Response Times Matter – Medical

Beating the Clock: When Time is Muscle

Johns Hopkins University

https://www.hopkinsmedicine.org/innovative/downloads/issuearchive/jhu_cim_BeatingtheClock.pdf

Summer 2009

“When time is muscle, every little bit counts. A few minutes here and there can add up to a great difference – in saving a life, and in saving a heart. The next step was to get those patients to treatment even faster. Instead of waiting for the on-call balloon team to arrive, Trost devised a plan to use people who are already there – a critical care unit nurse, radiation technologist, and an emergency physician – to serve as a transition team, while the regular interventional cardiology team is en route.”

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Stroke 2006 Jan;37(1):263-6. Epub 2005 Dec 8.

Time is brain–quantified.

http://stroke.ahajournals.org/content/37/1/263

Conclusions— Quantitative estimates of the pace of neural circuitry loss in human ischemic stroke emphasize the time urgency of stroke care. The typical patient loses 1.9 million neurons each minute in which stroke is untreated.

Stroke. 2006 Jan;37(1):10.

The time man has cometh to brain: tick…death….tick…death.

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Journal of the American College of Cardiology

Volume 52, Issue 15, October 2008 DOI: 10.1016/j.jacc.2008.07.011

 PDF Article

Time Is Muscle: Translation Into Practice

Elliott M. Antman

http://www.onlinejacc.org/content/52/15/1216

“By focusing now on system efforts for improvements in timely care for STEMI, we will complete the cycle of research initiated by Reimer and Jennings (6) 30 years ago. Time is muscle … we must translate that into practice.”

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Time Is Muscle

June 7, 2016 Cooper University Healthcare

https://blogs.cooperhealth.org/healthyheart/2016/06/07/time-is-muscle/

“The phrase that is often used by cardiologists is “Time Is Muscle,” meaning the longer you wait to get someone in for treatment the more damage that can occur to the heart muscle and the less likely are the chances for recovery. However, this requires a well-coordinated team of EMS, emergency room physicians, support staff, Cath Lab technicians, and nurses.”

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Time is muscle in primary PCI: the strength of the evidence grows

by C. Michael Gibsona,*, James A. de Lemosb , Elliott M. Antmana

Brigham and Women’s Hospital and the Department of Medicine,

Harvard Medical School, USA b Cardiovascular Division UT Southwestern Medical School

This editorial refers to “Time-to-treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty” by G. De Luca et al. on page 1009

https://watermark.silverchair.com/1001.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAbEwggGtBgkqhkiG9w0BBwagggGeMIIBmgIBADCCAZMGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM5b7Hzs4u3wOXwU3EAgEQgIIBZKBOeyQ73xPtgUdU4lGBZskCRa-8cmL11ZygXeFujEKi0yDESzc_8gJWtxLgZjzSrqWUmZbhiCc7FwvDfBxzvb6QQZXhwK8mWUmqZQYdcCA4VDLtgdlmUbL8SBp8Eoek4GrUOK-8AXWEjMcY-mPj9Q3YAhIAWGpy0W-P4MKBrXOoy6kHI9hMm7qBC9_UR8RsSwugEFn5VCT6ZQnc7BhwDboKnLFbDPRlJBsjbrf3Uqr65M6WoN3Mod0zX3xyFdmJdXVq4MHhzW3hvYTgPPdkS6_HG11modxbIq2kf1u7aYrJFyRh3NGhpqZSgKilQf0508cqS0DC-aVEYJAz8FZ51LhCDffi3EOp4KuxAMJryqa_NC0L6QxtXh3aAF4M1TZPbR2OJb76UMzg1xPBgCpsyQtBfw7GIubcqxrS_tDRxL7U3MLvKucE8Ac2XHJXoiDnDALkMjtY9E–iW1saklinbHeGVp3

“These data add to a growing body of literature suggesting that renewed efforts are needed to reduce symptom-to-door and door to-balloon times in order to improve myocardial perfusion, myocardial salvage and clinical outcomes among patients undergoing primary PCI for STEMI.1”

“The other potential target for improvement lies in shortening symptom-to-door times.”

