It is interesting that the article mentions the golden hour, when most current trauma doctrine has gotten away from that because there's no literature to support, and the concept is based old doctrine.
That said, great article.
When did it change? And by no literature, do you mean no published studies or studies that haven't proven it true?
I'll see if I can find the sources. Golden hour is based on Cowley's research from the 60s and did baked-in averages based on outcomes from time of injury to survival rates with definitive care.
As care got pushed forward and resus techniques improved, outcomes improved. So today you have a much higher likelihood of surviving 4 limb amputations, even if you do not get to surgery inside of an hour, when in the 1960s the same injury you would die inside 30 minutes.
Elaborating on that, in Vietnam they were resuscitating guys with massive volumes of crystalloid until they were extremely coagulopathic. I'm giving as little as I can get away with these day in hemorrhagic shock
Yes. I should have been more specific. That's what we try to use exclusively. I'm in the OR. We've been using whole blood for a while with good successWith any luck, you’ll move to blood products like Houston ESD and some other places. That’s where we need to be.
Crowley scribbled the term Golden Hour on a cocktail napkin. My understanding is he created the concept based on his intuitive understanding that trauma patients would have better outcomes if they were seen by a surgeon sooner rather than later. But there was no real science to it. He was right, by the way. Sooner is better, but the hour was picked out of thin air and martini fumes.
As my brother from another mother mentioned, this was the ‘60s. Paramedicine and trauma care were not what they are today. A civilian paramedic of that era would not believe what we can do if they were sent through a wormhole to today. Military field trauma care is typically much more aggressive than the civilian side, and today’s SOF medics would make that guy from the ‘60s think he was in a Twilight Zone episode.
So, short version—the sooner you get care the better your outcome will be. Many life threatening injuries can be adequately managed in the field by a well-trained medic until evacuation is available/possible. That doesn’t obviate the need for physicians and surgeons but I do believe it can extend the time frame within which good outcomes can be achieved.
Crowley scribbled the term Golden Hour on a cocktail napkin. My understanding is he created the concept based on his intuitive understanding that trauma patients would have better outcomes if they were seen by a surgeon sooner rather than later. But there was no real science to it. He was right, by the way. Sooner is better, but the hour was picked out of thin air and martini fumes.
As my brother from another mother mentioned, this was the ‘60s. Paramedicine and trauma care were not what they are today. A civilian paramedic of that era would not believe what we can do if they were sent through a wormhole to today. Military field trauma care is typically much more aggressive than the civilian side, and today’s SOF medics would make that guy from the ‘60s think he was in a Twilight Zone episode.
So, short version—the sooner you get care the better your outcome will be. Many life threatening injuries can be adequately managed in the field by a well-trained medic until evacuation is available/possible. That doesn’t obviate the need for physicians and surgeons but I do believe it can extend the time frame within which good outcomes can be achieved.