ENG 100

12/01/14
Justin Bellace
The Golden Hour: Saving Lives Everyday

Proposal:
I first heard the term golden hour while I was taking my vehicle rescue technician class.
It intrigued me. My job as a technician is to remove the wreckage from around the person. Then I
started training to become an EMT. We were talking about trauma and then that term golden
hour came up again. Thats where I got my first chance to learn about it. Thats why the topic
still intrigues me today. Ive always been intrigued with the topic of the golden hour.
Now I just had to figure out how I will gather my information. I started off by talking to
my parents. My father has been a paramedic and nurse for most of his life and my mother is an
EMT. They both helped me understand what the golden hour is. But that wasnt a good amount
of information to start compose a research paper. I will get a lot of my information from
searching about it on google.

Process:
I looked for most of my information on google. I looked at www.trauma.org which was
very cool. I didnt know that the golden hour started in World War I but the practice didnt have
a name yet. I found an article on www.jems.com about the golden hour and I thought that it was
a very good read. Thats where I got the idea for the intro to my paper. This told me about R.
Adams Cowley, MD. He first coined the term golden hour. He saw that patients had a better
outcome when/if they got definitive care within an hour after their traumatic accident. I also
found an article from www.emsworld.com. I know for I wanted to show some negatives of the
golden hour. But I couldnt really find any. This article did bring a new point of view to the
things when I read it. I will go into more detail in my paper.
As for taking notes and what worked, I didnt really take notes. I would read the article
and find things I liked and then I would copy them and paste them onto a word document and
then when I was typing my paper I would look at what I found and then I would put them in my
paper. I think that it worked.

Paper:
Its 5pm, and you are just leaving work. Today isnt a good day to begin with because it
is raining and the road conditions arent the best. Your drive home is about 30 minutes so your
spouse expects you home around 5:30. But you dont make it home tonight. While you were
turning out of work, a pickup truck T-bones you on your drivers side door. The clock starts
ticking. What is your best chance of survival when the emergency crews arrive? The term the
responder like to use is the golden hour. I believe that the golden hour can be used to help a
patient have a better chance at surviving.
The definition of golden hour is an hour following traumatic injury being sustained,
during which there is the highest likelihood that prompt medical treatment will prevent death.
This is what is taught and stressed when you are learning vehicle extrication and EMS. Its
origins originate from World War I. In World War I, there was a real appreciation of the time
factor between wounding and adequate shock treatment. If the patient was treated within one
hour, the mortality was 10 percent. This increased markedly with time, so
that after eight hours, the mortality rate was 75 percent (Trauma.org). That
is a really good statistic for that time period. The table from the left shows
how to mortality rate increases by the hour. Again, these are statistics from
World War I and the mortality rates have decreased.
So the term golden hour was coined by and first described by R.
Adams Cowley, MD. He first recognized this practice while in Europe after

Time
from
injury

Mortality

1 hr

10 %

2 hr

11 %

3 hr

12 %

4 hr

33 %

5 hr

36 %

6 hr

41 %

8 hr

75 %

10 hr

75 %

World War II and also in Baltimore in the 1960s. He saw that the sooner trauma patients
reached definitive care-particularly if they arrived within 60 minutes of being injured-the better
their chance of survival (Eisele). So you can see where this came into play. This first started in

World War I as stated before and it carried through World War II to Korea and Vietnam. With
the entrance of mobile army surgical hospitals (M.A.S.H.), they helped increase survival rates
(History of Air Ambulance and Medevac).
Youre probably asking yourself, how does this apply to the person at the beginning?
There are a lot of arguments that suggest that the golden hour doesnt matter. Im here to tell you
it does matter. I first heard the term golden hour while I was taking my vehicle rescue technician
class. It intrigued me. My job as a technician is to remove the wreckage from around the person.
Then I started training to become an EMT. We were talking about trauma and then that term
golden hour came up again. Thats where I got my first chance to learn about it. Thats why the
topic still intrigues me today. We were told that we have to choices to make when we arrive on
the scene of a motor vehicle accident. Weve been told we can either stay and play or load
and go, and Eisele brings up that topic in his article. Many of my instructors have said that. But
here is where we get into the golden hour. If they have multiple injuries (broken bones,
lacerations, bleeding, bruising etc.) than our time on scene is 10 minutes and we have to load
and go. Our patient from the beginning will definitely be someone who is in the load and go
situation. As EMTs we are taught to get to the patient quickly, fix what we can fix, and quickly
get the patient to the right hospital (Eisele). Now how does that help a patient when it comes to
this concept of the golden hour? In the time of accident, the patient can have internal bleeding, if
the broke their femur, they could have a severed femoral artery. An EMT or paramedic cant
detect these in the field so they need to get to the hospital.
I found an article from www.emsworld.com titled Rethinking the Golden Hour of
Trauma. The author, Patrick Lickiss brings up a lot of good points in the article. This is in his
conclusion Several studies have suggested a decrease in mortality when trauma patients reach

