Talk:Golden hour (medicine)

Criticisms of the Golden Hour

The golden hour is not a universally accepted medical concept, perhaps we should have a section where its pros and cons are discussed? I'm not fully au-fait with the literature as it currently stands, but maybe someone who is should have a look? --John24601 20:31, 5 January 2006 (UTC)

Two cites

The two citations at the end of the article, is there some linkage we can provide? Merely referencing the studies in question, without giving the reader the opportunity to go to them and draw their own conclusions is akin to giving a hungry man a picture of food.

I, for one, am not married to the Golden Hour as a standard, and would welcome some rigorous investigation of the appropriateness of the load-and-go or stay-and-play methodologies for pre-hospital care, esp. of trauma patients. I am going to add a note to the effect that the "Golden Hour" concept is well-documented in cases of thrombosis-induced CVA, though it is three hours, not one, unless someone can convince me otherwise.

References don't have to be to online sources, but they have to exist. Dan100 (Talk) 13:54, 11 June 2007 (UTC)

Issues

As written right now, the article is focused largely on saying that the "golden hour" is wrong. Certainly, it has come into question recently, but we can't just blanketly say that it is wrong. This is a violation of NPOV. This article will have to be cleaned up so that both supporters and skeptics of the "golden hour" concept can read it and think that the concept is treated fairly. --Hnsampat 17:42, 22 June 2007 (UTC)

On the other hand, this is the era of evidence based medicine and many medical dogmas or myths have been debunked in the medical literature. If there's no high quality evidence to support the existance of the so-called golden hour, the absence of any such evidence in the article can hardly be said to be a POV problem. MoodyGroove 17:52, 22 June 2007 (UTC)MoodyGroove

Yes, but we're not supposed to be drawing conclusions for the reader. We just state the facts as they are. This article is talking about how the golden hour is a "myth" and how it's "wrong." The golden hour has been called into question recently, but it hasn't been "disproven." This article should discuss the controversy, but it shouldn't take sides on the issue. Right now, it's clearly taking a side. --Hnsampat 18:00, 22 June 2007 (UTC)

I agree there were some minor POV problems. For example, the lede was rephrased to say the golden hour "was" considered the first 60 minutes of a trauma emergency (it still is). It's also widely believed that the golden hour is valid (it just has no high quality evidence). It's also fair to point out that Dr. Bledsoe is an outspoken critic of the golden hour and other EMS "myths" (and he is). But the fact is that we are in a new era of modern medicine,. As such, the Wikipedia should side with the prevailing evidence. That's not making the mind up for the reader, unless you believe we should present both sides of blood letting, for example, and let the reader decide. Scientific articles are different from political articles, in my opinion. At any rate, I think I've corrected the minor POV issues that were present. MoodyGroove 19:23, 22 June 2007 (UTC)MoodyGroove

Kudos. You've done a good job de-POV'ing this article. I agree with you 100% that articles should not give undue weight to any particular topic. However, the "golden hour" has not been universally rejected the way blood-letting has. In fact, as you mentioned, it is still considered to be a valid rule of thumb. Even if it seems less applicable today, one must keep a few things in mind. First, the "golden hour" was always meant to be a rule of thumb and not a rigid cut-off point at which someone is doomed. Second, when the "golden hour" concept was conceived, we were still in the very very early days of trauma medicine. Medical advances since then have made it possible for people to survive even if they go beyond the "golden hour" before receiving treatment. So, the presence of some articles today saying that patients can survive beyond the "golden hour" is not proof of its invalidity. Furthermore, EMT and paramedic courses still teach the concept of the "golden hour" as it remains a valid rule of thumb. So, while we should acknowledge that there is controversy, we shouldn't take sides here. It is not for Wikipedia to decide which side of a scientific controversy is more valid. (Blood-letting is universally rejected; the golden hour is still taught as being valid, despite some evidence to the contrary.) --Hnsampat 20:42, 22 June 2007 (UTC)

