can advance on to 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 -- you 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. It progresses down to how those illnesses can progress and the natures of illness. Once that is 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. I can't speak to the hours of the time off my head. I can't remember. But many hours in the hospital, and then you progress to your field ride time, where you are 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'll sit for 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've passed all that, you are certified to be a paramedic.
MR. LALLY: And so with respect to your training as far as becoming an EMT and then your training as far as becoming a paramedic, there is sort of a written portion and a practical portion, as well; is that correct?
MR. NUTTALL: Correct.
MR. LALLY: You used the term in there as far as preceptor. What exactly does that mean within your field?
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 in what they did. 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 lesson in perpetuity or is there a continuing educational recertification process?
MR. NUTTALL: Right now for the town of Canton, that is a bid position. I submitted an application in writing and I was selected. So I am currently on -- in my group, I am our field training officer for my group, Group 2.
MR. LALLY: And my apologies. A poor question on my part. I was asking sort of more in general, so beyond the sort of preceptor sort of 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 is a national component, a 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: And where are they located?
MR. NUTTALL: Station 1 is 99 Revere Street. And Station 2 is 7 Sassamon Street.
MR. LALLY: And, when you are 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, 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 for the Canton Fire Department?
MR. NUTTALL: For us, we report at 08:00 to 08:00.
MR. LALLY: So 8:00 a.m. to 8:00 a.m.?
MR. NUTTALL: Yes.
MR. LALLY: Okay. And, within both of those station houses, how much sort of apparatus or how many different sort of vehicles and apparatus do you have within each of those station houses?
MR. NUTTALL: For Station 1, 99 Revere Street, we have Car 5 staffed with a captain. We have Engine 3 staffed with one lieutenant and two firefighters. And Ambulance 1, who is staffed with two firefighters. We do have a PB waivers and 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; that is, Engine 4 with two firefighters and a lieutenant and Ambulance 2 with the same setup as Ambulance 1. Both of those stations also have ladders. They are Ladder 1 and Ladder 2, respectively. And the crews for Ambulance 1 or Ambulance 2 will cross-man those ladders as needed.
MR. LALLY: Now, if I could turn your attention to January 28th into January 29th, so a Friday, into a Saturday. Do you recall -- 2022. Do you recall those dates?
MR. NUTTALL: Yes.
MR. LALLY: 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 were scheduled to work the morning, 8:00 a.m. on the 29th until 8:00 a.m. on the 30th?
MR. NUTTALL: Correct.
MR. LALLY: Okay. And prior to or 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 reportedly coming?
MR. NUTTALL: I was aware that there was a significant storm, supposedly. Well, there was a significant storm coming through. I woke up very early that morning just to check. I took a peek outside at my house. I live in the city of Brockton. I noticed that the conditions were -- it was starting to snow 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 day?
MR. NUTTALL: I was at Station 11, 99 Revere 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 like that?
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 is 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 yourself and the other firefighters have in relation to snow removal around the station?
MR. NUTTALL: So we are 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 into 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 -- that crew was actually outside removing snow when I pulled into 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 snowing. So we were approaching blizzard conditions, I would say.
MR. LALLY: And, when you arrived there, did a call come into your station sometime around or shortly after 6:00 o'clock in the morning on the 29th?
MR. NUTTALL: Yeah. I arrived, as I previously stated, around 5:50. I put my gear, my firefighter instructional 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: Okay. And do you recall what was the report in regard to, what the dispatch was 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 of any further information. So when that came on, we had one of the parameters that morning and one of the firefighters, who was a relatively new firefighter, I made the decision to step on 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, right?
MR. NUTTALL: Correct. As the tones were going off and because I came in so early, I was still in civilian clothing. I had a Canton Fire tee shirt on. So I actually donned my turnout gear for that call.
MR. LALLY: And, as far as the other individuals on that Ambulance 1 that were going to that call, as well, who were they?
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. Due to 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, is Car 5, Engine 3, Ambulance 1.
MR. LALLY: And do you know who was on Engine 3 and who was in Car 5?
MR. NUTTALL: Car 5 was Captain Robery. Engine 3 was Lieutenant Greg Woodbury, Firefighter Frank Walsh and Firefighter Katie McLaughlin.
MR. LALLY: And, as far as the 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 and 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. So when you were 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 there?
MR. NUTTALL: So as I previously stated, I was -- 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, an unresponsive male in the snow. So I grabbed our first-in bag, which has miscellaneous medical supplies; some I.V. supplies and 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. So when the ambulance arrived on scene, I had all three of those bags on my person, and we were able to, 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 sound 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. 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: Okay. 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: 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, in my opinion, seemed to have picked up since my drive in, and the snow was increased.
