March 28, 2014
The Golden Hour Box And Trauma Survival
Over 20,000 people a year suffer major trauma in the UK alone. Of those, around 27 percent die from their injuries. The National Health Service (NHS) believes that “many of these deaths could be prevented with systematic improvements to the delivery of major trauma care.” The most common cause of fatalities in these cases is brain injury. Acute haemorrhage is a close second and is the leading cause of fatality in the three hours immediately following injury. It is certainly not all bad news. The chances of survival are in fact now far greater than ever before. Making it through major trauma, often described as serious multiple injuries that could lead to serious disability or death, depends not only on the speed with which help arrives, but also on the ever-improving equipment and techniques used by the trauma doctors and paramedics. Many of these innovations come to us by way of the military and have been tested and proven on the battlefield.
Key to survival rates is early intervention and diagnosis. Equally important is the need to have the right equipment and skills at the accident scene. US military medics have dubbed the first hour after trauma as “the Golden Hour” and many UK air ambulance teams routinely carry the so-called Golden Hour Box developed by military personnel. This has allowed blood transfusion to be carried out at the scene. It includes a refrigeration unit containing a supply of type O rhesus negative blood which can be used for transfusion regardless of the recipients own blood group. Fresh frozen plasma is used to reduce the risk of death from bleeding by encouraging the blood to clot. Battlefield experience has shown that wounded soldiers who receive an immediate transfusion have a greater chance of recovering from serious injury.
For a long time the accepted surgical wisdom was that, if a trauma victim needed surgery, this should be carried out as one definitive operation. Now, however, many on-scene trauma doctors employ preliminary “damage control surgery” if massive blood loss is a real threat to survival. Some even use the CoaguChek XS unit that can rapidly evaluate a blood sample to assess the likelihood of clotting.
Another invention of the military now in common use in the trauma field is Celox, a highly effective clotting agent.. Produced from by-products of the shrimp industry, this can either be applied direct to the wound in powder form or in the form of Celox impregnated dressings. It is most beneficial where victims have an increased risk of fatal bleeding, such as those taking blood thinning drugs like Warfarin.
Relatively new to trauma medicine is the CABC (catastrophic hemorrhage, airways, breathing, circulation) Protocol which determines the order of treating those areas. Sudden high blood loss can lead to death quicker than airway obstruction and, as we have seen, bleeding can often be treated quickly and efficiently. Following the CABC Protocol, medics are now trained to treat the bleed first and the airways problems next.
In the worst cases of low blood pressure where veins have collapsed after blood loss, the Intraosseus Vascular Access (IO) Device can be called upon. This injects saline directly into bones and raises blood volume.
Treating victims of trauma is now much more sophisticated and specialized. Survival and recovery levels are improving constantly. But none of this comes cheap. The enormous cost of technology and manpower means there is still a long way to go before all trauma victims can get the best and quickest treatment.
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