--- Marc Gosselin <[EMAIL PROTECTED]> wrote:
> Ca permet plutôt un meilleur focus de tout le monde afin
> de respecter les délais le plus possible. Un peu comme la
> norme de 30 min pour la thrombolyse qui avait été
> popularisée il y a quelques années.
Tu fais sans aucuns doutes allusion
Au "20 minutes Door to Needle" ))))
> Pour ce qui est du fameux Golden Hour de l'ATLS ... Je
> crois que c'est un bien beau principe en soit mais qu'il
> n'est pas basé sur grand-chose de vérifiable ( J'entends
> déjà le grondement de C Brault ...)
Du tout
Ça fait belle lurette que ce myth à été "débunker"
Depuis "longtemps"
Le golden hour à autant de justification et d'utilité que
le Platinum 10
Tout juste un beau jingle, un bel outil
Charles (pas plus bornés que vous))))
.......
Acad Emerg Med 2001 Jul;8(7):758-60
The Golden Hour: Scientific Fact or Medical "Urban Legend"?
Lerner EB, Moscati RM.
Department of Emergency Medicine, State University of New
York at Buffalo, and the Center for Transportation Injury
Research (CenTIR), Buffalo, NY (EBL, RMM).
The term "golden hour" is commonly used to characterize the
urgent need for the care of trauma patients. This term
implies that morbidity and mortality are affected if care
is not instituted within the first hour after injury. This
concept justifies much of our current trauma system.
However, definitive references are generally not provided
when this concept is discussed. It remains unclear whether
objective data exist. This article discusses a detailed
literature and historical record search for support of the
"golden hour" concept. None is identified.
..................
Prehospital Disaster Med 2002 Apr-Jun;17(2):75-80 Related
Articles, Links
Can the "golden hour of shock" safely be extended in blunt
polytrauma patients? Prospective cohort study at a level I
hospital in eastern Switzerland.
Osterwalder JJ.
Emergency Department, Cantonal Hospital, St. Gallen,
Switzerland.
BACKGROUND: The objective was to test, in this trauma
system, the North American hypothesis that exceeding the
60-minute limit for the entire prehospital time ("golden
hour of shock") increases mortality of blunt polytrauma
patients.
METHODS: In a prospective, observational, cohort study
conducted between 1990 and 1996, a severity
characterization of trauma (ASCOT) score was used to
compare the actual mortality with the predicted mortality
in 107 blunt polytrauma patients (Group 1) with prehospital
rescue periods < or = 60 minutes (time from accident until
arrival at the emergency department). The same comparison
was performed for 147 blunt polytrauma patients (Group 2)
with rescue periods > 60 minutes. Inclusion criteria were
blunt trauma of at least two body sites, an Injury Severity
Score (ISS) of > or = 8, and direct admission to the trauma
centre. Multivariate regression analysis was performed to
test for bias and confounding, and to identify factors that
might influence mortality. Odd ratio (OR) and 95%
confidence interval (CI) were calculated.
RESULTS: The mortality in Group 1 was 14%, and was not
statistically significantly higher than the 10.2% observed
for Group 2. 4.8 patients, or 47% more than predicted, died
in Group 1 (p = 0.057). The corresponding figures in Group
2 were 4.2 patients or 22% fewer than predicted (p = 0.19).
Multivariate logistic regression confirmed this trend with
a significant mortality odds ratio of 8 (95% CI 1.7 to
38.5) for Group 1 compared to Group 2. Significantly more
patients in Group 2 were treated by emergency physicians.
CONCLUSIONS: It appears in this trauma system, in which
emergency physicians often are deployed, that the 'golden
hour of shock' can be extended safely in many blunt
polytrauma patients, since this was associated with better
survival figures than in those patients for whom the time
was < 1 hour.
................
La notion d'HEURE D'OR
Auteur : Dr Eric Royer
Mise à jour : 30/04/99
Un certain nombre de questions relatives à l'HEURE D'OR en
traumatologie sont récemment tombées sur la liste de
diffusion d'Urgence.
Il semblerait que cette notion adoptée par les
Nord-américains soit encore assez méconnue chez nous bien
qu'acceptée, maintenant, par la plupart.
Plutôt que de relancer une polémique sur la médicalisation
préhospitalière, il m'a paru intéressant de rappeler ce que
représentait cette notion en rapportant le résumé de la
communication du Dr Léon Dontigny à la 1ère journée Caraïbe
de Médecine d'Urgence qui s'est tenue à Fort-de-France le
13 mars 1999.
