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In emergency medicine the golden hour is the first sixty minutes after an accident or the onset of acute illness. The victim's chances of survival are greatest if he or she can be in the operating room within the Golden Hour.
Origins
The concept of the "golden hour" comes from U.S. military wartime experience, particularly in the Vietnam War. In cases of severe trauma, especially internal bleeding, nothing can replace surgery. In addition, medical complications such as shock may occur if the patient is not managed appropriately and expeditiously. It is therefore necessary to transport victims as fast as possible to specialists who are most often found at a hospital trauma center. Because some injuries can cause a trauma victim to decompensate extremely rapidly, the lag time between injury and treatment should ideally be kept to a bare minimum; over time, this lag time was further clarified to a now-standard time frame of no more than 60 minutes, after which time the survival rate for traumatic patients tends to fall off dramatically.
The late Dr. R Adams Cowley is credited with promoting this concept first as a military surgeon and later as head of the University of Maryland Shock Trauma Center. See Lerner and Moscati (2001), and [http://www.umm.edu/shocktrauma/history.html.
While the Golden Hour remains a useful tool in teaching emergency medical services providers the importance of low scene times and rapid transport, recent studies throw the concept into question. The concept was never based on any type of scientific evidence; it was instead an abitrary time given by a single surgeon in the early days of EMS. The "Golden Hour" was never tested until recently, when studies showed that there was indeed a very weak correlation between time into surgery and mortality from trauma. The studies did not, however, find any "magical time" or find any evidence to suggest that the Golden Hour is anything but a myth.
Basics
Prehospital care
Prehospital care is limited to the minimum, i.e.
- A.B.C (airway, breathing, circulation)
- cover wounds
- realign ("reduce") broken limbs
- protect the spine.
Inserting an intravenous drip must be fast and not delay transportation.
Endotracheal intubation is the only act that may delay the transportation. This prehospital strategy is also called scoop and run (also referred to as load and go or swoop and scoop; the latter reference is most often used by helicopter paramedic teams), as opposed to the stay and play that is more adapted to less severe cases (when there is no severe trauma, the trauma caused by the transportation itself is more important than the gain of time).
MEDEVAC helicopters are often used to move victims to a trauma center within the golden hour.
Hospital selection
The ambulance must transport the victim to the hospital with the facilities to treat the patient. This is not always the closest hospital, as the closest hospital may lack the facilities or may be overwhelmed by other victims from the same incident (see also triage).
Limited examination
Third point, only limited examination in the emergency department. If there is no evidence for surgical intervention, only three radiographs should be performed: cervical spine, chest and pelvis.
Summary
As noted on the University of Maryland Shock Trauma Center's website, "(g)radually, the "Golden Hour" theory was emerging based on the importance of speed as well as skill in operating procedures. As (Dr. Cowley) explained in an interview: "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."
The Golden Hour can be summarized by the 3R rule* of Dr. Donald Trunkey, an academic trauma surgeon. It involves:
- getting the right patient
- to the right place
- at the right time
The Discovery Health Channel series The Critical Hour is a documentary-style reality TV program focusing on traumatic injuries and the difference the Golden Hour concept can make in saving lives; among the hospital settings regularly featured on the show is the University of Maryland Shock Trauma Center.
See also
Reference
- Lerner EB, Moscati, RM. The Golden Hour: Scientific Fact or Medical "Urban Legend"? Academic Emergency Medicine Volume 8, Number 7, Pages 758-760, 2001.
"Golden hour (medicine)"