Golden Hour And Trauma Mortality

Neurosciences | Posted on 05/11/2020 by Dr. Kapil Khandelwal

The golden hour or also called the golden time is the period of time post a traumatic injury during which there is the highest chance of survival, provided prompt and adequate medical care is received. Generally considered to last for an hour from the time of injury, the golden hour can vary in multiple cases depending on the severity of the trauma. However, the concept suggests that if a patient who has suffered a traumatic injury receives definitive medical treatment within the first 60 minutes post-injury, his chances of morbidity and mortality significantly increase.

The term ‘Golden Hour’ was coined by R. Adams Cowley, founder of the Shock Trauma Institute, Baltimore who said that “the first hour after injury will largely determine a critically injured person’s chances for survival”. He also mentioned that “There is a golden hour between life and death. If you are critically injured, you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later — but something has happened in your body that is irreparable.” This was in 1975 when there was no organized trauma system and also a lack of adequate medical care. However, the relevance of the concept today is to make people aware of the importance of urgent medical treatment in cases of trauma. The concept emphasizes the relevance and urgency of care in preventing trauma deaths. That said, a golden hour cannot be a definitive period applicable in all cases, in some trauma situations the golden hour could be mere minutes while for others it could extend to several hours, varying by the intensity of the trauma caused.

While it is a well-known fact that the chances of survival are the greatest if the patient receives definitive care within a short period of time after the injury; however, it cannot be concluded that survival rates drop post 60 minutes, but it is still suggested the sooner the care is received the better. More so, attentive and timely care also increases the likelihood of a better quality of life since the treatment can be initiated timely to save organs, cure issues, etc. In case of delayed medical treatment, a lot of complications may arise such as infections, internal bleeding, and organ failure, which might not affect survival but can cause a huge impact on the quality of life. Some injuries can cause conditions to deteriorate rapidly; hence the lag time between the incident and treatment should be a bare minimum. Moreover, sometimes delayed care can cause shock to the patient which can result in death. Hence, the golden hour is an indicative time period in which it is assumed that definitive care can save lives as well as preserve its quality to a large extent. A patient who has suffered trauma should be transported to a medical care facility as soon as possible and the doctors must consider such cases on priority.

Hence, the golden hour concept is not limited to an hour; it encapsulates the importance of admitting the patient to a trauma centre or facility immediately to enhance the chances of survival and quality of life. The concept is of very much relevance since trauma is a major cause of morbidity and mortality, more so for people below the age of 40 years. Especially in developed nations such as India, trauma is a leading cause of death. It also is a force behind death from cardiovascular diseases and cancer. However, trauma mortality depends on a trimodal distribution – immediate, early or late.

• Immediate deaths occur minutes after injury and are usually unpreventable such as brain injury, haemorrhage, etc.
• Early death happens minutes or hours post-trauma and is mostly related to haemorrhage. These are preventable provided definite care is received within the golden hour depending on the intensity of the injury.
• Late death occurs either days or weeks after the trauma and is highly preventable since they have the longest golden hour and also the maximum chances of survival. Trauma mortality, in this case, occurs because of reasons such as organ failure, sepsis, etc.

As per research: Specifically, in India, trauma from road traffic accidents (RTAs), acute myocardial infarction (AMI) and cerebrovascular accident (CVA) is the most common cause of death and disability. Robust emergency medicine (EM) services and proper education on acute care are necessary to avoid trauma mortality. And even with the advancements in medical care and the development of hospitals, there needs to be more effort in critically and immediately handling patients to reduce trauma mortality in the country.

The concept of the golden hour needs to spread across the country, more immediate care programmes with sufficient funds need to be created, as well as more people need to be educated about the criticality of rushing a trauma patient to the nearest medical centre. Also, the process of admitting an emergency case needs to be simplified with lower complications on the part of the person bringing the patient to the hospital. Further, hospitals need to be more advanced, attentive and quick in trauma patient handling and must equip themselves with the necessary facilities to reduce trauma mortality.