Dr Léon DONTIGNY, M.D., FRCS(c), FACS.
Chirurgie cardiovasculaire et thoracique.
Programme de traumatologie.
Hôpital du Sacré-C?ur de Montréal.
Le premier déterminant de la morbidité et de la mortalité
est la gravité des lésions ; le second est le délai avec
lequel ces lésions sont traitées.
Le modèle américain s'est d'abord inspiré des expériences
militaires, et en particulier au Vietnam, pour démontrer
que le temps est précieux comme l'or.
La prise en charge doit donc tenir compte du facteur temps
et chaque geste doit être justifié en fonction des délais
encourus.
Une telle approche ne peut se faire à la hâte mais plutôt
de façon systématique telle qu'enseignée dans le ATLS
(cours avancé de réanimation du polytraumatisé).
Idéalement, l'évaluation initiale rapide, la réanimation,
l'évaluation secondaire plus complète en vue du traitement
définitif, doivent se faire au cours de la première heure
et la compression dans le temps devient une constante de
chaque étape de la chaîne d'interventions.
En phase préhospitalière, on se limite aux gestes
essentiels :
Perméabilité des voies respiratoires, contrôle de
l'hémorragie externe, couverture des plaies, alignement des
membres, protection de la colonne vertébrale et fixation de
la colonne cervicale.
Figure 1 - Ces gestes interviennent dans ce qu'on appelle
les "Golden 10 minutes".
L'installation de voies veineuses doit être "expéditive" et
ne pas retarder le transport. L'intubation endotrachéale,
si elle est indiquée, est le seul geste qui peut vraiment
justifier le retard, si elle ne peut être faite lors du
transport.
A la salle d'urgence, on complète l'ABC de la réanimation
(A : airway, B : breathing, C : circulation).
Trois radiographies sont requises : poumon, colonne
cervicale et bassin ; aucune n'est essentielle si le
patient doit être dirigé immédiatement en salle
d'opération.
Le remplacement liquidien nous permet d'évaluer la gravité
du choc pendant qu'on détermine la cause. En face d'une
hémorragie active, il n'y a aucun substitut à la chirurgie
précoce. En présence d'une atteinte neurologique, la
scannographie demeure l'examen de choix, si le patient est
suffisamment stabilisé. Retenons que le traitement initial
du traumatisme crânio-cérébral est une oxygénation et une
perfusion adéquates.
Cette approche systématique nous apparaît cruciale, mais
insuffisante. Pour éviter des délais inutiles,
l'orientation du patient doit être prédéterminée et ce, sur
une base régionale telle que préconisée par la règle des 3
R de Trunkey :
? Right patient : condition du patient
? Right place : orientation du patient
? Right time : délais courts
Bien que cette notion d'HEURE D'OR soit universelle, son
application est subordonnée à l'organisation d'un système
de soins intégrés compatible. C'est ce qui a été fait au
Canada avec l'établissement d'une carte sanitaire basée sur
différents niveaux de prestations de soins des centres
hospitaliers en catégories (primaire, secondaire,
tertiaire) et sur un triage fait sur les lieux de
l'accident selon un index préhospitalier traumatologique :
1. stabilisation médicale : dans un centre situé à plus de
30 minutes d'un centre de niveau supérieur. Stabiliser le
patient et permettre son transport dans un centre de niveau
supérieur.
2. primaire : centre situé à plus de 30 minutes d'un centre
secondaire ou tertiaire offrant des soins chirurgicaux
autres qu'orthopédiques ou neurochirurgicaux.
3. secondaire : centre avec une unité d'orthopédie où les
patients traumatisés sans lésion neurologique peuvent se
faire traiter définitivement.
4. tertiaire : tous les soins chirurgicaux et
neurochirurgicaux peuvent être réalisés.
En France, notre système est intermédiaire avec une
médicalisation préhospitalière qui est très efficace dès
lors qu'elle respecte ce principe de l'HEURE D'OR
traumatologique.
Les CHU représentent à peu près les "Trauma Centers"
américains ou les centres tertiaires, les autres services
d'urgences peuvent être comparés aux centres primaires et
secondaires qu'il faudra savoir contourner si c'est
nécessaire pour respecter l'HEURE D'OR; la stabilisation
étant réalisée par la médicalisation préhospitalière.
Le gain de temps prôné par les Nord-américains n'a pas été
limité à l'amélioration de la prise en charge du patient
mais aussi, comme on l'a vu plus haut, à la prise en charge
du système et de sa réorganisation.
