Two of the most significant studies that found a significant correlation between reduced out-of hospital times and decreased mortality rates were from Quebec in the 1990’s. The fact of the matter is that there is a paucity of data to support the golden hour and even some data that refute it. However, this concept is established on a less than rigorous scientific foundation. It has subjected the general public to significant potential risk from well-intentioned ambulance crews careening rapidly through busy streets, transporting injured patients in crowded driving conditions, or air ambulances flying in less than ideal weather. The idea that definitive trauma care must be initiated within 60 minutes has spawned a billion dollar industry of trauma systems, trauma centers, aeromedical rescue, and advanced pre-hospital life support. This dogma likely arose from the military, as many battlefield fatalities occur within the first minutes post-injury. A companion to the golden hour has arisen in pre-hospital lore called the “platinum 10 minutes.” This is based on the concept that seriously injured patients should have no more than 10 minutes of scene-time stabilization by emergency medical personnel prior to transport to definitive care at a trauma center. The foundation for this statement is a bit unclear, but it is widely believed that at the time he stated this, Cowley was trying to win support for a shock trauma hospital and a helicopter program that would fly any trauma victim in the state of Maryland to a trauma hospital in Baltimore within 60 minutes (the golden hour). In a 1975 article, he stated, “the first hour after injury will largely determine a critically-injured person’s chances for survival.” 1 However, no references or data were provided to support this statement. Adams Cowley, founder of Baltimore’s famous Shock Trauma Institute. The vernacular term “golden hour” is widely attributed to R. This article will briefly unpack the origins of the golden hour and look at evidence to refute or support it. Nevertheless, like many holy shrines in medicine, once exposed to the light of an evidenced-based review, it is found to lack conclusive evidence in the literature to support our biases. Teleologically this seems to make great sense, as no one would argue that we should leave an injured patient bleeding on the streets for longer periods of time. The underlying tenet is that an injured patient has 60 minutes from the time of injury to receive definitive care, after which morbidity and mortality increase significantly.
The term “golden hour” is a well-known part of the lexicon of trauma surgeons and emergency medical service (EMS) providers who take care of injured patients on a daily basis.
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