The myth of the golden hour ?

[chbare]

All I have to go on at this point are Dr. Cowley's words, and from what I have read, he had specifically stated a time frame on one hour based on earlier evidence as noted in my prior post. While it may have been a good marketing slogan, I do think Dr. Cowley believed in the concept and did what he thought was best for the patients of Maryland. In retrospect, getting critical patients with uncontrolled hemorrhage to the OR ASAP is still critically important; however, the specifics of modalities we use today were not in place. I suspect, our modalities and theories will be different 40 or so years into the future.

I am not faulting the concept at the time; however, I like other people on this forum am faulting the modern provider for holding onto this concept.

Take care,

chbare.

[MS Medic]

Understanding Dr. Cowley's concept of the golden hour can better be accomplished if we look at the situation as historical researchers, rather scientific researchers, trying to understand the meaning of an ancient text. Look at the context of the times he wrote it in. He was THE pioneer in the modern field of trauma care establishing preceps w/o the benifit of the knowledge or medical technology we currently have the luxury of.

Prior to Dr. Cowley's revolutionary changes, the basic tenents of trauma care were to take your time and allow the pt to stabilize before initiating treatment. A pt could sit in the hospital for hours before any real attempt to treat him was begun.

At that time doctors did not have the bank of X-rays, CT, MRIs, etc. Significant exploritory surgery was required to find and fix the insult. Rather than letting a person sit for hours, he promoted rapidly initiating assesment and treatment of trauma pts. His concept of initiating it in 60 min or less was most likely based around the limited knowledge of trauma care and limited resources available.

While the whole 60 min thing might not be as important as it use to be, just like dealing with a MI or CVA, time matters. The only true "cure" for sigificant truama is surgical intervention and the faster the time from the traumatic injury to appropriate intervention the better the chance of full recovery.

[aussiephil]

Understanding Dr. Cowley's concept of the golden hour can better be accomplished if we look at the situation as historical researchers, rather scientific researchers, trying to understand the meaning of an ancient text. Look at the context of the times he wrote it in. He was THE pioneer in the modern field of trauma care establishing preceps w/o the benifit of the knowledge or medical technology we currently have the luxury of.

Prior to Dr. Cowley's revolutionary changes, the basic tenents of trauma care were to take your time and allow the pt to stabilize before initiating treatment. A pt could sit in the hospital for hours before any real attempt to treat him was begun.

At that time doctors did not have the bank of X-rays, CT, MRIs, etc. Significant exploritory surgery was required to find and fix the insult. Rather than letting a person sit for hours, he promoted rapidly initiating assesment and treatment of trauma pts. His concept of initiating it in 60 min or less was most likely based around the limited knowledge of trauma care and limited resources available.

While the whole 60 min thing might not be as important as it use to be, just like dealing with a MI or CVA, time matters. The only true "cure" for sigificant truama is surgical intervention and the faster the time from the traumatic injury to appropriate intervention the better the chance of full recovery.

Yes you are right in that historically it was most probably a good idea at the time, but we also need to remember that this was a time when we did not use evidence based practice, presented evidence was not scutinised (look at tholydamide) & people held what the almighty doctor said as gospel.

This was also a time when EMS had nominal skills & interventions that are of benefit, education levels were much lower than they are today.

The entire medical profession has moved forward, however I find it concerning that myths that were once relevant but are not so, are still being taught as gospel. Part of the problem here si that they still have to teach to the lowest common denominator. The idiot factor. The moron medics who believe that they know better & like to stay & play rather than scoop & run. We need to remember that while we are better educated, we are not MD's, never will be.

[Kiwiology]

Lord knows if the golden hour got proven to be false the IAFF would loose a significant piece of its marketing toolbox!