La gestion du temps fait intervenir l'ensemble des acteurs
et du système d'intervention.
Comme nous avons pu l'expérimenter et le vérifier lors des
stages ATMU ®, et comme le dit le Dr Dontigny : la façon de
gagner du temps, ce n'est pas d'accélérer, mais d'être
systématique.
.....................
The Golden Hour
Scientific Fact or Medical "Urban Legend"?
E. Brooke Lerner, MS, EMT-P and Ronald M. Moscati, MD
>From the Department of Emergency Medicine, State
University of New York at
Buffalo, and the Center for Transportation Injury Research
(CenTIR),
Buffalo, NY (EBL, RMM).
Address for correspondence and reprints: Address for
correspondence and reprints: E. Brooke Lerner, MS, EMT-P,
Department of Emergency Medicine, 462 Grider Street,
Buffalo, NY 14215; fax: 716-898-5988; e-mail:
[EMAIL PROTECTED]
The term "golden hour" is commonly used to characterize the
urgent need for the care of trauma patients. This term
implies that morbidity and mortality are affected if care
is not instituted within the first hour after injury.
This concept justifies much of our current trauma system.
However,definitive references are generally not provided
when this concept is discussed. It remains unclear whether
objective data exist. This article discusses a detailed
literature and historical record search for support of
the "golden hour" concept. None is identified.
Key words: emergency medical services; time;
transportation; trauma; golden hour
THE TERM "golden hour" is ubiquitous in the trauma care
literature. The idea is that trauma patients have better
outcomes if they are provided definitive care within 60
minutes of the occurrence of their injuries. The golden
hour
justifies much of the current trauma system.
Out-of-hospital care concepts such as scoop and run,
aeromedical transport, and trauma center designations with
trauma teams in place are, in part, predicated on the idea
that time is
a critical factor in the management of injured patients.
Numerous research projects have been conducted with the
intention of finding better ways to deliver patients to
trauma centers within the "golden hour." However,
references are rarely traced back more than a level or two
to determine whether actual objective data exist to support
the concept.
We made an attempt to identify the origin of the "golden
hour" and the scientific evidence upon which it is based.
While it seems intuitive that less time is better for
trauma patients, there are risks and costs involved
in attempting to deliver patients to trauma centers within
an hour. These may be justified if there is a benefit, but
may not be if there is no proven benefit or if the benefit
applies only to certain circumstances.
The search for the golden hour began by identifying
articles that give a reference when using the term "golden
hour." Two articles reference Trunkey for the term.1,2
However, within Trunkey's article, there is no mention of
the "golden hour" and, in fact, although there are no
references given, the article describes different time
constraints for different types of injury.3
For example, Trunkey states that head-injured patients must
receive surgery within four hours of injury, while those
with severe hemorrhage require surgical intervention within
20 minutes.
Other articles that mention the golden hour attribute the
origin of the term to Cowley.4,5,6 One of these referenced
articles by Cowley refers to an article by Foster that says
the mortality rate triples for every 30-minute increase
from time of injury to definitive care.7 This 1969 article
by Foster reviews the state of helicopter transport at the
time and discusses disagreement among physicians as to
whether time is an important factor in trauma care.8 In
this article, Foster quotes Robert J. Baker from an
interview he gave to the Medical World News in which he
stated that for every 30 minutes after injury, a threefold
increase in mortality can be expected. The Medical World
News article with this quotation discusses the creation of
the American Trauma Society and the current state of trauma
care.9 No references are given for Baker's statement, and a
search of MEDLINE and Index Medicus revealed no papers that
appear to contain research data to support his statements.
The textbook for the American College of Emergency
Physicians' Basic Trauma Life Support course attributes the
term golden hour to Cowley, but gives no reference.4
According to the text's editor, the information came from a
biography of Cowley entitled Shock-Trauma (Campell C,
personal communication, April 7, 2000). This book credits
Cowley as the originator of the term and states that the
term is based on the findings of his research on
cardiogenic shock conducted using a canine model, but no
references for this research are given.10
A search of research articles by Cowley on trauma provided
several leads.
One was a trauma case series of 760 patients that he
co-authored in 1979.11
This case series gives no details of the patients' times to
definitive care and their relation to outcome. It does
reference articles by Frey et al. and Hoffman as
demonstrating that availability and rapid access to medical
care are the most important early determinants of motor
vehicle crash survival.
