The Golden Hour

daedalus

Forum Deputy Chief
1,784
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You hate cardiology :p

Maybe Paramedics need to spend a few weeks ON THE TRAUMA SERVICE. How wonderful would that be for training? They would see the definitive care through the bitter end on trauma patients! They would be treated like PGY-1s and be expected to scrub in on cases and observe, perhaps hold retraction etc, be required to attend code traumas in the ER, learn about physical therapists, etc.
 

Veneficus

Forum Chief
7,301
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You hate cardiology :p

Maybe Paramedics need to spend a few weeks ON THE TRAUMA SERVICE. How wonderful would that be for training? They would see the definitive care through the bitter end on trauma patients! They would be treated like PGY-1s and be expected to scrub in on cases and observe, perhaps hold retraction etc, be required to attend code traumas in the ER, learn about physical therapists, etc.


That is a great idea! but it would shut down a lot of medic mills or places that do clinicals at community hospitals.

yes I do hate cardio, too much cookbook, not enough thinking.
 

Ridryder911

EMS Guru
5,923
40
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Although R Adams Cowley was a pioneer in Trauma Care the "Golden Hour" has been proven through multiple studies as flawed. What many fail to remember or even know is the term "Golden Hour" was more a bureaucratic term. The whole intention was to receive funding ...period. It is well known it was numbers for a bureaucratic dream.

Yes, it was ingenious in the intent of shifting and focusing upon funding and very instrumental upon the development of trauma systems. I am not demeaning the results of what occurred but the statements that there is a specific and certain time involved is foolish and never have been proven. As Vent and others describe there are numerous of time sensitive injuries from CVA, AMI to even an ischemic bowel. Dependent upon several factors what type and if repair or treatment can make a difference.

Many are not aware, but for over three years I studied Trauma Systems and was declared a Trauma Specialist that developed state wide and intrastate trauma protocols for various states. This also included specific(s) guidelines for determine what trauma centers should consist of. So, I do have some experience in this area. I also am quite aware of what true facts are out there and what is assumed to be right.

I am quite aware that trauma is a well studied injury and illness. One can almost predict and almost pinpoint survivability. That one could review TRISS and other type of statistics to determine the probability of survivability of trauma patients. It is a no brainer that delaying care both prehospital and even in hospital could and is detrimental to many type of patients. Yet, it is essential to recognize how delay usually occurs and how that may be minimized.

Yes, HEMS are effective in some areas and in some instances. I have witnessed and participated in many of those circumstances. There are also a "myth" that just because a patient is able to be flown, reduction of mortality and morbidity occurs. Something that has never been proven. Again, it is all in proportion to the time to a proper receiving facility that is appropriately prepared for such injuries and illnesses, and time it takes to get to that facility. Majority of the time ground units may actually be faster and safer than air units.

One has to remember that an aircraft cannot just "take off" it takes time. Time of dispatch, locating, checking weather, preparing aircraft for take off, flying time, then a safe landing. None of this cannot be eliminated and one needs to consider this time factor also. I have witnessed flights that were within reasonable time to transport per ground in comparison to await for an aircraft. This is part of the need of intense education and critical thinking skills, something that needs to emphasized more and more. When it is appropriate to wait or a split decision to transport or even rendezvous. A quick but accurate assessment to provide an accurate triage assessment to transport the patient not to the closest facility but the most appropriate facility. One of the most important points Dr Cowley fought hard to speak out.

One has to remember, a large caliber GSW to the chest or brain has the same results if it occurred in the parking lot of a Trauma Center or 60 miles away. There are injuries, no matter what, no matter where that occur cannot be saved and then again there are injuries that can be...

Well developed regional trauma plans along with Paramedic judgemental protocols so such critical thinking skills are allowed are essential. Continuation of education, reevaluation of systems and the sucess has to occurr.

R/r 911
 
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reaper

Working Bum
2,817
75
48
Very well stated RR.

I have been pushing this thinking for HEMS usage. Some just don't get it or are scared to treat a pt in their unit. Hopefuly that will change with education.
 
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