What Is the Golden Hour in Medicine?

Reviewed on 2/26/2021
The “golden hour” is the term often used in trauma or emergency care

The “golden hour” is the term often used in trauma or emergency care

The “golden hour” is the term often used in trauma or emergency care to suggest that an injured or sick person must receive definitive treatment within the first 60 minutes from the time of injury or appearance of symptoms. It was believed that once this time has lapsed, the risk of death or long-term complications will significantly increase.

The concept of “golden hour” is derived from the French military's World War I data. The doctors then believed that there is a golden hour between life and death. If an injury had caused potentially irreparable damage to the body, it needed to be taken care of within the 1-hour time frame, or the person would die in the next few days or weeks.

Several doctors have criticized the “golden hour concept” because there is no evidence to suggest that survival rates definitely drop after 60 minutes. Some have suggested that there must be a rapid intervention in trauma cases as soon as possible rather than a confined 1-hour time period.

Golden hour in road traffic accidents

During road traffic accidents, intervention done in the first few minutes might determine if the person will live or die. The main principle in managing the victim here is stabilizing their Airway, Breathing, and Circulation and carry them to the nearest hospital. If this is not possible, a “scoop and run” approach rather than “stay and play” is encouraged. This means rather than waste time giving improper first aid at the site of injury (and searching for help in vain), it is better to get the victim to the hospital as soon as possible.

That being said, the potentially life- and limb-saving interventions (a tracheostomy, an epinephrine injection, intravenous fluids, splinting the broken bones, and collecting amputated toes/fingers in ice and carrying them along with the patient) that can be done in the field by skilled people should not be delayed.

The disadvantages of the “scoop and run” approach are an increased risk of transport-related injury (motor vehicle crashes), delayed initiation of chest compressions, etc.

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Golden hour in stroke patients

A stroke happens when the blood flow to an area of the brain is cut off, causing the brain cells to die of the lack of oxygen. “Time saved is the brain saved,” is the principle in most stroke cases. Given the fact that the “stroke in young” is on a rise, this adage becomes more and more important.

It is established that stroke patients have a much higher chance of avoiding long-term brain damage if they arrive at the hospital and receive treatment with a drug called tissue plasminogen activator (TPA) in the first hour of stroke. TPA is an enzyme drug that can dissolve clots, and any stroke-ready hospital can administer it. Therefore, when you see someone having a stroke, the absolute first thing to do is call 9-1-1.

According to the American Heart Association, for every minute in which a stroke is left untreated, the average patient loses 1.9 million brain cells. With each passing hour of no treatment, the brain loses as many brain cells as it does in almost 3.6 years of normal aging.

The golden hour in heart attack patients

When a person has a heart attack, the first 60 minutes are decisive. The heart muscles start dying if they have no blood supply in the first 80-90 minutes. Therefore, depending on the degree of damage, doctors can opt for medical management (clot busters or thrombolytics), stent placement, or bypass surgery to re-establish the normal blood flow as soon as possible. The earlier a patient receives a thrombolytic (or reperfusion) treatment after a heart attack, the higher the chance that they will survive and have less heart damage.

To summarize, the “golden hour” often means as soon as possible. Good judgment calls are always essential in trauma and emergency care.

  • For some patients, for example, those with anaphylaxis (a life-threatening allergic reaction), the “golden hour” is only a few minutes, or they may die.
  • For road traffic accidents with amputations of the hands or fingers, the sooner the parts can be attached, the better. This must be done within a maximum of 6 hours of injury, or the digit or body part will die.
  • Re-establishing of the blood flow for the damaged heart muscle in a heart attack is advised within 1.5 hours of symptom onset to avoid death of the heart cells.
  • Although field intubation can be a good thing, it may not always be the correct thing to do if it will take a long time and eventually delay reaching the hospital.

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References
https://integrisok.com/resources/on-your-health/2019/may/why-is-the-golden-hour-so-important-when-it-comes-to-stroke#:~:text=The%20reason%20the%20first%20hour,TPA%20within%20that%20first%20hour.

https://www.clinicalnegligenceteam.co.uk/blog/emergency-medical-treatment-golden-hour/

https://litfl.com/trauma-mortality-and-the-golden-hour/

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