What Is The 'Golden Hour' And Is It Linked To Death?

Getting proper care immediately after a severe medical emergency can literally be a life or death matter. The first 60 minutes after a trauma has been referred to as the "golden hour," a time span during which medical intervention is most likely to save lives. During this period, care that stops bleeding; restores or maintains the supply of oxygen to the brain, heart, and other vital organs; and stabilizes blood pressure can dramatically improve the odds of survival and recovery.

The term golden hour is attributed to a trauma surgeon, R. Adams Cowley, who launched Baltimore's Shock Trauma Center in the 1970s. Cowley's experience as a military surgeon during the Vietnam War, where rapid treatment of injured soldiers saved lives, motivated his efforts to promote rapid transport and treatment for people experiencing life-threatening injuries and illnesses. This has led to the creation of strategies to improve access to timely care and protocols for assessing and treating trauma patients. However, while rapid care is important, there is some disagreement over whether an actual 60-minute golden hour is supported by evidence.

Trauma is a leading cause of death worldwide, especially in people younger than 45 years old. Trauma includes violent assaults, traffic incidents, workplace accidents, and falls. Immediately after injury, the body tries to keep systems operating. For example, when it comes to the body regulating heart rate, adrenaline can raise both heart rate and blood pressure, somewhat offsetting the effects of blood loss. Additionally, the brain releases endorphins that can block pain signals right after an injury. However, despite these attempts by the body to manage trauma, getting timely professional care is crucial.

Medical professionals have developed a patient care protocol, often referred to by the mnemonic ABCDE, to follow during the golden hour. First, they check a patient's airway, breathing, and circulation and then check for neurological issues like paralysis (disability) and look for additional injuries (exposure). During the early stages of treatment, patients are also stabilized with intravenous fluids, oxygen, medication, and blood transfusion if needed. Then medical staff assess patients for internal injuries with imaging like an X-ray (a bit of technology with a fascinating discovery story behind it), CT, or ultrasound. Patients in need of further care are then sent off for surgery or more intensive care.

Medical care during the golden hour is meant to improve odds of survival, but it also affects long-term quality of life for trauma patients. Timely care can lead to faster and easier recovery, reduced odds of complications, and lower medical costs. For example, stroke treatments who get rapid care often experience less brain damage and have better long-term outcomes.

While the golden hour has become a de facto gold standard for emergency care, research has found little evidence that there is a strict 60-minute window for treatment. A 2010 study of more than 3,000 trauma patients found no correlation between the amount of time it took for emergency medical services to get patients to care and outcomes. However, data from the U.S. military showed that efforts to get injured service members to care within 60 minutes dramatically reduced death rates and saved hundreds of lives.

The likely case is that 60 minutes is not a hard and fast rule for ensuring trauma patient survival. Improving transportation where needed, such as in rural areas, and performing life-saving interventions like CPR at the scene or on the way to the hospital would likely improve survival odds. Trauma response should also consider the risks that come with rapid transport for each case. Even though it may not be an ironclad rule, the idea of the golden hour has led to improved chances of survival for trauma patients. In a medical emergency, time is of the essence.