ldquoGolden Hour after Traumardquo

-Literature review

DrSharad H Gajuryal

MHA Resident

Hospital Administration

Introduction

Objective

History

Literature to Support and Refute

Golden Hour

Conclusion

Introduction

ldquoGolden Hourrdquo-Term to represent the urgent

need for care of trauma patients

Implies that morbidity and mortality are

affected if care not instituted within one hour

of injury

ldquoThe hour immediately following traumatic

injury in which medical treatment for

preventing irreversible internal damage

and optimizing the chance of survival is

most effective

DrDonald Trunkey have summarized the

ldquoGolden Hour ldquoby 3R rule ie Getting the

Right Patient to

Right Place at

Right Time

Trauma is a Serious injury to the body

as from physical violence or an accident

Trauma is defined as a sudden

unexpected dramatic forceful or violent

event (Johnson 2009)

Trauma-Trimodal Distribution

Trauma is the leading cause of death in the first four decades of

life within developing countries Death from trauma has a

trimodal distribution

Within seconds to minutes -brain

Minutes to hours (GOLDEN HOUR)

Several days or weeks after the initial injury-MOF Sepsis

Trauma Facts Management of trauma is a neglected field in

developing nations

WHO estimates that 58 million deaths annually are due to injuries 90 of which occur in developing countries

Maximum proportion of these deaths occur before patients even reach the hospital

Two third (607) of the accident victims belonged to the age range of 15 to 44 years

This is the economically productive age-group and major financial support for their families

All trauma are not related to road transportation injury

Objective

To unpack the origin of golden hour and look

at evidence to refute or support it from

multiple review of the literature searched

manually

Data Sources

Literatures were searched in MEDLINE HINARI

and Cochrane Library Studies reporting on

golden hour prehospital time taken for

emergency medical services and outcome

parameter was included

The primary outcome was the influence on

mortality

History

Origin of the term ldquoGolden Hourrdquo was attributed to

Sir R Adams Cowley Father of Trauma Medicineldquo-

Founder of Baltimorersquos Famous Shock Trauma Institute

ldquo Cowleyrsquos article in 1975 states the first hour

after injury will largely determine a critically-

injured personrsquos chances for survivalrdquo

Lerner EB et alin their literature review determined

the origin of the term ldquoGolden Hourrdquo Most frequently

the phrase was attributed to RAdams Cowley They

cited a series of studies discussing the golden

hour(1)

But noticed that those studies were often referenced

to each other and were not accompanied by

supporting data or references

They only had little scientific evidence to support

golden hour

A retrospective cohort study of Dinn MM et al from trauma registry from 2000-2011 in adult patients with severe head injuries

Study was conducted in urban setting of Australia to determine the effect of patient arrival within the golden hour on patient outcomes

Study outcomes were in-hospital mortality and survival to hospital discharge

A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour There was evidence of improved functional outcomes in patients arriving within 60 min of injury time(3)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

Introduction

Objective

History

Literature to Support and Refute

Golden Hour

Conclusion

Introduction

ldquoGolden Hourrdquo-Term to represent the urgent

need for care of trauma patients

Implies that morbidity and mortality are

affected if care not instituted within one hour

of injury

ldquoThe hour immediately following traumatic

injury in which medical treatment for

preventing irreversible internal damage

and optimizing the chance of survival is

most effective

DrDonald Trunkey have summarized the

ldquoGolden Hour ldquoby 3R rule ie Getting the

Right Patient to

Right Place at

Right Time

Trauma is a Serious injury to the body

as from physical violence or an accident

Trauma is defined as a sudden

unexpected dramatic forceful or violent

event (Johnson 2009)

Trauma-Trimodal Distribution

Trauma is the leading cause of death in the first four decades of

life within developing countries Death from trauma has a

trimodal distribution

Within seconds to minutes -brain

Minutes to hours (GOLDEN HOUR)

Several days or weeks after the initial injury-MOF Sepsis

Trauma Facts Management of trauma is a neglected field in

developing nations

WHO estimates that 58 million deaths annually are due to injuries 90 of which occur in developing countries

Maximum proportion of these deaths occur before patients even reach the hospital

Two third (607) of the accident victims belonged to the age range of 15 to 44 years

This is the economically productive age-group and major financial support for their families

