"Golden Hour" Myth

[MedicPrincess]

I am breaking this away from the KED thread. Lets go for a rational, calm discussion on this.

I understand the feeling of "Hurry up! This injury happened 15 minutes ago, we have a 20 minute transport time... we need to go."

http://www.thomcosafetynet.com/handouts/2007/BryanBledsoe.pdf



In this discussion, the talk a little about the "Golden 24 hours"

http://www.trauma.org/index.php/com...permail/trauma-list/2005-February/024766.html


Here it is talked about the "Golden Hour" was made up to sell the shock trauma hospital.

http://www.ems1.com/ems-products/co...gain-Medical-Not-Military-Anti-Shock-Trousers

And this one discussed the only 2 conditions where time is actually critical... CVA and AMI

http://www.emsprime.com/


#6..... The Golden Hour was made up, the Platinum Ten was also made up.

http://www.kellygrayson.com/pdfs/EMS Mythbusters.pdf


Now, this isn't to say time doesn't matter on some patients. My patient the other night with a HR of 20, hypotensive, cyanotic, with an AMS.... Okay... Time matters.

But the majority of our calls, you have time to fully assess your pt, get a good history of the problem, and treat appropriately. Up to a 20 minute scene time is not necessarily a bad thing for MOST patients.

Its the hurry up, oh god this patients going to die right now if I don't do XYZ tx, why aren't they on my stretcher yet, oh man there is so much I have to do attitude that results in inadequate patient assessments and errors.

 

[KEVD18]

Bravo MP!!!!!!!

 

[Ridryder911]

Very good points:

Wow! Someone is still citing from the OPALS study. That itself could be called a MYTH. Most Paramedics don't actually read the whole thing, rather take snippets taken out of context or misquoted ideas. Somewhat similar to the slide presentation presented. Although, many of what they say can be true or partial truths. Again, most do not really read what the study totally says or finally recommends. Yes, OPALS was very detailed and greatly lengthy. Kinda like the MAST trouser study. It did not say that they harmed the patient, rather they did not improve either. In fact part of the problem, that there is so much data, some complained that it might have been too much of a good thing.....

I do wish Paramedics were required to take statistics and research courses to help interpret studies.

One thing for certain to remind us. On real trauma patients, there is very little for us to do and treat in trauma, our best treatment is to remove the patient rapidly and effectively to the most appropriate facility. Again, having the ability to appropriately triage real trauma patients vs. non real life threatening injuries (over triage) is more complex issue than we would want. Now, this does not mean one should be "spazzing or geeking out" rather they should be expediting and not staying on the scene causing further needless delay. Splinting, bandaging (if even performed), IV's and even intubation can all occur while en-route.

Air transport has not been found to be more effective in scenes < than 20-30 minutes of the destination. Hopefully, most are aware of this. If not read multiple studies even the criteria suggested by CAMTS. Ironically I now fly as much medical as trauma. CVA's, AMI's (that need to be cathed) are just as time sensitive as trauma. ******edited by MedicPrinces*******