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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 really intrigued me. My job as a technician is to remove the wreckage from around any person
trapped in a car. Then I started training to become an EMT. We were talking about trauma and
then that term golden hour came up again. That’s where I got my first chance to learn about it.
That’s why the topic still intrigues me today. I’ve 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 wasn’t 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 didn’t know that the golden hour started in World War I but the practice didn’t 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. That’s 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 couldn’t 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 didn’t 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:
It’s 5pm, and you are just leaving work. Today isn’t a good day to begin with because it
is raining and the road conditions aren’t the best. Your drive home is about 30 minutes so your
spouse expects you home around 5:30. But you don’t make it home tonight. While you were
turning out of work, a pickup truck T-bones you on your driver’s 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).
You’re 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 doesn’t matter. I’m here to tell you
it does matter. If you read the proposal, you’ll understand where I’m coming from. In short, I
found out about this practice when I was becoming a vehicle rescue technician, and when I
started my EMT class. We were told that we have to choices to make when we arrive on the
scene of a motor vehicle accident. We’ve 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”. As
EMT’s 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, and a lot of many other injuries. An
EMT or paramedic can’t 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
man’s 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 man’s opinion. But look where his opinion got him. His term carried
all the way from the 1970s to now. That’s 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 isn’t 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.
With everything that we have learned from this paper, let’s go back to our patient in 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 let’s say it takes them
10 minutes to get that person out of the car. That’s now 20 minutes. The EMT’s 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 wasn’t 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 don’t think I would have found if it wasn’t for this paper. As
for what worked and what didn’t work, I’m going to be honest, I procrastinated and I didn’t start
my project until Sunday. But At least I didn’t start it later. That really didn’t 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.