Dr.Rahul Thanky

• Dr.Rahul Thanky, Consultant Emergency Medicine, Wockhardt Hospitals, Nashik

The term “Golden hour” was coined by R Adam Cowley, a military surgeon. The golden hour is the period of time immediately after a traumatic injury during which there is the highest likelihood that prompt medical and surgical treatment will prevent death (Wikipedia). The exact time period ultimately depends on the nature of the injury and can be more than or less than this duration. While initially used for trauma, this term is broadly used to highlight the core principle of urgent and rapid treatment in all life-threatening conditions. The concept of Golden Hour refers to the window of opportunity right after the injury when an intervention is made at the earliest to could impact the survival of the patient.

Trauma is one of the leading causes of death in India, claiming nearly 2 lakh lives every year. The other leading causes of (rapid) loss of life would be heart attacks and strokes. Receiving medical care in the least time possible would enhance chances of survival. In cases of trauma, the time period may be in mere minutes as the victim may have an obstructed airway or critically injured lungs severely affecting breathing or bleed out unless there is an emergent intervention. In heart attacks, every minute lost leads to loss of heart muscle, and in case of a stroke, there can be potentially irreversible neurological damage.

It is a sad fact that many patients still die simply due to a delay in receiving medical care. These delays are due to various reasons, such as:

1. Delay in seeking help thinking that the situation will improve in some time. This is especially true of patients with chest pain or stroke-like symptoms who often fail to understand the potential seriousness of their symptoms.
2. Lack of a robust pre-hospital EMS service which often leaves the patient searching for an ambulance.
3. Reluctance of bystanders to offer help out of lack of knowledge or fear of legal liability. A World Health Organisation (WHO) report on ‘pre-hospital trauma care systems’ says “Even the most sophisticated and well-equipped pre-hospital trauma care system can do little if bystanders fail to recognise the seriousness of a situation, call for help, and provide basic care until help arrives”
4. A large number of hospitals (both big and small) are not equipped to deal with such cases, a fact corroborated by a recent study conducted by AIIMS.