All trauma are not related to road transportation injury

Objective

To unpack the origin of golden hour and look

at evidence to refute or support it from

multiple review of the literature searched

manually

Data Sources

Literatures were searched in MEDLINE HINARI

and Cochrane Library Studies reporting on

golden hour prehospital time taken for

emergency medical services and outcome

parameter was included

The primary outcome was the influence on

mortality

History

Origin of the term ldquoGolden Hourrdquo was attributed to

Sir R Adams Cowley Father of Trauma Medicineldquo-

Founder of Baltimorersquos Famous Shock Trauma Institute

ldquo Cowleyrsquos article in 1975 states the first hour

after injury will largely determine a critically-

injured personrsquos chances for survivalrdquo

Lerner EB et alin their literature review determined

the origin of the term ldquoGolden Hourrdquo Most frequently

the phrase was attributed to RAdams Cowley They

cited a series of studies discussing the golden

hour(1)

But noticed that those studies were often referenced

to each other and were not accompanied by

supporting data or references

They only had little scientific evidence to support

golden hour

A retrospective cohort study of Dinn MM et al from trauma registry from 2000-2011 in adult patients with severe head injuries

Study was conducted in urban setting of Australia to determine the effect of patient arrival within the golden hour on patient outcomes

Study outcomes were in-hospital mortality and survival to hospital discharge

A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour There was evidence of improved functional outcomes in patients arriving within 60 min of injury time(3)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

Introduction

ldquoGolden Hourrdquo-Term to represent the urgent

need for care of trauma patients

Implies that morbidity and mortality are

affected if care not instituted within one hour

of injury

ldquoThe hour immediately following traumatic

injury in which medical treatment for

preventing irreversible internal damage

and optimizing the chance of survival is

most effective

DrDonald Trunkey have summarized the

ldquoGolden Hour ldquoby 3R rule ie Getting the

Right Patient to

Right Place at

Right Time

Trauma is a Serious injury to the body

as from physical violence or an accident

Trauma is defined as a sudden

unexpected dramatic forceful or violent

event (Johnson 2009)

Trauma-Trimodal Distribution

Trauma is the leading cause of death in the first four decades of

life within developing countries Death from trauma has a

trimodal distribution

Within seconds to minutes -brain

Minutes to hours (GOLDEN HOUR)

Several days or weeks after the initial injury-MOF Sepsis

Trauma Facts Management of trauma is a neglected field in

developing nations

WHO estimates that 58 million deaths annually are due to injuries 90 of which occur in developing countries

Maximum proportion of these deaths occur before patients even reach the hospital

Two third (607) of the accident victims belonged to the age range of 15 to 44 years

This is the economically productive age-group and major financial support for their families

All trauma are not related to road transportation injury

Objective

To unpack the origin of golden hour and look

at evidence to refute or support it from

multiple review of the literature searched

manually

Data Sources

Literatures were searched in MEDLINE HINARI

and Cochrane Library Studies reporting on

golden hour prehospital time taken for

emergency medical services and outcome

parameter was included

The primary outcome was the influence on

mortality

History

Origin of the term ldquoGolden Hourrdquo was attributed to

Sir R Adams Cowley Father of Trauma Medicineldquo-

Founder of Baltimorersquos Famous Shock Trauma Institute

ldquo Cowleyrsquos article in 1975 states the first hour

after injury will largely determine a critically-

injured personrsquos chances for survivalrdquo

Lerner EB et alin their literature review determined

the origin of the term ldquoGolden Hourrdquo Most frequently

the phrase was attributed to RAdams Cowley They

cited a series of studies discussing the golden

hour(1)

But noticed that those studies were often referenced

to each other and were not accompanied by

supporting data or references

They only had little scientific evidence to support

golden hour

A retrospective cohort study of Dinn MM et al from trauma registry from 2000-2011 in adult patients with severe head injuries

Study was conducted in urban setting of Australia to determine the effect of patient arrival within the golden hour on patient outcomes

Study outcomes were in-hospital mortality and survival to hospital discharge

A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour There was evidence of improved functional outcomes in patients arriving within 60 min of injury time(3)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

ldquoThe hour immediately following traumatic

injury in which medical treatment for

preventing irreversible internal damage

and optimizing the chance of survival is

most effective

DrDonald Trunkey have summarized the

ldquoGolden Hour ldquoby 3R rule ie Getting the

Right Patient to

Right Place at

Right Time

Trauma is a Serious injury to the body

as from physical violence or an accident

Trauma is defined as a sudden

unexpected dramatic forceful or violent

event (Johnson 2009)

Trauma-Trimodal Distribution

Trauma is the leading cause of death in the first four decades of

life within developing countries Death from trauma has a

trimodal distribution

Within seconds to minutes -brain

Minutes to hours (GOLDEN HOUR)