MR. LALLY: So when you step out of the ambulance, can you describe for the jury sort of where you're going 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 a 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. I 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 an ambulance and you observe them, are you sort of turning left or right or how were you heading when you come around the ambulance?
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 you observed around the patient, how would you -- or what, if any, description do you have of those people?
MR. NUTTALL: There were three individuals. I believe all three of them were female. My primary focus was the individual in the snow on the ground. I went right to him. I kind of bypassed everybody from there and went directly to that individual.
MR. LALLY: Is that sort of typically how you approach a scene, is just sort of tunnel vision right for the patient?
MR. NUTTALL: Typically on a call like that if somebody is unresponsive on the ground, you typically go directly to the patient and ascertain any -- 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 Officer O'Keefe, John O'Keefe.
MR. LALLY: And how was Officer or Mr. O'Keefe's body positioned in relation to the ground when you first approached him?
MR. NUTTALL: So I found him supine, laying in the snow. I 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 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, it may be pretty well understood, but when you use -- you used the term "supine." What exactly do you mean by that?
MR. NUTTALL: He was laying on his back.
MR. LALLY: Okay. So 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: Okay. And is there a certain division as far as treatment and diagnosis and things of that nature are concerned 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, 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 used a term as far as bag valve mask; is that correct?
MR. NUTTALL: Yes.
MR. LALLY: And can you explain to the jury sort of what that is?
MR. NUTTALL: All that is, is it's -- 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: And is there an acronym that is used within those reports as far as bag valve mask?
MR. NUTTALL: BVM.
MR. LALLY: BVM. Okay. And turning back to sort of when you initially approached where Mr. O'Keefe is, if you know, about how far away from -- where is he in relation to -- well, let me back up just a little bit.
MR. NUTTALL: Okay.
MR. LALLY: So you arrive at this residence at 34 Fairview Road, correct?
MR. NUTTALL: Yes.
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 sort of in the general area as far as where Mr. O'Keefe was?
MR. NUTTALL: In terms of when I got to him?
MR. LALLY: Yes.
MR. NUTTALL: So when I first got to him, we checked for signs of life, and I, as stated, was 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 had noted, that there was 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, if you know?
MR. NUTTALL: I estimated it about where the sidewalk met the front lawn of that residence. That would be my best estimation.
MR. LALLY: Okay. Do you have any estimation as far as footage or anything like that?
MR. NUTTALL: I would say about six, eight feet, perhaps.
MR. LALLY: So approximately six to eight feet from the curb?
MR. NUTTALL: Correct.
MR. LALLY: So you indicated that -- so what are the first things you're checking as far as when you first arrive at a patient for this kind of call?
MR. NUTTALL: I'm sorry. Can you repeat?
MR. LALLY: That's okay. That's okay. It's my fault. So as far as when you -- let me back you up for just one second. You used the term in there as far as a cardiac arrest, correct?
MR. NUTTALL: Correct.
MR. LALLY: Okay. Can you explain to the jury what you understand that term to mean based on your training and experience?
MR. NUTTALL: So a cardiac arrest is the cessation of a stable cardiac rhythm in terms of life. Typically it's either asystole, pulses of electrical activity, or V- fib or V-tach. Typically, you ascertain that by there is no pulse. You check any of the pulses, be it femoral pulse or carotid pulse or radial pulse. You will find nothing. And, when that is found, you go to lifesaving measures, which is CPR.
MR. LALLY: And, just in reference to one other term you used in there as far asystole, could you explain to the jury what you understand that term to mean based on your training and experience?
MR. NUTTALL: Asystole, to put it as clear as I can, is a flatline. There is no electrical activity in the heart.
MR. LALLY: And so you're working sort of at the head of Mr. O'Keefe; is that correct?
MR. NUTTALL: Correct.
MR. LALLY: Okay. 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 at that point?
MR. NUTTALL: So I was -- as we talked about it 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 are 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: He was dressed for the weather. He had several layers on. Other than that, our primary focus was kind of getting him extricated and out of the elements, just because there was -- as stated, conditions were sub-optimal and we wanted to get him into an environment with better lighting and some heat so we could further assess if he had any injuries and go from there.
MR. LALLY: And so the other firefighters and paramedics 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: I believe the other firefighters that were dispatched, they were getting extrication equipment. I believe we put this individual on what we refer to as a scoop stretcher. It's 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 if somebody was grabbing the scoop stretcher, somebody else was grabbing the ambulance stretcher. And I believe that was a coordinated effort on their part.