“The present study lends further support to an intuitive and straightforward paradigm: prompt re-perfusion, whether achieved pharmacologically or through PCI, is associated with improved angiographic, electrocardiographic and clinical outcomes. We have witnessed a relentless push in the “new device” era to open arteries “better”, but now is the time to emphasize the need to open them “quicker” in the setting of primary PCI. Now is the time to face the new challenge of educating both patients and providers to implement strategies to minimize delays in primary PCI.”

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Time is Brain – Think FAST When Stroke Happens

Stroke Alliance For Europe – Posted by admin on Mar 17, 2017

http://www.safestroke.eu/2017/03/17/time-brain-think-fast-prevent-stroke-strokeeurope/

Stroke is a serious, like-threatening medical condition that occurs when the blood supply to part of the brain is cut off. It is a medical emergency because time plays a vital role in the life of the person having a stroke. Minutes can make a difference between life and death, the difference between brain cells that are saved and brain cells that are damaged forever, between recovery and lifelong disability. Every minute the brain is oxygen deprived, brain cells get irreversibly damaged, so the longer door to needle time, the bigger the injury to the brain.

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Call 9-1-1. First and Fast Preserves Heart Muscle

http://hocowellandwise.org/2013/09/9-1-1-time-is-muscle/

“When a heart attack strikes, swift action can save a life. Physicians like to say “Time is muscle” – meaning- the faster you call and the faster you get treatment- the better your chances of preserving heart function.”

Response Times Matter – Trauma

Timing is Everything: Bringing Military Trauma Care to American Neighborhoods

By Will Cohen  /  Jan. 1, 2018, 2:22 p.m. The Gate – University of Chicago

http://uchicagogate.com/articles/2018/1/1/timing-everything-bringing-military-trauma-care-american-neighborhoods/

While wars are being fought thousands of miles overseas, few realize that lessons being learned on the battlefield are being applied every day in violent areas of America’s inner cities, after mass shootings and terror attacks, and in the average community hospital. As the severity of injuries in the wars in Afghanistan and Iraq increased, so did our ability to treat these injuries.

As important as it is to get an injured service member to major medical centers outside the combat zone, the most important concept in the entire military trauma care process is the golden hour.

“The golden hour is that period of time where what you do or don’t do to a patient, determines whether they do very well or very poorly” Hampton said.

If critically injured patients receive treatment rapidly after injury, their survival chances increase dramatically. 

The concept of the golden hour is not unique to military trauma care. In fact, the term was first coined by Dr. R. Adams Cowley at the University of Maryland Medical Center. His research and focus on the time from injury to treatment have largely underpinned the creation of the network of EMS and trauma centers throughout the United States.

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Emergency response to trauma makes life or death difference

July 30, 1999

http://www.cnn.com/HEALTH/9907/30/emergency.response/

Medical professionals say there is a “the golden hour” — a limited time period that a physician has to restore life functions quickly to a trauma patient. If that window of opportunity is missed, fatal brain damage or irreversible shock will occur.

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HEALTH NEWS

SEPTEMBER 30, 2015 / 7:37 PM

Children’s Healthcare’s new medical helicopter a “flying ICU”

By: Beth Galvin

http://www.fox5atlanta.com/health/fox-medical-team/childrens-healthcares-new-medical-helicopter-a-flying-icu

In trauma care, they talk about “the golden hour,” how critical those first 60 minutes can be, how little time you have to get critically injured patients to a trauma center, like Children’s.

“For pediatrics it’s even worse.  We talk about the ‘platinum 30 minutes,” says Greg Pereira, Children’s Director of Trauma Transport. 

“Every second counts,” he says. 

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U.S. Military ‘Golden Hour’ Rule Saved Lives

Andrew M. Seaman

3 MIN READ

https://www.reuters.com/article/us-health-trauma-transport/u-s-military-golden-hour-rule-saved-lives-idUSKCN0RU31F20150930

A mandate to get wounded U.S. soldiers to appropriate medical care within one hour of injury improved survival on the battlefield, according to a new study.

