# Golden Hour Loss



## Red Flag 1 (Nov 23, 2017)

This


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## DocIllinois (Nov 23, 2017)

A great read.  

I enjoyed learning about how medics leading the way in local counterinsurgency began more or less in the Vietnam War.


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## Serenity (Nov 23, 2017)

Added to my tbr list.  I jumped to Chapter 9 since I’m more interested in modern application during gwot.  Fascinating stuff re the the Golden hour standard!  Thanks RF1, the best thing about this site is when people with depth of experience share links they think are valuable.  There’s always something interesting to be learnt.  :)


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## Serenity (Nov 28, 2017)

This should probably go into the TV thread and I'm sorry for polluting your serious thread RF1.

I mentioned this thread and the original article to hubby and immediately he said: "Yeah, remember M*A*S*H?"  
Me:  "The theme song was a trigger to change channel..."  
Him:  "I used to watch M*A*S*H all the time when I was a kid!"

Anyway, that got me reading up on MASH on my train tip to and from work yesterday.  Something about an association with a TV series that suddenly makes the topic of military medicine more accessible mentally somehow.  It's not about guerilla warfare medicine or about the golden hour, but I found the below article on the MASH system easy to understand and interesting.  It helped me better appreciate how much planning, research, commitment and courage is required to keep people alive during combat.  It highlighted the significant contribution of the US Army in medical research.  I was kind of in awe and have an even greater respect for those who choose to this career path.  Suddenly, warrior in my mind has been redefined to be wielding a scalpel...but not even that, it's also all the personnel who assist in making these units mobile.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569328/pdf/jnma00186-0014.pdf

I was so impressed by the above article, I then googled one of the authors and found this interview which I enjoyed:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569337/pdf/jnma00186-0010.pdf

Anyway, I told myself, I should at least watch a couple of episode of M*A*S*H.  I know it's a satire, but omg...it was unexpectedly entertaining in an inappropriate non-PC way...


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## SpitfireV (Nov 28, 2017)

DocIllinois said:


> A great read.
> 
> I enjoyed learning about how medics leading the way in local counterinsurgency began more or less in the Vietnam War.



I think there's an argument to be made that that started in Borneo or Malaya.


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## DocIllinois (Nov 28, 2017)

SpitfireV said:


> I think there's an argument to be made that that started in Borneo or Malaya.



A definite argument there, yes.  

Was referring to US doctrine, though.


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## SpitfireV (Nov 28, 2017)

DocIllinois said:


> A definite argument there, yes.
> 
> Was referring to US doctrine, though.



Fair enough.


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## Johca (Nov 29, 2017)

The golden hour has subtle differences in standards of care of trauma victims when capacity and capability to do immediate casualty evacuation or to do the rapid personnel recovery is lacking or unavailable to get the critically injured to surgical intervention.

Most recent example:

Niger Attack Lays Bare U.S. Troops’ Long Wait for Medical Help in Africa

“You’re never going to have the golden hour in Africa; it’s not possible,” General Bolduc said in a telephone interview. “But you have an acceptable amount of time that commanders have agreed on.”

For security reasons, he would not disclose the time frame in Africa.

Pentagon Probing Troubling Questions after Deadly Niger Ambush

"For personnel recovery, Africa Command relies heavily on contract search and rescue assets due to lack of dedicated assets to support operations," Waldhauser said."Furthermore, African partners lack the capability and capacity to assist with personnel recovery missions."

For months before the ambush, the U.S. military had requested more drones or other surveillance aircraft in Niger and additional military medical support, but those requests met resistance from the U.S. ambassador to the country, who was reluctant to increase the American presence in the country, according to a U.S. officialbriefed on the attack.


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## Red Flag 1 (Nov 29, 2017)

[QUOTE="r


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## snapt (Nov 30, 2017)

If you're a podcast person the PFC podcast is putting out some really great stuff as well.


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## x SF med (Nov 30, 2017)

So, Rocky was my instructor for 300-F-1 at FSH when he was a CPT...  imagine what that was like... yes he made history part of the curriculum and the tests, and every essay and SOAP was graded for correct English.  Every medical professional should have to sit through at least one of his 'taking a patient history' sessions.  In the 9 months of 300-F-1 I learned more than I care to imagine now, imagine a firehose attached to a pressure washer.


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## policemedic (Nov 30, 2017)

I think many people fail to understand the Golden Hour and the Platinum 10 minutes are concepts and not actual timeframes. 

As prolonged field care (again) becomes the norm, the application and understanding of concepts as opposed to blind adherence to dogma—that may or may not have scientific evidence to back it up—becomes more and more important.


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## Devildoc (Nov 30, 2017)

policemedic said:


> I think many people fail to understand the Golden Hour and the Platinum 10 minutes are concepts and not actual timeframes.
> 
> As prolonged field care (again) becomes the norm, the application and understanding of concepts as opposed to blind adherence to dogma—that may or may not have scientific evidence to back it up—becomes more and more important.



This.  I have been trying to figure out how to articulate my response, but just haven't had an opportunity, and this is better than what I would have said.

Trauma patient outcome data from rapid transport (air & ground) is out there, and the results have been interesting: almost zero difference in outcome based on mode of transport, but better outcome if patient is stabilized and appropriately treated on the scene.