MR. LALLY: And I apologize as I keep going back and forth. But if I could take you back just one moment before that.
MR. NUTTALL: Uh-huh.
MR. LALLY: When you first sort of arrived to Mr. O'Keefe, you mentioned that there were 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 there?
MR. NUTTALL: That group seemed to be agitated. It was a scene of heightened emotions. As I stated, when I stepped out of the ambulance, I could hear screaming. I could hear people yelling. And it seems, just to be -- that group was just quite agitated.
MR. LALLY: Now, at some point, you are able to get him on that 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 have fluorescent lighting in the ceiling of the ambulances. So those were on and we were able to see there were some more injuries once we were able to 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 the patient care at that point?
MR. NUTTALL: So the biggest priority is continuous, high- quality CPR. And that is the biggest thing with any cardiac arrest, is uninterruption of compressions. So when we got him into the back of the ambulance, we continued CPR throughout. So while multiple people were performing CPR and eventually a mechanical CPR device was applied, those compressions were uninterrupted. And others were removing clothing, 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 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 protocol, sir?
MR. NUTTALL: Just -- you mentioned earlier, sir, that there is tunnel vision. The absence of clothing kind of helps to remove that so you can see everything. You can assess everything.
MR. LALLY: And you mentioned 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 manufactured by Stryker. And, for lack of a better term, it's basically just a plunger that does CPR. 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 Mr. O'Keefe into the back of the ambulance and you're removing some of the clothing, what, if anything, did you note at that time or at any subsequent time with regard to footwear?
MR. NUTTALL: To be candid, I wasn't really looking at the footwear. I believe it was brought to my attention when we eventually transferred patient care to Good Samaritan Medical Center that the individual was missing a shoe. However, that wasn't my primary focus at that time.
MR. LALLY: And the items of clothing that were removed from within the ambulance, eventually when you transfer that patient care to the hospital, what, if anything, happens with that?
MR. NUTTALL: In terms of the chain of custody of the clothing?
MR. LALLY: Yes.
MR. NUTTALL: That is typically brought in either with the individual or after. And that is usually deposited on the floor of the room where that patient is, and then the hospital takes custody of it. Occasionally, we'll put it in bags. However, I could not speak to where that clothing went on this case.
MR. LALLY: Okay. But fair to say whatever clothing was taken off in the ambulance left the ambulance at some point, correct?
MR. NUTTALL: Correct.
MR. LALLY: Okay, and went to the hospital; is that correct?
MR. NUTTALL: Yes.
MR. LALLY: Now, when you have Mr. O'Keefe in the back of the ambulance and the lighting is better, what, if anything, did you observe following sort of the removal of the clothing as far as what, if any, injuries did you observe to Mr. O'Keefe in that sense?
MR. NUTTALL: 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, just above his eye on his forehead. And there was scratches on the right arm, the upper arm.
MR. LALLY: And you used the term as far as a hematoma. Could you explain what you understand that term to mean?
MR. NUTTALL: 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 note anything beyond the egg on the head and the scratches on the right arm?
MR. NUTTALL: As we got further down our treatment modality, we went to advanced -- we placed an advanced airway. He was noted to have some blood, some mucous and some bile in the back of his airway 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 -- it's just a plastic tube that is passed through the mouth, into the trachea through the vocal cords. It's a definitive airway, if you will. It isolates the trachea so you can better ventilate your patient and you don't have to worry about any air getting into the stomach, any gastric infiltration. And that is the gold standard First Offender cardiac arrest, is a properly placed endotracheal tube.
MR. LALLY: You mentioned that was some substances suctioned from the airway; is that correct?
MR. NUTTALL: Correct.
MR. LALLY: And what were they again? I'm sorry.
MR. NUTTALL: I believe it was blood, bile and mucous.
MR. LALLY: And do you have any idea how much of that was suctioned?
MR. NUTTALL: I couldn't give you an exact number, but it was enough that we needed to set up a suction system to remove it before we intubated.
MR. LALLY: And, just turning briefly again to the arm, these were 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: I don't believe I saw any, to my knowledge.
MR. LALLY: And, 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 or lower arm or both or where was it?
MR. NUTTALL: I believe it was just below his shoulder. They ran, I would say, probably three or four inches from, I would say, about the shoulder, right down to maybe two inches above the elbow.
MR. LALLY: And, as far as Mr. O'Keefe's note, what, if any, observations did you make of that, as well?
