What is the "Golden Hour"?

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Rick:

Your last point about the third mode makes sense now that I sit back and
look at it. Thanks for pointing that out. 

BEB


Bryan E. Bledsoe, DO, FACEP
Midlothian, TX
 
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-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of DocRickFry at aol.com
Sent: Wednesday, February 02, 2005 10:12 AM
To: Trauma & Critical Care mailing list
Subject: Re: What is the "Golden Hour"?

Brian--
I think you have summed up the current state of the art quite eloquently.  I
don't have a real answer for you, except the obvious that the faster
potentially deadly injuries are definitively treated the better the
outcome--seems obvious, but hard to actually practice in the heat of battle.
I think it is not wise to put a specific time interval on it, even if it
makes one feel more comfortable, as striving for the best outcomes is not
the same as striving for a specific time--if you strive for four hours,
there are an awful lot of injuries where that would be too late--.  I agree
that the golden one hour is not accurate either, as it is too broad a stroke
for such a spectrum of injuries that occur in the real world.  What you
should do is audit all deaths or adverse outcomes with the goal of looking
at their times to definitive treatment, and decide if it could have been
less, sooner, or any indication that there was room for improvement.  For
instance, a ruptured spleen arriving at an ER 15 minutes after injury who
then sits hypotensive for four hours  before going to the OR, then dies from
MSOF a few days later--I think most would agree that is a preventable death,
and clearly four hours was too long in that scenario--in others maybe not.
One point in your post I would dispute--you said that the third death peak
in the trimodal distribution has nothing to do with this issue--that is
clearly inaccurate.  It has virtually everything to do with it, as so many
of those deaths--from MSOF,etc, relate very clearly to the adequacy of the
initial resuscitation and urgency of management, as in the above example.
ERF

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