Trauma care Golden Hour

Road Accidents is one of the leading causes of death, disability and hospitalization. Victims are unable to reach the right hospital within the golden hour due to lack of awareness and proper rescue facilities

- Dr Nilu Sunil

India ranks 1st in number of road traffic accident death across 199 countries in the world At least one out of 10 people killed on roads across the world is from India, according to the World Health Organization. The cost of road accidents is borne not only by the victims and their family, but by the economy as a whole in terms of untimely deaths, injuries, disabilities and loss of potential income.

During the year 2020, the total recorded 3,66,138 road accidents caused loss of 1,31,714 persons lives and injured 3,48,279 persons. The road traffic accidents are the leading cause of death of young working people, between the ages of 18 to 45 years, who are usually the bread winners of the family.

There is a trimodal peak of death and the first peak occurs within seconds to minutes. It is usually due to laceration of the brain stem, heart, aorta, and other large vessels. Salvage after injury in these instances is difficult, and the victims most often succumb to the trauma.

The second peak occurs within minutes to hours later and can be due to diverse injuries such as subdural hematoma, hemopneumothorax, splenic laceration, life-threatening long bone fractures, and significant blood loss. This group is potentially at risk of death, which may be averted if aggressive and appropriate management is instituted at the earliest. The concept of the golden hour (the 1st hour after trauma) arose from the treatment of this group of patients.

The 'golden hour 'is term often used in trauma to suggest that an injured patient has 60 minutes from time of injury to receive definitive care, after which morbidity and mortality significantly increase. That emphasizes the urgency of care required by major trauma patients to prevent 'early deaths' predominantly from hemorrhagic shock.

Most preventable deaths are due to hemorrhage