Golden Hour

The Golden Hour is an term used in emergency medicine which refers to the first sixty minutes after an accident or the onset of acute illness. The victim's chances of survival are greatest if he or she can be transported to an hospital within the Golden Hour.

This concept comes from the US military experience, especially in the Vietnam war. The fact is that in the case of a severe trauma, nothing can replace surgery (especially in case of an internal bleeding); it is therefore necessary to transport the victim as fast as possible to a trauma center.

First, the prehospital care are thus limited to the minimum, i.e.

A.B.C (airway, breathing, circulation)
cover the wounds
realign the members when broken (reduction)
protection of the spine.

The intravenous drip must be fast and must not delay the transportation. The endotracheal intubation is the only act that can delay the transportation. This prehospital strategy is also called scoop and run, opposed to the stay and play that is more adapted to less severe cases (when there is no severe trauma, the trauma caused by the transportation itself is more important than the gain of time).

Second point, the victim must be transported not always to the closest hospital, but to the hospital that has the equipment and team to treat the trauma (see also triage).

Third point, only limited examination at the emergnency department. When there is no evidence for surgical intervention, only three radiographies should be performed: lungs, spine and pelvis.

The golden hour can be sumarised by the 3R rule of Trunkey:

Right patient
Right place
Right time

MEDEVAC helicopters are often used to move victims to a trauma center within the Golden Hour.

Golden Hour

See also