MR. NUTTALL: Initially, it was noted to be very cold. The individual was cold all around to the touch, but his nose was also quite cold, 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: Through your training and experience, are you familiar with a term or a device known as an OPA?
MR. NUTTALL: Correct. Yes.
MR. LALLY: And can you explain to the jury sort of what OPA stands for and what is that device and what does it do?
MR. NUTTALL: So an OPA or an oropharyngeal airway, is basically a small plastic device that's 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: Turning back for one moment to the injuries that you observed on Mr. O'Keefe's right arm, were those injuries that were actively bleeding at the time that you observed them?
MR. NUTTALL: No.
MR. LALLY: And what, if anything, did you observe as to that 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 of 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 be his hand, 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 am presuming due to the exposure, because we did, when we got him onto the ambulance and we were removing clothing, it was noted that he was very -- 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 sort of initially there and you're doing your assessment and the three females are in your general area. Correct?
MR. NUTTALL: Correct.
MR. LALLY: Okay. And, at some point, did you or any of the other paramedics or EMTs on scene 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 or something else?
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, it was -- they seemed to be erratic. There was a lot going on in that scene. It did seem to be said over and over and at varying volumes. And then there was just a lot of -- everybody appeared to be quite flustered.
MR. LALLY: And the individual, one of the three females that said that, what, if any observations did you make as to her face or anything like that?
MR. NUTTALL: The individual that said, I hit him, I hit him, appeared to have some blood on her face, presumably for attempting CPR prior to our arrival.
MR. LALLY: And you say "presumably attempting 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 being -- there was no interventions being done to Mr. O'Keefe when I got to him.
MR. LALLY: To be clear, sort of when you're in the back, fast-forwarding now to sort of in the back of the ambulance, you're, again, sort of focused on the respiratory and the head, correct?
MR. NUTTALL: Correct.
MR. LALLY: And who, if anyone else, from your apartment is in the back of the ambulance and what, if anything, are they doing at that point?
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, one of the easier operations of 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, did Firefighter Flematti -- 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 regard to obtain it?
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, did Firefighter McLaughlin leave the ambulance to do that; is that correct?
MR. NUTTALL: Correct.
MR. LALLY: But you weren't present for any of that, correct?
MR. NUTTALL: No.
MR. LALLY: So there is some period of time in the back of the ambulance and then 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 back of the patient compartment was myself, Firefighter Kelly and Firefighter Flematti with Firefighter McLaughlin driving Ambulance 1.
MR. LALLY: If I may have just one moment, Your Honor?
JUDGE CANNONE: Yes.
BY MR. LALLY:
MR. LALLY: And so when it comes to the report that we were -- 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: May I approach the witness, Your Honor?
JUDGE CANNONE: Yes.
BY MR. LALLY:
MR. LALLY: Sir, I'm showing you a document and ask you just to review that for a moment and look up when you're finished.
MR. NUTTALL: All right. (Witness complies.)
MR. LALLY: Do you recognize that, sir?
MR. NUTTALL: I do.
MR. LALLY: And what do you recognize that to be?
MR. NUTTALL: This is what I believe to be? This is what I believe to be the NFIRS report written by Captain Robery and the patient care report written by Firefighter Flematti.
MR. LALLY: Thank you, sir.
MR. LALLY: May I approach, Your Honor?
JUDGE CANNONE: Yes.
MR. LALLY: The Commonwealth would seek to introduce this as the next exhibit. I believe it's 160.
MS. MCLAUGHLIN: It's already premarked or --
COURT REPORTER: No. No.
MR. LALLY: It's not.
JUDGE CANNONE: Is there an objection?
MR. JACKSON: May I have just a moment, Your Honor?
JUDGE CANNONE: Okay.
MR. JACKSON: No objection, Your Honor.
JUDGE CANNONE: That will be marked, then, Madam Court Reporter, please.
(Whereupon, patient care report was entered and marked Exhibit No. 160 in Evidence.)
COURT REPORTER: No. 160.
MR. LALLY: Mr. Officer, if I could ask for the lights to be dimmed just a little? And, Ms. Gilman, if I could have what's been previously marked as Exhibit No. 9?
BY MR. LALLY:
MR. LALLY: Mr. Nuttall, just directing your attention up to the screen there and what's been previously marked as Exhibit No. 9, do you recognize what's depicted in that photograph?
MR. NUTTALL: I do.
MR. LALLY: And what do you recognize that to be?
MR. NUTTALL: I believe that to be 34 Fairview Road.
