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.[1] 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; however, there is no evidence to suggest that survival rates drop off after 60 minutes. 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.
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In 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 center, for definitive treatment. 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.
Los Angeles Paramedic and second amendment author John Longenecker explains that The Golden Hour is not about transporting the urgent patient and getting them into the system, but in treating the patient immediately on scene or en route. The entire mission of EMS worldwide is not to bring the patient to the "care" but to bring the definitive care to the patient (Mobile Intensive Care Unit / Advanced Life Support) for the purpose of mitigating the morbidity and mortality of acute illness and injury. 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 means field care. This is impacted for the better by lay education for intervention outside the clinical setting and reach of professionals by concepts such as Citizen CPR. Cases such as choking [the so-called cafe coronary], cases of bleeding, cardiac arrest and especially the early recognition of a medical emergency have proven to turn outcomes for the better. Many emergencies' outcomes turn entirely on the first moments of the event, and the role of Good Samaritans is becoming increasingly documented as life-saving.
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 and society], the occupation of medical assets, general recovery and facility versus deficit, and other parameters defining general improvement, adding to the knowledge base and awareness of the quality of care. Longenecker mentions the patient's Golden Hour as aided by immediate lay intervention while it still counts versus that precise window of opportunity lost while awaiting assets [doing nothing as in the bystander effect aka the Genovese syndrome]. Longenecker compares the concept of lay Good Samaritan care in the absence of medical first responders [EMS] to the concept of layman armed self-defense in the absence of law enforcement first responders [Police] in his monograph, The CPR Corollary. The CPR Corollary delineates fifteen equivalents of moral purpose and public interest between the ubiquitous armed citizen and the ubiquitous CPR trained citizen. In time of crime and grave danger, Longenecker shows where there is also a Golden Hour analog (a defined temporal component) for the target of violence where superior self-defense survival attitudes and preparedness greatly improve outcomes for both individual and community.
The late Dr. R Adams Cowley 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.[2][3] The concept of the "Golden Hour" may have been derived from French military World War I data.[4] 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."[3]
While most medical professionals agree that delays in definitive care are undesirable, recent peer reviewed literature casts doubt on the validity of the 'golden hour' as it appears to lack a scientific basis. Dr. Bryan Bledsoe, an outspoken critic of the golden hour and other EMS "myths" like critical incident stress management, has indicated that the peer reviewed medical literature does not demonstrate any "magical time" for saving critical patients.[5]
The television drama series The Golden Hour and the video game series Trauma Center were based on this concept. In a Simpsons comic, Dr. Hibbert refers to the golden hour, except he says it is in the middle of the night during a time when doctors can charge the patients extra. In the Sims 3, the Golden Hour is a title given to a book along the medical career track. Grey's Anatomy season 7 episode 15 is titled The Golden Hour.
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