U.S. military 'golden hour' rule saved lives

(Reuters Health) - A mandate to get wounded U.S. soldiers to appropriate medical care within one hour of injury improved survival on the battlefield, according to a new study.

U.S. soldiers attend to a wounded soldier at the site of a blast in Kabul, Afghanistan June 30, 2015. REUTERS/Omar Sobhani

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.

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: and JAMA Surgery, online September 30, 2015.