Historic Trauma Cases: JFK

Fifty years ago this month, on Nov. 22, 1963, John Fitzgerald Kennedy (JFK), the 35th President of the United States, was assassinated at the age of 46.

Kennedy was a charismatic politician, a military hero, a former congressman and senator and the father of a six-year-old daughter, Caroline, and a three-year-old son, John-John, at the time.

As President, Kennedy created the Peace Corps, negotiated the Nuclear Test Ban Treaty with the former Soviet Union, instituted the race for the moon and helped move the country forward as the Civil Rights Movement took shape.

Jack Kennedy was born May 29, 1917, in Brookline, Mass., an affluent suburb of Boston.

He was the second of nine children of Rose Kennedy and her husband and Kennedy family patriarch, Joseph Kennedy, Sr., a powerful businessman and self-made millionaire who served as U.S. Ambassador to England for President Franklin D. Roosevelt.

A would-be college history professor who enjoyed unexpected success as an author on international politics while still a college student, Kennedy entered politics at the behest of his father following the death of his older brother Joe, a pilot whose plane exploded shortly after taking off on a bombing mission over Germany during World War II.

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At age 29, JFK became the junior congressman from Massachusetts, winning a seat in U.S. House of Representatives, and soon after ran for the Senate and won despite impossible odds.

In 1960, he ran for the U.S. Presidency and won by one of the slimmest margins in history over Republican rival Richard M. Nixon. He became the youngest president to enter the Oval Office in January 1961.

1963 had started out as a good year for JFK whose popularity was at its highest after successfully averting nuclear war with Russia during the Cuban Missile Crisis. But it would turn sorrowful in August when Jacqueline Kennedy delivered the couple’s third child prematurely. Patrick Kennedy passed away three days later due to pulmonary complications that caused his heart to stop beating.

Both the President and First Lady were devastated and it was hoped that the beginning of his re-election campaign would distract the president from his grief.

November 22, 1963

At 12:30 p.m., shots rang out in Dealy Plaza in downtown Dallas.

At 12:33 p.m., the phone rang in Parkland Hospital’s emergency staff were informed that the police dispatcher had just called with the message the president had been shot and was enroute to the hospital.

Two trauma rooms were set up for the president who arrived at 12:35 p.m.

The Presidential limo pulled right up to the door of the Parkland ED. JFK was laying half on the floor and half on the back seat with Mrs. Kennedy and Secret Service agents lying over top of him. He had arrived within approximately five minutes of sustaining his injury.

There was blood was noted to be all over the back seat of the car, and on Mrs. Kennedy who had held her husband’s head on her lap.

JFK was placed on a stretcher and rushed into trauma room No. 1 where his clothes were cut off.

Triage & Surgery

Initial assessment revealed that the president’s color to be bluish to ashen, he had slow voluntary movement, his eyes were open and his pupils were fixed and dilated.

He had no palpable pulse and there were only a few chest sounds audible by stethoscope that the staff thought were heartbeats. It was noted that he had a small bullet wound in the front lower neck and a large, gaping head wound.

A tracheal incision was made on either side of the neck wound so a surgical airway could be secured. Bilateral chest tubes were inserted but there did not appear to be a tension or hemothorax on either side. Large-bore IVs were inserted and IV fluids were infused.

Due to the amount of blood that he had lost, it was decided to transfuse the president. Mrs. Kennedy was asked if she knew her husband’s blood type but she was unable to recall it at that point in time. The Secret Service agent who had this information had been placed in the outside parking lot to guard the facility and was not aware that this information was needed.

Since no one was sure of his blood type, JFK was typed and crossed. Due to his history of having Addison’s disease, JFK was also given a shot of cortisone by a Navy physician who was accompanying him on the trip.

The OR was called and told to set up for an emergency craniotomy. Within minutes there were four general surgeons, four anesthesiologists, a neurologist, a neurosurgeon, an oral surgeon, a heart specialist and an urologist in the room working on the president.

