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Post by gerardb on Oct 13, 2015 23:28:33 GMT
My father was, for many years, a professional firefighter. He used to mention 'The Golden Hour' a lot, particularly in the context of road traffic crashes where serious trauma injuries were sustained. My understanding of it is that it is applied, in particular, to trauma incidents (though we do have time critical medical emergencies) and refers to the time from the onset of the incident through to the application of definitive care.
I have this morning read two articles on the subject of 'The Golden Hour', one of which is authored by Bryan Bledsoe - a name synonymous with emergency pre-hospital care. The theme of both articles is the same, namely, that there is not a single scientific article that either supports or refutes the concept of 'The Golden Hour'. Now, the first article was published in 2001 and Bledsoe's in 2002. In the intervening period since these articles were published, there could very well have been studies conducted and peer-reviewed literature published on the subject, either supporting or refuting the concept. However, I am not certain that is even important. The way I look at it is that this phrase, this concept, is the voicing of, the concretisation if you like, of something that is essentially, for us as EMS personnel, intuitive. Someone is haemorrhaging, we act to stop the bleeding. Someone is showing signs of shock we intervene and do what we can to alleviate those symptoms. It is about providing the most appropriate interventions and care in a timely manner whilst ensuring our own safety and that of the patient.
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kat
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Post by kat on Oct 14, 2015 0:49:58 GMT
The reading I have done about the Golden Hour refer to the time critical hour after an traumatic accident and getting the patient to definitive care.(yes Gerard I see this is familiar to your answer)However again like Gerard the information also says that this is neither here nor there. So I have come to the conclusion that the Golden Hour refers to - the best time practice that ambulance medical intervention increases a chances of a patients survival following a traumatic incident. Meaning it seems in the past that the hour referred to hospital care but now with increased trained medical staff on the road the "Golden Hour" time frame is when the ambulance arrives.
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Post by Barry on Oct 14, 2015 22:46:52 GMT
Hi Team, Just want to throw another angle to the "Golden Hour" for you to research There is research out there saying that patients who are subject to aggressive treatment don't have a higher survival rate to patients that aren't treated aggressively.
This was highlighted in the Vietnam war compared to the Falkland's war.
My question to you all is , Why is this?
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Post by Ian TanMan on Oct 15, 2015 8:31:19 GMT
Maybe Barry it is because the types of injuries are too massive to treat effectively in the pre hospital setting, or the time to definitive care is too great-doesnt matter how aggressive your treatment is.....if the hole is big enough you will bleed out :-) Maybe also, being 'aggressive' might mean that you miss something basic and obvious-I personally had a medic and doctor ask me for a bandage when I arrived at an incident where a young male stepped out of his car after an argument with his girlfriend....whilst she was still driving on a state highway at 100kmh......they wanted a bandage to stop the minimal bleeding from a near amputation of his foot-yes it looked pretty cool......but I personally thought that the fact he was gurgling and had inadequate breathing was more of an issue-one I dealt with with my basic ambulance skills......they however made the foot pretty with my bandage.....so maybe taking time and avoiding tunnel vision would help rather than being balls to the wall (can I say that?) and rushing straight in and fixing what you first see.......
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Post by Barry on Oct 19, 2015 19:45:39 GMT
HI Team, Here is another question for you to give me an answer to.......enjoy Anaphylaxis is a life threatening condition that can often easily be treated with an intramuscular injection of adrenaline. Two questions: 1 The administration of intramuscular adrenaline was, up until recently, a Paramedic and ICP skill. Why do you think that this was changed and added to the delegated scope of practice of the EMT? What ‘safety’ factors have been implemented with this change? 2 How can you ensure that a patient with anaphylaxis in your area receives adrenaline quickly?
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kat
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Post by kat on Oct 19, 2015 21:42:32 GMT
I agree with Ian in that the type of injury has a lot to do with survival and "The Golden Hour". Other point with trauma we have to consider is the environmental aspect and the relationship it has on the patients injury. EG: with external bleeding the cold worsens the extent of the bleeding because it slow the blood clotting. In a war situation Barry I wonder about the sympathetic system and how being in a situation where your life is in constant danger if you would be in a constant flight or fight mode. How much adrenaline would naturally be pumping through your body 24\7 and what role that state would have on any injuries you would sustain while fighting.