definitive care during the Golden Hour, but recent research demonstrates no link between time
and survival. The concept of the Golden Hour, though logical, appears to be the result of one
mans opinion and not the conclusion of a formal research study. Nonetheless, the term and the
idea entered EMS and have been present since the early 1970s (Lickiss). He brings up a good
point when he says it is one mans opinion. But look where his opinion got him. His term carried
all the way from the 1970s to now. Thats 34 years! And on my final source I found from
looking at where Patrick Lickiss got his information. It led me to a section of book I guess that
talks about the golden hour. It was a very good read. It talked about the origins of the term and
research that people have done on the topic because they too are fascinated with the topic like I
am. The one name that kept popping up in all of my research was R. Adams Cowley. I find it
interesting. I think it is interesting that his name appeared in all of the things I read to help me
write this paper. And all of the articles and websites still question where it came from, but they
all have the same thing in common. They all talk about R. Adams Cowley. As for patient
outcome, there isnt any real way to prove it because through all of my research I found that it is
hard to prove whether or not the patient has a better chance. Brooke Lerner said it very well It is
crucial for medical researchers to critically examine concepts such as the golden hour that are
widely accepted but are in fact not scientifically supported. I do think that there is a better
patient outcome when getting the patient to the right hospital in 60 minutes. I know it is hard to
prove, but we are taught to get to the patient quickly, fix what we can fix (Eisele) and get them
in the ambulance and start to go to the hospital in 10 minutes.
Know with everything that we have learned from this paper, lets go back to our patient
from the beginning. Our patient was T-boned on their way home from work. The normal
response time for a fire company is about 10 minutes depending on the time of day. Then lets

say it takes them 10 minutes to get that person out of the car. Thats now 20 minutes. The EMTs
have to do a trauma assessment and get the patient in the ambulance and start transport under 10
minutes. So that brings us to 30. And from where they are, the trauma center is 15 minutes away.
That brings our total time to 45 minutes. That is well within the 60 minutes in the golden hour.
With all this in mind, I think that our patient will have a great chance at surviving from this
traumatic accident.

Ponder:
This paper wasnt easy. I was very stressed out about it and I kept second guessing
myself about my paper the whole time. I think I wrote a very good paper. From researching my
topic, to formulating the thesis statement, and to actually writing my paper, I really enjoyed it. I
found out a lot of information that I dont think I would have found if it wasnt for this paper. As
for what worked and what didnt work, Im going to be honest, I procrastinated and I didnt start
my project until Sunday. But At least I didnt start it later. That really didnt work and that may
be why I think I was second guessing myself all the time. What worked for me was that I had an
endless wealth of knowledge who were my parents who would help and give me advice while I
was writing this paper. My take away from this paper would be not to procrastinate as much. I
also am going to take away all of the information I have found from researching for this paper.
As for some future research questions they might be something like:
What are some numbers that suggest there is no difference in patient outcome?
Where is this used besides the EMS world?

Bibliography:

Bellace, Louis E., Major USAF NC. "THE CLOCK IS TICKING IN PEDITRIC
CRITICAL CARE TRANSPORT! MAKING THE RIGHT TRANSPORT CHOICES
FOR OUR PATIENTS." Thesis. AIR COMMAND AND STAFF COLLEGE AIR
UNIVERSITY, 2011. Print.

Eisele, Charlie, BSN, NREMT-P. "The Golden Hour -." JEMS.com. N.p., n.d. Web. 01
Dec. 2014.

Lerner, E. Brooke, and Ronald M. Moscati. "The Golden Hour: Scientific Fact or
Medical "Urban Legend"?" Academic Emergency Medicine 8.7 (2001): 758-60. Web. 03
Dec. 2014. <http://www.infopuntveiligheid.nl/infopuntdocumenten/j.15532712.2001.tb00201.x.pdf>.

Lickiss, Patrick, BS, NREMT-P. "EMS Trauma Care | EMSWorld.com."

EMSWorld.com. EMS World, 28 June 2012. Web. 01 Dec. 2014.

HISTORY OF AIR AMBULANCE AND MEDEVAC Word Doc. 02 Dec. 2014

"TRAUMA.ORG: History of Trauma: Trauma Resuscitation." TRAUMA.ORG: History

of Trauma: Trauma Resuscitation. N.p., n.d. Web. 01 Dec. 2014.