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Ann Emerg Med. 2010 Mar;55(3):235-246.e4. doi: 10.1016/j.annemergmed.2009.07.024. Epub 2009 Sep 23.

Emergency medical services intervals and survival in trauma: assessment of the "golden hour" in a North American prospective cohort.

Collaborators (267)

Kerby JD, Brown TB, Terndrup T, Acker JE, Minor ML, MacLennan PA, Pritchard PR, Caldwell S, Lai KR, Idris AH, Benitez F, Fowler R, Lemecha D, Minei J, Pepe P, Ramsay M, Simonson R, Wigginton J, Black R, Cason D, Craft B, Detamble L, Dykes R, Harvey T, Hewitt S, Isaacs M, Kay J, Kayea T, LaChance R, Lehman T, Mayer P, Metzger J, Miller D, Navarro K, Parker S, Pickard K, Porter W, Starling TJ, Tine T, Vinson C, Abebefe D, Arze S, Black S, Bush M, Forman M, Goodloe J, Kelly R, Lachar G, Mangram A, Morales M, Thornton E, Wiebe R, Kerber R, Hata S, Atkins D, Aufderheide TP, Pirrallo RG, Brasel KJ, Winthrop AL, Klein JP, Chianelli J, Forster R, Milbrath M, Pukansky L, Sternig K, Chin E, Frieberg N, Krueger K, Szewczuga D, Duerr T, Funk R, Jacobsen G, Spitzer J, Demien R, Martins J, Cohn J, Spahn RR, Jankowski M, James T, Wentlandt WE Jr, Berousek D, Satula BM, Behling JB, Redman DK, Hook S, Neargarder A, Singer J, Reminga T, Shepherd D, Holzhauer P, Rubin J, Skold C, Alvarez O, Harkins H, Barthell E, Haselow W, Yee A, Whitcomb J, Castro EE, Motarjeme S, Stiell I, Christenson J, Hameed M, Yelle JD, Osmond M, Vaillancourt C, Evans D, Abu-Laban R, Stempien M, Dreyer J, Munkley D, Maloney J, Colella P, Affleck A, Waldbillig D, Bradford P, Lees M, Arcieri V, Wilson A, Boyle K, Luinstra-Toohey L, Trickett J, Sykes N, Graham E, Ballah K, Hedges C, Mathers P, Andrusiek D, Bishop D, Straight R, Twaites B, Donn S, Callaway C, Tisherman S, Rittenberger J, Hostler D, Sabol P, Sicchitano G, Sherry S, Shrader A, Stull G, Torres M, Groft W, McCaughan R, Rohrer R, Cole J, Fuchs D, Guyette F, Jenkins W, Roth R, Walker H, Corcos A, Doshi A, Ong A, Peitzman A, Hedges JR, Newgard CD, Daya MR, Lowe RA, Jui J, Schmidt TA, Sahni R, Warden CR, Muhr MD, Stouffer JA, Gorman K, Rosteck P, Koenig K, Lee J, Barnes R, Tucker H, Allen B, Bishop TJ, Glaser A, Schreiber MA, Anderson J, Ramzy AI, Gubler D, Wittwer LK, Underwood S, Barone B, Haun-Taylor D, Bryant E, Miller J, Davis D, Hoyt D, Coimbra R, Vilke G, Haynes B, Schwartz B, Sise M, Kennedy F, Smino F, Tominaga G, Steele J, Kudenchuk PJ, Rea TD, Bulger E, Eisenberg MS, Copass M, Sodeman E, LaFave M, Boehl J, Jones D, Somers G, Ayrs D, Whorton A, Warren S, Fogarty J, Larsen J, Helbock M, Slutsky A, Morrison L, Dorian P, Bradshaw D, Burgess R, Cameron B, Chad S, Cheskes S, Craig A, Dewar S, Dodd T, Duquette R, Epp M, Feldman M, Jones V, MacDonald R, MacLay L, McNenley S, Moore J, Moran P, Murray M, Nemeth M, Olnyk R, Perreira T, Renaud R, Roche K, Shield J, Silver D, Stevens J, Verbeek R, Waite T, Webb K, Welsford M, Farrell R, Hutchinson J, Weisfeldt M, Ornato JP, Hoyt DB, Holcomb JB, Hoke T, Sopko G, Lathrop D, Mascette A, Nickens PD, Hallstrom A, Nichol G, Emerson S, Powell J, Sears G, Bardarson B, Van Ottingham L, Leonen A, Ledingham RB, Finley C, Moore R, Bergsten-Buret B.

Author information

Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.



The first hour after the onset of out-of-hospital traumatic injury is referred to as the "golden hour," yet the relationship between time and outcome remains unclear. We evaluate the association between emergency medical services (EMS) intervals and mortality among trauma patients with field-based physiologic abnormality.


This was a secondary analysis of an out-of-hospital, prospective cohort registry of adult (aged > or =15 years) trauma patients transported by 146 EMS agencies to 51 Level I and II trauma hospitals in 10 sites across North America from December 1, 2005, through March 31, 2007. Inclusion criteria were systolic blood pressure less than or equal to 90 mm Hg, respiratory rate less than 10 or greater than 29 breaths/min, Glasgow Coma Scale score less than or equal to 12, or advanced airway intervention. The outcome was in-hospital mortality. We evaluated EMS intervals (activation, response, on-scene, transport, and total time) with logistic regression and 2-step instrumental variable models, adjusted for field-based confounders.


There were 3,656 trauma patients available for analysis, of whom 806 (22.0%) died. In multivariable analyses, there was no significant association between time and mortality for any EMS interval: activation (odds ratio [OR] 1.00; 95% confidence interval [CI] 0.95 to 1.05), response (OR 1.00; 95% CI 9.97 to 1.04), on-scene (OR 1.00; 95% CI 0.99 to 1.01), transport (OR 1.00; 95% CI 0.98 to 1.01), or total EMS time (OR 1.00; 95% CI 0.99 to 1.01). Subgroup and instrumental variable analyses did not qualitatively change these findings.


In this North American sample, there was no association between EMS intervals and mortality among injured patients with physiologic abnormality in the field.

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