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The Golden Hour After Injury Among Civilians Caught in Conflict Zones

Published online by Cambridge University Press:  17 June 2019

Joseph D. Forrester ,
Auriel August ,
Lawrence Z. Cai ,
Adam L. Kushner  and
Sherry M. Wren
Joseph D. Forrester*
Affiliation:
Department of Surgery, Stanford University Medical Center, Stanford, California
Auriel August
Affiliation:
Department of Surgery, Stanford University Medical Center, Stanford, California
Lawrence Z. Cai
Affiliation:
Stanford University School of Medicine, Stanford, California
Adam L. Kushner
Affiliation:
Surgeons OverSeas, New York, New York Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Department of Surgery, Columbia University, New York, New York
Sherry M. Wren
Affiliation:
Department of Surgery, Stanford University Medical Center, Stanford, California Palo Alto Veterans Affairs Health Care System, Palo Alto, California.
*
Correspondence and reprint requests to Joseph D. Forrester, Department of Surgery, 300 Pasteur Drive H3591, Stanford, CA 94305 (e-mail: jdf1@stanford.edu).
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Abstract

Introduction:

The term “golden hour” describes the first 60 minutes after patients sustain injury. In resource-available settings, rapid transport to trauma centers within this time period is standard-of-care. We compared transport times of injured civilians in modern conflict zones to assess the degree to which injured civilians are transported within the golden hour in these environments.

Methods:

We evaluated PubMed, Ovid, and Web of Science databases for manuscripts describing transport time after trauma among civilian victims of trauma from January 1990 to November 2017.

Results:

The initial database search identified 2704 abstracts. Twenty-nine studies met inclusion and exclusion criteria. Conflicts in Yugoslavia/Bosnia/Herzegovina, Syria, Afghanistan, Iraq, Israel, Cambodia, Somalia, Georgia, Lebanon, Nigeria, Democratic Republic of Congo, and Turkey were represented, describing 47 273 patients. Only 7 (24%) manuscripts described transport times under 1 hour. Transport typically required several hours to days.

Conclusion:

Anticipated transport times have important implications for field triage of injured persons in civilian conflict settings because existing overburdened civilian health care systems may become further overwhelmed if in-hospital health capacity is unable to keep pace with inflow of the severely wounded.

Keywords

conflictwartrauma surgeryglobal healthglobal surgery
Type
Report from the Field
Information
Disaster Medicine and Public Health Preparedness , Volume 13 , Issue 5-6 , December 2019 , pp. 1074 - 1082
Copyright
Copyright © 2019 Society for Disaster Medicine and Public Health, Inc. 

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