Golden hour (medicine)
Encyclopedia
In emergency medicine
, the golden hour refers to a time period lasting from a few minutes to several hours following trauma
tic 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; 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.
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.
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."
, has indicated that the peer reviewed medical literature does not demonstrate any "magical time" for saving critical patients.
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.
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...
, the golden hour refers to a time period lasting from a few minutes to several hours following trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
tic 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; 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.
General concept
In cases of severe trauma, especially internal bleeding, surgicalSurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a 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
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
trauma center
Trauma center
A trauma center is a hospital equipped to provide comprehensive emergency medical services to patients suffering traumatic injuries. Trauma centers grew into existence out of the realization that traumatic injury is a disease process unto itself requiring specialized and experienced...
, 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.
Origins of the term
The late Dr. R Adams CowleyR Adams Cowley
R Adams Cowley was an American surgeon considered a pioneer in emergency medicine and the treatment of shock trauma. He is also known for being one of the first to perform open-heart surgery and invented both a surgical clamp that bears his name and a prototype pacemaker that was used by Dwight D...
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
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
military
Military
A military is an organization authorized by its greater society to use lethal force, usually including use of weapons, in defending its country by combating actual or perceived threats. The military may have additional functions of use to its greater society, such as advancing a political agenda e.g...
World War I
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
data. The R Adams Cowley Shock Trauma Center
R Adams Cowley Shock Trauma Center
R Adams Cowley Shock Trauma Center is a free-standing trauma hospital in Baltimore, Maryland and is part of the University of Maryland Medical Center. It was the first facility in the world to treat shock...
section of the University of Maryland Medical Center
University of Maryland Medical Center
The University of Maryland Medical Center is a teaching hospital with 705 beds based in Baltimore, Maryland, that provides the full range of health care to people throughout Maryland and the Mid-Atlantic region. It gets more than 35,000 inpatient admissions and 165,000 outpatient visits each year...
'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."
Controversy
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 managementCritical Incident Stress Management
Critical incident stress management is an adaptive short term helping process that focuses solely on an immediate and identifiable problem. It spans pre-incident preparedness to acute crisis to post-crisis follow up. Its stated purpose is to enable people to return to their daily routine more...
, has indicated that the peer reviewed medical literature does not demonstrate any "magical time" for saving critical patients.
In popular culture
The television drama series The Golden HourThe Golden Hour (TV series)
The Golden Hour was an ITV drama series, first shown in 2005.The series centred on the activities of a specialist medical unit, HEMS which is based in London, operated by the London Ambulance Service, in dealing with emergency cases...
and the video game series Trauma Center were based on this concept.
In a Simpsons comic, Dr. Hibbert
Julius Hibbert
Dr. Julius M. Hibbert, usually referred to as Dr. Hibbert, is a recurring character on the animated series The Simpsons. His speaking voice is provided by Harry Shearer and his singing voice was by Thurl Ravenscroft, and he first appeared in the episode "Bart the Daredevil". Dr...
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.