I almost hate to nitpick, since we're mostly in agreement, but in a scientific controversy, the evidence decides which side of a controversy is more valid. Whether or not there is acceptance of evidence is another matter altogether. It takes years for medicine to "universally reject" paradigms, therapies, or modalities that are disproven or discredited in the peer reviewed literature. It's a battle to get clinicians to follow evidence based guidelines and critical pathways for patients experiencing myocardial infarction, for example. The force of dogma and tradition in medicine should not be underestimated. So yes, the 'golden hour' is still taught, and still "widely accepted" (and the article says that again). However, if you're willing to admit that the Wikipedia should "report the facts" then pointing out that the golden hour is not evidence based is not POV, it's just calling a spade a spade. Regards, MoodyGroove 21:19, 22 June 2007 (UTC)MoodyGroove

Again, my point was not that we should act like the golden hour is pure truth. My point is that, just because dissent exists in the literature, the article should not automatically presume the dissent to be true. Maybe the golden hour is correct and maybe it isn't. But the article should not act like it is a well-established fact that the golden hour is false, because it's not a well-established fact; it's just what some recent articles seem to be getting at. (I'd also like to stress once again that this whole matter of whether the golden hour is "true" or not is kind of pointless, as the golden hour always has been a rule of thumb, meaning that it's not meant to be 100% predictive of what will happen to a patient. Also, R Adams Cowley coined the term "golden hour" specifically in reference to shock, even though it's taken on a broader meaning after that.) But, this whole argument is moot now, as we agree on the content of the article. The article is fine as it stands right now. --Hnsampat 03:30, 23 June 2007 (UTC)

Removed from article

If you wish to salvage this content, please move to a more appropriate article. MoodyGroove 20:22, 22 June 2007 (UTC)MoodyGroove

==Basics== ===Prehospital care=== Prehospital care is limited to the minimum, i.e. * A.B.C (airway, breathing, circulation) * cover wounds * realign ("reduce") broken limbs * protect the [[spine (anatomy)|spine]]. Inserting an [[intravenous drip]] must be fast and not delay transportation. [[Intubation|Endotracheal intubation]] is the only act that may delay the transportation. This prehospital strategy is also called '''scoop and run''' (also referred to as '''load and go''' or '''swoop and scoop'''; the latter reference is most often used by helicopter paramedic teams), as opposed to the '''stay and play''' that is more adapted to less severe cases (when there is no severe trauma, the trauma caused by the transportation itself is more important than the gain of time). [[MEDEVAC]] helicopters are often used to move victims to a trauma center within the golden hour. ===Hospital selection=== The ambulance must transport the victim to the hospital with the facilities to treat the patient. This is not always the closest hospital, as the closest hospital may lack the facilities or may be overwhelmed by other victims from the same incident (see also [[triage]]). ===Limited examination=== Third point, only limited examination in the [[emergency room|emergency department]]. If there is no evidence for surgical intervention, only three [[Radiography|radiographs]] should be performed: [[cervical spine]], [[chest]] and [[pelvis]]. ===Summary=== The Golden Hour can be summarized by the 3R rule[http://www.ohsu.edu/surgery/UGS/FACULTY/DDTcv.shtml] of Dr. Donald Trunkey, an academic trauma surgeon. It involves: * getting the right patient * to the right place * at the right time The [[Discovery Health Channel]] series ''[[The Critical Hour]]'' is a documentary-style [[reality TV]] program focusing on traumatic injuries and the difference the Golden Hour concept can make in saving lives; among the hospital settings regularly featured on the show is the University of Maryland Shock Trauma Center.

"Platinum ten minutes"

A term brought up in my current EMT course is the "platinum ten minutes", which is related to the golden hour. (google hits) The term refers to not staying more than 10 minutes on scene (when possible) and not "bandaging someone to death". There aren't many hits, so it may not be notable enough, but just a suggestion. -- MacAddct  1984 ^{(talk • contribs)} 20:18, 7 April 2008 (UTC)

Remove "Medical conditions with time-critical treatment considerations" section?