Several days or weeks after the initial injury-MOF Sepsis

Trauma Facts Management of trauma is a neglected field in

developing nations

WHO estimates that 58 million deaths annually are due to injuries 90 of which occur in developing countries

Maximum proportion of these deaths occur before patients even reach the hospital

Two third (607) of the accident victims belonged to the age range of 15 to 44 years

This is the economically productive age-group and major financial support for their families

All trauma are not related to road transportation injury

Objective

To unpack the origin of golden hour and look

at evidence to refute or support it from

multiple review of the literature searched

manually

Data Sources

Literatures were searched in MEDLINE HINARI

and Cochrane Library Studies reporting on

golden hour prehospital time taken for

emergency medical services and outcome

parameter was included

The primary outcome was the influence on

mortality

History

Origin of the term ldquoGolden Hourrdquo was attributed to

Sir R Adams Cowley Father of Trauma Medicineldquo-

Founder of Baltimorersquos Famous Shock Trauma Institute

ldquo Cowleyrsquos article in 1975 states the first hour

after injury will largely determine a critically-

injured personrsquos chances for survivalrdquo

Lerner EB et alin their literature review determined

the origin of the term ldquoGolden Hourrdquo Most frequently

the phrase was attributed to RAdams Cowley They

cited a series of studies discussing the golden

hour(1)

But noticed that those studies were often referenced

to each other and were not accompanied by

supporting data or references

They only had little scientific evidence to support

golden hour

A retrospective cohort study of Dinn MM et al from trauma registry from 2000-2011 in adult patients with severe head injuries

Study was conducted in urban setting of Australia to determine the effect of patient arrival within the golden hour on patient outcomes

Study outcomes were in-hospital mortality and survival to hospital discharge

A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour There was evidence of improved functional outcomes in patients arriving within 60 min of injury time(3)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

DrDonald Trunkey have summarized the

ldquoGolden Hour ldquoby 3R rule ie Getting the

Right Patient to

Right Place at

Right Time

Trauma is a Serious injury to the body

as from physical violence or an accident

Trauma is defined as a sudden

unexpected dramatic forceful or violent

event (Johnson 2009)

Trauma-Trimodal Distribution

Trauma is the leading cause of death in the first four decades of

life within developing countries Death from trauma has a

trimodal distribution

Within seconds to minutes -brain

Minutes to hours (GOLDEN HOUR)

Several days or weeks after the initial injury-MOF Sepsis

Trauma Facts Management of trauma is a neglected field in

developing nations

WHO estimates that 58 million deaths annually are due to injuries 90 of which occur in developing countries

Maximum proportion of these deaths occur before patients even reach the hospital

Two third (607) of the accident victims belonged to the age range of 15 to 44 years

This is the economically productive age-group and major financial support for their families

All trauma are not related to road transportation injury

Objective

To unpack the origin of golden hour and look

at evidence to refute or support it from

multiple review of the literature searched

manually

Data Sources

Literatures were searched in MEDLINE HINARI

and Cochrane Library Studies reporting on

golden hour prehospital time taken for

emergency medical services and outcome

parameter was included

The primary outcome was the influence on

mortality

History

Origin of the term ldquoGolden Hourrdquo was attributed to

Sir R Adams Cowley Father of Trauma Medicineldquo-

Founder of Baltimorersquos Famous Shock Trauma Institute

ldquo Cowleyrsquos article in 1975 states the first hour

after injury will largely determine a critically-

injured personrsquos chances for survivalrdquo

Lerner EB et alin their literature review determined

the origin of the term ldquoGolden Hourrdquo Most frequently

the phrase was attributed to RAdams Cowley They

cited a series of studies discussing the golden

hour(1)

But noticed that those studies were often referenced

to each other and were not accompanied by

supporting data or references

They only had little scientific evidence to support

golden hour

A retrospective cohort study of Dinn MM et al from trauma registry from 2000-2011 in adult patients with severe head injuries

Study was conducted in urban setting of Australia to determine the effect of patient arrival within the golden hour on patient outcomes

Study outcomes were in-hospital mortality and survival to hospital discharge

A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour There was evidence of improved functional outcomes in patients arriving within 60 min of injury time(3)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

Trauma is a Serious injury to the body

as from physical violence or an accident

Trauma is defined as a sudden

unexpected dramatic forceful or violent

event (Johnson 2009)