The Frey article, a case series of 150 trauma patients, and
the Hoffman article, a case series of 2,392 motor vehicle
crash patients, both recommend giving ambulance personnel a
more advanced level of training, but no data on a
relationship between time and patient outcome are
provided.12,13
A text on trauma edited by Cowley contains a chapter
authored by Shankar, which discusses "Cowley's golden
hour," referencing a 1976 Cowley article.14
In this 1976 article, Cowley states: "all [trauma] patients
[treated by the Maryland trauma system] are assumed to be
dying and much of the golden hour for total stabilization
has passed."15 This article describes the Maryland trauma
system and states that the first 60 minutes after an injury
determines a patient's resulting mortality. It references a
paper of his own, written in 1975.15 Within this 1975
article, another review of the Maryland emergency medical
services system, he states that: "the first hour after
injury will largely determine a critically-injured person's
chances for survival," but no data or reference is
provided.16
A 1977 article by Cowley also mentions the "golden hour,"
referencing his 1976 and 1973 articles (which referenced
Foster).17 In 1979, the foreword and an article in The
American Surgeon written by Cowley state that trauma
patients should, and in Maryland do, reach the trauma
center in less than the "golden hour" he found to be
crucial for trauma patient outcome, but no reference is
given.18,19
Cowley passed away in 1991 and the University of Utah
maintains his personal papers. A request to the University
of Utah library for any additional information on the
origins of the golden hour yielded two outlines of Cowley
speeches. The first speech was given to the American
Helicopter Association on January 15, 1974, and includes
the quote from Baker given in the Medical World News
report. It also contains a statement that care of military
casualties and Cowley's personal experience had
demonstrated an inverse relationship between favorable
injury outcome and time to definitive therapy. However, no
data or reference to such data is given. The other speech,
presented to the American Academy of Orthopedic Surgeons on
November 25, 1974, describes time and the number of body
systems and organs injured as the two most important
factors influencing shock outcomes. Cowley states
that 90% of Maryland trauma patients transported from the
scene of injury arrive at the trauma center in less than
one hour from the time of injury, while 90% of patients
transported from an outlying hospital arrive at the trauma
center in over six hours. The mortality of patients
transported from outlying hospitals is twice that of
patients transported from the scene directly to the trauma
center. No mention of matching for severity and/or the
possibility of selection bias is given with these data.
However, Cowley does go on to say that the care given in
the first hour determines the extent of organ damage that
the patient might sustain. Interestingly, Cowley's next
statement is that "it may even be that we should be talking
about the first golden fifteen minutes as a vital period."
Others have studied the relationship between time and
trauma patient outcome, but the published studies do not
appear to resolve the issue. Early published studies that
support the golden hour concept came from the Vietnam
War, where the survival rate in medical facilities was
increased 2% over previous wars and the average time to
definitive care was reduced from an average of five hours
in the Korean War to only one hour.20 It is difficult
to apply these findings in the civilian U.S. population
since these data probably describe only young healthy males
suffering penetrating injuries.
Further, there is no evidence that these conclusions do not
suffer from the ecologic fallacy (i.e., no data to show
that soldiers who had shorter out-of-hospital times had
better outcomes).
Several civilian studies have supported the "shorter total
out-of-hospital time is better"
philosophy.2,21,22,23,24,25,26 However, these studies have
had very small sample sizes and did not control for key
variables such as injury severity, treatment, or
demographics. Other published studies have disputed the
"shorter is better" philosophy.5,6,27,28,29 Several of
these studies had findings that were the result of a
secondary analysis, while others had obvious selection
bias, or looked only at patients with extremely long total
out-of-hospital times.
There are no large, well-controlled studies in the civilian
population that either strongly support or refute the idea
that faster is universally better in trauma care. The
numerous smaller studies are not sufficiently similar to
use meta-analysis to resolve the question. While it appears
the term most likely did originate with Cowley, it does not
appear to have originated from explicit research findings.
It was based primarily on the experience and opinion of one
of the fathers of trauma surgery and trauma system design.
Other trauma experts at the time also promulgated the idea
behind the term.
The intuitive nature of the concept and the prestige of
those who originally expressed it resulted in its
widespread application and acceptance. Despite the lack of
definitive scientific evidence, numerous research studies
and requests for research funding are based on achieving
the golden hour for all trauma patients and take for
granted that time always matters.
Our search into the background of this term yielded little
scientific evidence to support it. It is crucial for
medical researchers to critically examine concepts such as
the golden hour that are widely accepted but are in
fact not scientifically supported. We frequently strive to
push ever higher the ceiling of medical knowledge, but we
must also ensure that the knowledge base upon which we
stand is solid.
