8.Robert Costanzo — Direct/Cross/Redirect
191 linesMS. SPRAGUE: Commonwealth calls Robert Costanzo.
MR. REDDINGTON: May we approach the sidebar, please?
THE COURT: Sure, yeah.
THE COURT: All right. Good morning, sir.
ROBERT COSTANZO: Morning.
MS. SPRAGUE: If I may.
THE COURT: Yes, please.
MS. SPRAGUE: Thank you. Good morning. Can you please state and spell your name for the record?
ROBERT COSTANZO: It's Robert Costanzo, C-O-S-T-A-N-Z-O.
MS. SPRAGUE: And your date of birth, please?
ROBERT COSTANZO: 4/24/1985.
MS. SPRAGUE: Where do you work?
ROBERT COSTANZO: Pembroke Fire Department.
MS. SPRAGUE: And how long have you been a Pembroke firefighter?
ROBERT COSTANZO: I've been there since 2011.
MS. SPRAGUE: And are you also a paramedic?
ROBERT COSTANZO: I am.
MS. SPRAGUE: How long have you been a paramedic?
ROBERT COSTANZO: I've been with Pembroke since 2011, and I started in EMS in 2006.
MS. SPRAGUE: And have you done all the training and certification required to be a paramedic?
ROBERT COSTANZO: Yes.
MS. SPRAGUE: I wanna direct your attention to January 24th, 2023. Were you working that day?
ROBERT COSTANZO: Yes, I was.
MS. SPRAGUE: And were you working an overtime shift that day?
ROBERT COSTANZO: Yes.
MS. SPRAGUE: What was your role on that shift?
ROBERT COSTANZO: I was assigned to the ambulance.
MS. SPRAGUE: And at some point after 6:00 PM that day, was there a call put out by Duxbury Fire Department for mutual aid?
ROBERT COSTANZO: Yes.
MS. SPRAGUE: And being members of the Pembroke Fire Department, did you respond to that request for mutual aid?
ROBERT COSTANZO: Yes, we did.
MS. SPRAGUE: Who responded?
ROBERT COSTANZO: It was me and my partner.
MS. SPRAGUE: Who was your partner?
ROBERT COSTANZO: Dan Smith.
MS. SPRAGUE: And did you go in an ambulance or some type of engine?
ROBERT COSTANZO: An ambulance.
MS. SPRAGUE: Okay. And did you respond to the area of 47 Summer Street?
ROBERT COSTANZO: Yes, we did.
MS. SPRAGUE: And approximately how long did it take you to get there?
ROBERT COSTANZO: Between five and eight minutes.
MS. SPRAGUE: When you arrived, what did you see?
ROBERT COSTANZO: There were multiple pieces of equipment, other ambulances, police cars.
MS. SPRAGUE: When you arrived, were you directed to the backyard?
ROBERT COSTANZO: Yes.
MS. SPRAGUE: And did you see a patient there in the backyard?
ROBERT COSTANZO: Yes, we did.
MS. SPRAGUE: And where was she located?
ROBERT COSTANZO: She was on the ground with a Duxbury firefighter. She was already C-spined on a long board with a collar. She was unresponsive, but breathing on the ground.
MS. SPRAGUE: And did you learn her name was Lindsay Clancy?
ROBERT COSTANZO: Yes.
MS. SPRAGUE: And when you say she was already on a board with a C-spine, what type of equipment are we talking about? And if you could just explain to the jurors.
ROBERT COSTANZO: So it's just a long, flat board that we use to secure people when there's a possible spinal injury, and she already had the collar on her neck. They had already started treatment prior to our arrival, so they had her all secured to the long backboard with the collar applied.
MS. SPRAGUE: And did you notice anything about her wrists at that time?
ROBERT COSTANZO: Yes, her wrists were bandaged previously, assuming some kind of injury. There was no active bleeding or anything through the bandage. It was just ... But her wrists were bandaged.
MS. SPRAGUE: Was it white bandaging?
ROBERT COSTANZO: Yes.
MS. SPRAGUE: And so nothing was seeping through to your eye? Did you see anything on her neck area?
ROBERT COSTANZO: She had some superficial lacerations that we could see around the collar. But we don't typically remove equipment after it's already been placed. So I didn't investigate any further than that. There was no active bleeding that I could see, so we just left it alone.
MS. SPRAGUE: So there was, even with the collar, there was nothing- no blood flowing out of the collar or pooling around her or anything like that?
ROBERT COSTANZO: Correct.
MS. SPRAGUE: Was she breathing?
ROBERT COSTANZO: She was.
MS. SPRAGUE: Was she responsive?
MS. SPRAGUE: Was she making any noise at all?
ROBERT COSTANZO: She was moaning and groaning, but no, no words, no verbal response.
MS. SPRAGUE: Did you bring her to your ambulance?
ROBERT COSTANZO: Yes, we did.
