The Golden Hour

[Lucifer 6]

I just heard Stat Flight give a 22 minute ETA to an accident scene in Northern Westchester. With them relocated to Orange County, are trauma patients in No.Westchester/Putnam County not being delivered to a Level 1 Trauma Center within the "Golden Hour"? If not, what can be done about it?

[JohnnyOV 2]

Depends on where in NW Westchester you are. Central NW, it is a straight, 15 min shot down the Taconic. NE county could be anywhere from 20-45 minutes by ground depending on where in the back country you are. In my opinion, moving the base of STAT flight was a fantastic move. Prior to the move, basically any entrapment, or red-tag patient located anywhere in northern Westeschester was "immediately" brought to the medical center by the bird. This immediately however does not take into consideration waiting in a bus with the patient for the helicopter to land, ect. ect..... see this thread -

[Goose 188]

I think the bigger concern is why the helicopter is being requested in northern westchester to begin with. As a small side bar, there has also been some debate over the validity of the "Golden Hour." Some say it was a pitch by R. Adams Crowley to ensure funding for the U of Maryland Shock Trauma Center.

Edited April 12, 2011 by Goose

[Guest feraldan]

As an aside, the term "Golden Hour" is a seriously outdated myth and professional EMS in most parts of the country has been moving away from both the term and the concept. I'm NOT advocating prolonged on scene time with serious traumas but the "Golden Hour" was actually invented as a marketing ploy for a trauma center in Maryland. Somehow, we ended up adopting it and why it still persists in modern EMS education is a mystery.

EDIT: Goose beat me to it. lol

Edited April 12, 2011 by feraldan

[Alpinerunner 61]

That is very interesting. I must say the golden hour never made sense to me, being that every trauma injury is different and some patients can last 20 mins and some can last days. It seems VERY arbitrary being there is no "average/typical" type of trauma injury.

[mreis95 77]

A lot depends on how long it takes to stabilize the pt on scene and remove the pt or pts that denote the use of stat flight nowadays. If it's a prolonged extrication why not have them already there when you finally cut the pt out.

**however there is also an eagerness and excitement to use stat flight**

Edited April 13, 2011 by mreis95

[SRS131EMTFF 471]

Try being the only in-service ALS unit for 50 miles, that will certainly teach you something about the Golden Hour. Waiting for the bird up here means waiting for it to come from Dartmouth, Albany or NYs North Country, plain and simple ain't gonna happen....

While EMS is Westchester certainly has it problems, being almost saturated with paramedics and being about an hour from over half a dozen world class trauma centers, I was certainly spoiled when it comes to resources when compared to my gig up here in VT.

[Guest feraldan]

A lot depends on how long it takes to stabilize the pt on scene and remove the pt or pts that denote the use of stat flight nowadays. If it's a prolonged extrication why not have them already there when you finally cut the pt cut out

Because we call in birds waaaaaaay too much based on that rationale. The bottom line is helicopters can be dangerous to both the flight crew and the responders on the ground during emergency operations, so they should only be called when we definitely need one and not when we have time for them to get here.

And if someone on scene is getting excited about calling in HEMS, that person should find something different to do with their time. The decision should be made by a calm, rational ALS-level provider, after a physical evaluation.

[mreis95 77]

Try being the only in-service ALS unit for 50 miles, that will certainly teach you something about the Golden Hour. Waiting for the bird up here means waiting for it to come from Dartmouth, Albany or NYs North Country, plain and simple ain't gonna happen....

While EMS is Westchester certainly has it problems, being almost saturated with paramedics and being about an hour from over half a dozen world class trauma centers, I was certainly spoiled when it comes to resources when compared to my gig up here in VT.

The northern part of the county isn't saturated with medics, the systems in place work but I wouldn't call it saturated. And 99.9 of these go to WMC which is 20 mins not lights and sirens. But I agree however we are spoiled with what we have around here.

[Guest alsfirefighter]

The standard of care for the most part is being met in regards to trauma patients in northern westchester. In fact in my area it was standard to go by ground as it was actually slightly faster. The bigger issue isn't the use of air resources currently, (it was before it was removed solving the issue) but the wait times we are experiencing for ambulances now on most calls and even more tell tale of the current ems status in an area...trauma calls. A large majority of Westchester was near the 15 mile ring from WMC and I believe the entire county is for the most part within the 20 mile ring averaging about a 30 minute ride...again similar to what a medevac would be.

[Dinosaur 844]

A lot depends on how long it takes to stabilize the pt on scene and remove the pt or pts that denote the use of stat flight nowadays. If it's a prolonged extrication why not have them already there when you finally cut the pt cut out.

**however there is also an eagerness and excitement to use stat flight**

Cause they don't transport any faster than the ambulance. I've seen a ground ambulance leave and make it to the Medical Center at the same time as the helicopter so it never made sense to me.

[Dinosaur 844]

I think the bigger concern is why the helicopter is being requested in northern westchester to begin with. As a small side bar, there has also been some debate over the validity of the "Golden Hour." Some say it was a pitch by R. Adams Crowley to ensure funding for the U of Maryland Shock Trauma Center.

Do you seriously doubt the benefit of getting an injured patient to a hospital quickly? What good are we going to do keeping them in the street?

Now we do the same thing for MI and stroke. Crowley may have been advancing his agenda but medevacs proved themselves in Viet Nam and Korea.

[ny10570 745]

Dinosaur you actually highlighted the problem with the golden hour. The concept was first conceived during research into combat mortality in vietnam. They found that after an hour between injury and surgery the survival rate had a significant drop. Combined with a retrospective review of Korean War data that supported this claim it became Crowley's talking point. The catch is relatively few of our patients are gun shot and blast victims (blast victims being the largest portion of 1 hr drop off). We're treating two different patient populations.

Our patients can often afford the longer transport times where as it turns out medical events such as an MI is much more time sensitive but many times harder to get the patient off scene quickly. In the context of ground transport being safer and keeping air resources available for patients that really need them we are long overdue for re-evaluating our air medical resource utilization.

[Goose 188]

Do you seriously doubt the benefit of getting an injured patient to a hospital quickly? What good are we going to do keeping them in the street?

Now we do the same thing for MI and stroke. Crowley may have been advancing his agenda but medevacs proved themselves in Viet Nam and Korea.

If you reread my post, i said there has been some debate in regards to Crowley's claims (never said i dillly-dally on scene or agree/disagree w/ the golden hour). For the sake of an honest and intelligent discussion those debates/concerns should be discussed. I do, however, believe that air ambulance assets have a very narrow window of utility in westchester.

[Guest alsfirefighter]

Do you seriously doubt the benefit of getting an injured patient to a hospital quickly? What good are we going to do keeping them in the street?

Now we do the same thing for MI and stroke. Crowley may have been advancing his agenda but medevacs proved themselves in Viet Nam and Korea.

He never said nothing to the contrary about not getting a patient to the hospital quickly but the fact that there are many professionals disputing or challenging the prespice of the "golden hour."

I will take the step and say however that there is a difference between getting your patient to the hospital "quickly" and "promptly" and good providers know the difference between the two and when each is appropriate.

I'm not sure I understand what we are doing the same for MI's and Stroke as you refer to...however our only change is that any STEMI we take the to the medical center and stroke patients to a "stroke center" which just about everyone is now. Funny thing is I know more patients with MI's where it could have been sold that a medevac was needed then most trauma cases in the county. But I don't want to put that into anyone's head now that medevac requests have sharply (and long overdue) declined.