U.S. military’s ‘golden hour’ mandate is saving lives

After the golden hour mandate was implemented, the median time to transport a wounded service member dropped from 90 to 43 minutes, and the fatality rate fell from 13.7 to 7.6 percent. (Credit: U.S. Navy photo by HMC Josh Ives via Flickr).

The first hour after a medical trauma has long been viewed as the difference between life and death. Now, a new study confirms it.

Receiving trauma care within the first hour saves the lives of US service men and women on the battlefield.

In 2009, Secretary of Defense Robert M. Gates mandated a “golden hour” protocol for United States military personnel with life-threatening injuries, cutting the previous military standard in half. New research shows the change has had dramatic results.

The golden hour mandate presented a number of logistical and practical hurdles, researchers say.

“Ideally we’d land a helicopter to medevac a wounded soldier, but that’s not always possible in the middle of a firefight in mountainous terrain in the dead of night,” says Russ S. Kotwal, of the US Army Institute of Surgical Research and an adjunct assistant professor at the Texas A&M University College of Medicine. “What the military also did was push medical capability forward on aircraft and on the ground in order to be better able to treat life-threatening injuries immediately.”

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Even when a medevac was a feasible option, ordering a helicopter often meant layers of bureaucracy, which military leadership worked to slim down. “Previously there were a number of levels of command involved in ordering a helicopter,” Kotwal says. “Leadership streamlined that procedure and in the process decreased the amount of time it took to get the wounded to the care they needed.”

For the study, published in JAMA Surgery, researchers analyzed battlefield data for more than 21,000 military casualties during the US involvement in the Afghanistan conflict from September 11, 2001 to March 31, 2014, comparing outcomes before and after the June 15, 2009 implementation of the golden hour mandate.

Before the golden hour mandate was implemented, the median time to transport a wounded service member was 90 minutes. After the mandate, the transport time dropped to 43 minutes. Cutting the average transport time in half also cut the fatality rate nearly in half, from 13.7 to 7.6 percent. Additionally, the final projected versus the actual case fatality rate equated to 359 lives saved.

Incomplete or inaccessible data complicated the study’s findings in several instances. “Unlike in a traditional hospital setting where physicians write the course of treatment down immediately after the procedure or use a scribe, battlefield medics are often working in a mass casualty scenario in the dark of night in the middle of a firefight,” Kotwal says.

“Sometimes prehospital care does not get recorded properly—or at all—and that has left us with a hole in the data. Medical providers need to know what’s already been done, what interventions and how much blood products, antibiotics, or pain meds they’ve already received.

Because of this, Kotwal says the military should mandate accurate and timely recording of battlefield trauma care to inot only improve data collection, but trauma outcomes, as well. To that end, the Department of Defense has developed new prehospital documentation tools and service members have begun training to use them.

Source: Texas A&M University