By Dr. Lonnie Schwirtlich
Physicians Premier Emergency Room
In emergency medicine, the “Golden Hour” is the first hour after a medical emergency begins. Getting diagnosed and starting treatment during that first sixty minutes of an emergency is a very important factor in determining how severe the initial effects of your health emergency might turn out to be, but also, the potential complications and suffering thereafter. These complications and post-emergency problems are oftentimes more painful, potentially disfiguring, disabling, and costly than the initial emergency, and have a greater likelihood of limiting your ability to function normally for the rest of your life. That is why it is considered optimal to always be seen and treated as soon as possible after developing what you feel is a medical emergency.
Noteworthy examples of the life-enhancing and even life-saving value of the “Golden Hour” include:
- If you fall and break a bone in some extremity, you can potentially lose that extremity if it is either deformed by the injury and pinches off the blood supply to that limb, or ruptures the blood vessel next to it that supplies blood to that extremity.
- If you rupture an organ in your abdomen—such as your liver or spleen in a fall, auto accident, stab wound or gunshot wound, you have the potential to bleed all of your blood out in that first hour after the trauma and die of blood loss. Even if you do survive but your blood pressure was too low for too long, you could potentially experience kidney failure or brain damage from the kidney or brain not receiving adequate oxygen.
- If you start having a heart attack and come in within the “Golden Hour” and the facility you go to can give you a clot-buster drug or get you into a cath lab where they use a catheter and the clot-busting drugs to get rid of the clot causing the heart attack, you can be fully functional afterward and get back to normal physical activities, such as walking up a flight of stairs. If you wait until after 90 minutes from the onset of what might be a heart attack, you risk gradually losing heart muscle and challenging your heart’s ability to pump blood to the rest of your body. If you wait six hours or more, the heart muscle in the area of the clot effectively dies. Even if the heart attack is properly addressed, after delayed intervention, it could make walking across a room without getting short of breath a legitimate challenge.
- One of the most dramatic examples is if you have a stroke and lose the ability to move one side of your body. If you seek treatment within the “Golden Hour” and get the clot dissolving medicine into the area where the blood vessel to the brain is obstructed, you can many times dissolve the clot, eliminate the stroke, and be fully functional again. But if you wait longer than 3 hours from onset of the stroke, it may be too late for clot-busting drugs because the brain tissue is already damaged, and at that point, a clot-buster could make the brain bleed, so you can’t administer it.
- If you are experiencing abdominal pain and it turns out to be appendicitis—and your ER doctor discovers this before your appendix ruptures its puss into your abdomen, you can have it removed with three tiny puncture holes and almost no scar, frequently returning home in less than a day with no post-surgery difficulties. However, if you wait until it ruptures, you have to have your entire abdomen opened up and washed out, frequently resulting in a weeks-long hospital stay with frequent abscesses occurring, as well as the potential for bowel obstructions and infertility problems thereafter, which could then require other surgeries later in life.
The gist of this is simple—the sooner you seek care for what you believe is a medical emergency, the less you will suffer, the more you will decrease your chance of experiencing complications from that emergency, and the better your recovery from that emergency.
That is why the Prudent Layperson Standard was developed and brought into effect decades ago by Congress and also enshrined in law in Texas. The Prudent Layperson Standard makes clear you can and should go to the nearest and quickest emergency facility if you think you’re suffering from a medical emergency. This, in turn, means that your insurance company should cover the costs, regardless of whether that emergency facility and/or doctor is in-network. Remember this—in the event of a medical emergency, time is of the essence. You should never—in a time like that—being worried about the “network status” of your provider or the medical facility where you are seeking care.
As we often say: “time is tissue.” The “Golden Hour” reminds us that if ever faced with an emergency that is suddenly threatening our health or the health of a loved one, getting to the closest and fastest ER facility could be the difference between life and death; and for those who survive, a better life. To clarify, don’t ever wait to seek care just because you think your condition might improve. Do what needs to be done and know that your decisive action could save your life or the life of a loved one!