The Golden Hour - is it a real a principal for EMS?

[aussiephil]

I thought it was a debate about the historical evolution of the golden hour mantra?? :?

Or the use & acceptance of it as a principal that ems is quick to quote, but appears no one is really prepared to defend. There are a lot of people looking, a few have voted, but not too many that have voted yes are prepared to say why they believe we should cling to it.

Plus 5 for Dust for saying how he feels & backing it up.

Thanks for your input Dr B

[Inf]

I like how you mentioned stress on prehospital trauma call. If you get a really bad car wreck your thoughts are on: how difficult that intubation is going to be with jaw thrust, how much does this guy weight for lidocaine, will I be able to get an IV on him? Its unfortunate that in most places IO for adults is not in protocols, and it should really be the first access method used for cardiac arrests and severe trauma, but finding an unbroken bone for a site may be tricky. Blood products for severely hemorrhagic patients is not in protocols either, seems like having a refrigerator on an ambulance is a crazy idea - a few units of type O- blood and lorazepam would've found their place in such a mini refrigerator.

[croaker260]

Am I the only one confused...

As a side note, The library of congress has been very helpful in me finding that study..that in and of itself has been a learning experience and I have new respect for those who are career librarians....finding the actual copy of this is harder that you would think...

-Steve

[Dustdevil]

Am I the only one confused...

LOL! Nope! I am scratching my head too.

That post is like it's in the totally wrong discussion or something. :?

It reminds me of the infamous "PID O2 15lpm b/14ga wide open and consider narcan" post.

[Inf]

That was a reply to the original post you twerps :roll:

[akroeze]

That was a reply to the original post you twerps :roll:

3 posts and you're throwing out insults? You'll last a long time here for sure...

[Dustdevil]

I like how you mentioned stress on prehospital trauma call.

That was a reply to the original post you twerps :roll:

Really? The original post in what thread?

Phil did not say anything about stress, or even use the word "stress" in his original post. :?

Crack kills.

[Scaramedic]

Wait does this mean there is no scientific basis for PHTLS's platinum 10 minutes?? :wink:

I always translated the "golden hour" as nothing more than a concept that says time is of the essence. I have never believed the human body had a timer that says "61 minutes, ok boys shut it all down." Every patient, every situation is different, the concept of rapid transport should be taught not a random time set.

Peace,

Marty

[aussiephil]

Marty

I couldn't agree more, I think the issue is really how much trust is placed in those pre hospital on getting the patient to the most appropriate hospital for their definitive treatment, commencement of care, & their ability to make that call.

As the good Dr Bledsoe has said, if this was a marketing strategy that has been pushed worldwide, then we need to be looking at more evidence based practice to determine what is the best resolution for patients.

For example, we here no longer have to rush every patient at breakneck speed to the nearest hospital.

We are able to transport each patient to the most appropriate hospital, provided they are stable, for their injury/illness. In many cases this may be the nearest Band Aid centre, but the choice is ours.

The main problem that ems comes across & the lowest common denominator is the emt/medic who wants to think that they can provide more than pre hospital primary care. We are not, & should never think we are medical practitioners. We are pre hospital care providers & as such treat problems symptomatically.

We need education to make our assessments of the patients conditions & to make our provisional diagnosis & in many cases we are correct, this doesn't put us on par with a Doctor.

EMS Should delete the olden Hour Mantra & teach a more realistic approach, explaining the trimodal distribution of death by trauma & fully explaining the concept of expeditious transport of patients to hospital.

[AZCEP]

As the good Dr Bledsoe has said, if this was a marketing strategy that has been pushed worldwide, then we need to be looking at more evidence based practice to determine what is the best resolution for patients.

The trouble is this is so ingrained in every student from the beginning of their education that it is near impossible to get away from. Combine this with the inability to find what the optimal time frame is, and there is quite a problem in place.

For example, we here no longer have to rush every patient at breakneck speed to the nearest hospital.

We are able to transport each patient to the most appropriate hospital, provided they are stable, for their injury/illness. In many cases this may be the nearest Band Aid centre, but the choice is ours.

I'd wager this is not the common practice in Australia, and I'm relatively certain it isn't in the U.S. This is definitely a step in the right direction, but everyone has a different set of circumstances to deal with.

The main problem that ems comes across & the lowest common denominator is the emt/medic who wants to think that they can provide more than pre hospital primary care. We are not, & should never think we are medical practitioners. We are pre hospital care providers & as such treat problems symptomatically.

How, exactly, are we not medical practitioners? EMS is a very specific MEDICAL field. It is significantly different from any other MEDICAL endeavor, but it is still medicine. Even, as you describe, treating symptomatically is much the same as physicians will do. Sure, MD/DO's have more education, and tools at their disposal, but they are still treating symptoms, right?

We need education to make our assessments of the patients conditions & to make our provisional diagnosis & in many cases we are correct, this doesn't put us on par with a Doctor.

How does it not "put us on par"? When restricted to the information that we are able to gather, in the situation we gather it, physicians will work off of provisional diagnoses until such time as they can gather more information to better focus their management.

EMS should delete the Golden Hour Mantra & teach a more realistic approach, explaining the trimodal distribution of death by trauma & fully explaining the concept of expeditious transport of patients to hospital.

Until we can achieve the backing of those that put this system in place to begin with--namely physicians--we will never be able to break from the mantra. Just as there are so many ridiculous mnemonics, or sayings, that are used on a daily basis that need to be expunged from having ever being uttered to a student of EMS. The providers in the field have to agree that the old standby's just don't have a place any longer. Everything from A-B-C's to "treat the patient not the monitor", will continue to be mentioned and taught, evidence or not.