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 The 2009 rule, implemented by then-Secretary of Defense Robert
Gates, potentially saved 359 lives, according to the report in JAMA
Surgery.
"I think the Secretary of Defense's mandate made a difference," said
Dr. Russ Kotwal, the study's lead author from the U.S. Army
Institute of Surgical Research at Joint Base San Antonio-Ft. Sam
Houston.
He and his colleagues write that the 60-minute mandate, which is
widely known as the "golden hour," cut in half the previous goal of
two hours between a call for prehospital helicopter transport and
arrival at a treatment facility.
For the study, the researchers used data on 21,089 soldiers wounded
in Afghanistan from September 2001 through March 2014.
After the mandate, the average transport time decreased from 90
minutes to 43 minutes - based on patients with the most complete
data. Also, the percentage of missions achieving transport within
the "golden hour" increased from about 25 percent to 75 percent.
Overall, 16 percent of those wounded before the mandate were killed
in action, compared to about 10 percent after the mandate.
When the researchers included wounded soldiers who survived past the
battlefield, the fatality rate was about 14 percent before the
mandate and about 8 percent after.
The percentage of soldiers who died after reaching a treatment
facility remained consistent, at about 4 percent before and after
the mandate.
In an editorial accompanying the new study, Dr. Todd Rasmussen
cautioned that it's important to remember that these results were in
an "optimal theater of war" with air access and surgical facilities.
"Future casualty care scenarios may be frighteningly more complex
and involve delayed resuscitation, prolonged field care, and
longer-distance critical care transport," wrote Rasmussen, of the
U.S. Combat Casualty Care Research Program at Fort Detrick in
Maryland.
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The new study also has practical implications for the general U.S.
population, Kotwal said.
For example, in remote areas of the U.S. the new study shows it's
important to improve evacuation times for trauma patients or to push
out enhanced medical capabilities to first responders.
"The 'golden hour' is not about getting people to a hospital,"
Kotwal said. "It’s about getting them the care that’s required."
Rasmussen added in his editorial that military and civilian planners
should learn from the "golden hour" effort - including its
limitations, such as the difficulty of acquiring the data to do
these types of analyses.
SOURCE: http://bit.ly/1OHhtIk and http://bit.ly/1OHhuMA JAMA
Surgery, online September 30, 2015.
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