The Golden Hour – Is it still relevant?
Just this week I had a great discussion with a trauma doctor on the ‘Golden Hour’; it is a concept that is very familiar to most rescuers.
The Golden Hour states that we have sixty minutes from the point of injury until we should be delivering our casualty to definitive care. It is important to understand that definitive care, for the most seriously injured, is actually the operating theatre.
I have long held the belief that from a medical point of view, the concept of saying ‘ONE HOUR’ cannot surely apply to every casualty, and the medical relevance of the concept will always be a point for debate.
What is widely agreed however, is that unnecessary delays are not good for your casualty; whether that delay comes in initial response, extrication or onward transportation, every effort should be made to reduce on scene times where possible.
So, from a technical rescue point of view, I still find the concept has some relevance. Within the golden hour, the technical rescue is allocated 20 minutes (or less) to stabilize, disentangle and extricate the casualty, and I think that this still serves as an excellent guide.
It may be argued that due to advances in vehicle design and the increase in number of passive safety systems, this is no longer achievable. I disagree.
We must remember however, that although time is critical where traumatically injured patients are concerned; your actions must never compromise your safety of the care of the casualty, so a fine balance must be achieved.
Finally, it is interesting to note that the golden hour may be extended to ensure that the casualty is taken to the most appropriate definitive care. That is to say they will be taken to the hospital with the specific resources/skills to deal with the injuries that have been identified (rather than the closest). For this reason you may hear it described as the ‘Golden Period’. From a technical rescue point of view, this extension takes effect after our part is played, perhaps placing greater emphasis on the need to extricate safely and timely.
As usual, I welcome your thoughts.
Ian Dunbar