MR. LALLY: And is that a relatively fair and accurate portrayal of what it looked like around the time that you arrived there absent sort of lighting conditions and things of that nature?
MR. NUTTALL: Yes.
MR. LALLY: Ms. Gilman, if I could have Exhibit No. 18? May I approach the witness, Your Honor?
JUDGE CANNONE: Yes.
BY MR. LALLY:
MR. LALLY: Sir, there should be -- so basically that button on top there and point at that screen.
MR. NUTTALL: All right.
MR. LALLY: Now, if I could ask you, using that laser pointer before you -- well, first, let me ask, do you recognize what's up on the screen as Exhibit 18?
MR. NUTTALL: Yes. 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, do you see that area in this photograph?
MR. NUTTALL: I do.
MR. LALLY: And, if you could, using that laser point, just direct the jury's attention to where in this photograph you've seen that area?
MR. NUTTALL: I would say right around this general area. Right about here.
MR. LALLY: And, lastly, Ms. Gilman, if I could have Exhibit No. 14?
BY MR. LALLY:
MR. LALLY: And, again, sir, do you recognize what's up on the screen as Exhibit No. 14?
MR. NUTTALL: I do.
MR. LALLY: And what do you recognize that to be?
MR. NUTTALL: That I believe to be is 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: Okay. And if you could, again using that laser pointer, just direct the jury's attention to where in this photograph you observed that?
MR. NUTTALL: I'd say right around in this general area. In there.
MR. LALLY: Thank you, sir.
MR. LALLY: Mr. Officer, we can have the lights back up. Your Honor, 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: Cross-examination?
MR. JACKSON: Thank you, Your Honor.
CROSS-EXAMINATION BY MR. JACKSON:
MR. JACKSON: Good afternoon, Firefighter Nuttall.
MR. NUTTALL: Sir. How are you?
MR. JACKSON: You were coming -- I want to make sure I get the timing right. You were coming off nearly a 24-hour shift when you got the call?
MR. NUTTALL: No, sir. I was reporting for duty that morning.
MR. JACKSON: Just starting the shift when you got the call?
MR. NUTTALL: Correct.
MR. JACKSON: Understood. I want to ask one quick question that you mentioned just a couple of seconds ago under question by Mr. Lally. With regard to the clothing, the normal protocol for clothing that's removed from a patient --
MR. NUTTALL: Yes.
MR. JACKSON: -- you said it's oftentimes just sort of discarded onto the floor?
MR. NUTTALL: In terms of in the ambulance or at the hospital?
MR. JACKSON: Either one.
MR. NUTTALL: Yes.
MR. JACKSON: Okay. Both?
MR. NUTTALL: So typically, when we remove clothing 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 will do a quick roll just to check the back of the patient. And then he's usually rolled back if there is nothing found and that'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: It's like a pillow?
MR. NUTTALL: Yes. Exactly.
MR. JACKSON: Right.
MR. NUTTALL: It's a disaster. So typically those bigger jackets are just removed, and that is 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. You remove the big, heavy jacket.
MR. NUTTALL: Yes, sir.
MR. JACKSON: You discard it and got it away from the body so you could better assess the injuries?
MR. NUTTALL: Correct.
MR. JACKSON: 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 they 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?
MR. NUTTALL: In terms of removing the article of clothing?
MR. JACKSON: 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?
MR. NUTTALL: Correct.
MR. JACKSON: Okay. 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 if you'll 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 accidents can be very different than a drowning?
MR. NUTTALL: Exactly.
MR. JACKSON: Someone in this case exposed in a snowbank you're going to deal with or assess and note the weather, correct?
MR. NUTTALL: Uh-huh.
MR. JACKSON: Is that yes?
MR. NUTTALL: Yes.
MR. JACKSON: You're also going to note and assess the condition of a patient --
MR. NUTTALL: Correct.
MR. JACKSON: -- as it pertains to the weather?
MR. NUTTALL: Yes.
MR. JACKSON: So someone, for instance, that's in a snowbank, naked, no clothes on at all, is going to be a little different assessment than someone who is completely dressed for winter, correct?
MR. NUTTALL: The initial assessment, but every patient is going to be automatically circulation airway breathing.
MR. JACKSON: Understood.
MR. NUTTALL: We approached this individual the exact same way. We automatically went directly to cardiac.
MR. JACKSON: I guess what I'm asking is your attention is focused on some of those details for sure?
MR. NUTTALL: Correct.
MR. JACKSON: And that's how you remember that big, heavy coat that he was wearing, correct?
MR. NUTTALL: I remember he was properly dressed.