The 2009 rule, implemented by then-Secretary of Defense Robert Gates, potentially saved 359 lives, according to the report in JAMA Surgery.

The Committee for Tactical Emergency Casualty Care – 2018 C-TECC

The Committee for Tactical Emergency Casualty Care (C-TECC) was convened to speed the transition of military medical lessons learned from the battlefield to civilian medical response to high risk situations.

Addressing preventable death remains the holy grail of trauma care. Be it the ‘Golden Hour’ or the ‘Platinum Ten Minutes,’ all trauma guidelines and training in some way are designed with the goal in mind of preventing the death of otherwise survivable victims.

In New Orleans’ violent streets, 10 minutes often determine who lives and dies

Updated on July 12, 2017 at 9:57 AM Posted on July 12, 2016 at 10:55 AM

http://www.nola.com/crime/index.ssf/2016/07/surviving_a_shooting_the_diffe.htmh

In the world of New Orleans street violence, there are typically two types of people, the wounded and the dead. So why do some gunshot victims live, while others die? In many cases, survival depends on how quickly the victim is treated, both on the scene and in the emergency room.

Those factors are in the hands of a coordinated team of paramedics, trauma surgeons and nurses trained in techniques honed by military personnel on the battlefields of Iraq and Afghanistan and tested daily in a city with one of the highest murder rates in the country.

“The Platinum 10” the 1st 10 minutes post-injury and one of the most important aspects of the “Golden Hour”

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By MASF Member –

February 24, 2017

https://masf.co/2017/02/24/the-platinum-10-the-first-10-minutes-post-injury-and-one-of-the-most-important-aspects-the-golden-hour/

We have a simple question we ask students in all of our classes when we talk about controlling life-threatening hemorrhage; “How long do you have to stop the bleeding if you’re injured?” The answer, while it may seem like a simple one, really isn’t all that simple. The answer; “The rest of your life”.

We like to call it “The Golden Hour”. This oft-used term is related to the importance of getting a trauma victim to definitive, advanced care within 60 minutes of the injury with the timer starting at the moment of injury.

One of the most important aspects of this “Golden Hour” is the very beginning. It’s the first 10 minutes post-injury that may tell the tale. We like to call it “The Platinum 10”.

Increasing time to operation is associated with decreased survival in patients with a positive FAST exam requiring emergent laparotomy

Ronald R. Barbosa, MD,1 Susan E. Rowell, MD,2 Erin E. Fox, PhD,3 John B. Holcomb, MD,4 Eileen M. Bulger, MD,5Herbert A Phelan, MD, MSCS,6 Louis H. Alarcon, MD,7 John G. Myers, MD,8 Karen J. Brasel, MD,9 Peter C. Muskat, MD,10 Deborah J. del Junco, PhD,4 Bryan A. Cotton, MD, MPH,4 Charles E. Wade, PhD,4 Mohammad H. Rahbar, PhD,3,11 Mitchell J. Cohen, MD,12 Martin A. Schreiber, MD,1 and on behalf of the PROMMTT Study Group

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3744056/

Focused assessment with sonography for trauma (FAST) is commonly used to facilitate the timely diagnosis of life threatening hemorrhage in injured patients. Most patients with positive findings on FAST require laparotomy.

In patients with a positive FAST who required emergent laparotomy, delay in operation was associated with increased early and late in-hospital mortality. Delays in time to operation in trauma patients with a positive FAST should be minimized.

The profile of wounding in civilian public mass shooting fatalities

Journal of Trauma and Acute Care Surgery, Publish Ahead of Print DOI: 10.1097/TA.0000000000001031

1 Department of Emergency Medicine, The George Washington University, Washington, DC

2 Emergency Medical Services Program, The George Washington University, Washington, DC

3 Center for Trauma and Critical Care, Department of Surgery, The George Washington University, Washington, DC

The site of injury, probable site of fatal injury, and presence of potentially survivable injury (defined as survival if pre-hospital care is provided within 10 minutes and trauma center care within 60 minutes of injury) was determined independently by each author.

