Talk:Golden hour (medicine)
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[edit] Criticisms of the Golden Hour
The golden hour is not a universally accepted medical concept, perhaps we should have a section where its pros and cons are discussed? I'm not fully au-fait with the literature as it currently stands, but maybe someone who is should have a look? --John24601 20:31, 5 January 2006 (UTC)
[edit] Two cites
The two citations at the end of the article, is there some linkage we can provide? Merely referencing the studies in question, without giving the reader the opportunity to go to them and draw their own conclusions is akin to giving a hungry man a picture of food.
I, for one, am not married to the Golden Hour as a standard, and would welcome some rigorous investigation of the appropriateness of the load-and-go or stay-and-play methodologies for pre-hospital care, esp. of trauma patients. I am going to add a note to the effect that the "Golden Hour" concept is well-documented in cases of thrombosis-induced CVA, though it is three hours, not one, unless someone can convince me otherwise.
- References don't have to be to online sources, but they have to exist. Dan100 (Talk) 13:54, 11 June 2007 (UTC)
[edit] POV issues
As written right now, the article is focused largely on saying that the "golden hour" is wrong. Certainly, it has come into question recently, but we can't just blanketly say that it is wrong. This is a violation of NPOV. This article will have to be cleaned up so that both supporters and skeptics of the "golden hour" concept can read it and think that the concept is treated fairly. --Hnsampat 17:42, 22 June 2007 (UTC)
- On the other hand, this is the era of evidence based medicine and many medical dogmas or myths have been debunked in the medical literature. If there's no high quality evidence to support the existance of the so-called golden hour, the absence of any such evidence in the article can hardly be said to be a POV problem. MoodyGroove 17:52, 22 June 2007 (UTC)MoodyGroove
Yes, but we're not supposed to be drawing conclusions for the reader. We just state the facts as they are. This article is talking about how the golden hour is a "myth" and how it's "wrong." The golden hour has been called into question recently, but it hasn't been "disproven." This article should discuss the controversy, but it shouldn't take sides on the issue. Right now, it's clearly taking a side. --Hnsampat 18:00, 22 June 2007 (UTC)
- I agree there were some minor POV problems. For example, the lede was rephrased to say the golden hour "was" considered the first 60 minutes of a trauma emergency (it still is). It's also widely believed that the golden hour is valid (it just has no high quality evidence). It's also fair to point out that Dr. Bledsoe is an outspoken critic of the golden hour and other EMS "myths" (and he is). But the fact is that we are in a new era of modern medicine,. As such, the Wikipedia should side with the prevailing evidence. That's not making the mind up for the reader, unless you believe we should present both sides of blood letting, for example, and let the reader decide. Scientific articles are different from political articles, in my opinion. At any rate, I think I've corrected the minor POV issues that were present. MoodyGroove 19:23, 22 June 2007 (UTC)MoodyGroove
Kudos. You've done a good job de-POV'ing this article. I agree with you 100% that articles should not give undue weight to any particular topic. However, the "golden hour" has not been universally rejected the way blood-letting has. In fact, as you mentioned, it is still considered to be a valid rule of thumb. Even if it seems less applicable today, one must keep a few things in mind. First, the "golden hour" was always meant to be a rule of thumb and not a rigid cut-off point at which someone is doomed. Second, when the "golden hour" concept was conceived, we were still in the very very early days of trauma medicine. Medical advances since then have made it possible for people to survive even if they go beyond the "golden hour" before receiving treatment. So, the presence of some articles today saying that patients can survive beyond the "golden hour" is not proof of its invalidity. Furthermore, EMT and paramedic courses still teach the concept of the "golden hour" as it remains a valid rule of thumb. So, while we should acknowledge that there is controversy, we shouldn't take sides here. It is not for Wikipedia to decide which side of a scientific controversy is more valid. (Blood-letting is universally rejected; the golden hour is still taught as being valid, despite some evidence to the contrary.) --Hnsampat 20:42, 22 June 2007 (UTC)
- I almost hate to nitpick, since we're mostly in agreement, but in a scientific controversy, the evidence decides which side of a controversy is more valid. Whether or not there is acceptance of evidence is another matter altogether. It takes years for medicine to "universally reject" paradigms, therapies, or modalities that are disproven or discredited in the peer reviewed literature. It's a battle to get clinicians to follow evidence based guidelines and critical pathways for patients experiencing myocardial infarction, for example. The force of dogma and tradition in medicine should not be underestimated. So yes, the 'golden hour' is still taught, and still "widely accepted" (and the article says that again). However, if you're willing to admit that the Wikipedia should "report the facts" then pointing out that the golden hour is not evidence based is not POV, it's just calling a spade a spade. Regards, MoodyGroove 21:19, 22 June 2007 (UTC)MoodyGroove
Again, my point was not that we should act like the golden hour is pure truth. My point is that, just because dissent exists in the literature, the article should not automatically presume the dissent to be true. Maybe the golden hour is correct and maybe it isn't. But the article should not act like it is a well-established fact that the golden hour is false, because it's not a well-established fact; it's just what some recent articles seem to be getting at. (I'd also like to stress once again that this whole matter of whether the golden hour is "true" or not is kind of pointless, as the golden hour always has been a rule of thumb, meaning that it's not meant to be 100% predictive of what will happen to a patient. Also, R Adams Cowley coined the term "golden hour" specifically in reference to shock, even though it's taken on a broader meaning after that.) But, this whole argument is moot now, as we agree on the content of the article. The article is fine as it stands right now. --Hnsampat 03:30, 23 June 2007 (UTC)
[edit] Removed from article
If you wish to salvage this content, please move to a more appropriate article. MoodyGroove 20:22, 22 June 2007 (UTC)MoodyGroove
==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 (anatomy)|spine]]. Inserting an [[intravenous drip]] must be fast and not delay transportation. [[Intubation|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 room|emergency department]]. If there is no evidence for surgical intervention, only three [[Radiography|radiographs]] should be performed: [[cervical spine]], [[chest]] and [[pelvis]]. ===Summary=== The Golden Hour can be summarized by the 3R rule[http://www.ohsu.edu/surgery/UGS/FACULTY/DDTcv.shtml] 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.
[edit] "Platinum ten minutes"
A term brought up in my current EMT course is the "platinum ten minutes", which is related to the golden hour. (google hits) The term refers to not staying more than 10 minutes on scene (when possible) and not "bandaging someone to death". There aren't many hits, so it may not be notable enough, but just a suggestion. -- MacAddct 1984 (talk • contribs) 20:18, 7 April 2008 (UTC)
[edit] Remove "Medical conditions with time-critical treatment considerations" section?
If no one objects, I'm going to remove this section. The article is about a controversial saying in regards to treating trauma patients. Strokes and heart attacks are not trauma, and as such, don't belong in the article. Comments? JPINFV (talk) 01:36, 13 June 2008 (UTC)
- Strokes DO have a time limit for thrombolytic drugs to work effectively... if there isn't a better place to reference the time-criticality of that sort of treatment, why not leave it in the article, even if designate it as not really a 'golden hour' issue in the sense it was originally conceived? Jclemens (talk) 01:48, 13 June 2008 (UTC)
- I'm not arguing whether there is a time limit (which is longer than an hour anyways for strokes). The problem is that the golden hour is taught about trauma, not medical conditions. A better place to note treatment time constraints for conditions such as a stroke would be the main stroke/CVA article, not being pigeon holed into an article as 'evidence' when it doesn't pertain to the point of the article (trauma care). JPINFV (talk) 03:41, 13 June 2008 (UTC)