MR. JACKSON: 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.
MR. JACKSON: Your Honor, I'd like to mark two photographs as the next in order. These have not yet been marked. I believe it would be 160 --
JUDGE CANNONE: It doesn't matter so much the number. Why don't you just show the prosecutor the photos.
MR. JACKSON: One sixty-one and 162, in order. May I approach?
JUDGE CANNONE: Yes.
BY MR. JACKSON:
MR. JACKSON: Look at those. 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 yes.
MR. JACKSON: You do recognize them?
MR. NUTTALL: Yes.
MR. JACKSON: Does that appear to be what John O'Keefe was wearing when you found him?
MR. NUTTALL: I don't recall, sir, to be perfectly honest.
MR. JACKSON: May I approach, Your Honor?
JUDGE CANNONE: Yes.
BY MR. JACKSON:
MR. JACKSON: Do you recall this being part of -- let me ask it 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 these. This, what I'm holding in my hand, appears to be the front and back of a thin --
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 approach?
JUDGE CANNONE: Yes.
BY MR. JACKSON:
MR. JACKSON: Does that appear to be a thin, cotton hoodie?
MR. NUTTALL: Yes. That appears to be a thinner layer of clothing.
MR. JACKSON: May I approach?
JUDGE CANNONE: Yes.
BY MR. JACKSON:
MR. JACKSON: Not a heavy coat. Is that fair?
MR. NUTTALL: Fair.
MR. JACKSON: It's not a winter jacket?
MR. NUTTALL: Fair.
MR. JACKSON: Is it fair to say you had a lot on your mind when you were out at that scene, correct?
MR. NUTTALL: In terms of --
MR. JACKSON: Saving a man's life?
MR. NUTTALL: Correct.
MR. JACKSON: And your credentials are impressive. You were there, focused on one thing; and, that is, trying to make sure that a man did not die?
MR. NUTTALL: Correct.
MR. JACKSON: 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, you 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, you probably couldn't tell me, correct?
MR. NUTTALL: Outside of the three?
MR. JACKSON: Outside of the three.
MR. NUTTALL: Correct.
MR. JACKSON: 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, forties, Caucasian, female?
MR. NUTTALL: Correct.
MR. JACKSON: You said all three of them sort of looked alike, right?
MR. NUTTALL: 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 the patient care.
MR. JACKSON: Is it fair to say that 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 complete different?
MR. NUTTALL: Correct.
MR. JACKSON: 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, as you put it, you had a, quote, unquote, "much better" picture of what you were dealing with; is that right?
MR. NUTTALL: Correct.
MR. JACKSON: You testified 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; is that right?
MR. NUTTALL: Yes.
MR. JACKSON: Are you talking about the major trauma that 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 be pointing above your ear, right?
MR. NUTTALL: Correct. Yes.
MR. JACKSON: That's not where you're talking about?
MR. NUTTALL: To use my person, I would say right here (indicating). So more towards the right, above his right eye.
MR. JACKSON: Right of center but still on the front of his head?
MR. NUTTALL: Correct.
MR. JACKSON: 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 appeared to be scratches?
MR. NUTTALL: Yes.
MR. JACKSON: That's your word, not mine, correct?
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 they were abrasions?
MR. NUTTALL: Scratches and abrasions, in my point of view, seem to go hand in hand.
MR. JACKSON: But the word that you used was scratches?
MR. NUTTALL: Yes. They looked like furrows.
MR. JACKSON: Say that again?
MR. NUTTALL: Furrows, if you will, for lack of a better term. Just --
MR. JACKSON: I don't understand that word.
MR. NUTTALL: So if you remove something, you create a furrow in the skin.
MR. JACKSON: Yes. Furrows.
MR. NUTTALL: There you go. Yes. Sorry. Excuse my accent.
MR. JACKSON: No, no, no, no. I'm on your turf. It's my accent. I'm so sorry. Boy, that one -- there's going to be meme somewhere.
MR. NUTTALL: Hey, My Cousin Vinny.
MR. JACKSON: Yes. Got it. All right. So when you said "furrows," you made your hand in almost like a claw and dragged it against your right biceps?
MR. LALLY: Objection.
JUDGE CANNONE: Sustained.
BY MR. JACKSON:
MR. JACKSON: Can you repeat the movement that you did for the jurors when you said "furrows"?
MR. LALLY: Objection.
JUDGE CANNONE: Sustained. Let's move on to the next question.
BY MR. JACKSON:
MR. JACKSON: You would agree that a very common cause of a hematoma over one's eye is being hit or punched?