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Original Investigation

January 2016

The Effect of a Golden Hour Policy on the Morbidity and Mortality of Combat Casualties

Russ S. Kotwal, MD, MPH1,2,3Jeffrey T. Howard, PhD1Jean A. Orman, ScD, MPH1; et alBruce W. Tarpey, BS1Jeffrey A. Bailey, MD1,2Howard R. Champion, FRCS2Robert L. Mabry, MD1John B. Holcomb, MD4Kirby R. Gross, MD1,2

Author Affiliations Article Information

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JAMA Surg. 2016;151(1):15-24. doi:10.1001/jamasurg.2015.3104

https://jamanetwork.com/journals/jamasurgery/fullarticle/2446845

The term golden hour was coined to encourage urgency of trauma care. In 2009, Secretary of Defense Robert M. Gates mandated prehospital helicopter transport of critically injured combat casualties in 60 minutes or less.

A mandate made in 2009 by Secretary of Defense Gates reduced the time between combat injury and receiving definitive care. If no mandate had been issued, linear model projections predict a CFR of 10.3 at the end of the study period vs 8.6 actually observed, a difference of 1.7 that equates to 359 lives saved.

Time and treatment capability are important factors for the survival of critically injured casualties. In the civilian sector, increased prehospital capability and expertise, as well as rapid transport to surgical and hospital care, have been shown to improve trauma outcomes.3137

With the premise that battlefield casualties would gain additional benefit from further reduced time between injury and care and a firm belief that 1 hour was a matter of morale and moral obligation to the troops, on June 15, 2009, Secretary of Defense Robert M. Gates mandated a standard of 60 minutes or less, from call to arrival at the treatment facility.

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JAMA Surg. 2016 Jan;151(1):15-24. doi: 10.1001/jamasurg.2015.3104.

The Effect of a Golden Hour Policy on the Morbidity and Mortality of Combat Casualties.

Kotwal RS1Howard JT2Orman JA2Tarpey BW2Bailey JA3Champion HR4Mabry RL2Holcomb JB5Gross KR3.

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https://www.ncbi.nlm.nih.gov/pubmed/26422778

The term golden hour was coined to encourage urgency of trauma care. In 2009, Secretary of Defense Robert M. Gates mandated prehospital helicopter transport of critically injured combat casualties in 60 minutes or less.

OBJECTIVES:

To compare morbidity and mortality outcomes for casualties before vs after the mandate and for those who underwent prehospital helicopter transport in 60 minutes or less vs more than 60 minutes.

Decline in CFR after the mandate was associated with an increasing percentage of casualties transported in 60 minutes or less (regression coefficient, -0.141; P < .001), with projected vs actual CFR equating to 359 lives saved.

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The Platinum Ten Minutes: The Key to Survival When Catastrophe Strikes

http://www.tytekmedical.com/news/42/the-platinum-ten-minutes%3A-the-key-to-survival-when-catastrophe-strikes

“More often now, doctors talk about the platinum ten minutes. For many victims in a catastrophe this is the short window after the event when providing care is vitally important. It can literally mean the difference between life and death for many.”

“A lot of things can make a difference in that platinum ten minutes. The location where an incident occurs, for one. The time it takes emergency vehicles and other help to arrive is another.”

Faster on-scene times associated with decreased mortality in Helicopter Emergency Medical Services (HEMS) transported trauma patients – British Medical Journal

12 October, 2017

  1. Hannah Pham Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
  2. Yana Puckett2, Sharmila Dissanaike2 Department of General Surgery, University Medical Center, Lubbock, Texas

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http://tsaco.bmj.com/content/2/1/e000122

We hypothesize that longer HEMS dispatch and on-scene times are associated with worse patient outcomes. There was a positive trend between HEMS dispatch time and mortality. Longer HEMS on-scene and dispatch times appeared to be associated with increased mortality in trauma patients. Efforts should focus on reducing on-scene and dispatch times.

Before adjusted analysis, our findings supported our hypothesis in that both dispatch times and on-scene times <10 min are associated with the lower mortality.