If no one objects, I'm going to remove this section. The article is about a controversial saying in regards to treating trauma patients. Strokes and heart attacks are not trauma, and as such, don't belong in the article. Comments? JPINFV (talk) 01:36, 13 June 2008 (UTC)

Strokes DO have a time limit for thrombolytic drugs to work effectively... if there isn't a better place to reference the time-criticality of that sort of treatment, why not leave it in the article, even if designate it as not really a 'golden hour' issue in the sense it was originally conceived? Jclemens (talk) 01:48, 13 June 2008 (UTC)

I'm not arguing whether there is a time limit (which is longer than an hour anyways for strokes). The problem is that the golden hour is taught about trauma, not medical conditions. A better place to note treatment time constraints for conditions such as a stroke would be the main stroke/CVA article, not being pigeon holed into an article as 'evidence' when it doesn't pertain to the point of the article (trauma care). JPINFV (talk) 03:41, 13 June 2008 (UTC)

See if what I just did to that section made it a little more tolerable. Jclemens (talk) 04:25, 13 June 2008 (UTC)

Agree with JPINFV the golden hour refers to trauma. There are other medical emergencies that may be listed there but not here.--Doc James (talk · contribs · email) 17:33, 15 April 2009 (UTC)

Removed text

• I've removed the following self-sourced text, which was added by someone knowledgeable in the field, but requires published references and a neutral tone to be considered here. As it stands it looks a bit like original research. JNW (talk) 14:03, 13 October 2013 (UTC)

In contrast, former Los Angeles Paramedic John Longenecker, M.I.C.P. [Inactive] points to the evolution in the concept as more of a knowable, demonstrable fact over decades than a disputable unrevisited opinion lacking evidence. Further, The Golden Hour is not about death as a single outcome, but about survival and quality of life as the primary, measurable, desirable outcome.

At its core, The Golden Hour is a concept of statistical inference. As an applied practice from that inference and as a value of EMS worldwide, it expedites the patient's entry into the system for definitive care on the knowledge that the patient’s ultimate outcome is entirely dependent upon what is done for them immediately. The gist of the Golden Hour concept is immediately.

The original concept developed from a scattergram plotting of patient outcomes versus intervention. It soon became clear from the scattergram that recovery was better when the patient was seen immediately, and if not found among the facts, then favorable outcomes dropped off precitipitously.

This concept includes both definitive field care as in Advanced Life Support [Paramedics] or even simple citizen First-aid, such as stopping severe bleeding or bystander CPR. The patient's ultimate outcome can depend on the simplest immediate action.

The Golden Hour as a concept is not a window of sixty minutes or so as if there were always some sort of headroom safety factor as a reliable constant, but a statistical conclusion (inference) that patients in critical illness or injury require immediate treatment and that they do best the sooner they are treated, whatever that treatment may be.

Part of such outcomes within the meaning of this article include patient recovery in terms of cost, length of hospitalization stay, proper staffing, use and the occupation of resources, ultimate outcomes of death vs. disability vs. regaining facility vs. complete recovery – all of which as measurements of savings and recovery are directly proportional to the promptness of immediate care. This is the societal impact of The Golden Hour.

The optimal outcomes oftentimes begin with lay intervention contemporaneous with the request for aid. Lay intervention plays a role in this concept because it is generally held that bystander assistance not only begins the patient's chart with information [reporting as witness or historian], but also begins the patient's entry into the system by being the first to administer perhaps life-saving care.

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Following or after?