In the end, they all agreed that there was nothing they could do, and so with his wife Jacqueline in the room, JFK was pronounced dead at 1 p.m. Central Time.

Texas Governor, John Connelly, had also been wounded during the assassination attempt by a bullet that passed through his thigh. His injury was no life-threatening, but the trajectory of the bullet would feed a conspiracy theory that there was more than one shooter as depicted in the movie “JFK.” It is one of many theories about what really happened that day in Dallas.

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The Autopsy

At 1:58 p.m., the physicians were still awaiting word on jurisdiction when the Secret Service with Mrs. Kennedy’s permission made the decision to remove his body from ED and return to Washington, D.C. JFK was taken to Loveland Air Force Base and placed on Air Force One. It was there before take-off that LBJ was sworn in as President.

JFK’s body was taken to Bethesda Naval Hospital in Maryland.
Entire books have been written concerning the way that the autopsy and documentation of post-mortem events occurred. All of these missteps further compounded the other confusing issues of this assassination. Some of the more controversial issues are listed below:

There was no bullet tracking procedure performed due to orders from high-ranking officials. A bullet tracking procedure follows the path of a bullet and is considered one of the basic steps in an autopsy when death occurs due to a gunshot wound (GSW).
The notes and films taken during this historic homicide investigation (the Parkland Hospital records, the autopsy records, X-rays, etc.) were burned immediately after the autopsy and thus never reviewed.

Because of the destruction of the medical records, controversy continues to surround JFK’s death.
The autopsy results which were released through the investigation indicated two bullets. This would be the basis of the Warren Commission Report.

The fatal missile entered the skull above and to the right of the external occipital protuberance. The second missile entered the right superior posterior thorax above the scapula and traversed the soft tissues of the right side of the neck and produced contusions of the right lung.

There was no mention of the bullet in the neck because the autopsy staff believed it was a wound made when the tracheotomy was done.

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If it Happened Today

Would JFK have lived if he sustained his injuries today?

The majority of medical experts agree that the outcome would be the same today as it was 50 years ago. The bullet that entered JFK’s skull produced a lethal injury.

As a result of JFK’s assassination, a coordinated government effort took place to provide the president with the highest level of healthcare available.

Whenever the president, vice president or other high-ranking government officials travel, there are healthcare teams who travel with them. These teams contain nurses and physicians whose sole function is to provide render care should an injury or illness occur.

There are also designated hospitals along each travel route that have been screened for security and prepared for the chance that they could have to care for a high profile patient.

Another question frequently asked is whether the care that JFK received in 1963 would differ that much today. The answer is that probably nothing would be done differently today. He arrived at the hospital with fixed and dilated pupils and a large gaping head wound. His pulse stopped within seconds of his arrival

.If the same scenario occurred today he would not need a CT scan, an MRI, an intracranial pressure monitor or an operating room (unless he was an organ donor and they needed to harvest his organs).

Controversy Continues

Debate surrounding JFK’s death continues and likely will for generations to come. The lack of documentation and miscommunication that occurred baffles those in healthcare today.

The lack of evidence collected the destruction of evidence and the refusal of key staff to record their involvement in a case that had worldwide ramifications is difficult to understand today.

This did not mean that staff had refused to talk to the media, but the fact that so few documented their findings in an appropriate official and legal venue due to being told to never discuss the case due to “national security” has just created even more confusion and misinformation.

If there was a case of this magnitude today, the medical records would have been meticulously written, would be considered legal evidence and would not be destroyed. The autopsy would be done in the jurisdiction where the homicide took place and there would be a bullet tracking procedure done. Topic of organ procurement would also need to be addressed.

The lessons learned over the past 50 years will never ease the grief that the Kennedy family or the nation felt, but hopefully history will never be repeated

Resources for this article are accessible here.

Cynthia Blank-Reid is a trauma clinical nurse specialist in Philadelphia.

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