Trauma-Trimodal Distribution

Trauma is the leading cause of death in the first four decades of

life within developing countries Death from trauma has a

trimodal distribution

Within seconds to minutes -brain

Minutes to hours (GOLDEN HOUR)

Several days or weeks after the initial injury-MOF Sepsis

Trauma Facts Management of trauma is a neglected field in

developing nations

WHO estimates that 58 million deaths annually are due to injuries 90 of which occur in developing countries

Maximum proportion of these deaths occur before patients even reach the hospital

Two third (607) of the accident victims belonged to the age range of 15 to 44 years

This is the economically productive age-group and major financial support for their families

All trauma are not related to road transportation injury

Objective

To unpack the origin of golden hour and look

at evidence to refute or support it from

multiple review of the literature searched

manually

Data Sources

Literatures were searched in MEDLINE HINARI

and Cochrane Library Studies reporting on

golden hour prehospital time taken for

emergency medical services and outcome

parameter was included

The primary outcome was the influence on

mortality

History

Origin of the term ldquoGolden Hourrdquo was attributed to

Sir R Adams Cowley Father of Trauma Medicineldquo-

Founder of Baltimorersquos Famous Shock Trauma Institute

ldquo Cowleyrsquos article in 1975 states the first hour

after injury will largely determine a critically-

injured personrsquos chances for survivalrdquo

Lerner EB et alin their literature review determined

the origin of the term ldquoGolden Hourrdquo Most frequently

the phrase was attributed to RAdams Cowley They

cited a series of studies discussing the golden

hour(1)

But noticed that those studies were often referenced

to each other and were not accompanied by

supporting data or references

They only had little scientific evidence to support

golden hour

A retrospective cohort study of Dinn MM et al from trauma registry from 2000-2011 in adult patients with severe head injuries

Study was conducted in urban setting of Australia to determine the effect of patient arrival within the golden hour on patient outcomes

Study outcomes were in-hospital mortality and survival to hospital discharge

A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour There was evidence of improved functional outcomes in patients arriving within 60 min of injury time(3)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

Trauma-Trimodal Distribution

Trauma is the leading cause of death in the first four decades of

life within developing countries Death from trauma has a

trimodal distribution

Within seconds to minutes -brain

Minutes to hours (GOLDEN HOUR)

Several days or weeks after the initial injury-MOF Sepsis

Trauma Facts Management of trauma is a neglected field in

developing nations

WHO estimates that 58 million deaths annually are due to injuries 90 of which occur in developing countries

Maximum proportion of these deaths occur before patients even reach the hospital

Two third (607) of the accident victims belonged to the age range of 15 to 44 years

This is the economically productive age-group and major financial support for their families

All trauma are not related to road transportation injury

Objective

To unpack the origin of golden hour and look

at evidence to refute or support it from

multiple review of the literature searched

manually

Data Sources

Literatures were searched in MEDLINE HINARI

and Cochrane Library Studies reporting on

golden hour prehospital time taken for

emergency medical services and outcome

parameter was included

The primary outcome was the influence on

mortality

History

Origin of the term ldquoGolden Hourrdquo was attributed to

Sir R Adams Cowley Father of Trauma Medicineldquo-

Founder of Baltimorersquos Famous Shock Trauma Institute

ldquo Cowleyrsquos article in 1975 states the first hour

after injury will largely determine a critically-

injured personrsquos chances for survivalrdquo

Lerner EB et alin their literature review determined

the origin of the term ldquoGolden Hourrdquo Most frequently

the phrase was attributed to RAdams Cowley They

cited a series of studies discussing the golden

hour(1)

But noticed that those studies were often referenced

to each other and were not accompanied by

supporting data or references

They only had little scientific evidence to support

golden hour

A retrospective cohort study of Dinn MM et al from trauma registry from 2000-2011 in adult patients with severe head injuries

Study was conducted in urban setting of Australia to determine the effect of patient arrival within the golden hour on patient outcomes

Study outcomes were in-hospital mortality and survival to hospital discharge

A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour There was evidence of improved functional outcomes in patients arriving within 60 min of injury time(3)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

Trauma Facts Management of trauma is a neglected field in

developing nations

WHO estimates that 58 million deaths annually are due to injuries 90 of which occur in developing countries

Maximum proportion of these deaths occur before patients even reach the hospital

Two third (607) of the accident victims belonged to the age range of 15 to 44 years

This is the economically productive age-group and major financial support for their families