@ User:CateFromArcadia: You made this revert . Could you, please, explain the "specific meaning which seems more appropriate here"? What "specific meaning" do you mean? 85.193.228.103 (talk) 13:36, 17 January 2021 (UTC)

Thank you for mentioning me! 'Following' often implies that something occurs directly after the event, whereas 'after' can be used more broadly to mean any time later. In this particular instance, as the Golden Hour refers to the period directly following a traumatic injury, I would argue that 'following' does a better job at expressing this. It is, ultimately, a fairly small distinction, but I don't think 'following' is an especially niche or "clever" word, or one which is likely to impede on someone's understanding of the article, and so I didn't see any reason to change what was originally written. I do appreciate your efforts to keep Wikipedia accessible though! Feel free to continue this discussion if you see fit. Thanks again! :) CateFromArcadia (talk) 16:24, 17 January 2021 (UTC)

@ User:CateFromArcadia: Imagine that someone did something immediately after something bad happened, for example someone called an ambulance. According to Google we get:

"after the injury he immediately" => 40800 results

"following the injury he immediately" => 3 results

According to your "theory" (no offense meant), the results should be completely different. How is it that "after" is so often connected with "immediately", and "following" is not? 85.193.228.103 (talk) 19:12, 17 January 2021 (UTC)

I would argue that, even ignoring any potential flaws with this method of testing the assumption, this evidence doesn't necessarily contradict my point: for example, I could conversely argue that the smaller number of results for 'following' and 'immediately' in the same sentence supports my suggestion that 'following' implies immediacy, as the use of the former would then render the latter redundant.

A cursory Google search provides dictionary definitions of following which implicitly support my point (for example "being next in order or time" from Merriam-Webster), though clearly there isn't a rigid distinction, and the words are frequently used interchangeably. Beyond that, I have no source besides my own understanding of my native language, but of course the English language is strange and flexible, and two people rarely have the same experience with it.

That being said, I hope it's clear I'm not trying to cause or prolong any kind of argument here, and I probably won't return to this page unless you have anything else to add to the discussion. Thanks again for talking it through with me! :) CateFromArcadia (talk) 15:46, 19 January 2021 (UTC)

@CateFromArcadia: First of all, you contradict yourself because you wrote: "the Golden Hour refers to the period directly following a traumatic injury", and now: "immediately after" goes too far in the other direction by limiting the time frame. In which direction, and how can it limit the time frame? The time frame is precisely defined as one hour. The word "immediately" is very important. Both "after" and "following" are too vague in this context. If the golden hour is not the period of time immediately after an injury, then when does it start? After ten, twenty or more minutes?

As for "following", according to Google we get:

"immediately after the" => 124m, 23m in books

"immediately following the" => 83m 5.8m in books

85.193.252.19 (talk) 18:21, 13 April 2021 (UTC) (still the same)

I didn't do a good job of explaining my point about limiting the time frame and as such you misunderstood it, but having reread the article and remembered the context I concede that the point I was trying to make isn't really applicable.

You used the same Google argument last time, but I would argue that this evidence doesn't sufficiently support your point; if I wanted, I could use it to support mine: the fact that "immediately following" is less common than "immediately after" could easily imply that to use the former is tautologous, as "following" already has connotations of immediacy. Regardless, I don't think the prevalence of a phrase in search results is reason enough to argue for or against its exclusion, especially when, as in this case, that number is still in the millions.

All things considered, I think your proposed phrase "immediately after" works if you want to change it, though I still see no issue with the original phrase, which for me was precise enough to convey its intended meaning. As much as I appreciate your efforts to keep Wikipedia accessible, I don't think going around replacing already basic and common words with even simpler counterparts is necessary; alternative projects exist for approaches like that, and you will inevitably lose elements of the meaning in at least some cases, regardless of your intentions.

I will remove this page from my watchlist now; as I have said, I have no involvement with this article beyond our discussions and I don't wish to drag this out any longer, so unless you tag me I won't return.

As always, thank you for your willingness to discuss this with me, and I hope we have now come to some kind of understanding. CateFromArcadia (talk) 18:51, 13 April 2021 (UTC)