The golden hour is the period of time immediately after a traumatic injury during which there is the highest likelihood that prompt medical and surgical treatment will prevent death. [1] [2] While initially defined as an hour, the exact time period depends on the nature of the injury and can be more than or less than this duration. [2] It is well established that the person's chances of survival are greatest if they receive care within a short period of time after a severe injury; however, there is no evidence to suggest that survival rates drop off after 60 minutes. Some have come to use the term to refer to the core principle of rapid intervention in trauma cases, rather than the narrow meaning of a critical one-hour time period.
Cases of severe trauma, especially internal bleeding, require surgical intervention. Complications such as shock may occur if the person is not managed appropriately and expeditiously. It therefore becomes a priority to transport people with severe trauma as fast as possible to specialists, most often found at a hospital trauma center, for treatment. Because some injuries can cause people to deteriorate extremely rapidly, the lag time between injury and treatment should ideally be kept to a bare minimum; this has come to be specified as no more than 60 minutes, after which time the survival rate for people who have sustained trauma is alleged to fall off dramatically.
The recommended amount of time for emergency medical services is less than 10 minutes at the location of the trauma before transporting. [2]
R Adams Cowley is credited with promoting this concept, first in his capacity as a military surgeon and later as head of the University of Maryland Shock Trauma Center. [3] [4] The concept of the "Golden Hour" may have been derived from the French military's World War I data. [5] The R Adams Cowley Shock Trauma Center section of the University of Maryland Medical Center's website quotes Cowley as saying, "There is a golden hour between life and death. If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later — but something has happened in your body that is irreparable." [4]
While most medical professionals agree that delays in definitive care are undesirable as they may lead to significant increases in morbidity and mortality, research casts doubt on the validity of the 60-minute 'golden hour' as it appears to lack a scientific basis. [6] [7] The physician Bryan Bledsoe, an outspoken critic of the golden hour and other EMS "myths" like critical incident stress management, has indicated that the peer-reviewed medical literature does not demonstrate any "magical time" for saving critical patients. [8] There are different critical periods for different injuries. [9]
Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.
Shock is the state of insufficient blood flow to the tissues of the body as a result of problems with the circulatory system. Initial symptoms of shock may include weakness, fast heart rate, fast breathing, sweating, anxiety, and increased thirst. This may be followed by confusion, unconsciousness, or cardiac arrest, as complications worsen.
An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care center.
A trauma center, or trauma centre, is a hospital equipped and staffed to provide care for patients suffering from major traumatic injuries such as falls, motor vehicle collisions, or gunshot wounds. A trauma center may also refer to an emergency department without the presence of specialized services to care for victims of major trauma.
Internal bleeding is a loss of blood from a blood vessel that collects inside the body, and is not usually visible from the outside. It can be a serious medical emergency but the extent of severity depends on bleeding rate and location of the bleeding. Severe internal bleeding into the chest, abdomen, pelvis, or thighs can cause hemorrhagic shock or death if proper medical treatment is not received quickly. Internal bleeding is a medical emergency and should be treated immediately by medical professionals.
Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Depending on the severity of injury, quickness of management, and transportation to an appropriate medical facility may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment.
Neurogenic shock is a distributive type of shock resulting in hypotension, often with bradycardia, caused by disruption of autonomic nervous system pathways. It can occur after damage to the central nervous system, such as spinal cord injury and traumatic brain injury. Low blood pressure occurs due to decreased systemic vascular resistance resulting from loss of sympathetic tone, which in turn causes blood pooling within the extremities rather than being available to circulate throughout the body. The slowed heart rate results from a vagal response unopposed by a sympathetic nervous system (SNS) response. Such cardiovascular instability is exacerbated by hypoxia, or treatment with endotracheal or endobronchial suction used to prevent pulmonary aspiration.
Advanced trauma life support (ATLS) is a training program for medical providers in the management of acute trauma cases, developed by the American College of Surgeons. Similar programs exist for immediate care providers such as paramedics. The program has been adopted worldwide in over 60 countries, sometimes under the name of Early Management of Severe Trauma, especially outside North America. Its goal is to teach a simplified and standardized approach to trauma patients. Originally designed for emergency situations where only one doctor and one nurse are present, ATLS is now widely accepted as the standard of care for initial assessment and treatment in trauma centers. The premise of the ATLS program is to treat the greatest threat to life first. It also advocates that the lack of a definitive diagnosis and a detailed history should not slow the application of indicated treatment for life-threatening injury, with the most time-critical interventions performed early.
