Golden hour / Platinum Ten.

[911emt911]

I was in the chat room today just talking about running lights and sirens. Some stated that we should not do it. Then it led to the talk about the golden hour. They stated, which I haven't never heard before, that it was put in effect to keep a certain trauma open years ago, if I heard it right???????????? Everyone in the room disagreed with it stating it was bull-crap. I stated the fact "doesn't every second count in a life and death situation", in reference to getting on-scene quicker, safely, and to the ER in a safe but quick way in a true emergency. But they all though it was bull. I'm not saying that they are right or wrong, I was just curious on everyone elses opinion, and if it is fact or more fiction than anything.

[DwayneEMTP]

You don't state if the L&S are response or return, that would make a difference to most I think.

I did notice that you stated clearly that safety is the major concern. That being said, I'm on board with you.

When time is short, and the difference between life and death is a surgeon, getting to difinitive care is important, as long as we always remember that endangering ourselves and/or others is never an acceptable risk.

When you can't decide, perhaps ask yourself; Is allowing this person to arrive at the ER 30 soconds sooner a fair trade for the look on my wife's/mom's/girlfriend's face when they tell her I died in a needless crash?

Dwayne

[Medic26]

All things have to be considered when pondering the response and transport modes. I work for 2 different services that have two different schools of thought with use of lights and sirens for response and transport.

My personal experience with the use of lights and sirens is that they are rarely needed for transport of a patient. The time you save rarely has any effect on the outcome because in general it is very small. This can however be altered depending on the amount of traffic, time of day and distance traveled to the receiving facility. I have this debate all the time at my part time gig, just because the "protocol" states "rapid transport" for trauma, suspected strokes and STEMI's do's not automatically mean you have to use L & S to get there. Mind you this is a service that our maximum transport time is 20 minutes tops from the furthest out area under normal driving conditions. Do you really think that driving like a MORON and getting there in 17 minutes instead of 20 minutes is really going to have that big of an impact on patient outcome..........RARELY! If you have a patient who is that bad which is probably < 5% of the time then by all means.....GIT-R-DUN.

As far as response mode to the scene... I am a little more liberal. Why you ask....because dispatch information is unreliable. People making these calls usually have no clue and are so excited they have no true concept of what is really happening. Generally I will response with caution using L & S for most respiratory, cardiac, MVC and ALOC/Unresponsive calls. Simple fall victims, sick person, general illness and the like get routine traffic generally. Our dispatchers are trained in EMD at the 911 center, but they rarely give us a priority code anymore. They also have the option to "upgrade" a call to Delta upon their own discression too.......which is usually a BS complaint when we arrive. Better to air on the side of caution I suppose. :roll:

[AnthonyM83]

There are many emergencies where the patient can degrade very quickly (traumas and respiratory emergencies come to mind), so I would say L&S are appropriate, both to call and to hospital. Cardiac arrests also come to mind.

Also, when discussing how much time L&S save, one must do it in relation to their own area. In Los Angeles, where every main street may be gridlocked for miles, L&S save significant time.

[JPINFV]

First off, I do believe that there's a big difference between paramedic run transports and basic run transports. I think that it's more understandable for a basic crew to transport l/s because of their limited treatment options. Paramedics, on the other hand, should be able to stabilize most patients to the point that an extra few minutes will not change the clinical outlook of the patient.

The second thing is the fact that we're talking about saving minutes, on average, at a large risk. Minutes, in most cases, will not change the clinical outcome of the patient, especially with a paramedic on board. Due to this, the risk:reward ratio is slanted heavily towards the risk side.

Remember, it doesn't matter how much time you were saving when you get in an accident. The response or transport will end up being longer [if the patient even still requires transport] plus you and your partner will probably end up getting to visit the local hospital too.

[Asysin2leads]

JP, I think you touched on something that is a myth in EMS; that is, when ALS is transporting, the need for rapid transport is unnecessary. This is far from the truth. In an MI situation, rapid transport is still necessary. I can give nitro, aspirin, and morphine in the field, which may slow the progression of an MI but only PCI or fibrinolytics are going to make a difference and the time to intervention is key. In some places ALS can give fibrinolytics, but still, this person needs a hospital.

This is also true with CVA's, ischemic or hemmorhagic, and as all of you whackers cum trauma support specialists out there in volly land like to remind me, constantly, especially trauma patients. The best ALS can do is stabilize. Definitive treatment is still, and should be, the hospital.

[JPINFV]

I never meant to intend that paramedics could stabilize ALL patients till the point that paramedics could take all the time in the world (hence I used the term "most" instead of "all"). Take a diabetic AMS patient. Sure, for a basic who can't start a line and give D50, rapid transit is in line. On the other hand, a paramedic can give D50 and reverse the cause. Similarly, paramedics can provide a multiple of treatments for difficulty breathing that basics are unable to provide (albuterol, CPAP, etc). Why should a patient be transported with l/s if a dose of albuterol returns the person to a normal respiration pattern?

[Just Plain Ruff]

actually L&S was only a small portion of our discussion.

I, 911emt911 and aussiephil and others were discussing the validity of the golden hour.

some statements were made that I think made 911emt911 uncomfortable because they had never heard the statements.

the main statement we made was that the golden hour was a number that was consistently given to the public and ems in order to necessitate the need for more trauma centers. It was our position that this number was a arbitrary number and I believe Aussiephil referenced the 3 stages of dying, immediate, hours and then days. Correct me if I got that wrong phil.

So it is my opinion, and my opinion that the golden hour is a mantra similar to global warming. If you don't sign on to it then you are not a good medic. That's not true at all.

I worked in a rural area where the golden hour is often used up just getting to the scene. Traumatic injury occurs, takes 2-10 minutes to get the call, then 30 minutes to get to the scene and then packaging the patient for transport and then transport takes another 30 minutes. That's over an hour and their "Golden" hour is shot.

I've had many many patients who by the wisdom of the golden hour theorists and believers, those patients should have died because they did not get to definitive treatment but I saw those patients walking around out in public many many times. So the golden hour isn't golden.

Now before those of you who are going to nail me for my opinion, I can almost guess where your criticisms will come from, "MIke, they must not have been hurt all that bad" or some other statements. Remember this is my opinion and my opinion only.

I believe that the golden hour was used a lot in the past to justify additional trauma systems and centers. I also believe that those who came up with the Golden hour also had a vested interest in keeping their trauma center especially when we all know that trauma centers lose money not make money. (what else in EMS or medicine makes money)

So this is my opinion, I have no real stats or sources to back it up but I do know that the Golden hour has had some good things come of it like having trauma centers to send patients to, making ems decrease their scene time in order to get them to definitive care.

But let's discuss decreasing trauma scene times, many times on a trauma where I worked, it was myself and my partner. Doing everything in under 10 minutes often was impossible. Rushing thru things also makes you miss things and possibly further injure the patient.

Just my opinion

[brentoli]

whackers cum trauma support specialists

Is there a college I can graduate with that printed on my degree?

[Richard B the EMT]

As I remember it, the Golden Hour concept was, getting the trauma patient to surgery in under an hour from the time of the initial injury.

I concur the crew and ambulance's safety takes precedence over any patient, but then, in a perfect world, nobody would need a trauma surgeon, or an ED, right? or us?