FOOTNOTES
Supported by the Federal Highway Administration under grant
No. DTFH61-98-X-00103 as awarded by the Center for
Transportation Injury Research (CenTIR).
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Frey CF, Huelke DF, Gikas PW. Resuscitation and survival in
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Shankar BS: Systems evaluation. In: Cowley RA, Conn A,
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Cowley RA. The resuscitation and stabilization of major
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83:16 -22.
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State Med J. 1975;24 : 37-45.
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Received for publication October 2, 2000. Revision received
February 27,
2000. Accepted for publication March 15, 2001.
.......................
Prehospital Times
Date: 19.02.97 18:12
From: Enrique Montbrun [EMAIL PROTECTED]
Hello everybody! The time critical nature of trauma care
has been well established. What are acceptable prehospital
times for delivery of the patient to a trauma center in the
suburban or rural environment? What are your opinion about
field stabilization for the trauma patient where travel
times are longer than golden hour? "stay and stabilize" or
"scoop and run". How do you do to manage trauma victims in
place where medevac take a long time to response?
Dr. Enrique Montbrun
Assistant Professor of Surgery
Universidad Central of venezuela
Date: 20.02.97 17:22
From: Aviel Roy-Shapira
It makes sense, but the 'golden hour' has never been
scientifically validated.
An unstable trauma patient belongs in the operating room.
You cannot stablize such patients in the field, no matter
how long it takes to drive.
Put another way, those patients whom you can stabilize in
the field are patients who stopped bleeding. These patient
can be resuscitated en-route, and it matters not if you
stay and play or scoop and run. For the patients who cannot
be resuscitated in the field, any delay in evacutation to a
facility with operating capabilities is deadly.
The safest course is to roll them out and do everything
en-route as advocated by the PHTLS course.
That said, I think that one should make sure about A and B,
before moving the patient. That does not necessarily mean
intubation, but at least be able to ventilate with a
bag-valve mask. I also think that tension pneumothorax
should be treated in the field. So it is not pure scoop and
run - remember that the run in "S&R" is run as in run away.
I believe the term originated in Vietnam, when it was
impossible to do anything in the field because of danger to
the evacuating team.
Avi
===========================================
Aviel Roy-Shapira, M.D. Ben-Gurion University Medical
School
Dept. of Surgery A. POB 151, Beer Sheva, Israel
Date: 20.02.97 18:17
From: "John A. Aucar, M.D." [EMAIL PROTECTED]
Extrication and transport times are typically short (10-15
min) in Houston, but vary widely according to
circumstances. I'm not that certain that the "golden hour"
should be accepted as fact (fact: a term that marks the
point at which we allow investigation to cease).
Some believe that the patients protective physiologic
mechanisms will "stabilize" him better than we can. If he
is not fatally wounded, he can survive significant
transport times. If he is progressively deteriorating, you
can probably not achieve "stabilization" in the field,
unless you can control the injury. Except for securing an
airway and pressure control of external bleeding, you
should not "stay and play", but rather get to the nearest
operating room or angiogram suite.
If a patient is unstable, say from a pelvic fracture or
hepatic injury, his only hope is probably that the blood
pressure will fall and vessels constrict enough to limit
the bleeding and redirect blood flow to heart, brain and
kidneys. His worst luck might be that a well meaning
meddler may decide to "resuscitate" him with fluid and
increase his BP, lower his body temp, dilute his clotting
factors and aggravate the bleeding and it's subsequent
complications. There is experimental support for this
perspective in animal studies and penetrating human trauma.
It's application to blunt trauma is purely extrapolated. No
one to my knowledge has shown the feasibility or advantage
to delivering definitive care in the field, except perhaps
for limb amputations.
JAA
--
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
! John A. Aucar, M.D.,F.A.C.S. !
! Dept. of Surgery !
! One Baylor Plaza !
! Houston, TX 77030 !
! ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
! Assistant Professor, Surgery, Baylor College of Medicine
!
! Ben Taub Gen. Hospital; http://www.bcm.tmc.edu/surgery/ !
Date: 20.02.97 20:05
From: "Smith, J. Stanley, MD"
one hour maximum. Scoop and run is better with
immobilization and splinting of fractures and spine. If too
long for paramedics, try to rendezvous in between.