A trauma team is a multidisciplinary group of healthcare workers under the direction of a team leader that works together to assess and treat the severely injured. This team typically meets before the patient reaches the trauma center. Upon arrival, the team does an initial assessment and necessary resuscitation, adhering to a defined protocol.
R Adams Cowley Shock Trauma Center is a free-standing trauma hospital in Baltimore, Maryland and is part of the University of Maryland Medical Center. It was the first facility in the world to treat shock. Shock Trauma was founded by R Adams Cowley, considered the father and major innovator of trauma medicine.
R Adams Cowley was an American surgeon considered a pioneer in emergency medicine and the treatment of shock trauma. Called the "Father of Trauma Medicine", he was the founder of the United States' first trauma center at the University of Maryland in 1958, after the United States army awarded him $100,000 to study shock in people—the first award of its kind in the United States. The trauma unit at first consisted of two beds, and was later expanded to four beds. Many people called the four-bed unit the "death lab." Cowley was the creator of the "Golden Hour" concept, the period of 60 minutes or less following injury when immediate definitive care is crucial to a trauma patient's survival. He was a leader in the use of helicopters for medical evacuations of civilians, beginning in 1969, and founded the Society of Thoracic Surgeons. He also founded the nation's first statewide EMS system, called MIEMSS by Executive Order of Maryland's Governor Mandel, 1972, as well as the National Study Center for Trauma and EMS, enacted by Congress in 1986 and signed into law by President Ronald Reagan. He is also known for being one of the first surgeons to perform open-heart surgery and invented both a surgical clamp that bears his name and the prototype pacemaker that was used by Dwight D. Eisenhower.
The University of Maryland Medical Center (UMMC) is a teaching hospital with 806 beds based in Baltimore, Maryland, that provides the full range of health care to people throughout Maryland and the Mid-Atlantic region. It gets more than 26,000 inpatient admissions and 284,000 outpatient visits each year. UMMC has approximately 9,050 employees at the UMMC Downtown Campus, as well as 1,300 attending physicians and 950 resident physicians across the Downtown and the Midtown campuses. UMMC provides training for about half of Maryland's physicians and other health care professionals. All members of the medical staff are on the faculty of the University of Maryland School of Medicine.
The following outline is provided as an overview of and topical guide to emergency medicine:
Ascension St. Mary's Hospital is a hospital in Saginaw, Michigan, United States. Ascension St. Mary's is certified as a Comprehensive Stroke Center by The Joint Commission. The hospital is a member of Ascension Michigan, and is a teaching affiliate of the Michigan State University College of Human Medicine as well as Central Michigan University. The American College of Surgeons verified the emergency department as a level II trauma center. The 268-bed hospital includes various specialty services, including neurological surgery, oncology and orthopedics.
Trauma in children, also known as pediatric trauma, refers to a traumatic injury that happens to an infant, child or adolescent. Because of anatomical and physiological differences between children and adults the care and management of this population differs.
Peter Meong Rhee is an American surgeon, medical professor, and military veteran. During his 24 years in the United States Navy, Rhee served as a battlefield casualty physician in Afghanistan and Iraq.
A wilderness medical emergency is a medical emergency that takes place in a wilderness or remote setting affinitive care. Such an emergency can require specialized skills, treatment techniques, and knowledge in order to manage the patient for an extended period of time before and during evacuation.
A Mobile Trauma Bay is a containerized ambulance bay mounted on an Oshkosh Logistic Vehicle System Replacement (LVSR). It holds state-of-the-art medical equipment and carries a Shock Trauma Platoon, generally consisting of one doctor, a nurse and three corpsmen, providing advanced resuscitative care to critically injured service members within the first hour after a traumatic injury. It takes emergency medical care far forward, saving more lives. Over 98% of the wounded Marines who make it into the MTB, make it out alive.
David R. Boyd was an American surgeon and pioneer in emergency medicine. Boyd is considered to be one of the "fathers of EMS systems." His colleague John Otten noted that Boyd "had been responsible for saving thousands of lives - more than anyone in the medical profession."
Hasan Badre Alam is a trauma surgeon, surgeon-scientist, and a medical professor in the United States. He is the Loyal and Edith Davis Professor of Surgery, the Chairman of Department of Surgery at the Feinberg School of Medicine (FSM)/Northwestern University, and the Surgeon-in-Chief at Northwestern Memorial Hospital (NMH) in Chicago.