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Disaster Med Public Health Prep. 2019 Dec;13(5-6):1074-1082. doi: 10.1017/dmp.2019.42.

The Golden Hour After Injury Among Civilians Caught in Conflict Zones.

Author information

1
Department of Surgery, Stanford University Medical Center, Stanford, California.
2
Stanford University School of Medicine, Stanford, California.
3
Surgeons OverSeas, New York, New York.
4
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
5
Department of Surgery, Columbia University, New York, New York.
6
Palo Alto Veterans Affairs Health Care System, Palo Alto, California.

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:

conflict; global health; global surgery; trauma surgery; war

PMID:
31203832
DOI:
10.1017/dmp.2019.42

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