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## Johca (Nov 30, 2017)

The golden hour is a concept supporting transport to definitive surgical intervention on the operating table.  The concept favors getting the trauma patient there sooner rather than later.  The concept specific to civilian EMS supports having a get there and evacuation network of immediate responders being trained, qualified, and certified to provide appropriate stabilization treatments and appropriate treatments during the transport of the patient to such level of medical intervention.  The network other than time constraints imposed by lack of roads, great distances, obstacles increasing time and distance doesn't care if the evacuating is done by aircraft, motor vehicle, horseback, or mancarry by litter.

The monograph introducing this golden hour discussion is focused on guerrilla warfare medicine which when including general medical healthcare and preventive medicine of a population demography where many number of the heard are maimed and injured.  In this perspective it is asserting the better solution is to put a hospital staffed and equipped for general and specialized medical and surgical care in place to care for specific need of supporting the guerrilla, partisan,  insurgent or other groups friendly to or being proxies to the interests of the United States.

Much historical relevance from WWII and subsequent conflicts is relied upon, particularly the medical support given to insurgent and partisan forces in Yugoslavia.  Readers not familiar with Special Operations Mediterranean area of operations may not be aware that most of that medical support to partisan forces didn't materialize  until there where significant numbers of allied bomber squadron aircrews shot down in the Baltic States, primarily Yugoslavia, needing recovery and evacuation.  Further the aeromedical evacuation of partisans to Italy included noncombatant wives, children, and parents of the partisan fighting forces.  There was much international politics during WWII complicating decisions who to support, when to support, and how to support.  The political complications have only increased in the years after WWII.

If a glimpse into the politics is of interest:   An analysis of the circumstances surrounding the rescue and evacuation of allied aircrewmen from Yugoslavia, 1941-1945


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## Devildoc (Nov 30, 2017)

The creation of "The Golden Hour" was coined by R Adams Cowley, who correlated trauma outcomes with speed to definitive care.  What he did not have as a variable was pre-hospital treatment since his studies and observations came before the formal creation of EMS and pre-hospital medicine.  That pretty much changed the paradigm.  With regards to the monograph, it changes the paradigm even more.


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## Frank S. (Nov 30, 2017)

policemedic said:


> I think many people fail to understand the Golden Hour and the Platinum 10 minutes are concepts and not actual timeframes.
> 
> As prolonged field care (again) becomes the norm, the application and understanding of concepts as opposed to blind adherence to dogma—that may or may not have scientific evidence to back it up—becomes more and more important.



In my time spent in hospitals I wondered why there were clocks everywhere. I imagine they helped staff keep track of their tasks and checks more readily, but as a patient I made it a kind of game to break down hours in minutes, seconds, minutes grouped in 10s or 12s, counting backwards, realizing which clock was more accurate, which one was fast, etc.
Just a memory of sorts the comment above brought back. Time is of the essence but the hardest essence to grasp.
Here is a reading suggestion,which is more anecdotal than technical, but probably interesting to some:
https://www.amazon.com/Doctor-at-Dienbienphu-Paul-Grauwin/dp/B0006AU8E2

Paul-Henri Grauwin - Wikipedia


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## Johca (Nov 30, 2017)

Regarding Golden Hour concept undergoing change over time.

Combat Casualty Care Research drives innovation to improve survivability and reimagine future combat care

EVOLUTION OF THE GOLDEN HOUR: The traditional (pre-2015) concept of the golden hour is based on movement of the injured person to a fixed location or echelon of care within 60 minutes. The evolved concept for 2015 and beyond involves delivering advanced resuscitative capability to the injured person within one hour, regardless of location or echelon of care. (SOURCE: Col Todd E. Rasmussen, USAMRMC CCCRP)


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## DocIllinois (Nov 30, 2017)

Frank S. said:


> In my time spent in hospitals I wondered why there were clocks everywhere. I imagine they helped staff keep track of their tasks and checks more readily, but as a patient I made it a kind of game to break down hours in minutes, seconds, minutes grouped in 10s or 12s, counting backwards, realizing which clock was more accurate, which one was fast, etc.
> Just a memory of sorts the comment above brought back. Time is of the essence but the hardest essence to grasp.
> Here is a reading suggestion,which is more anecdotal than technical, but probably interesting to some:
> https://www.amazon.com/Doctor-at-Dienbienphu-Paul-Grauwin/dp/B0006AU8E2
> ...



What did Docteur Grauwin's patients count?  

Certainly not the time.  _Pinces chirurgicales?_


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## Frank S. (Nov 30, 2017)

Seconds between detonations and impacts?


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## DocIllinois (Nov 30, 2017)

The time between the subsequent attentions of Uncle Ho's Viet Minh, perhaps?


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## Red Flag 1 (Nov 30, 2017)

Johca said:


> Regarding Golden Hour concept undergoing change over time.
> 
> 
> EVOLUTION OF THE GOLDEN HOUR:


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## Johca (Nov 30, 2017)

I agree with concepts of moving things closer to the patient began happening at least in the being proposed and discussed level within the Air Force medical service before 2015.

Due to my duty position in the ACC Surgeons office as Chief of Pararescue Medical Operation 1993-1994) (no combat rescue officers until 2001) I was aware of many concepts being proposed and discussed pertinent to aeromedical evacuation (no dedicated aeromedical fleet replacement for the C-9 nightingale fleet), Flying Squadron Medical Elements, and crisis response field hospitals (became proposal primarily due to Operation Support Democracy.  It was Desert Shield/Storm that exposed the aeromedical aircraft fleet and aeromedical medical protocols and capabilities were in need of improvements.


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## Red Flag 1 (Jan 17, 2018)

A POD


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