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07 June 2011

The Golden Hour

In emergency medicine, the golden hour refers to a period following traumatic injury being sustained by a casualty during which there prompt medical treatment will prevent death.

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In emergency medicine, the golden hour refers to a time period lasting from a few minutes to several hours following traumatic injury being sustained by a casualty, during which there is the highest likelihood that prompt medical treatment will prevent death.

It is well established that the victim’s chances of survival are greatest if they receive care within a short period of time after a severe injury. Some have come to use the term to refer to the core principle of rapid intervention in trauma cases, rather than the narrow meaning of a critical one-hour time period.

Cases of severe trauma, especially internal bleeding, surgical intervention is required. Complications such as shock may occur if the patient is not managed appropriately and expeditiously. It therefore becomes a priority to transport patients suffering from severe trauma as fast as possible to specialists, most often found at a hospital trauma centre, for definitive treatment, and this is where the Medical Helicopter service becomes vital.

Because some injuries can cause a trauma patient to deteriorate extremely rapidly, the lag time between injury and treatment should ideally be kept to a bare minimum; over time, this lag time has come to be specified as a now-standard time frame of no more than 60 minutes, after which time the survival rate for traumatic patients is alleged to fall off dramatically.

What is the Golden Hour?

 Los Angeles Paramedic and second amendment author John Longenecker describes The Golden Hour as “a statistical inference which shows that the patient’s ultimate outcome is directly proportional to what is done for them immediately”.

This is impacted for the better by lay education for intervention outside the clinical setting and reach of professionals. These are called Out of Hospital events. Cases such as choking [the so-called cafe coronary], cases of bleeding, cardiac arrest and even early recognition of a medical emergency have proven to turn outcomes for the better.

Outcomes are not always measured entirely in terms of survival, Longenecker points out, but in terms of quality of life, length of hospital stay, cost [to patient or society], occupation of medical assets, general recovery and facility versus deficit, and other parameters defining general improvement, knowledge and quality of care.

Longenecker mentions The Golden Hour as aided by immediate lay intervention while it still counts versus that precise window of opportunity lost awaiting assets, and compares the concept of lay care in the absence of first responders.

 The term “Golden Hour” originates from the late Dr R Adams Cowley. who is credited with promoting this concept, first in his capacity as a military surgeon and later as head of the University of Maryland Shock Trauma Center. The concept of the “Golden Hour” may have been derived from French military World War I data.

The R Adams Cowley Shock Trauma Center section of the University of Maryland Medical Center’s website quotes Cowley as saying, “There is a golden hour between life and death.

If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later — but something has happened in your body that is irreparable. ”

(Press release, June 2011)

Visit Helivac here.

 
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