Author Topic: ROC Data and the Golden Hour  (Read 5295 times)

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Offline medic45

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ROC Data and the Golden Hour
« on: August 11, 2015, 17:52:34 »
Here is a link on some of the ongoing ROC research:

https://roc.uwctc.org/tiki/tiki-read_article.php?articleId=139

For discussion.

Online mariomike

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Re: ROC Data and the Golden Hour
« Reply #1 on: August 11, 2015, 18:48:12 »
I was in Operations, so I can't comment on studies. But, in Metro, ( don't know what the SOP was out of town ) if north of Eglinton patients meeting the guideline went direct non-stop from the scene to Sunnybrook. Likewise, south of Eglinton went from the scene ( without stopping at a receiving hospital en route ) to St. Mike's. That included pregnant patients. Children went to Sick Kids. All three are Level 1 trauma centres.
That was a 30 minute ride. Scene time was not to exceed 10 minutes unless extenuating circumstances (extrication, multiple patients). Add Response Time, and you're at about the Golden Hour mark.
As far as I know, that's still the SOP.

"Dr. Bryan Bledsoe, an outspoken critic of the golden hour and other EMS "myths" like critical incident stress management, has indicated that the peer reviewed medical literature does not demonstrate any "magical time" for saving critical patients."
https://en.wikipedia.org/wiki/Golden_hour_(medicine)#Controversy
« Last Edit: August 11, 2015, 19:32:43 by mariomike »
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Offline ArmyDoc

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Re: ROC Data and the Golden Hour
« Reply #2 on: August 11, 2015, 20:25:05 »
Current NATO guidelines are 10-1-2. 10 min to initial lifesaving treatment (ie Combat First Aid), 1 hour to Damage Control Resuscitation, 2 hours to Damage Control Surgery. The Golden Hour has become the Golden Two Hours, in essence.

Offline MedCorps

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Re: ROC Data and the Golden Hour
« Reply #3 on: August 11, 2015, 20:42:17 »
I think the crux of the 10-1-2 model really sits in the 10. 

We are providing a high level of care almost instantaneously after a trauma occurs.  With self-aid, buddy aid (first aid, combat first aid, TCCC) and forward Med A / Med Tech care the average service member who is injured stands a much better chance then a civilian in a similar situation of making it to damage control resus (DCR) and DCS.

A week ago I received a really good briefing on the direction the future field force is going. The Working Group has just finished off iteration #2 and is moving to #3 in October time fame. If everything works out according to plan you will see the scope of DCR increased in our updated doctrine and field TO&E.  This along with critical care transport (ground or forward air evacuation) from DCR to DCS along with the changes to Role 2B and 2E care will really build on the lessons learned by the CF H Svcs Gp and NATO in Afghanistan / Iraq.

MC

Online mariomike

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Re: ROC Data and the Golden Hour
« Reply #4 on: August 12, 2015, 08:30:17 »
Here is a link on some of the ongoing ROC research:

https://roc.uwctc.org/tiki/tiki-read_article.php?articleId=139

For discussion.

I participated in ROC with Toronto Rescu:
http://www.emergencymedicine.utoronto.ca/research/ptmr/CS/ROC/rescunet.htm

Has the CAF done a similar study?

« Last Edit: August 12, 2015, 11:46:56 by mariomike »
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Offline medic45

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Re: ROC Data and the Golden Hour
« Reply #5 on: August 12, 2015, 15:45:26 »
Will the change in doctrine lead to changes in TO&E or is it purely a doctrine change at this time?

Offline MedCorps

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Re: ROC Data and the Golden Hour
« Reply #6 on: August 13, 2015, 17:14:53 »
It is both.  The CF H Svcs Gp field doctrine is being updated concurrently with the Future Field Force Working Group and some trials and evaluations which will be seen on some upcoming exercises in 2016.

You are likely to see some TO&E changes at the three field ambulances and at 1 Canadian Field Hospital. The higher-level doctrine will likely come out before the TO&E changes, which makes sense given the complexity at changing TO&E's and the fact the approved doctrinal principals should guide procurement and force employment.

Some of this is the result of the changes in health services doctrine in NATO and the changes to the NATO concept of Role 1, Role 2 and Role 3 which Canada needs to bring themselves in line with. Other factors are lessons learned from recent conflicts, changes to Canadian Army force structures (Force 2013), changes to tactical aviation force employment doctrine (Force 2017) and the desire to provide a higher level of care further forward.

If I hear anything I will let you know.  If you have any questions let me know and I can ask around.  I know a number of people on the Working Group.

MC


Offline ArmyDoc

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Re: ROC Data and the Golden Hour
« Reply #7 on: August 13, 2015, 19:53:23 »
I participated in ROC with Toronto Rescu:
http://www.emergencymedicine.utoronto.ca/research/ptmr/CS/ROC/rescunet.htm

Has the CAF done a similar study?
CAF has access to the Joint Theatre Trauma Registry, a U.S. Led trauma registry. Furthermore, many of our specialists  either use data from JTTR or participate in ongoing research trials. Much of the recent research changes to blood product administration (1:1:1), for example, was driven by NATO's collective combat trauma experience.

Offline ArmyDoc

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Re: ROC Data and the Golden Hour
« Reply #8 on: August 13, 2015, 20:01:41 »
Will the change in doctrine lead to changes in TO&E or is it purely a doctrine change at this time?
Any changes in TO&E would come from internal reallocation of positions. It is vanishly improbable that these changes to doctrine would increase the number of positions available to H Svcs.

Offline Cantthinkofanything

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Re: ROC Data and the Golden Hour
« Reply #9 on: August 14, 2015, 17:34:43 »
I feel that this study does little to shed light on what is already well known within the trauma community.  Interventions and delivery of the patient within "x" amount of time only aids in the survival of an extremely small amount of patients.  The obvious intervention being surgery.  The surgical aspect of this time frame should be what is in question when it comes to survival rates.   The numbers identify transport to trauma centers but doesn't identify how many patients received surgical care.  The ratio of delivery+surgical care to mortality should be identified.

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Re: ROC Data and the Golden Hour
« Reply #10 on: August 26, 2015, 13:54:56 »
I feel that this study does little to shed light on what is already well known within the trauma community.

On Operations, our mandate was only to collect the data, and let the experts interpret it.

This what they told us:
"Toronto Paramedic Services is the largest contributor to the Resuscitation Outcomes Consortium (ROC), and is one of only ten Regional
Clinical Centres across North America comprising this network. The ROC’s mission is to conduct clinical research in the areas of CPR and
traumatic injury in the prehospital setting."
« Last Edit: August 26, 2015, 14:18:12 by mariomike »
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