MS. SPRAGUE: And when you got to the ambulance, what was your role?
ROBERT COSTANZO: I was the tech in charge. So we did as much of an assessment as we could without removing her from the board to look for any further injuries. Other than the injuries that the Duxbury Fire Department had already found, we didn't find any further injuries. And then we continued with treatment, vital signs and such.
MS. SPRAGUE: When you did the assessment, did you look at her head?
ROBERT COSTANZO: Yes.
MS. SPRAGUE: Were there any cuts or bumps or dents that you noticed in her head?
ROBERT COSTANZO: Not that we noticed, no.
MS. SPRAGUE: What about her arms other than the bandaging on her wrist? Were there any cuts, obvious broken bones or injuries to her arms or her hands?
ROBERT COSTANZO: No obvious broken bones or anything, no.
MS. SPRAGUE: And you said you were the tech. What does that mean?
ROBERT COSTANZO: I was the medic that was in charge.
ROBERT COSTANZO: It's medic that's in charge, or you're the medic in charge.
MS. SPRAGUE: Okay.
ROBERT COSTANZO: So I was the medic in charge.
MS. SPRAGUE: And was anyone else in the back of the ambulance with you treating Ms. Clancy?
ROBERT COSTANZO: Yes, my partner, Dan Smith.
MS. SPRAGUE: Who was driving the ambulance, if you recall?
ROBERT COSTANZO: It was our deputy chief, Jim Shea.
MS. SPRAGUE: And do you recall which hospital you went to?
ROBERT COSTANZO: South Shore Hospital.
MS. SPRAGUE: While you're... Well, let me ask you, how long approximately did it take you to get from 47 Summer Street in Duxbury to South Shore Hospital?
ROBERT COSTANZO: It's typically about— From Pembroke, it would be about 15 minutes, so it would be a little bit longer than that. I'm not sure of the exact time, so probably maybe 18 minutes.
MS. SPRAGUE: Okay. And while you're in that transport, in the back of the ambulance, after you've done this examination of Lindsay Clancy to see if there are any other injuries, what do you do next?
ROBERT COSTANZO: So we would start treatment. So we started, put in two IVs as a precaution, and any other treatment that was needed. So we noticed that her pupils were constricted, and she was unresponsive, so we treated for a potential opioid, opioid overdose. We gave two milligrams of Narcan, and she seemed to become a little bit more agitated, reaching, trying to grab, reaching out with her arms. But no, no verbal communication. She never, like, fully woke up.
MS. SPRAGUE: And have you given Narcan to individuals in the past in your role as a paramedic?
ROBERT COSTANZO: Yes, I have.
MS. SPRAGUE: What is the typical reaction when you give a patient Narcan?
ROBERT COSTANZO: It depends on the drug that they took or the amount of drugs that they took, but depending on what they take, they usually... Their respirations will go up. Their pupils will get a little bigger. Sometimes they fully wake up.
THE COURT: Do we know whom they, who they are? Who is he referring to?
ROBERT COSTANZO: The patient.
MS. SPRAGUE: And you were referring to patients that you've dealt with in the past in your role as a paramedic, is that correct?
ROBERT COSTANZO: That's correct, yes.
MS. SPRAGUE: Okay. And so they would often wake up when given Narcan?
ROBERT COSTANZO: Yes.
MS. SPRAGUE: Okay. And what type of drugs, based on your training experience, does Narcan work on?
ROBERT COSTANZO: We're trained to use it for opioid overdoses, so heroin, fentanyl, other drugs like that.
MS. SPRAGUE: Okay. And does Narcan typically work on benzodiazepine?
ROBERT COSTANZO: We are not trained to use it for any other, anything other than opioids.
MS. SPRAGUE: Okay. And when you gave Lindsay Clancy the Narcan, she did not wake up, correct?
MS. SPRAGUE: Did you provide any other care to Lindsay Clancy on the way to the hospital?
ROBERT COSTANZO: Just continued to monitor vitals and make sure there was no decline.
MS. SPRAGUE: And once you arrived at the hospital, did you transfer her care to the hospital staff?
ROBERT COSTANZO: Yes, we did.
MS. SPRAGUE: No other questions.
MR. REDDINGTON: All right. So you're not trained in Narcan on benzodiazepines, is that correct?
ROBERT COSTANZO: Yeah, we don't give it for benzodiazepines.
MR. REDDINGTON: Right. And in any event, when you gave Narcan to the body that was laying on the ground, she had already been wrapped up on her wrist, right?
ROBERT COSTANZO: That's correct.
MR. REDDINGTON: Already been wrapped up, had the thing on the neck to prevent the head from moving, right?
ROBERT COSTANZO: That's correct.
MR. REDDINGTON: And also had bandages perhaps on her neck area, I'm not sure.
ROBERT COSTANZO: There were no bandages that I could see—
MR. REDDINGTON: Just the collar thing.