MR. NUTTALL: Correct.
MR. JACKSON: 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.
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 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 toward the right side --
MR. NUTTALL: Yes.
MR. JACKSON: -- over the right eye. Are those injuries that you've just described consistent or inconsistent with some sort of physical altercation?
MR. LALLY: Objection, Your Honor.
JUDGE CANNONE: Sustained. Next question, please.
BY MR. JACKSON:
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.
(Whereupon, there was a sidebar conference as follows:)
JUDGE CANNONE: What is the objection?
MR. LALLY: I don't know whether this witness has the basis of knowledge to document causality as it comes through injuries that he observed.
JUDGE CANNONE: So if you can build a foundation, you can do that. And don't ask for demonstrations or having him repeat something. It's only one time.
MR. JACKSON: I don't understand what the Court's issue is. If people didn't pay attention to it, then I --
JUDGE CANNONE: Are you pointing your finger at me?
MR. JACKSON: No. I'm pointing my finger at the jurors. If the jurors do not see what he did -- there is nothing argumentative about saying, what did you do? I want to make sure everybody saw what he did.
MR. LALLY: I'm not sure --
JUDGE CANNONE: They've seen it once.
MR. JACKSON: I don't know that they've seen it once.
JUDGE CANNONE: Well, that's --
MR. JACKSON: As a matter of fact, they did see it once.
JUDGE CANNONE: I was watching. It was good enough and it wasn't enough to respond to it with demonstrations.
MR. JACKSON: Fair enough. Your Honor, just to dovetail off of what Mr. Lally indicated, this witness testified that for about the first 30 minutes of his testimony about his extensive medical background. I feel like it's a waste of time, but I could ask him a few more questions about whether or not he's seen many fights before or the product of that.
JUDGE CANNONE: You can ask him about causation, as well.
MR. JACKSON: Okay. Fair enough.
(Whereupon, the sidebar conference concluded.)
BY MR. JACKSON:
MR. JACKSON: Thank you.
MR. NUTTALL: Yes, sir.
MR. JACKSON: In your experience as obviously a training firefighter, can you tell me again the word that you used?
MR. NUTTALL: Field training officer.
MR. JACKSON: Thank you. As a field training officer, have you seen in your experience the product or 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?
MR. NUTTALL: Yes.
MR. JACKSON: Injuries to the nose?
MR. NUTTALL: Yes, sir.
MR. JACKSON: To the ears?
MR. NUTTALL: Yes.
MR. JACKSON: To the eyes?
MR. NUTTALL: Yes.
MR. JACKSON: Defensive wounds on the hands?
MR. NUTTALL: Yes.
MR. JACKSON: Did you note the -- we've already talked about -- and I don't want to go over all this again. 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 is 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, for instance.
MR. JACKSON: Of course. I'm not asking you to the exclusion of everything else.
MR. NUTTALL: Yes.
MR. JACKSON: 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: Yes.
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 them?
MR. NUTTALL: Correct.
MR. JACKSON: The bruising may have been there --
MR. NUTTALL: It might have been there. It just wasn't observable, just due to the condition of his hands.
MR. JACKSON: You just may have overlooked it?
MR. NUTTALL: Yes.
MR. JACKSON: 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 asked with that responsibility, but you did not engage with her?
MR. NUTTALL: Correct.
MR. JACKSON: When I say "engage with her," you weren't standing there with her when she --
MR. NUTTALL: No. I was in the back of the ambulance.
MR. JACKSON: You claim to have heard the statement, "I hit him. I hit him."
MR. NUTTALL: Yes.
MR. JACKSON: Several times from the woman with the blood on her face?
MR. NUTTALL: Correct.
MR. JACKSON: You indicated that she was erratic?
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.
MR. JACKSON: Very upset?
MR. NUTTALL: 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 was obviously continuing on patient care, focusing on patient care.
MR. JACKSON: Did you hear her say, could I have 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 where 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 (as read), "Question: When you spoke to her and she said, I hit him, I hit him, were you with the other representative, sir, there at the time? Were there other people around you"? Do you remember being asked that question by a grand juror?
MR. NUTTALL: I don't recall.
MR. JACKSON: Do you remember answering (as read), "No. There were other people around me. I had Paramedic Flematti with me. I believe Firefighter Kelly was there, as well.
MR. NUTTALL: Correct. So the three of us were all providing patient care around Mr. O'Keefe.
MR. JACKSON: Okay. And you indicated that we were all there together. You were kneeling and you were doing the airway while -- you called him Tony?