Date: 21.02.97 12:08
From: "J.K.Turner"
Re - fluid resuscitation in the field. You may be
interested to know that the Medical Care Research Unit,
University of Sheffield is at present conducting an RCT of
pre-hospital IV fluids in trauma patients. 300+ paramedics
have been randomised to two treatment protocols i.e. give
fluids or withhold them. These are predominantly blunt
trauma patients (penetrating trauma accounts for less than
5% of all trauma in the UK) so hopefully we will produce
some evidence for the blunt injury group which will
contribute to the debate.
Janette Turner - Research Fellow & project leader
Medical Care Research Unit
University of Sheffield
Regent Court
30 Regent Street
SHEFFIELD, S1 4DA
Date: 22.02.97 18:36
From: "Smith, J. Stanley, MD" [EMAIL PROTECTED]
The most recent annual report for the state of
Pennsylvania's Trauma Centers was released this week
showing an average prehospital time of 45 minutes from the
time of injury to trauma center arrival for direct
admissions from the scene of the accident.
We have a suburban/rural trauma center with a helicopter
service. We also have an EMS service and receive most of
our patients by ground ambulance. Our average prehospital
time for the year 1996 was 48 minutes. Considering this
represents time from the injury or first communication of
the accident, response of the EMS system (scrambling,
travel time to the scene), assessment at the scene, and
travel to the hospital, 45-48 minutes seems about right for
a suburban/rural system.
Date: 25.02.97 16:54
From: Frank Grosso [EMAIL PROTECTED]
I respectfully have to disagree with Dr Roy-Shapira with
the above portion of his response. The theory of the
"golden Hour" has been proved as much as many other medical
theories have been "proved".I believe it was Dr R Adams
Cowley who did research in the 1950s and 1960s, originally
on dogs. He basically took the dogs and and phlebotomized
them. They were all hooked up to blood pressure and cardiac
monitors. THose whose blood was autotransfused within a 1
hour period would usually recover and hold thier blood
pressure and would survive. Those who waited for greater
than an hour for the auto transfusion did not. They would
begin to rally and restore thier BP as thier bodies
compensentary mechanisms took over. But thier vitals would
eventually decline in spite of a later autotransfusion and
die. Dr Cowley investigated this golden hour after working
as an Army field surgeon with the US Army in Europe
immediately post WW2. He found that soldiers who reached
his field hospital within an hour after having thier
accident( fairly common with the old jeeps that frequently
rolled over) were more likely to survive than those with
longer transport times. Well, he followed up with the above
mentioned dog experiment. He convinced his fellow surgeons
to let him care for thier traum patients that they
considered to have no hope. Families eagerly agreed to this
ray of hope. Well, the patient was put into one room, while
the room next door was made into a lab. Serial studies were
performed on every test they could perform, every hour I
believe. He was able to save 50 % of these "totally
hopeless" patients. More importantly, although not to those
patients, was the information he found to support his
theories. He eventually developed this 2 room suite in a
corner of the University of Maryland into the R Adams
Cowley Shock Trauma Center here in Baltimore, the first(I
believe) Trauma Center in the world. It is now a 120+ bed
hospital accepting only trauma patients.
Ok, sorry about the long winded answer1 :) I do tend to
ramble on at times....Anyway, I do not have the specific
cites of his articles and or texts that provide the
concrete back up to support my statements . However, if you
are interested in seeing the raw data, I live across from
our regional Health sciences library. I would be able to
give you the citations at the very least and would be able
to scan in a journal article or excerpt and email it to
you. I'm not sure about the legalities of sending that to
multiple persons( ie the whole list).
Cheers!
Frank
Date: 27.02.97 07:43
From: "Aviel Roy-Shapira" [EMAIL PROTECTED]
Thanks for the interesting details about Dr. Cowley's
experimental work.
Perhaps I should have said that the concept of the golden
hour was never validated in Humans.
Dr. Cowley's contributions to the care of trauma are an
example to us all, and notwithstanding the above comment,
we still use the golden hour as a goal in most trauma
systems.
Please send the citations. It would be interesting to
review the raw data.
Avi
Aviel Roy-Shapira, M.D.
Dept. of Surgery A, and the Critical Care Unit, Soroka
University Hospital
POBox 151, Beer Sheva, Israel
Date: 01.03.97 02:37
From: Ken Mattox [EMAIL PROTECTED]
Dr. Avi Roy-Shapira is RIGHT. The Golden hour is merely a
concept. It has NEVER been validated in people, animals, or
a computer model. Population based studies from several
centers have also demonstrated that it is not a fact but a
concept. Marketing concept.
k
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