Death Ignores the Golden Hour

The Argument for Mobile, Father-Forward Surgery

(Photo by Staff Sgt. Douglas Ellis, U.S. Air Force)


In this military review published by U.S. Army, it is stressed that the first hour after the occurrence of a traumatic injury is considered most critical for emergency stabilization of a casualty on the battlefield. This “Golden Hour” concept establishes a serviceable standard for distribution of medical resource supporting areas of operation, and the review points out how the Golden Hour paradigm could be a more deliberate mission support model.

A study of combat casualties in 2012 analysed nearly 4,600 combat fatalities in Iraq and Afghanistan through June 2011 and found that 87,3% of deaths occurred prior to hospital arrival. Of those deaths, approximately one in four was deemed potentially survivable from prehospital care and evacuation. Especially, haemorrhage remains the greatest killer on the battlefield as it accounts for 91% of potentially survivable prehospital battlefields deaths.

Moreover, a study in 2018 of more than 4,500 casualties revealed that patients who received a required blood transfusion on the battlefield were more likely to reach the hospital alive compared to those who did not received a needed transfusion.

Accordingly, in 2018 the Committee on Tactical Combat Casualty Care incorporated the concepts of advanced resuscitative care (ARC) which employs the principles of on-target blood transfusion, and the author points out that maintaining a supply of transfusable blood products on target should be considered a medical logistics priority.

Read the entire literature here and get information more in detail.