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THE MANAGEMENT IN “THE GOLDEN HOUR” AND THE

SURVIVAL RATE OF THE POLYTRAUMATIZED PATIENT

Journal of Experimental Medical & Surgical Research

Year XVII · Nr.1/2010 · Pag.36 – 43

https://www.researchgate.net/publication/279976600_THE_MANAGEMENT_IN_THE_GOLDEN_HOUR_AND_THE_SURVIVAL_RATE_OF_THE_POLYTRAUMATIZED_PATIENT [accessed Mar 16 2018].

Conclusions: The survival rate is much more reliant on the platinum minutes” than the

overall intervention time, if it is maintained under 60 minutes;

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JAMA Surg. 2016 Jan;151(1):15-24. doi: 10.1001/jamasurg.2015.3104.

The Effect of a Golden Hour Policy on the Morbidity and Mortality of Combat Casualties.

Kotwal RS1Howard JT2Orman JA2Tarpey BW2Bailey JA3Champion HR4Mabry RL2Holcomb JB5Gross KR3.

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https://www.ncbi.nlm.nih.gov/pubmed/26422778

The term golden hour was coined to encourage urgency of trauma care. In 2009, Secretary of Defense Robert M. Gates mandated prehospital helicopter transport of critically injured combat casualties in 60 minutes or less.

OBJECTIVES:

To compare morbidity and mortality outcomes for casualties before vs after the mandate and for those who underwent prehospital helicopter transport in 60 minutes or less vs more than 60 minutes.

Decline in CFR after the mandate was associated with an increasing percentage of casualties transported in 60 minutes or less (regression coefficient, -0.141; P < .001), with projected vs actual CFR equating to 359 lives saved.

Golden hour policy improves combat survival

https://www.medicalbrief.co.za/archives/golden-hour-policy-improves-combat-survival/

Conclusions and Relevance: A mandate made in 2009 by Secretary of Defense Gates reduced the time between combat injury and receiving definitive care. Prehospital transport time and treatment capability are important factors for casualty survival on the battlefield.

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Early identification of patients requiring massive transfusion, embolization or hemostatic surgery for traumatic hemorrhage: A systematic review and meta-analysis

Tran, Alexandre MD; Matar, Maher MD; Lampron, Jacinthe MD; Steyerberg, Ewout PhD; Taljaard, Monica PhD; Vaillancourt, Christian MD

Journal of Trauma and Acute Care Surgery: March 2018 – Volume 84 – Issue 3 – p 505–516

doi: 10.1097/TA.0000000000001760

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Systematic Review

https://journals.lww.com/jtrauma/Abstract/2018/03000/Early_identification_of_patients_requiring_massive.14.aspx

BACKGROUND Delays in appropriate triage of bleeding trauma patients result in poor outcomes.

NEW RESEARCH SHOWS GOLDEN HOUR TRAUMA CARE SAVES LIVES ON THE BATTLEFIELD

The first hour after a medical trauma has long been viewed as the difference between life and death.

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Vital Record Texas A&M Health Sciences Center November 4, 2015

https://vitalrecord.tamhsc.edu/new-research-shows-golden-hour-trauma-care-saves-lives-on-the-battlefield/

The first hour after a medical trauma has long been viewed as the difference between life and death. Now, a new study from the U.S. Army Institute of Surgical Research and the Texas A&M Health Science Center College of Medicine, confirms that receiving trauma care within the first hour has saved the lives of U.S. service men and women on the battlefield.

This first hour after a trauma is commonly known as ‘the golden hour,’ a phrase first coined by Dr. R Adams Cowley at the University of Maryland Medical Center in Baltimore in 1957. In 2009, Secretary of Defense Robert M. Gates mandated a golden hour protocol for United States military personnel with life-threatening injuries. This cut the previous military standard in half, and research shows use of the golden hour is having a dramatic impact.

The study’s authors analyzed battlefield data for more than 21,000 military casualties during the U.S. involvement in the Afghanistan conflict. The data covered September 11, 2001 to March 31, 2014, comparing outcomes before and after the June 15, 2009 implementation of the golden hour mandate.

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.

 

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