Paramedics in the Pre-Hospital care setting are a crucial part of the “When seconds matter” team of Bahrain’s First Emergency Medical Conference, 2019. The teamwork concept is emphasized within newly developed Paramedic Internship Programs in Saudi Arabia where preceptors reiterate “The Golden-Hour” phrase. Dr. Cowley coined this phrase and recognized the importance of “The Golden Hour” from his personal experiences in post-World War II and his career in the 1960s. His practices allowed him to recognize that the earlier the trauma patient reached definitive care, the greater the chances were of survival [1].

Paramedics are a crucial part of the team by having a quick response time to the scene, treat the patient’s life-threatening injuries first, and transport the patient to the most appropriate hospital. The Paramedic’s on-scene time is as vital as their patient assessment and critical thinking skills, to make an appropriate in-field diagnosis. “Not All Pre-hospital Time is Equal: Influence of Scene Time on Mortality” emphasizes that a prolonged on scene time is associated with increased mortality rates [2].

With the advancement of medical equipment, proven clinical trials, continuing education, and paramedic protocols in place that allow paramedics to activate the nearest hospital’s cath-lab, paramedics are able to make a definitive field diagnosis and transport their patient to the appropriate facility. This “golden-hour” term can be utilized not only for trauma patients but other critical patients that have a field diagnosis of a stroke or a STEMI. American Heart Association guidelines state that hospitals treating STEMI patients with emergency percutaneous coronary interventions should reliably achieve a door-to-balloon time of 90 minutes or less [3].

Together with the collaborating of appropriate trauma hospitals, paramedic department’s protocols, and advanced medical equipment, paramedics are able to transmit a 12-lead of a STEMI patient to a hospital with a cath-lab, and test for elevated troponin levels for non-STEMI patients [4]. Additionally, paramedics can perform a FAST exam to detect internal abdominal bleeds and implement the RUSH protocol and detect symptoms of a stroke to greater the chances of survival in patients [5]. Ultimately, from each of these pre-hospital care efforts, the goal is to improve the patient’s prognosis.

References

1. Eisele C. The golden hour. J Emerg Med Serv. 2008. Accessed on December 2019. Available from: https://www.jems.com/articles/2008/08/golden-hour.html
2. Brown JB, Rosengart MR, Forsythe RM, Reynolds BR, Gestring ML, Hallinan WM, et al. Not all prehospital time is equal. J Trauma Acute Care Surg. 2016;81(1):93–100. https://doi.org/10.1097/TA.0000000000000999
3. American Heart Association. Recommendations for criteria for STEMI systems of care. 2016. Accessed on October 5, 2019. Available from: http://www.heart.org/HEARTORG/HealthcareProfessional/Mission Lifeline-Recommendations-for-Criteria-for-STEMI-Systems-of Care_UCM_312070_Article.jsp#.XeOR9S3MwWo.
4. Juliano M, Wason C. Comparison of point-of-care versus laboratory troponin testing in an emergency department setting. Mil Med. 2017;182(7):e1938–40. https://doi.org/10.7205/MILMED-D-16-00387
5. Seif D, Perera P, Mailhot T, Riley D, Mandavia D. Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol. Crit Care Res Pract. 2012;2012:503254. https://doi.org/10.1155/2012/503254