Author Topic: Rethinking the "Golden Hour" (A Bit)?  (Read 3043 times)

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Rethinking the "Golden Hour" (A Bit)?
« on: August 25, 2009, 09:52:04 »
Mods:  Torn between here and AFG news, but felt this might be better for professional debate - feel free to shift if required.

Shared with the usual disclaimer....

Doctors want ‘golden hour’ leeway
Lara Jakes, Associated Press via Marine Corps Times, 25 Aug 09
Article link

CAMP BASTION, Afghanistan — The U.S. military is rethinking its “golden hour” goal for critically injured troops, questioning whether it should spend a little longer evacuating patients to get them to a better hospital.

Defense Secretary Robert Gates has been adamant that troops in Afghanistan, where the craggy terrain makes medical evacuations difficult, get help as quickly as those in Iraq. Wounded troops in Iraq generally are reached, stabilized and hospitalized within what medical providers call the “golden hour” — the time it generally takes to deliver care needed to save a person’s life.

But at the base hospital located on what Afghans call the “desert of death,” doctors Tuesday told Marine Corps Commandant Gen. James Conway that it’s better to make sure patients who are wounded in battle zones get the best care possible, rather than be taken to the closest medical facility.

“Seventy minutes to the right place is better than 50 minutes to the wrong place,” said Navy Capt. Joseph Rappolo, a trauma surgeon.

Conway, in Afghanistan visiting troops, said he could agree — as long as emergency evacuation teams on the scene provide some care first.

The Bastion hospital treats about 200 patients each week. It has an operating room, an intensive care unit and a morgue, and is one of the few hospitals in Afghanistan that provides full treatment for the critically injured.

Its medical staff says they care for as many wounded Afghan civilians as they do troops. Troops are generally treated and released — or flown out of the war zone — within a day or two. The Afghan patients, however, have few other places to go for care, and wind up staying longer.

Among them Tuesday was Sakhai, a little boy who was idly playing with a pink balloon as he lay on his hospital bed. He did not know his age or last name. The stump of his bandaged right leg, its foot blown off, stretched out in front of him.

Through an interpreter, Sakhai said he’d been in the hospital for four days. Sakhai said he was hurt when a mortar exploded in front of him in his Helmand province village. His younger brother was killed in the blast. Helmand is a Taliban stronghold in Afghanistan.

Sakhai was asked if his leg hurt. No, he said, shaking his head solemnly. His parents had already gone home.

The Bastion hospital is run by U.S., Dutch and British staff — it receives more blood from donors than any medical facility in the United Kingdom, said British Staff Sgt. Darren Makin.

Given the golden hour debate, U.S. military commanders now are wondering if they should open additional high-care hospitals in southern Afghanistan, where troops might be pushing into in the future. Other military hospitals in Afghanistan, such as the one at Bagram Air Field outside Kabul, have top-of-the-line medical facilities. Most, however, do not.

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Offline Rider Pride

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Re: Rethinking the "Golden Hour" (A Bit)?
« Reply #1 on: August 25, 2009, 19:13:34 »
The "golden hour" is just a guideline.

The concept is based upon the idea that the second of 4 critical times in Trauma (6 mins, 1 hour, 24 hours, 72 hours) is where you will save the majority of lives that can be sorted out in surgery.

Its been proven by Hagman et all that the "golden hour" can be from 10 mins to 4 hours, as long as the casualty has breath and pulse, and the things that kill you quick are taken care of (bleeding, obstructed airway, tension pneumo), most surgically correctable injuries will survive beyond it.
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Offline Simian Turner

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Re: Rethinking the "Golden Hour" (A Bit)?
« Reply #2 on: August 25, 2009, 20:39:35 »
This article negates the primary reason for having NATO military health facilites in Afghanistan.  Is it to care for the NATO soldier or the injured Afghan?  When there is capacity to do so Afghans need to be treated, however, do you want all beds filled with non-NATO patients and are therefore unable to conduct military operations. 

Once the Afghan is in the door of the facility regardless of how he was injured they will receive appropriate treatment.  The mechanism of injury and party to blame is one important factor in entitlement to care/responsibility.  Since helicopters are the primary means of patient transport from combat areas, the flight hours and serviceability becomes another factor.

Patient care priority becomes a relative thing unless all resource capabilities are at 100%.  What I get concerned about are statements such as these made:

“Seventy minutes to the right place is better than 50 minutes to the wrong place,” said Navy Capt. Joseph Rappolo, a trauma surgeon.

IMHO, there is no wrong place, some places are better than others.

Conway, in Afghanistan visiting troops, said he could agree — as long as emergency evacuation teams on the scene provide some care first.

Some care - how about life and limb saving care on scene!

Other military hospitals in Afghanistan, such as the one at Bagram Air Field outside Kabul, have top-of-the-line medical facilities. Most, however, do not.

Most military facilities there are better than residents of NATO countries could seek out in their home nations on short notice.  The facilities at Camp Bastion and KAF are as well-equipped as most trauma centres in any NATO country.
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Offline Blackadder1916

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Re: Rethinking the "Golden Hour" (A Bit)?
« Reply #3 on: August 26, 2009, 11:53:48 »
Quote
Given the golden hour debate, U.S. military commanders now are wondering if they should open additional high-care hospitals in southern Afghanistan, where troops might be pushing into in the future.

Is there really a debate here or is this simply "one journalist" who wrote "one article" (haven't found anything else on the net besides this wire service piece) and (IMO) not understanding the concept of "the golden hour" (in a military context) is trying to generate buzz by taking a rather routine military planning problem (where to place HSS assets to best support ops), tying it to a few (perhaps unrelated) quotes and calling it a story.

Is it conceivable that US forces in Aghanistan will establish a greater HSS presence in areas with recently (or future) increased US ops - definitely.  Will these HSS assets be located "as close as the tactical situation permits" (time and distance) - definitely.

What may be the "eventual" story here is someone (media, special interest group, family, etc . . .) tying the death or disability of an American soldier to the "negligence" of the "American" military (in the typical American-centric perception) in not having him on an (American) surgical table in one hour from the time he was wounded, as opposed to the 90 minutes than reality may dictate.
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Offline Simian Turner

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Re: Rethinking the "Golden Hour" (A Bit)?
« Reply #4 on: August 27, 2009, 00:20:56 »
What may be the "eventual" story here is someone (media, special interest group, family, etc . . .) tying the death or disability of an American soldier to the "negligence" of the "American" military (in the typical American-centric perception) in not having him on an (American) surgical table in one hour from the time he was wounded, as opposed to the 90 minutes than reality may dictate.

I cannot find the article links but I know of at least two occasions when injuries to US and UK soldiers have resulted in these types of concerns.  Both resulted in "congressional"-type inquiries from home nations.  I think the current media interests relates back to the US incident.
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