The golden hour and the difference between life and death

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An excerpt from Surviving the Emergency Room.

by Ron Clark, MD

With regard to emergency trauma care, a few minutes can mean the difference between life and death.  This first hour of definitive medical care is called the “golden hour.”  It is usually this first hour where the patient’s medical fate is sealed.  In general, the faster that medical care is rendered, the better the medical outcome will be.

The old adage that all bleeding stops at sometime is true.  In a traumatic situation, you would hope that the bleeding has stopped because of an emergent intervention by the emergency physician or a trauma surgeon.  The other way that bleeding stops is when the patient runs out of blood, which is obviously not the ideal outcome.

The golden hour is not just limited to traumatic emergency situations.  This first hour of emergent medical care is also very important in situations such as heart attack or stroke, where time is heart muscle or brain tissue.  Emergent medical interventions can have a profound impact on a patient’s survival and ultimate ability to function.  Patients and loved ones need to be aware that not all hospitals have the ability to offer definitive medical care.  For patients who arrive at an emergency department that is unable to provide the emergent medial care that is needed, the transfer process will begin.  The time that is wasted during the transfer process can lead to disaster.

Patients should be aware of the golden hour principle and the fact that each hospital has their own strengths and weaknesses.  If you have time and a particular medical problem arises, be aware that you or your loved one needs to be at a hospital that can offer definitive medical care.  The best advice is to research your local hospitals ahead of time to determine their specialty capabilities.  In other words, go browsing the “medical shops” before you need to buy.  With this knowledge, you will be able to make the most informed and most appropriate decision about where to go when the need arises.  Most people do not plan for a medical emergency, although everyone will have one at one time or another.

Most patients will be sick enough to know when they are in the golden hour and most of them will miss it when it is gone.

Ron Clark is an emergency physician and author of Surviving the Emergency Room.

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