to light; evidenced no palpable pulse; and had a few chest sounds which were thought to be heart beats.195 On the basis of these findings, Dr. Carrico concluded that President Kennedy was still alive.196

Dr. Carrico noted two wounds: a small bullet wound in the front lower neck, and an extensive wound in the President's head where a sizable portion of the skull was missing.197 He observed shredded brain tissue and "considerable slow oozing" from the latter wound, followed by "more profuse bleeding" after some circulation was established.198 Dr. Carrico felt the President's back and determined that there was no large wound there which would be an immediate threat to life.199 Observing the serious problems presented by the head wound and inadequate respiration, Dr. Carrico directed his attention to improving the President's breathing.200 He noted contusions, hematoma to the right of the larynx, which was deviated slightly to the left, and also ragged tissue which indicated a tracheal injury.201 Dr. Carrico inserted a cuffed endotracheal tube past the injury, inflated the cuff, and connected it to a Bennett machine to assist in respiration.202

At that point, direction of the President's treatment was undertaken by Dr. Malcolm O. Perry, who arrived at trauma room 1 a few moments after the President.203 Dr. Perry noted the President's back brace as he felt for a femoral pulse, which he did not find.0204 Observing that an effective airway had to be established if treatment was to be effective, Dr. Perry performed a tracheotomy, which required 3 to 5 minutes.205 While Dr. Perry was performing the tracheotomy, Drs. Carrico and Ronald Jones made cutdowns on the President's right leg and left arm, respectively, to infuse blood and fluids into the circulatory system.206 Dr. Carrico treated the President's known ad-renal insufficiency by administering hydrocortisone.207 Dr. Robert N. McClelland entered at that point and assisted Dr. Perry with the tracheotomy.208

Dr. Fouad Bashour, chief of cardiology, Dr. M. T. Jenkins, chief of anesthesiology, and Dr. A. H. Giesecke, Jr., then joined in the effort to revive the President.0209 When Dr. Perry noted free air and blood in the President's chest cavity, he asked that chest tubes be inserted to allow for drainage of blood and air. Drs. Paul C. Peters and Charles R. Baxter initiated these procedures.210 As a result of the infusion of liquids through the cutdowns, the cardiac massage, and the airway, the doctors were able to maintain peripheral circulation as monitored at the neck (carotid) artery and at the wrist (radial) pulse. A femoral pulse was also detected in the President's leg.211 While these medical efforts were in progress, Dr. Clark noted some electrical activity on the cardiotachyscope attached to monitor the President's heart responses.212 Dr. Clark, who most closely observed the head wound, described a large, gaping wound in the right rear part of the head, with substantial damage and exposure of brain tissue, and a considerable loss of blood.213 Dr. Clark did not see any other hole or wound on the President's head. According to Dr. Clark,