The Golden Hour

[GilaRRT]

I know Dr. Cowley was a pioneer; however, we are still having literature about the "golden hour" being published as late as 2009. Come on guys, give up the ghost and let this one go.

Emergency Medical Services Intervals and Survival in Trauma: Assessment of the "Golden Hour" in a North American Prospective Cohort

Presented as an abstract at the Society for Academic Emergency Medicine Annual Meeting, May 2008, Washington, DC.

Resuscitation Outcomes Consortium InvestigatorsCraig D. Newgard, MD, MPHa, Robert H. Schmicker, MSb, Jerris R. Hedges, MD, MS, MMMe, John P. Trickett, BScNf, Daniel P. Davis, MDh, Eileen M. Bulger, MDc, Tom P. Aufderheide, MDi, Joseph P. Minei, MDj, J. Steven Hata, MD, FCCP, MSck, K. Dean Gubler, DO, MPHl, Todd B. Brown, MD, MSPHm, Jean-Denis Yelle, MDg, Berit Bardarson, RNb, Graham Nichol, MD, MPHbd

Received 13 March 2009; received in revised form 19 June 2009; accepted 22 July 2009. published online 24 September 2009.

Corrected Proof

Study objective

The first hour after the onset of out-of-hospital traumatic injury is referred to as the "golden hour," yet the relationship between time and outcome remains unclear. We evaluate the association between emergency medical services (EMS) intervals and mortality among trauma patients with field-based physiologic abnormality.

Methods

This was a secondary analysis of an out-of-hospital, prospective cohort registry of adult (aged ≥15 years) trauma patients transported by 146 EMS agencies to 51 Level I and II trauma hospitals in 10 sites across North America from December 1, 2005, through March 31, 2007. Inclusion criteria were systolic blood pressure less than or equal to 90 mm Hg, respiratory rate less than 10 or greater than 29 breaths/min, Glasgow Coma Scale score less than or equal to 12, or advanced airway intervention. The outcome was inhospital mortality. We evaluated EMS intervals (activation, response, on-scene, transport, and total time) with logistic regression and 2-step instrumental variable models, adjusted for field-based confounders.

Results

There were 3,656 trauma patients available for analysis, of whom 806 (22.0%) died. In multivariable analyses, there was no significant association between time and mortality for any EMS interval: activation (odds ratio [OR] 1.00; 95% confidence interval [CI] 0.95 to 1.05), response (OR 1.00; 95% CI 9.97 to 1.04), on-scene (OR 1.00; 95% CI 0.99 to 1.01), transport (OR 1.00; 95% CI 0.98 to 1.01), or total EMS time (OR 1.00; 95% CI 0.99 to 1.01). Subgroup and instrumental variable analyses did not qualitatively change these findings.

Conclusion

In this North American sample, there was no association between EMS intervals and mortality among injured patients with physiologic abnormality in the field.

[ukstudent]

Did the study find any correlation between the Pt's that died, such as age or co-morbidities prior to the accidents/traumas.

[GilaRRT]

Did the study find any correlation between the Pt's that died, such as age or co-morbidities prior to the accidents/traumas.

I do not think so with this particular study. I am amazed that we are still seeing literature about the "golden hour." What is even more amazing, is that people still utilise the term as if it were a solid concept.

[ukstudent]

There is too much money being made with the "golden hour." The State of Maryland even has it's own flight transport program based on this. Think about all the other flight programs around that have grown and grown since the golden hour came into vogue. Evidence based practice only changes anything if the powers to be are not making money from the old practice.

[mwboswell]

There is too much money being made with the "golden hour." The State of Maryland even has it's own flight transport program based on this. Think about all the other flight programs around that have grown and grown since the golden hour came into vogue. Evidence based practice only changes anything if the powers to be are not making money from the old practice.

Also too much hype touting that HEMS improves patient outcomes.

In my opinion (ahem, clearing throat) let me repeat one more time IN My Opinion...

HEMS is good for:

1) Remote areas that have a lengthy scene-to-hospital transport time

2) Inter-facility transports over LARGE distances (IE across the state, NOT across the county)

3) When you need to go directly to a specialty center (burn, stroke, cardiac) and it is outside of the range of ground EMS...NOTE- I left "trauma" off that specialty center list.

4) A pretty-shiny-sparkly toy that makes for good pictures on all your hospital's PR/marketing media/webpages, because after all, if your hospital has a flight program, then they JUST HAVE TO BE a better hospital and you should go there!

5) Breaking the bank when your manager/director doesn't appreciate that HEMS can actually loose money

...again folks, just my person opinion is all.

And this doesn't mean I don't love my flight RN's/EMT's that I know and work with; it's not their fault!

[bodhisattvya]

Also too much hype touting that HEMS improves patient outcomes.

In my opinion (ahem, clearing throat) let me repeat one more time IN My Opinion...

HEMS is good for:

1) Remote areas that have a lengthy scene-to-hospital transport time

2) Inter-facility transports over LARGE distances (IE across the state, NOT across the county)

3) When you need to go directly to a specialty center (burn, stroke, cardiac) and it is outside of the range of ground EMS...NOTE- I left "trauma" off that specialty center list.

4) A pretty-shiny-sparkly toy that makes for good pictures on all your hospital's PR/marketing media/webpages, because after all, if your hospital has a flight program, then they JUST HAVE TO BE a better hospital and you should go there!

5) Breaking the bank when your manager/director doesn't appreciate that HEMS can actually loose money

...again folks, just my person opinion is all.

And this doesn't mean I don't love my flight RN's/EMT's that I know and work with; it's not their fault!

re:#2: I don't know where you live. However, I live in a county in a Western State that is bigger than the entire State of Connecticut. It takes two hours driving time to go from the western end of the county to the eastern end. I get what you are saying in principle however & agree with the rest of your post.

[Virgo_RN, BSN, RN]

Interesting.