All trauma are not related to road transportation injury

Objective

To unpack the origin of golden hour and look

at evidence to refute or support it from

multiple review of the literature searched

manually

Data Sources

Literatures were searched in MEDLINE HINARI

and Cochrane Library Studies reporting on

golden hour prehospital time taken for

emergency medical services and outcome

parameter was included

The primary outcome was the influence on

mortality

History

Origin of the term ldquoGolden Hourrdquo was attributed to

Sir R Adams Cowley Father of Trauma Medicineldquo-

Founder of Baltimorersquos Famous Shock Trauma Institute

ldquo Cowleyrsquos article in 1975 states the first hour

after injury will largely determine a critically-

injured personrsquos chances for survivalrdquo

Lerner EB et alin their literature review determined

the origin of the term ldquoGolden Hourrdquo Most frequently

the phrase was attributed to RAdams Cowley They

cited a series of studies discussing the golden

hour(1)

But noticed that those studies were often referenced

to each other and were not accompanied by

supporting data or references

They only had little scientific evidence to support

golden hour

A retrospective cohort study of Dinn MM et al from trauma registry from 2000-2011 in adult patients with severe head injuries

Study was conducted in urban setting of Australia to determine the effect of patient arrival within the golden hour on patient outcomes

Study outcomes were in-hospital mortality and survival to hospital discharge

A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour There was evidence of improved functional outcomes in patients arriving within 60 min of injury time(3)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

Objective

To unpack the origin of golden hour and look

at evidence to refute or support it from

multiple review of the literature searched

manually

Data Sources

Literatures were searched in MEDLINE HINARI

and Cochrane Library Studies reporting on

golden hour prehospital time taken for

emergency medical services and outcome

parameter was included

The primary outcome was the influence on

mortality

History

Origin of the term ldquoGolden Hourrdquo was attributed to

Sir R Adams Cowley Father of Trauma Medicineldquo-

Founder of Baltimorersquos Famous Shock Trauma Institute

ldquo Cowleyrsquos article in 1975 states the first hour

after injury will largely determine a critically-

injured personrsquos chances for survivalrdquo

Lerner EB et alin their literature review determined

the origin of the term ldquoGolden Hourrdquo Most frequently

the phrase was attributed to RAdams Cowley They

cited a series of studies discussing the golden

hour(1)

But noticed that those studies were often referenced

to each other and were not accompanied by

supporting data or references

They only had little scientific evidence to support

golden hour

A retrospective cohort study of Dinn MM et al from trauma registry from 2000-2011 in adult patients with severe head injuries

Study was conducted in urban setting of Australia to determine the effect of patient arrival within the golden hour on patient outcomes

Study outcomes were in-hospital mortality and survival to hospital discharge

A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour There was evidence of improved functional outcomes in patients arriving within 60 min of injury time(3)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

Data Sources

Literatures were searched in MEDLINE HINARI

and Cochrane Library Studies reporting on

golden hour prehospital time taken for

emergency medical services and outcome

parameter was included

The primary outcome was the influence on

mortality

History

Origin of the term ldquoGolden Hourrdquo was attributed to

Sir R Adams Cowley Father of Trauma Medicineldquo-

Founder of Baltimorersquos Famous Shock Trauma Institute

ldquo Cowleyrsquos article in 1975 states the first hour

after injury will largely determine a critically-

injured personrsquos chances for survivalrdquo

Lerner EB et alin their literature review determined

the origin of the term ldquoGolden Hourrdquo Most frequently

the phrase was attributed to RAdams Cowley They

cited a series of studies discussing the golden

hour(1)

But noticed that those studies were often referenced

to each other and were not accompanied by

supporting data or references

They only had little scientific evidence to support

golden hour

A retrospective cohort study of Dinn MM et al from trauma registry from 2000-2011 in adult patients with severe head injuries

Study was conducted in urban setting of Australia to determine the effect of patient arrival within the golden hour on patient outcomes

Study outcomes were in-hospital mortality and survival to hospital discharge

A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour There was evidence of improved functional outcomes in patients arriving within 60 min of injury time(3)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

History

Origin of the term ldquoGolden Hourrdquo was attributed to

Sir R Adams Cowley Father of Trauma Medicineldquo-

Founder of Baltimorersquos Famous Shock Trauma Institute

ldquo Cowleyrsquos article in 1975 states the first hour

after injury will largely determine a critically-

injured personrsquos chances for survivalrdquo

Lerner EB et alin their literature review determined

the origin of the term ldquoGolden Hourrdquo Most frequently

the phrase was attributed to RAdams Cowley They

cited a series of studies discussing the golden

hour(1)

