The Golden Hour After a Brain Injury
The term “Golden Hour” is sometimes called the “Golden Time.” It refers to a period of time lasting for about one hour following a traumatic injury. There is also a term, the “Golden Period” which some literature distinguishes from the Golden Hour and the Golden Time. The Golden Period will be briefly discussed later.
The traumatic injury can be the result of a casualty, such as an automobile collision, or a medical emergency, such as a stroke. The injury need not necessarily involve a traumatic brain injury, but it may. The significance of the Golden Hour is that, in general, if medical treatment is rendered during that period of time, it will be less likely to result in the death of the individual. The term was originally coined by Dr. R. Adams Cowley who was a military surgeon and later headed the University of Maryland Shock Trauma Center.
The theory behind the Golden Hour is that, for example, if an injured individual is not stabilized and treated quickly, he or she may experience internal bleeding or shock. Shock is a life-threatening condition that occurs when the body, including the brain, is not getting enough blood flow. Shock can damage multiple organs and requires immediate medical treatment because it can worsen very rapidly. Therefore, a delay between the occurrence of the trauma and the initiation of care should be minimized; the longer the delay, the lower the survival rate.
Emergency medical personnel generally adhere to the concept of the Golden Hour in responding to emergencies, but the actual relationship between the timing of trauma and initial treatment remains unclear. For example, a 2010 study failed to find a significant correlation between EMS activation, response, arrival time, transport time, or total EMS time and mortality. The study was limited to individuals with physiologic abnormality in the field[1].
Yet, in another study specifically related to individuals with severe head injuries, transportation to trauma centers within the Golden Hour was found to correlate more closely with trauma system effectiveness. Survival analysis was used to determine the effect of arrival time on overall mortality. Outcomes were based upon in-hospital mortality and survival to hospital discharge without requiring transfer for rehabilitation, specialized rehabilitation, neurorehabilitative services or clinically relevant post-acute rehabilitation. The study found no survival benefit for individuals arriving for acute care within 60 minutes of injury time, but an apparent benefit for those arriving within two hours of injury time. Arrival within 60 minutes of injury time correlated with a greater likelihood of survival to hospital discharge without requiring ongoing rehabilitation. According to this study, a survival benefit for individuals existed for individuals arriving earlier to the hospital, but the benefit may even extend beyond the Golden Hour[2].
The Golden Period may be said to be essentially synonymous with the Golden Hour, but divided into more distinct, functional parts. It consists of seven segments:
- Time of injury to 911 call
- Time of 911 call to EMS dispatch
- Time of EMS dispatch to ambulance response
- Time of ambulance response to arrival on scene
- Time spent on scene with the patient
- Time of ambulance transport to the hospital
- Time the individual spends in the emergency room prior to surgery or other treatment[3]
Individuals who, because of prompt treatment during the Golden Hour, benefit greatly from the innovative rehabilitation, specialized rehabilitation, clinically relevant care, supported living and residential services of NeuLife. NeuLife helps to achieve successful and sustained outcomes for even the most difficult and challenging diagnoses. NeuLife’s philosophy is that healing, wellness and personal fulfillment are best attained in a positive and uplifting therapeutic environment where caring staff encourage, assist and support each client so that he or she may achieve specific goals. NeuLife believes that personal fulfillment is equally as important as goals to increase function and independence.
NeuLife, in Mount Dora, Florida, is a fully accessible residential post-acute program providing superior care and specialized rehabilitation to individuals diagnosed with traumatic brain injury (TBI), spinal cord injury (SCI), traumatic amputations and other catastrophic injuries.
2725 Robie Avenue
Mount Dora, Florida 32757
Call: 800.626.3836
Email: [email protected]
Visit: NeuLifeRehab.com
[1] 2009 American College of Emergency Physicians. Published by Mosby, Inc.; http://www.ncbi.nlm.nih.gov/pubmed/19783323
[2] Redefining the golden hour for severe head injury in an urban setting: the effect of prehospital arrival on patient outcomes, http://www.ncbi.nlm.nih.gov/pubmed/22336130
[3] INSTRUCTOR GUIDE
Trauma Assessment and Patient Destination
Prehospital Trauma Life Support, 5th Edition, Mosby
Maryland EMS Protocols
