Tim Noonan, a.k.a. the “Roguemedic” likes to challenge the status quo and entrenched ideas in the world of EMS and medical care. He has looked at everything from substandard pain management protocols to the harm caused by routine back boarding of patients following motor vehicle accidents.

Golden Hour Under Fire

Saving an accident victimIn a recent column over at Roguemedic.com, Tim takes on the time honored trauma concept of the “Golden Hour.” The Golden Hour was a term coined by Dr. R. Adams Cowley, founder of the Maryland Shock Trauma Center at the University of Maryland Hospital in Baltimore. Around these parts and I think in many parts of the world, it has become doctrine but, as Tim points out, there is not a lot of evidence to support Dr. Cowley’s supposition.

Is the science behind the Golden Hour as spurious as the paper from the early 1900’s that branded poinsettias as poisonous? Tim seems to think so. So, apparently do the authors of an article “The golden hour: scientific fact or medical ‘urban legend’?”

EMS and Rapid Triage, Treatment, Transport

My question for Tim would be, aside from the arguments for rapid helicopter transport which most areas, even Maryland, are moving away from the concept of rapidly identifying and transporting trauma patients to definitive care is what we do. By ground or by air, we triage, treat, and when needed, transport patients. Golden Hour or No Golden Hour, EMS is based around promptness.

I’m curious to see what you think so drop me a comment on the MedicCast blog page for this episode or shoot me an email at podmedic@mac.com. I look forward to hearing from you.

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Follow up on the link to this news item and all of the article and additional resource links in the show notes for this episode — Ulcerative Colitis for EMS and Episode 318.

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4 Responses to Is the Golden Hour Full of Crap?

  1. I am not familiar with the research specifically around the utility of the Golden Hour concept. There is, however, research that suggests that delays in transport of trauma patients associated with EMS treatments, including IV administration and spinal immobilization, increases mortality. Older research shows patients transported in private vehicles (i.e. not by EMS) had lower mortality. For a discussion of these studies, see “Prehospital Intravenous Fluid Administration is Associated with Higher Mortality in Trauma Patients: A National Trauma Data Bank Analysis, Haut et al. Annals of Surgery. 2011;253(2):371-377 http://bit.ly/XURldS. Perhaps before abandoning the Golden Hour, which urges rapid transport, more research is needed on whether the treatments we employ on-scene are improving patient outcomes or, unfortunately, introducing delays that result in higher mortality and morbidity.

  2. podmedic says:

    Eric,

    Thanks for the comment and the research link. I agree with you that the concept of rapid triage and transport of trauma patients is key to effective treatment whether or not there is a “Golden Hour.”

  3. rogue medic says:

    Eric Jaeger,

    The studies using the National Trauma Data Bank® are not worth the time it takes to read them, except as examples of how we should not draw conclusions from incomplete data.

    Only 8.1% of trauma patients had spinal immobilization? IV (IntraVenous) starts were over 6 times more common than spinal immobilization for these trauma patients? Is there any place where this is the way EMS does things?

    8.1% had needle decompression, but only 4.4% were hypotensive? Is there any reason to assume that a patient who is not hypotensive will improve by having a large needle stuck in his chest?

    Chest decompression is almost 3 times more common than intubation in these trauma patients?

    More than one in every 12 1/2 trauma patients had chest decompression. MAST application is 3 1/2 times more common than spinal immobilization?

    Dr. Haut may have meant well, but the National Trauma Data Bank® is not accurate information. Even looking at the IV study, it is not known how many IVs were done on scene vs. in the ambulance. There was no assessment of the amount of fluid administered. Do IVs affect survival in trauma or does IV fluid affect survival in trauma? The study looked at IVs as something that could be calculated from the National Trauma Data Bank®.

    Then they did a helicopter study using the same National Trauma Data Bank® and concluded that helicopters save lives even though they did not determine that there was any difference in transport times to trauma centers. The magic rotor saved everyone.

    I just wrote about a study of scene times, transport times and survival from blunt trauma and from penetrating trauma.

    http://roguemedic.com/2013/01/ems-time-and-survival-from-blunt-and-penetrating-trauma/.

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