The term Golden Hour is used to underline the importance of urgent care that must be given to trauma patients soon after they have been critically injured.
BBe it a minor scratch or a life-threatening event, every family will have a story about an accident or some other trauma they were involved in. The burden of trauma is unrealized, but it is one of the most leading causes of significant debility and even death, especially among younger people between the age 15 to 30 years.
16 / Lakh people die every hour in accidents.
It is estimated that about 16 people per every 1 lakh population in India die due to road traffic accidents. It is our duty to bring awareness to common man about how a timely action can save lives in such an event.
It is of critical importance to categorize the patients who need medical assistance based on their clinical priority. The patients with life-threatening injuries need to be identified, evaluated, and resuscitated as a top priority in a quick and accurate manner to reduce mortality and morbidity.
The Golden hour and three peaks
Death from an injury can occur in 3 periods or peaks. The first peak will be within few seconds to minutes of an injury. Majority of these patients will die even before any medical personnel can reach out to them. The only way we can prevent death in this category of patients is by prevention, by following traffic rules and wearing personal protective gear while riding.
The second peak will occur within few minutes to several hours after the injury. These are the patients who benefit most from immediate action. The “Golden hour” signifies the importance of reaching out to these patients in a time-bound manner. It is not about what we can do in exactly 60 minutes, but rather an opportunity for the emergency medical team to significantly reduce the mortality and morbidity among these patients.
The third peak of death will occur from days to several weeks following the initial injury. Death usually occurs as a complication of the initial injury like severe infection, multiple organ failure etc. The mortality in these patients is greatly affected by the quality of care given in the preceding death peaks.
As almost all accidents happen in an out-of-hospital setting, it helps to have a basic knowledge on how to approach an injured patient. Any critically ill trauma patient will be attended in a trauma care hospital without any strings attached to the bystander for medical legal proceedings. The 108 ambulance or the nearest trauma care hospital is to be intimated as soon as possible. One should never try to make the patient sit or make them drink water without knowing the extent of injuries the patient might be having.
The patient needs to be shifted to a safe place and if any neck pain or injury is suspected, care should be taken not to move the head and neck much while moving the patient. The treatment ideally will be started by paramedic personnel arriving at the site of accident. Initial stabilization will be done, and the patient will be shifted immediately to the trauma care hospital.
The Emergency trauma team
It takes a whole trauma team to effectively resuscitate a critically ill trauma patient. The team will constitute the emergency physician and nurses, blood bank team, radiology team, operating team etc. Every person, starting from a doctor to the security and cleaning person, will have to fill in their specific role for effective outcome of the patient.
A detailed history of events and a definitive diagnosis is not necessary for initial resuscitation of a trauma patient. The injuries causing greatest threat to life are to be treated as a priority. This needs rapid and accurate evaluation of the patient in an orderly manner, identifying the problem and treating it.
The emergency trauma team will be ever ready, 24×7, to treat all trauma patients. With additional support from the by-standers and paramedical team, the mortality and morbidity of trauma patients can significantly be brought down.
CONSULTANT – EMERGENCY MEDICINE
MBBS , DNB – EMERGENCY MEDICINE