Hour of gold

The hour of gold ( golden delicious hour ) is a concept of emergency Médecine. The majority of the seriously injureds (Polytraumatisé, or victim of a Hemorrhage intern) die in the first hours. There are thus an optimal rate of survival if the victim is found on an operating table in the hour which follows the accident.

A famous study of Trunkey carried out in California in 1983 highlights for the consecutive deaths at a road accident that:

50% of killed dies on the blow, because of their lesions;
30% dies in the first four hours following the accident;
20% dies in the week, by multi-visceral failure.

Organization of the urgent medical assistance around the hour of gold

The respect of the hour of gold requires an organization of the care and a staff training intervening as a préhospitalier (first-aid workers, ancillary medical first-aid workers, Smur). It is necessary indeed:

to have a structure of care fixes ensuring a day before with an operational operating room suite the every day in any hour (see Accueil and treatment of the urgencies);
a personnel knowing to recognize the top priority, by carrying out a assessment rigorous, mobile and being able to be quickly on the spot;
a means of fast and sure evacuation, avoiding the aggravation of the traumatisms (in the ideal a Helicopter, failing this by the road).

When the top priority is identified, it is advisable to the minimum to reduce the gestures carried out before the evacuation and to carry out only gestures having a benefit proven in term of survival (it is the philosophy of the scoop and run and the play and run ):

stop of the external Hemorrhage S,
Release of the air routes and maintenance of the vital functions (possibly artificial Ventilation to see cardiopulmonary Reanimation)
immobilization of the Rachis and if required of the wounded members (reduction of the Fracture S and poses Attelle S)
to cover the wounds;
to maintain a blood Pressure minimal (Perfusion, drugs Vasopresseur S, shock-proof pants); this point is not regarded as a priority for all the first-aid organizations, and makes the difference between the scoop and run (to charge and run) and the play and run (techniquer and to run).

The role of sorting of the medical Régulation is paramount so that the patient arrives directly in a Hospital having of the technical plate and the competences adapted to the treatment of the polytraumatism.

Once arrived at the hospital, the examinations must be limited to bare essential (Radiographie of the Rachis, the Thorax and the basin) before the operation, except if one cannot what operate exactly.

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