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Understanding Traumatic Injury and the Golden Hour

Traumatic injury has become a major public health problem. In the United States, these injuries add up to over 150,000 deaths and over three million non-fatal injuries per year. Trauma injuries are the leading cause of death in the first half of life (1-45 years of age) and are the fourth leading cause of death for all ages,  accounting for motor vehicle collisions, sports injuries, falls, natural disasters, and a variety of other physical injuries that may happen while at home, at work, on the street, or just about anywhere. This makes it more important than ever for emergency responders to react fast.

Five Most Common Types of Traumatic Injuries

Traumatic injury is different from other injuries. It refers to those injuries that happen immediately due to a specific circumstance. Some of the most common traumatic injuries include:

1. Falls

It could be a homeowner missing steps on a ladder while cleaning out a gutter, a kid falling from a bunk bed, or an elderly person slipping in a bathtub. Regardless of the circumstance, these “simple” injuries are the most common causes of traumatic injury.

2. Motor Vehicle Accidents

Nearly 1.25 million people die in vehicular accidents every year, with an additional 20-50 million injured or disabled. These accidents involve cars, motorcycles, bicycles, and even pedestrians (Florida has been named the most dangerous state for pedestrians).

3. Sports Injuries

It doesn’t matter whether it’s a common televised sport, one played in the backyard, or an extreme sport playing off of cliffs or riding waves; any sport can lead to injury. Yes, even golf.

4. Violence

Gunshot wounds, domestic violence, child abuse, and other assaults are common causes of traumatic injury. To cover each would take a story of their own, after all, cities like Chicago are already reporting nearly $450 million in related hospital bills for gun violence over the past seven years alone.

5. Combat injuries

Explosive blasts are the most common cause of traumatic injury in active-duty military personnel, due to a pressure wave passing through the body of the soldier. Penetrating wounds, blows from shrapnel or debris, and falls or bodily collisions with objects following a blast, also results in traumatic injury ER visits.

Injury Severity Score (ISS)

There are a number of ways physicians and others score medical injury. Often determined by mortality, morbidity, and expected hospitalization time following trauma, ISS classification depends on injury toward the head or neck, face, thorax, abdomen, or extremities. Once decided, injuries are pocketed into a six-point scale: minor, moderate, serious, severe, critical, and maximal, which unfortunately is untreatable.

Despite the ISS determination, surgeons want to save lives. Most employ the concept of the golden hour.

The Golden Hour for Traumatic Injury

The “golden hour” is a well-known term used among trauma surgeons and emergency medical service responders suggesting that an injured person has about 60 minutes—a golden hour—in which traumatic care can improve their survival rate.

The term was coined by Dr. R Adams Cowley, a military surgeon and head of the University of Maryland’s Shock Trauma Center. “There is a golden hour between life and death,” Cowley wrote. “If you are critically injured you have less than 60 minutes to survive. You might not die right then; it may be three days or two weeks later—but something has happened in your body that is irreparable."

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