# Redefining the Golden Hour



## Infanteer (15 Oct 2018)

Great article over at War on the Rocks.  The data is out there to show that "the golden hour" changed the ration of killed to wounded on the battlefield from 1:4 to 1:10.  Aside from being another example of the use of analytics in the military profession, it also drove changes to battlefield medicine.  After Afghanistan, as we moved on to more traditional, regular warfighting scenarios, scenarios like a lack of air supremacy to an overload of the chain of evacuation due to a higher number of casualties were recognized, and it was commonplace to say "the golden hour doesn't exist."  The problem I saw is that it was often left at that.

The article attempts to explore some ways of enabling a golden hour in a regular combat scenario - primarily, improvements to prolonged field care, advanced resuscitative care, and long-distance en-route care.  Interested to hear the thoughts of the military medical professionals here.

https://warontherocks.com/2018/10/how-long-can-the-u-s-militarys-golden-hour-last/


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## mariomike (15 Oct 2018)

For reference to the discussion of the Golden Hour, 

ROC Data and the Golden Hour  
https://army.ca/forums/threads/120168.0.html

Rethinking the "Golden Hour" (A Bit)?  
https://army.ca/forums/threads/88721.0.html


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## Armymedic (15 Oct 2018)

Infanteer said:
			
		

> After Afghanistan, as we moved on to more traditional, regular warfighting scenarios, scenarios like a lack of air supremacy to an overload of the chain of evacuation due to a higher number of casualties were recognized, and it was commonplace to say "the golden hour doesn't exist."  The problem I saw is that it was often left at that.



In the context of the Canadian Armed Forces, they are right.

That is because to make the "golden hour" work, our military needs to have the personnel, equipment, the leadership, the capability and the will to make it happen.

That being said, outside of SOF's use of the MRST, the Army currently is not capable of supporting the golden hour as it does not hold any of the above items listed.

Our Health Services are only capable of producing 5-6 surgical teams, and equal number of forward resuscitation teams. 

TCCC is slow to adapt and currently stuck in Training/Doctrine quagmire. PFC currently a whole bunch of good ideas being held in a very small silo with no formal training. There is a huge drag on implementing a forward whole fresh blood protocol. Our Medics are limited by protocol to what they can do when.

Our Army hold no rotary wing capability, and MEDEVAC is just another mission for an already busy 450 Sqn. 

As long as Health Services, the Air Force and the Army remain distinct and separate entities, Canada will not be able to support the golden hour. You need a combined effort and the will of leadership to build and sustain the capability.


And then we need another hot war to get it right.


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## Civvymedic (15 Oct 2018)

Great article, I am interested in the responses from the Military Medical community also. Thoughts from the civilian side, I must say that many life saving interventions that we are currently using in regards to trauma care come from Military medicine. Most recently, modern bleed control techniques and transport to appropriate care. Post 9/11 conflicts and the lessons learned have offered much to the civilian medical community back home.


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## brihard (15 Oct 2018)

Civvymedic said:
			
		

> Great article, I am interested in the responses from the Military Medical community also. Thoughts from the civilian side, I must say that many life saving interventions that we are currently using in regards to trauma care come from Military medicine. Most recently, modern bleed control techniques and transport to appropriate care. Post 9/11 conflicts and the lessons learned have offered much to the civilian medical community back home.



Similarly in law enforcement. My organization in the past couple years rolled out tourniquets, hemostatics, and chest seals. In a number of other organizations they’ve been a real lifesaver.


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## PPCLI Guy (15 Oct 2018)

For the counterpoint, many Canadian civilians live well outside said Golden Hour, here in Canada.  We need to not be too precious....


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## Haggis (15 Oct 2018)

Brihard said:
			
		

> Similarly in law enforcement. My organization in the past couple years rolled out tourniquets, heamostatics, and chest seals.



I just finished my fifteenth career first aid course with my agency.  We, too have been rolling out tourniquets for the past couple of years along with a large number of local trauma kits.  We had an interesting discussion with the instructor about chest seals, notably the three sided vented ones that used to be SOP for "sucking chest wounds" which she said seem to be going out of style.


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## medicineman (16 Oct 2018)

Some thoughts from my relatively moldy military medical mind...when I was a baby medic, the "golden hour" was thought of more as the "silver six" hours, as we never assumed air superiority - we're talking NATO vs Commie Bastards in Western Europe.  Evacuation platoons were either co-located with a UMS but more often, doctrinally 1 -1.5 tactical bounds behind, depending on phase of war or casualty flow.  Cas would be road evaced to the evac platoon and staged - if they were in need of immediate stabilization, they were off loaded and either replaced on the amb or they just carried on.  The CASEVAC HLZ would be at the evac platoon, as it was (in theory) out of range of MANPADS and some area AD systems.  People requiring Immediate CASEVACs could be forwarded on to an ASC or the BMS.  Next stop would be a BMS or Treatment platoon...then ASC (Advanced Surgical Centre), unless they were co-located.  The idea was people were given check ups along the way and necessary interventions by higher levels of care than the medic in the back of the wagon.  The Brit experience in the Falklands (Goose Green in particular) used litter bearers to get many casualties back to the Regt Aid Post for onward transmission via helicopter to Ajax Bay and the Red and Green Life Machine.  The litter bearers, incidentally, always went back forward with ammo, machine gun barrels, batteries, etc.  There was also the issue when an entire Fd Amb was essentially rendered ineffective when all its equipment and much of its personnel were blown up in Fitzroy on the Sir Galahad and Sir Tristram.  Ahem.

Fast forward to now, where we (those of us that actually care we) feel the farther forward the better - the Russian experience in Chechnya, the Shock/Trauma teams in Iraq with the Americans and far forward staging the MO's with battle groups in Fallujah ("On Call in Hell" is a good read regarding this) help reduce the rates of possibly preventable fatalities...however, there are those that no matter who's there when they get wacked, are going to die.  The Russians were trying to keep their MO's within half a tactical bound or closer during FIBUA ops, because of the bad physics involved with close quarter combat and IED strikes within confined spaces.

Hope that helps a bit.

MM


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## mariomike (16 Oct 2018)

PPCLI Guy said:
			
		

> For the counterpoint, many Canadian civilians live well outside said Golden Hour, here in Canada.



Not sure how it compares with the CAF ( with so many possible locations ), but 77.5% of Canadians reside within 1-hour road travel catchments of Level I or Level II trauma centers.

( Data from the 2006 Canadian Census. )


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## brihard (16 Oct 2018)

mariomike said:
			
		

> Not sure how it compares with the CAF ( with so many possible locations ), but 77.5% of Canadians reside within 1-hour road travel catchments of Level I or Level II trauma centers.
> 
> ( Data from the 2006 Canadian Census. )



So 7-8 million don’t... Quite a bunch. I’m surprised it’s that high actually given how relatively concentrated our urban populations are.


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## mariomike (16 Oct 2018)

Brihard said:
			
		

> I’m surprised it’s that high actually given how relatively concentrated our urban populations are.



This goes into it in some detail,

"Access to trauma systems in Canada"
https://www.ncbi.nlm.nih.gov/pubmed/20838258


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