Did you try to clear the room of unnecessary people?
Dr. PERRY. This was done, not by me, but by the nurse supervisor, I assume, but several of the people were asked to leave the room. Generally, this is not necessary. In an instance such as this, it is a little more difficult, as you can understand.

Mr. Dulles.

Yes.
Dr. PERRY. But this care of an acutely injured and acutely injured patients goes on quite rapidly. Over 90,000 a year go through that emergency room, and, as a result, people are well trained in the performance of their duties. There is generally no problem in asking anyone lo leave the room because everyone is quite busy and they know what they have to do and are proceeding to do it.

Mr. Dulles.

Thank you very much.

Mr. Specter.

Upon your arrival in the room, where President Kennedy was situated, what did you observe as to his condition?
Dr. PERRY. At the time I entered the door, Dr. Carrico was attending him. He was attaching the Bennett apparatus to an endotracheal tube in place to assist his respiration.
The President was lying supine on the carriage, underneath the overhead lamp. His shirt, coat, had been removed. There was a sheet over his lower extremities and the lower portion of his trunk. He was unresponsive. There was no evidence of voluntary motion. His eyes were open, deviated up and outward, and the pupils were dilated and fixed.
I did not detect a heart beat and was told there was no blood pressure obtainable.
He was, however, having ineffective spasmodic respiratory efforts.
There was blood on the carriage.

Mr. Dulles.

What does that mean to the amateur, to the unprofessional?
Dr. PERRY. Short, rather jerky contractions of his chest and diaphragm, pulling for air.

Mr. Dulles.

I see.

Mr. Specter.

Were those respiratory efforts on his part alone or was he being aided in his breathing at that tame?
Dr. PERRY. He had just attached the machine and at this point it was not turned on. He was attempting to breathe.

Mr. Specter.

So that those efforts were being made at that juncture at least without mechanical aid?
Dr. PERRY. Those were spontaneous efforts on the part of the President.

Mr. Specter.

Will you continue, then, Dr. Perry, as to what you observed of his condition?
Dr. PERRY. Yes, there was blood noted on the carriage and a large avulsive wound on the right posterior cranium.
I cannot state the size, I did not examine it at all. I just noted the presence of lacerated brain tissue. In the lower part of the neck below the Adams apple was a small, roughly circular wound of perhaps 5 mm. in diameter from which blood was exuding slowly.
I did not see any other wounds.
I examined the chest briefly, and from the anterior portion did not see any thing.
I pushed up the brace on the left side very briefly to feel for his femoral pulse, but did not obtain any.
I did no further examination because it was obvious that if any treatment were to be carried out with any success a secure effective airway must be obtained immediately.
I asked Dr. Carrico if the wound on the neck was actually a wound or had he begun a tracheotomy and he replied in the negative, that it was a wound, and at that point--

Mr. Dulles.

I am a little confused, I thought Dr. Carrico was absent. That was an earlier period.
Dr. PERRY. No, sir; he was present.

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