But noticed that those studies were often referenced

to each other and were not accompanied by

supporting data or references

They only had little scientific evidence to support

golden hour

A retrospective cohort study of Dinn MM et al from trauma registry from 2000-2011 in adult patients with severe head injuries

Study was conducted in urban setting of Australia to determine the effect of patient arrival within the golden hour on patient outcomes

Study outcomes were in-hospital mortality and survival to hospital discharge

A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour There was evidence of improved functional outcomes in patients arriving within 60 min of injury time(3)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

Lerner EB et alin their literature review determined

the origin of the term ldquoGolden Hourrdquo Most frequently

the phrase was attributed to RAdams Cowley They

cited a series of studies discussing the golden

hour(1)

But noticed that those studies were often referenced

to each other and were not accompanied by

supporting data or references

They only had little scientific evidence to support

golden hour

A retrospective cohort study of Dinn MM et al from trauma registry from 2000-2011 in adult patients with severe head injuries

Study was conducted in urban setting of Australia to determine the effect of patient arrival within the golden hour on patient outcomes

Study outcomes were in-hospital mortality and survival to hospital discharge

A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour There was evidence of improved functional outcomes in patients arriving within 60 min of injury time(3)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

A retrospective cohort study of Dinn MM et al from trauma registry from 2000-2011 in adult patients with severe head injuries

Study was conducted in urban setting of Australia to determine the effect of patient arrival within the golden hour on patient outcomes

Study outcomes were in-hospital mortality and survival to hospital discharge

A survival benefit exists in patients arriving earlier to hospital after severe head injury but the benefit may extend beyond the golden hour There was evidence of improved functional outcomes in patients arriving within 60 min of injury time(3)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

A study conducted by Grossman DC et al in Washington for 6 month period to a total of 459 major trauma victims

A geographic locations was determined for these subjects

Of these 42 of subjects were injured in urban areas and the remainder in rural areas The severity of injuries was similar for urban and rural major trauma patients

Author concluded that Rural victims were over seven times more likely to die before arrival if the emergency medical services response time was more than 30 minutes

ie reduced pre hospital time has been found to be beneficial in rural trauma patient with long transport time

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

A prospective cohort study data from 146 EMS transport agencies over a 16 month period from 2005-2007 were analyzed in trauma patients of North America

The outcome was in-hospital mortality

Variable studied were EMS intervals

activation

response

on-scene

transport amp

total time

There were 3656 trauma patients available for analysis of whom 806 (220) died After Multivariate subgroup and instrumental analysis no significant association was found between time and mortality among injured patient(2)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

A comparative study done by Xi Xiang Tang et al focusing upon pre hospital trauma care and its outcome between Scotland and Germany showed that the mean time from an injury to arrival to the emergency department in Scottish patient (247 min)was longer than Germany patient (73 min )

Despite variation in prehospital transfer times and interventions no significant difference was demonstrated in revised trauma score upon arrival or for the unadjusted mortality rates(4)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

Lichtveld et al in Netherland for (1999-2000) 2

years in 507 trauma patients also confirmed that

risk of death is not influenced by time between

the accident and arrival at Hospital

Rather it is determined by by RTS age severe

neurological damage base excess and

hemoglobin (5)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

Similar conclusion was found in the study of

Lerner EB et al conducted in 2003 at New

york City The study was retrospective and

included 1877 trauma patients

Author concluded that patient age Injury Severity

Score and Revised Trauma Score all were significant

predictors of trauma patient mortality And total out-

of-hospital time was not associated with

mortality (6)

Pons PT et al and blackwell TH et al in trauma

patient in year 2005 and 2002 showed that

survival benefit was identified when the response

time is shorter ie lt5 mins and lt4 mins for

patient with high risk of mortality(78)

Some researcher even indicate that a slower smoother

transport to the hospital would be beneficial to patients

and pre hospital providers

A study conducted in Korea by Chung TN et al showed

that during the patient transport rush within golden hour

increased ambulance speed negatively affects the

quality of chest compression during transportation

By some estimates the risk of transportation related injury to EMS workers and

patients are also high during the transportation time in golden hours

The study conducted by Maguire BJ et al at Baltimore for period of 5 years

concluded that Emergency workers have a documented fatality rate of 125

among 100000 workers

These death and injuries largely belong to helicopter and ambulance crashes that

result from the emphasis on shorter pre hospital time frames during golden hour (9)

