Origins of the Golden Hour of Medical Care and Its Applicability to Combat Medicine.

摘要

The Golden Hour standard is used in emergency medicine and trauma care and states a person must receive definitive care within one hour to ensure optimal outcomes. The medical community accepted this standard without supporting evidence. It is a cornerstone of modern trauma systems. Secretary of Defense Gates endorsed this standard for military medicine (Gates 2009). His stance, combined with strong opinions from the trauma community, resulted in a requirement for units to operate within one hour of ROLE III care during deployments. A review of the association between evacuation time and outcomes fails to support the Golden Hour. The evidence suggests if combat injury is properly treated in the first several minutes, focusing on hemorrhage, airway management, and treatment of tension pneumothorax, combined with high quality en route care during evacuation, there is significantly more time available to reach ROLE III care before outcomes suffer. Therefore, the Golden Hour is an improper standard for combat medicine resulting in increased resource requirements and unnecessary restrictions on units. A more appropriate approach is enhanced individual soldier training on the management of the major immediate causes of combat death as well as positioning advanced resuscitative care as far forward as possible.