Golden hour (medicine)
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In emergency medicine the golden hour is the first sixty minutes after the occurrence of multi-system trauma. It is widely believed that the victim's chances of survival are greatest if he receives definitive care in the operating room within the first hour. Recent scrutiny, however, calls this assertion into question.
General concept
In cases of severe trauma, especially internal bleeding, nothing can replace surgery. Complications such as shock may occur if the patient is not managed appropriately and expeditiously. It is therefore necessary to transport victims as fast as possible to specialists who are most often found at a hospital trauma center. Because some injuries can cause a trauma victim to decompensate extremely rapidly, the lag time between injury and treatment should ideally be kept to a bare minimum; over time, this lag time was further clarified to 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.
Origins of the term
The late Dr. R Adams Cowley is credited with promoting this concept first as a military surgeon and later as head of the University of Maryland Shock Trauma Center.[1][2]
The concept of the "Golden Hour" may have been derived from French military World War I data.[3]
The R Adams Cowley Shock Trauma Center section of the University of Maryland Medical Center's website quotes Dr. R. Adams 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."[2]
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.[4]
Medical conditions with time-critical treatment considerations
On the other hand, two emergency medical conditions have well-documented time-critical treatment considerations: stroke and myocardial infarction (heart attack). In the case of stroke, there is a window of three hours within which the benefit of clot-busting drugs outweighs the risk of major bleeding. In the case of a heart attack, rapid stabilization of fatal arrhythmias can prevent sudden cardiac death. In addition, there is a direct relationship between time-to-treatment and the success of reperfusion (restoration of blood flow to the heart), including a time dependent reduction in the mortality.
In fiction
The TV drama series The Golden Hour is named after this medical concept.
References and notes
- ↑ Lerner, EB; Moscati (2001). "The Golden Hour: Scientific Fact or Medical "Urban Legend?"". Academic Emergency Medicine 8 (7): 758-760.
- ↑ 2.0 2.1 "Tribute to R Adams Cowley, M.D.," University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Accessed June 22, 2007.
- ↑ "Original data supporting the 'Golden Hour' concept produced from French World War I data," Trauma Resuscitation at Trauma.com, Accessed June 22, 2007.
- ↑ Bledsoe, Bryan E (2002). "The Golden Hour: Fact or Fiction". Emergency Medical Services 6 (31): 105.
Health Science > Medicine > Emergency medicine | |
|---|---|
| Procedures | Advanced cardiac life support (ACLS) · Advanced life support (ALS) · Advanced Trauma Life Support (ATLS) · Basic life support (BLS) · Cardiopulmonary resuscitation (CPR) · First aid · Pediatric Advanced Life Support (PALS) |
| Equipment | Ambulance · Bag valve mask (BVM) · Chest tube · Defibrillation (AED, ICD) · Electrocardiogram (ECG/EKG) · Intraosseous infusion (IO) · Intravenous therapy (IV) · Intubation · Nasopharyngeal airway (NPA) · Oropharyngeal airway (OPA) · Pocket mask |
| People | Certified first responder · Emergency medical technician (EMT) · Paramedic · Emergency physician |
| Drugs | Atropine · Amiodarone · Epinephrine/Adrenaline · Magnesium · Bicarbonate |
| Other | Golden hour · Emergency department · Emergency medical services · Emergency psychiatry · Medical emergency · Trauma center · Triage |
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