Conclusion

Pre-hospital trauma care service remains a

dynamic field of medicine for care of trauma

patients

Several studies have suggested a decrease in

mortality when trauma patients reach

definitive care during the Golden Hour but

recent research demonstrates no link between

time and survival

Due to great heterogeneity in the literature

confined conclusions cannot be drawn

The pressure to arrive at the hospital within the

Golden Hour may increase the number of

emergent transports which have been

demonstrated to increase the risk for collisions

resulting in injury and fatality

Despite the conflicting evidence regarding the golden

hour rapid transport to medical facility remains the

standard of trauma care

The goal should be to get lsquothe right patient to the right

place at the right time to receive the right carersquo

following trauma

References 1 Lerner EB Moscati RM The golden hour

Scientific fact or medical ldquourban legendrdquo AcadEmerg Med 2001 Jul8(7)758ndash60 [Medline]

2 Newgard CD Schmicker RH Hedges JR at al Emergency medical service intervals and survival in trauma assessment of the lsquogolden hourrsquo in a North American prospective cohort Ann of Emerg Med 201055(3)235-46 [Medline]

3 Dinh MM Bein K Roncal S Byrne CM Petchell J Brennan J Redefining the golden hour for severe head injury in an urban setting The effect of prehospital arrival times on patient outcomes Injury (2012) doi101016jinjury201201011 (in press)

Some researcher even indicate that a slower smoother

transport to the hospital would be beneficial to patients

and pre hospital providers

A study conducted in Korea by Chung TN et al showed

that during the patient transport rush within golden hour

increased ambulance speed negatively affects the

quality of chest compression during transportation

By some estimates the risk of transportation related injury to EMS workers and

patients are also high during the transportation time in golden hours

The study conducted by Maguire BJ et al at Baltimore for period of 5 years

concluded that Emergency workers have a documented fatality rate of 125

among 100000 workers

These death and injuries largely belong to helicopter and ambulance crashes that

result from the emphasis on shorter pre hospital time frames during golden hour (9)

Conclusion

Pre-hospital trauma care service remains a

dynamic field of medicine for care of trauma

patients

Several studies have suggested a decrease in

mortality when trauma patients reach

definitive care during the Golden Hour but

recent research demonstrates no link between

time and survival

Due to great heterogeneity in the literature

confined conclusions cannot be drawn

The pressure to arrive at the hospital within the

Golden Hour may increase the number of

emergent transports which have been

demonstrated to increase the risk for collisions

resulting in injury and fatality

Despite the conflicting evidence regarding the golden

hour rapid transport to medical facility remains the

standard of trauma care

The goal should be to get lsquothe right patient to the right

place at the right time to receive the right carersquo

following trauma

References 1 Lerner EB Moscati RM The golden hour

Scientific fact or medical ldquourban legendrdquo AcadEmerg Med 2001 Jul8(7)758ndash60 [Medline]

2 Newgard CD Schmicker RH Hedges JR at al Emergency medical service intervals and survival in trauma assessment of the lsquogolden hourrsquo in a North American prospective cohort Ann of Emerg Med 201055(3)235-46 [Medline]

3 Dinh MM Bein K Roncal S Byrne CM Petchell J Brennan J Redefining the golden hour for severe head injury in an urban setting The effect of prehospital arrival times on patient outcomes Injury (2012) doi101016jinjury201201011 (in press)

By some estimates the risk of transportation related injury to EMS workers and

patients are also high during the transportation time in golden hours

The study conducted by Maguire BJ et al at Baltimore for period of 5 years

concluded that Emergency workers have a documented fatality rate of 125

among 100000 workers

These death and injuries largely belong to helicopter and ambulance crashes that

result from the emphasis on shorter pre hospital time frames during golden hour (9)

Conclusion

Pre-hospital trauma care service remains a

dynamic field of medicine for care of trauma

patients

Several studies have suggested a decrease in

mortality when trauma patients reach

definitive care during the Golden Hour but

recent research demonstrates no link between

time and survival

Due to great heterogeneity in the literature

confined conclusions cannot be drawn

The pressure to arrive at the hospital within the

Golden Hour may increase the number of

emergent transports which have been

demonstrated to increase the risk for collisions

resulting in injury and fatality

Despite the conflicting evidence regarding the golden

hour rapid transport to medical facility remains the

standard of trauma care

The goal should be to get lsquothe right patient to the right

place at the right time to receive the right carersquo

following trauma

References 1 Lerner EB Moscati RM The golden hour

Scientific fact or medical ldquourban legendrdquo AcadEmerg Med 2001 Jul8(7)758ndash60 [Medline]