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Post by cathy on Oct 22, 2015 0:19:38 GMT
I agree with Ian in that the type of injury has a lot to do with survival and "The Golden Hour". Other point with trauma we have to consider is the environmental aspect and the relationship it has on the patients injury. EG: with external bleeding the cold worsens the extent of the bleeding because it slow the blood clotting. In a war situation Barry I wonder about the sympathetic system and how being in a situation where your life is in constant danger if you would be in a constant flight or fight mode. How much adrenaline would naturally be pumping through your body 24\7 and what role that state would have on any injuries you would sustain while fighting.
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Post by cathy on Oct 22, 2015 0:25:59 GMT
Hi there, firstly I feel the golden hour is an old expression and with the abilities of paramedics/ambulance staff and the excellent care given, this so called golden hour is not so vital. Paramedics/ambulance staff do a fantastic job of stabilising patients and increasing survival. Maybe patients feel a little more safe in a hospital environment but the care received by them is of an equal if not better in some cases, than what they may experience in hospital!!
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Post by Cathy on Oct 22, 2015 0:27:05 GMT
Sorry Kat don't know what I did to your quote thing.
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Post by Cathy on Oct 22, 2015 0:33:03 GMT
I think the time factor for giving Adrenaline has been the force behind EMTs giving this for anaphylaxis. Waiting for someone to come to a patient that needs adrenaline can be the difference between survival and not. An EMT that is well trained to give this will save lives. Easy as that. The safety practices that have been put in place would be the amount of training given and its based on Best Practice in medical settings.
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Post by janell on Oct 23, 2015 0:06:17 GMT
Hey guys! Hope all is going well. The "Golden Hour".... Yes I believe it's important and time can be crucial in different situations as many of the answers above have explained but the golden hour rule just can't be applied to every incident. There are many things that would restrict us from delivering patient care as quick as we should for example travelling to rural area's, extricating and multiple patients and so on. Obviously the quicker we can get patients to hospital the more chance of survival they will have. But... this still brings me to the fact that sometimes this cannot apply. I read the article that Gerard read and a couple of others and came up with the same conclusion that there were no articles that could agree or disagree with "The Golden Hour" theory. Now days we are educated with so much more skills, equipped with more advanced devices and have more transport options to assist us with patient care/transport as promptly and efficiently as we can.
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Post by janell on Oct 23, 2015 0:14:04 GMT
What a great answer Kat. I never thought about the sympathetic nervous system and what effects this could have on the injury....Great Stuff I agree with Ian in that the type of injury has a lot to do with survival and "The Golden Hour". Other point with trauma we have to consider is the environmental aspect and the relationship it has on the patients injury. EG: with external bleeding the cold worsens the extent of the bleeding because it slow the blood clotting. In a war situation Barry I wonder about the sympathetic system and how being in a situation where your life is in constant danger if you would be in a constant flight or fight mode. How much adrenaline would naturally be pumping through your body 24\7 and what role that state would have on any injuries you would sustain while fighting.
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Post by Kirsty on Oct 23, 2015 8:22:37 GMT
As everyone has quite rightly pointed out the 'Golden hour' concept suggests that a patient has an hour from the time trauma is sustained until they receive definitive care at a hospital before the risk of morbidity or mortality is increased. After much reading I think it appears that the concept of the golden hour was developed in a time when pre hospital care was less adequate than it is today. In the pre hospital setting today there are many more highly skilled professionals who can apply potentially life saving interventions without delay. In the Trimodal pattern of mortality we are still not going to be able to prevent the immediate deaths from catastrophic injuries but have a bigger impact in preventing early deaths characterised by haemorrhage related injuries. Timely treatment and transport will have the most effect on reducing late deaths mainly due to multi organ failure and sepsis. Whilst obviously prompt treatment and transport to hospital is the ultimate goal the scoop and run approach is not the ideal treatment for all trauma patients. My conclusion is that getting a patient to hospital in a strictly defined time frame will not necessary be the best outcome for them.
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Post by Barry on Oct 27, 2015 22:26:37 GMT
Hi Team, Some great thought processes going on here and we will discuss it on our first weekend "The Golden Hour", also we will talk about the Vietnam syndrome as well.
Look a bit deeper into the anaphylaxis and adrenaline and how it works on the receptor sites to help control anaphylaxis.
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Post by Brendoon on Oct 28, 2015 1:01:39 GMT
Hi all hope you're all well out there!
I guess with so many of our guidelines and procedures tried and tested in the military and war zones that eventually the best practices are filtered down to us. It seems the military are moving more and more resources and skills closer to the action, cutting right in on 'the golden hour' and having good results with faster and more advanced treatment available. It is working out what are the more aggressive treatments that work well out in the field as opposed to stabilizing the patient and transporting them to the appropriate care. Perhaps some treatments just don't work well in the field due to environmental considerations.
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