Golden hour / Platinum Ten.

[AZCEP]

The golden hour came about by Dr. Cowley, and his view that people needed to get to a trauma center faster to improve their survival. It was an instinctive mantra that has not been shown to be valid.

Lights and sirens, like much in EMS, are useful depending on the situation. We rarely if ever use them, while some of our "city mouse" neighbors use them for every call.

[aussiephil]

-50 for repeating a post & ignoring the advice that the search is your friend.

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.

Ruff you got that right, it is a trimodal death sequence. The thing to remember, & it is easy to get sidelined, it that the golden hour was initially proposed for trauma. End of Story.

The way hospitals are judged is via a Trimodal death sequence as stated above.

This does not mean that we, as pre hospital clinitians should sit on scene & delay transport. I personally believe that hospital - difinitive care - is where the sick & injured need to be as soon as possible.

That said, to put a specific time fram, in this case an hour, on a trauma, that is from the time the trauma happenned, can be inhibitive & cause clinitians to lose focus on what they should be doing, assessing & treating the patient safely.

Experience tells us that there are now ways of clearing for things in the field & I am sure they will progress over time (C-spine comes to mind - Fifthkid has a great protocol for that in Maine) & there is less emphasis on exploratory surgey today than ever before, the use of ultrasound to clear for abdo bleeds for example.

Too often we see people lying in an ED that was brought in from a serious trauma that is still on the same bed, in the same spot for hours because their injuries are not serious enough to warrant urgent surgery, they have no indicaators for maor internal injuries & have had spinal clearance via CT. So you have busted your ass for nothing.

More people in ems need to use their brains. They need to think before they rush a patient off for 'urgent trauma surgery'. Kown your anatony & patophisiology, look at your mechinism of injury, explore those areas for injury. Properly assess each patient. Transport them in a timley manner, in a way that is appropriate to their presenting condition.

That was the point of the discussion.

[911emt911]

I can understand where you all are coming from somewhat.....The whole subject is confusing, lol. So basicly what you are all saying is that the golden hour is only somewhat true, if true at all, and as long as we can get the trauma patients that we feel like need surgery to the hospital in a SAFE and quick manor, which we usually do, we can really just forget about the whole golden hour subject? But I totally agree about the fact that we bust our tails on a serious patient and run lights and sirens to the hospital, and they treat most of them like everybody else when we get there......

[unknown]

Golden Hour is what we thrive on.... it's what HEMS does best.

I can tell you there IS a significant diffence in the patients recovery, when we compair interfacility trauma transports verses from the scene transports straight to definitive care.......

[Scaramedic]

To quote Dr. Bledsoe from this thread...

In the overall scheme of things, the trauma patient who will benefit from rapid transporrt and who requires emergency surgery is quite small. In fact, in Clayton Shatney's 10-year study of helicopter patients at Stanford he found that number to be 1.8%. Guess what? A response time of 8 minutes (the "gold standard") is not associated with improved outcomes in medical OR trauma patients.

[aussiephil]

Golden Hour is what we thrive on.... it's what HEMS does best.

I can tell you there IS a significant diffence in the patients recovery, when we compair interfacility trauma transports verses from the scene transports straight to definitive care.......

Firstly, what is HEMS?

How is the comparison to minimising on scene time - ie. the principal of the golden hour of trauma, rushing treatment to an interhospital transfer for a trauma pt. No one denies that pts need difinitive care & if your service doesnt allow for a trauma bypass, then maybe they should look at it. You need to transport appropriate to the patiens clinical needs. That is not par of this discussion. This is about whether getting a patient to difinitive care within 1 hour, the golden hour, of the Trauma occuring increases outcome for patients.

To save retyping what has already been typed before me:

The Golden Hour - Is it a real principal for EMS?

[bbledsoe]

http://www.bryanbledsoe.com/data/pdf/mags/Golden%20Hour.pdf