Golden Hour ?

A simple google search shows that there are still articles, essays, editorials and opinions written about the "Golden Hour". However, there are problems with this that, over time, our understanding of just what exactly the "Golden Hour" (GH) refers to has morphed into more of a over-riding concept.

In relation to HEMS operations, it is the concept of the GH that frequently is mentioned or subtlety referred to as an attempt to justify the process. Especially when such programs are placed under the microscope of financial viability and cost effectiveness. After all, it's worth ANY expense if we can "save the patient"...right?

When the concept of the GH was first popularized, it was a driving philosophy to the care of the trauma patient requiring specific, specialized trauma care. It is not beyond comprehension that many mantra-speaking advocates currently may be incompletely informed as to the genesis of the concept. When it is applied to other patient care scenarios (IE: non-specialized trauma requiring care), the concepts application becomes difficult to apply effectively.

As the cited commentary points out that ethical constraints prevent applying the true scientific method to exploring the time vs. survivability relationship. At best, what we have is anecdotal data review/gathering. This is one of the lowest levels of evidence based research, akin to merely doing a "chart review". So we already see that the GH concept may never be able to accurately be tested with scientific certainty.

As well the GH concept makes for a nice slogan, mantra, moniker: it is concise, to the point, and full of symbolism. How far would the "Green-Thirty-Three-Minutes" have gone in marketing, operational philosophy and/or time-to-treatment goals? (I'm thinking not far).

So where are we at these days?

It is a given that any problem (trauma, illness, dysfunction) is better dealt with earlier on rather than later. Any state of dys-entropy or decay of function, follows rules of nature and declines into a nonfunctional state (AKA; dies). Prevention would be the best "treatment" but we all know that prevention is not often accepted by society as a catchy concept. After all, why deal with today what can be put off until tomorrow.

So we wait until something has to be done and then seek to intervene.

Any time a case needs to be made for rapid, fast, urgent, or accelerated patient transport or movement, especially in light of injury/trauma - this is where the GH rule becomes the motivator and driving force behind the operations. We are always trying to do it "faster" and "quicker" because we rationalize "it will save a life". While the logical assumption is "Yes" we may save a life, how do we quantify this? What if further observational studies show that the GH is really "15 minutes" for something like the time to build up irreversible oxidative decay of the all-important ATP machinery which is ultimately responsible for cellular respiration and as such, cellular survival....will we evolve the concept of the "golden 1/4 hour"?

I think for now, the GH "concept" at least serves as a guide, and not a law, in that we should consider the patient's needs and if possible to make sure they access them expeditiously with the knowledge that treatment specific to their needs (trauma, medical, psychological) will do them the best in the long run.

However: we should NEVER compromise provider safety for the sake of an oft-misquoted, mis-applied and mis-understood concept; thank you Dr Crowley.

Mark Boswell
MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P
Boswell Emergency Medical Education Technology