Aspiring to the golden hour: Prehospital times and patient outcomes, a scoping review

It is traditionally taught that traumatically injured patients should be transported to a hospital by emergency medical services in a timely manner to decrease morbidity and mortality. However, there is also thought to be a potential benefit in delaying transport to provide potentially life-saving interventions prehospitally. The purpose of this paper is to review the available literature on whether time spent in the pre-hospital setting affects morbidity and mortality of traumatically injured patients. A scoping review of published studies on PubMed and Google Scholar search engines was performed using keywords relevant to our study. Our search yielded a total of 871 studies, which were then narrowed down by review of the title and abstract to 81 relevant articles. These studies were reviewed in depth by the authors, yielding 14 studies that evaluated patient outcomes in relation to prehospital time for traumatically injured patients. The secondary review of articles yielded an additional 3 papers relevant to our review. The results of the available studies are mixed but seem to favor the notion that morbidity and mortality are reduced when traumatically injured patients are transported in a timely fashion. This scoping review also highlights the need for studies that standardize definitions of time, level of care provided, and model of care delivery. EMS Medicine Core Competencies 1.2.1 Trauma, 1.5.1 Time-Life Critical Conditions, 2.2.1.2.1 Use of lights and sirens, 2.4.4.1 Response times