The Golden Hour

[renpirate]

Here is an interesting link regarding MDR: http://www.emedicinehealth.com/articles/6120-1.asp

BTW, tonight I received training on driving the team's Mercury inflatable and aluminum boat. 8:30 pm at night and I'm on the lake....niiiice.

Mel

Nice link thanks!

You will definitely have fun. We try and do boat stuff at least once a month.

 

[Gary D.]

And people keep asking us how much diving can we do in Idaho and why the need for PSD's.
"States with the highest drowning rate are Alaska, Hawaii, Idaho, Louisiana, Montana, Mississippi, Arkansas, Oregon, and Florida."

If that's in order we are #3 and that's why we are flippin busy.

Gary D.

 

[renpirate]

I have been following up on the research and here is an excellent article that I found.
http://128.252.252.15/All-Net/english/neurpage/protect/nr-dn.htm

Fascinating stuff. On a historical note, but very sad, a lot of the information we have on the effects of hypothermia is based upon Nazi experiements.

 

[Tol]

On a busy team there will be chances for saves. But the hospital needs to be educated on drownings. If not they will all be recoveries.

We have had several well within the "GOLDEN HOUR" only to have the hospital FUBAR it. It get's real upsetting to do your part in the chain of events and have medical be the weak link.

Most will be recoveries. But there are those you bust your butt for. Those are the one's we train to get suited and wet within 3 minutes for.

Gary D.

I'm with you on the frustration. That said, I don't think this is usually an issue of the hospital.

It's unfortunate that so many of us have been fed the "golden hour" line, I know I was. There is absolutely no clinical evidence supporting the notion that 60 minutes has any significance. With a ruptured AAA you may have a golden 3 minutes. With a 5 y/o in cold water, you may have a successful resuscitation well beyond an hour. I think it is important that we start re-educating our teams. It makes a terrific dent in all of us to bring in someone we think is viable only to have them called before you finish your run report. The partial fix is to change our perception of what is viable. That is a function of good training.

You have enough experience that I suspect that you have a good sense of who has a chance and who doesn't. I think you are in the minority. Most folks in EMS and the vast majority of PSDs seem to have a very poor sense of this.

I'm not sure what kind of hospital you have near you. There certainly is a huge difference between a small town ER/urgent care and a Level 1 Trauma Center. It has been my impression that most places seem to do a good job with the initial active rewarming and maintaining hemodynamic stability while they do it. That said, I've always worked in metropolitan areas with at least one L1 ER. But I've done a lot of training for tiny outstate ERs.

JMHO, Tol

 

[Tol]

70 degrees is still in the cold water scenario so go for it.

We also extend the “GOLDEN HOUR” to 2 hours.

It isn’t the hospital that is the problem but the way a few of the ER Doc’s think. I know one that feels that if you drown, you drown and there is no way back. Then there are others that will try and bring back a mummy.

We just hope the good ones are on when it happens.

There is a good older tape out on cold water drowning by the USCG and Dr. Nimerof (sp) I’m at home and the tape is at work. I can get the title later if you want.

Here is a link with a lot of info on it that might worth sharing.
http://www.aquaticsafety.com/resume.html

Just remember to look out for number one then do everything you can for the victim(s).

Gary D.

Sorry, scanned past this before my prior post.

I agree with you about docs. There are some old school guys who will not work people that really deserve it. You can have the best staff and equipment in the world, but with a belligerent, undereducation doc....

I encourage you to avoid the golden hour part. In addition to being inaccurate, it is a misleading tool for thinking about preshospital planning. That said, it is quoted constantly.

Tol

 

[Gary D.]

Hi Tol, Welcome aboard.

We have a major medical area right next door in Spokane. Our local hospital can handle some major stuff as well and several years ago ours was the place to go for a drowning or CWND.

But then we got a couple of docs in ER that don’t think you can save anyone that has been submerged any length of time. Educating them, that’s like fighting city hall.

Not to long ago they shut one guy down in the mid 80’s that we had a good chance for. EMS just couldn’t get the doc to re-warm him first. Re-warming is a key step in the complicated process.

Knowing, you know when you get to them or at least when you get your hands on them. It’s a feeling that I can’t describe. Some you know want to go or have gone while others you bust your bacon to get into medical hands.

There have been, I’ll bet around a dozen or more that we have had a good chance on. But other factors like rough handling, BAC, age, size, and lack of education by upper medical and others things have not helped.

But you do know and it’s hard when they don’t make it.

Our “Golden Hour” has been “2 Golden Hours” for better than 20 years. Just because the majority of good saves have been within an hour who says that’s the limit? It’s worth the try. At least if we ever get a save over an hour the victim will think so.

It is frustrating at times. But we will continue to do our job the best that we can with the tools and knowledge we have. Part of that job is educating the higher ups in the food chain and we don’t get that good a grade there. That’s like walking into the cockpit of an airliner and trying to tell the pilots how to fly their plane.

Now on the other hand they just saved one of our LEO’s that had a severed carotid artery for roughly 7 hours. He is still with us and improving.

It's all in education and attitude.

Gary D.

 

[Tol]

Hi Tol, Welcome aboard.

We have a major medical area right next door in Spokane. Our local hospital can handle some major stuff as well and several years ago ours was the place to go for a drowning or CWND.

But then we got a couple of docs in ER that don’t think you can save anyone that has been submerged any length of time. Educating them, that’s like fighting city hall.

Not to long ago they shut one guy down in the mid 80’s that we had a good chance for. EMS just couldn’t get the doc to re-warm him first. Re-warming is a key step in the complicated process.

Knowing, you know when you get to them or at least when you get your hands on them. It’s a feeling that I can’t describe. Some you know want to go or have gone while others you bust your bacon to get into medical hands.

There have been, I’ll bet around a dozen or more that we have had a good chance on. But other factors like rough handling, BAC, age, size, and lack of education by upper medical and others things have not helped.

But you do know and it’s hard when they don’t make it.

Our “Golden Hour” has been “2 Golden Hours” for better than 20 years. Just because the majority of good saves have been within an hour who says that’s the limit? It’s worth the try. At least if we ever get a save over an hour the victim will think so.

It is frustrating at times. But we will continue to do our job the best that we can with the tools and knowledge we have. Part of that job is educating the higher ups in the food chain and we don’t get that good a grade there. That’s like walking into the cockpit of an airliner and trying to tell the pilots how to fly their plane.

Now on the other hand they just saved one of our LEO’s that had a severed carotid artery for roughly 7 hours. He is still with us and improving.

It's all in education and attitude.

Gary D.

Amen and Ditto!

I've been in EMS and the hospital for...wow, 13 years now (started to type a single digit)... and as I moved into PSD a couple of years ago I was surprised by some of what you are talking about. But it is so true.

My current goal is to a way to get PSD, EMS, and the local ER all on the same page about near-drownings and hypothermia. Each group is doing their own thing with no communication between them. The ER I can imagine being a bit independent. But EMS and PSD in our area are all part of the same fire dept. But hey, we had our first training together the other night! There is hope.

Thanks for the welcome aboard