ROBERT COSTANZO: 'Cause the collar blocks, yeah, some, most of it. I could see there are some holes in the collar that we could see some superficial lacerations through.
MR. REDDINGTON: Right.
ROBERT COSTANZO: But there was no active bleeding. Her wrists were already bandaged, so we don't take the bandages off after they're on.
MR. REDDINGTON: Okay.
ROBERT COSTANZO: And there was no blood screws.
MR. REDDINGTON: Good. I ask the questions, you can answer them, okay?
ROBERT COSTANZO: Okay.
MR. REDDINGTON: Narcan administered to Lindsay Clancy on the ground, yes?
ROBERT COSTANZO: In the ambulance, but yes.
MR. REDDINGTON: And there was no reaction. It didn't have any effect on her, right?
ROBERT COSTANZO: She appeared to become a little bit more... She started, like, reaching and grabbing a little bit more than she was before.
MR. REDDINGTON: That's consistent as well with a person who's had a head injury, right?
ROBERT COSTANZO: Could be.
MR. REDDINGTON: Yeah. So in any event, the Narcan that you're trained would be dealing with opioids, right?
ROBERT COSTANZO: Yes, that's correct.
MR. REDDINGTON: Now, did you know, sir, at all that she suffered a burst fracture of her cervical spine? Did you know that, sir?
MR. REDDINGTON: T5 through T6, T4, 6, 7, 8, all exploded, fractured. Did you know that?
MR. REDDINGTON: Did you know that there was hemorrhaging into her body, that she fractured every rib in her body?
MR. REDDINGTON: It was pretty dark out there, wasn't it?
ROBERT COSTANZO: It was.
MR. REDDINGTON: Did you obviously administer aid to her? Did you also have, like, a flashlight on your head? Were you holding a flashlight, or what?
ROBERT COSTANZO: She was already packaged. She was already on the long board and everything, so we picked her up, put her on the stretcher, and moved out of the backyard into the ambulance.
MR. REDDINGTON: All right. So how long did you handle, if you will, her while she was laying there?
ROBERT COSTANZO: On scene? We were only on scene for, I think it was seven minutes, I think, total on scene, from the time that we-
MR. REDDINGTON: Fairly chaotic?
ROBERT COSTANZO: Yes.
MR. REDDINGTON: And it was dark in the backyard, right?
ROBERT COSTANZO: Yes.
MR. REDDINGTON: There was no exterior lighting, no, no nothing on the house that was lit up, like spotlights or anything, right?
ROBERT COSTANZO: That's correct.
MR. REDDINGTON: No flashlights, right?
MR. REDDINGTON: And you scrutinized a hole in the thing that goes around the neck when someone has a head injury, especially a cervical injury, thoracic injuries. You scrutinized a hole that noted that there was a superficial wound to her neck?
ROBERT COSTANZO: That's all we could see through the side of the collar.
MR. REDDINGTON: Who's we?
ROBERT COSTANZO: Me and my partner.
MR. REDDINGTON: Was your partner scrutinizing the hole as well?
ROBERT COSTANZO: The hole? I don't un-
MR. REDDINGTON: You said there's a hole in the neck, in the thing that goes around the neck.
ROBERT COSTANZO: Yeah, there's holes in the collar that you can see through.
MR. REDDINGTON: Right. And you were scrutinizing. You were looking through it, right?
ROBERT COSTANZO: Yeah.
MR. REDDINGTON: You just told the jury, sir-
ROBERT COSTANZO: Yes.
MR. REDDINGTON: ... superficial cut on the neck, right?
ROBERT COSTANZO: Yes.
MR. REDDINGTON: Did your partner look through the hole as well? And you've talked about your testimony with the district attorneys in the past, haven't you?
ROBERT COSTANZO: Yes.
MR. REDDINGTON: One of the things that they asked you is whether or not it appeared as though the injuries to her neck or wrist were superficial. Isn't that right?
ROBERT COSTANZO: Yes.
MR. REDDINGTON: And other than looking through the little hole in the thing around her neck in the dark, you didn't see her neck after that was removed, did you?
MR. REDDINGTON: That's all I have.
THE COURT: Commonwealth redirect.
MS. SPRAGUE: Sir, after the seven minutes that you were in the dark backyard, you were then in an ambulance for 18 minutes with the patient, correct?
ROBERT COSTANZO: That's correct.
MS. SPRAGUE: And there's lighting in the ambulance, correct?
ROBERT COSTANZO: There is.
MS. SPRAGUE: During those 18 minutes in the well-lit ambulance, did you ever see blood seeping through the bandages on her wrists?
MS. SPRAGUE: During those 18 minutes in the well-lit ambulance, did you ever see blood pooling around her neck or flowing from the neck?
MS. SPRAGUE: Thank you.
THE COURT: All right. Anything further?
THE COURT: Thank you, sir. You may sit down. Thank you. Watch your step, please, sir.