The Golden Period, time planning for casualty survival, was first described by R Adams Cowley, MD, at the University of Maryland Medical Center in Baltimore. From his personal experiences and observations in post-World War II Europe, and then in Baltimore in the 1960s, Dr. Cowley recognized that the sooner trauma patients reached definitive care-particularly if they arrived within 60 minutes of being injured-the better their chance of survival.
Time from injury Mortality Rate:
1 hr 10%
2 hr 11%
3 hr 12%
4 hr 33%
5 hr 36%
6 hr 41%
8 hr 75%
10 hr 75%
The Golden Hour has been the guide for vehicle entrapment rescue for a long time, and has formed the basis for us to train and work within realistic time scales to achieve saveable life outcomes.
The Golden Hour has and still does work for the rescue scene environment for the good of the casualties’ outcome. It is still a very realistic time frame that we can use to guide our rescue abilities and actions.
This concept remains the standard for deciding on scene rescue times and governs the speed and effectiveness that we work too.
However this is fast becoming unachievable, with auto incidents happening in geographical locations many miles from the nearest rescue services and the nearest Operating Table.
New vehicle technology is fast becoming a problem for rescuers with the addition of multiple airbag systems.
Why are these systems effecting rescue times? Rescue agencies are limited to their tools’ effectiveness when it comes to new technology, struggling to cut metals leads to delays, new plans need to be tasked, working around safety systems will add to the time frame, taking extra care to cut around systems and put into place safer control measures to allow for techniques to be carried out, this all adds to the time frame of the rescue.
What used to be a simple roof removal completed in less than 15 minutes, is now taking longer on some vehicles. With severe crash deformity and entrapment these figures will increase greatly.
What used to be the Golden Hour can now be referred to as the Golden Period due to the problems we have mentioned.
With these factors in mind we now need to look at the importance of the Platinum 10 Minutes and what we do in the first instance to secure the casualty either in situ or in the Ambulance.
The Platinum 10 minutes
These are the actions taken once medical care arrives to stabilise the casualty to prevent further deterioration. In basic terms this is the action within the first 10 minutes that will in most cases save a life.
At events and such where medical teams are on site or placed at tactical locations, there is now a response termed the uranium 5 which is where the medical intervention teams will attempt to be on scene within the first 5 minutes of the incident occurring, this will give the critically injured casualty the best possible chance of survival. This could possibly be integrated into motor vehicle incidents on the road, but we must be realistic as this attendance time on a normal daily basis will in most cases, not be achievable.
The Golden Period is still a major factor in our time planning for the release of the casualty. But we must not throw caution to the wind to try and get them out within the hour compromising the casualty centered approach, with that said this should still be our aim even though it may not be achievable.
As you can see in the diagram the factors that work against us have been factored in, and this becomes a continuous circle of casualty centered operations.
As this is the Golden Period the times have not been added, this is because we will work to the best of our skills to reach the desired outcome, working around the implications that will be against us.
The Golden Period is achievable, there are however times when it is not achievable and modern vehicle construction does not help. Rescue times are getting longer and as an operational rescuer I see this on a regular basis.
With continuous medical and physical rescue these factors can be overcome, this can only be achieved through inter agency training on a regular basis.
Poor training, vehicle knowledge and medical skills are not an excuse and are of no interest or help to the casualty/s.
Original article can be downloaded from www.rtc-rescue.com
