Golden hour (medicine)

Golden hour principle
This article is about the concept of urgent assistance in medicine. For a special day time in photography, see Golden hour (photography).

In emergency medicine, the golden hour (also known as golden time) refers to a time period lasting for one hour, or less, following traumatic injury being sustained by a casualty or medical emergency, during which there is the highest likelihood that prompt medical treatment will prevent death.[1] It is well established that the patient'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

Cases of severe trauma, especially internal bleeding, require surgical intervention. 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; this has come to be specified as no more than 60 minutes, after which time the survival rate for traumatic patients is alleged to fall off dramatically.

Origins of the term

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]

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 management, has indicated that the peer reviewed medical literature does not demonstrate any "magical time" for saving critical patients.[5]

See also

References

  1. ↑ American College of Surgeons (2008). Atls, Advanced Trauma Life Support Program for Doctors. Amer College of Surgeons. ISBN 978-1880696316.
  2. ↑ Lerner, EB; Moscati (2001). "The Golden Hour: Scientific Fact or Medical "Urban Legend?"". Academic Emergency Medicine. 8 (7): 758–760. doi:10.1111/j.1553-2712.2001.tb00201.x. PMID 11435197.
  3. 1 2 "Tribute to R Adams Cowley, M.D.," University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Accessed June 22, 2007.
  4. ↑ "Original data supporting the 'Golden Hour' concept produced from French World War I data," Trauma Resuscitation at Trauma.com, Accessed June 22, 2007.
  5. ↑ Bledsoe, Bryan E (2002). "The Golden Hour: Fact or Fiction". Emergency Medical Services. 6 (31): 105. PMID 12078402.
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