golden hour

The Golden Hour is a term used in emergency medicine which refers to the first sixty minutes after an accident or the onset of acute illness. The victim's chances of survival are greatest if he or she can be in the operating room within the Golden Hour.

Origins

This concept comes from US military wartime experience, particularly in the Vietnam War. In cases of severe trauma, especially internal bleeding, nothing can replace surgery. It is therefore necessary to transport victims as fast as possible to a trauma center.

Basics

Prehospital Care

Prehospital care is limited to the minimum, i.e.

A.B.C (airway, breathing, circulation)
cover wounds
realign ("reduce") broken limbs
protect the spine.

Inserting an intravenous drip must be fast and not delay transportation. Endotracheal intubation is the only act that may delay the transportation. This prehospital strategy is also called scoop and run, opposed to the stay and play that is more adapted to less severe cases (when there is no severe trauma, the trauma caused by the transportation itself is more important than the gain of time).

Hospital Selection

The ambulance must transport the victim to the hospital with the facilities to treat the patient. This is not always the closest hospital, as the closest hospital may lack the facilities or may be overwelmed by other victims from the same incident (see also triage).

Limited Examination

Third point, only limited examination in the emergency department. If there is no evidence for surgical intervention, only three radiographs should be performed: lungs, spine and pelvis.

Summary

The golden hour can be summarized by the 3R rule of Trunkey:

Right patient
Right place
Right time

Transports

MEDEVAC helicopters are often used to move victims to a trauma center within the Golden Hour.

Golden Hour