2 Newgard CD Schmicker RH Hedges JR at al Emergency medical service intervals and survival in trauma assessment of the lsquogolden hourrsquo in a North American prospective cohort Ann of Emerg Med 201055(3)235-46 [Medline]

3 Dinh MM Bein K Roncal S Byrne CM Petchell J Brennan J Redefining the golden hour for severe head injury in an urban setting The effect of prehospital arrival times on patient outcomes Injury (2012) doi101016jinjury201201011 (in press)

Conclusion

Pre-hospital trauma care service remains a

dynamic field of medicine for care of trauma

patients

Several studies have suggested a decrease in

mortality when trauma patients reach

definitive care during the Golden Hour but

recent research demonstrates no link between

time and survival

Due to great heterogeneity in the literature

confined conclusions cannot be drawn

The pressure to arrive at the hospital within the

Golden Hour may increase the number of

emergent transports which have been

demonstrated to increase the risk for collisions

resulting in injury and fatality

Despite the conflicting evidence regarding the golden

hour rapid transport to medical facility remains the

standard of trauma care

The goal should be to get lsquothe right patient to the right

place at the right time to receive the right carersquo

following trauma

References 1 Lerner EB Moscati RM The golden hour

Scientific fact or medical ldquourban legendrdquo AcadEmerg Med 2001 Jul8(7)758ndash60 [Medline]

2 Newgard CD Schmicker RH Hedges JR at al Emergency medical service intervals and survival in trauma assessment of the lsquogolden hourrsquo in a North American prospective cohort Ann of Emerg Med 201055(3)235-46 [Medline]

3 Dinh MM Bein K Roncal S Byrne CM Petchell J Brennan J Redefining the golden hour for severe head injury in an urban setting The effect of prehospital arrival times on patient outcomes Injury (2012) doi101016jinjury201201011 (in press)

The pressure to arrive at the hospital within the

Golden Hour may increase the number of

emergent transports which have been

demonstrated to increase the risk for collisions

resulting in injury and fatality

Despite the conflicting evidence regarding the golden

hour rapid transport to medical facility remains the

standard of trauma care

The goal should be to get lsquothe right patient to the right

place at the right time to receive the right carersquo

following trauma

References 1 Lerner EB Moscati RM The golden hour

Scientific fact or medical ldquourban legendrdquo AcadEmerg Med 2001 Jul8(7)758ndash60 [Medline]

2 Newgard CD Schmicker RH Hedges JR at al Emergency medical service intervals and survival in trauma assessment of the lsquogolden hourrsquo in a North American prospective cohort Ann of Emerg Med 201055(3)235-46 [Medline]

3 Dinh MM Bein K Roncal S Byrne CM Petchell J Brennan J Redefining the golden hour for severe head injury in an urban setting The effect of prehospital arrival times on patient outcomes Injury (2012) doi101016jinjury201201011 (in press)

References 1 Lerner EB Moscati RM The golden hour

Scientific fact or medical ldquourban legendrdquo AcadEmerg Med 2001 Jul8(7)758ndash60 [Medline]

2 Newgard CD Schmicker RH Hedges JR at al Emergency medical service intervals and survival in trauma assessment of the lsquogolden hourrsquo in a North American prospective cohort Ann of Emerg Med 201055(3)235-46 [Medline]

3 Dinh MM Bein K Roncal S Byrne CM Petchell J Brennan J Redefining the golden hour for severe head injury in an urban setting The effect of prehospital arrival times on patient outcomes Injury (2012) doi101016jinjury201201011 (in press)

4 Tan XX Clement ND Frink M et al Pre-hospital trauma care A comparison of two healthcare systems Indian J Crit Care Med 20121622-7 [Medline]

5 Lichtveld RA Panhuizen IF Smit RBJ et al Predictors of death in trauma patients who are alive on arrival to hospital European Journal of Trauma and Emergency Surgery 20073346-51

6 Is total out-of-hospital time a significant predictor of trauma patient mortality

Lerner EB1 Billittier AJ Dorn JM Wu YW 7 Response time effectiveness comparison of response time and

survival in an urban emergency medical services system

Blackwell TH1 Kaufman JS

8 Paramedic response time does it affect patient survival

Pons PT1 Haukoos JS Bludworth W Cribley T Pons KA Markovchick VJ

9 Occupational fatalities in emergency medical services a

hidden crisis

Maguire BJ1 Hunting KL Smith GS Levick NR