MR. NUTTALL: Yes. Anthony. Tony.
MR. JACKSON: He was doing the CPR, correct?
MR. NUTTALL: 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 it, correct?
MR. NUTTALL: 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; is it?
MR. NUTTALL: I don't recall what I told Trooper Proctor.
MR. JACKSON: Let's start at the beginning. Do you recall having a conversation with Trooper Proctor on February 8th?
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?
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.
MR. NUTTALL: Okay.
MR. JACKSON: As a 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. And this is just a very quick information gathering strategy.
MR. JACKSON: But you'll agree that your testimony today has changed from what it was from your statement to Trooper Proctor on February 8th?
MR. NUTTALL: I don't know if I would so much say "change," sir. To be honest, I don't fully recall that meeting with Mr. Proctor.
MR. JACKSON: You don't -- I'm sorry?
MR. NUTTALL: I remember meeting with him. However, I don't fully remember what was discussed.
MR. JACKSON: So it's fair to say your memory is a little bit faulty as it pertains to that time frame?
MR. NUTTALL: Absolutely.
MR. JACKSON: 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.
MR. JACKSON: So the answer to that is, no, you did not?
MR. NUTTALL: No.
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 great that patient?
MR. NUTTALL: Correct.
MR. JACKSON: Once you got back to the station to take a breath, did you write any report?
MR. NUTTALL: I did not. No. I did not write a 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 of the injuries?
MR. NUTTALL: Not to my knowledge.
MR. JACKSON: Well, you would know if you wrote a report that said that?
MR. NUTTALL: Correct.
MR. JACKSON: And you did not?
MR. NUTTALL: I did not write the patient care report.
MR. JACKSON: At any time that day or any day subsequent thereto, did you contact the Canton Police Department, which were the first responders, and say --
MR. NUTTALL: I did not.
MR. JACKSON: 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 the 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?
MR. NUTTALL: Correct.
MR. JACKSON: And by the time we've come full circle to today, that statement has now pivoted?
MR. NUTTALL: In terms.
MR. JACKSON: You didn't hear it from -- you didn't overhear the person say it to a female now? She's talking directly to you now?
MR. NUTTALL: She spoke directly to me, yes.
MR. JACKSON: 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?
MR. NUTTALL: Yes.
MR. JACKSON: Probably daily?
MR. NUTTALL: Frequently.
MR. JACKSON: 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: Objection.
JUDGE CANNONE: He can have that. Have they?
MR. NUTTALL: Would you repeat the question for me, sir?
BY MR. JACKSON:
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 have changed. I've played them over in my head to the best of my ability, and I don't believe my story has swayed. If they've been enunciated incorrectly on my part, it wasn't intentional.
MR. JACKSON: Understood. And nobody is casting dispersions.
MR. NUTTALL: Yes.
MR. JACKSON: Memory is a funny thing. So your memory is as good about that as it is about that winter coat.
MR. NUTTALL: Yes, sir.
MR. JACKSON: Thanks. That's all I have.
JUDGE CANNONE: Mr. Lally?
MR. LALLY: Yes, Your Honor.
REDIRECT EXAMINATION BY MR. LALLY:
MR. LALLY: Mr. Nuttall, when it comes to you being asked about consistency of causality as far as different injuries that you observed on Mr. O'Keefe, correct?
MR. NUTTALL: Can you rephrase that for me?
MR. LALLY: Sure. Poorly phrased on my part. So you had been asked on cross-examination about some things that the injuries you observed on Mr. O'Keefe could be consistent with as far as having been the cause of those injuries, correct?
MR. NUTTALL: Correct.
MR. LALLY: How many sort of myriad of other causality or how many myriad of other sort 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 can 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 particular 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?
MR. NUTTALL: Sorry, sir. Could you rephrase that for me?
MR. LALLY: Sure. Let me withdraw that and move on to something else. Again, for clarity purposes, when -- you were asked about some statements that were attributed to you to Trooper Proctor during an interview, correct?
MR. NUTTALL: Correct.
MR. LALLY: Okay. And so with regard to what you recall differently, is it the statement that the person, the female with the blood on her face, made to you or the statement of the other female telling that person to be quiet?
MR. NUTTALL: 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 sort 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: Okay. And the other statement as far as the female with the blood on her face, and, again, that was the differentiating character between the three females that you observed there, correct?
MR. NUTTALL: Correct.
MR. LALLY: Okay. And your memory of that statement is, I hit him, I hit him, I hit him, correct?
MR. NUTTALL: Correct.
MR. LALLY: Nothing further.