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Source (The British Columbia Emergency Health Services)

Last Revised: Nov 12, 1999


The Golden Hour

The Golden Hour is a concept which states that preparing for a serious injury accident may have a direct bearing on the survival or recovery of the victim.

"We have witnessed the introduction of specialized trauma centers, life-flight helicopters and paramedic staffed ground ambulances in efforts to improve the care of the injured patient. Medical studies have firmly established the importance of rapid access to definitive care. The seriously injured patient has to be in definitive care (the operating room) within 60 minutes of injury in order to survive. This is called the "Golden Hour""

"Helicopter evacuation should never be requested lightly. Helicopter back-up can save lives when used wisely and cost effectively. Inappropriate use has cost impact to the taxpayer and wastes valuable time for other patients. The following simple guidelines will assist you in making the decision to request airevacuation. Generally A.C.C. will authorize requests for helicopter use when:

A Patient who has sustained catastrophic limb injury, multisystem trauma and/or has unstable cardiovascular, respiratory, metabolic or neurological status and/or has or is likely to have failing vital signs and one or more of the following conditions can be met: - there is a significant time saving that would benefit an unstable patient transported by air vs alternative methods, - when the patient can be taken directly to a specialized care facility and continuous monitoring and/or treatment are required and time is a factor, - when the patient will benefit from the flight paramedic's specialized training and time is a factor, - the helicopter resource is available and can operate within safe established operating parameters of weather and landing zones."

"The Mechanisms of Injuries requiring Rapid Transport to Hospital (typical in our sports) are:

  • 1) Free-fall from a height greater than 6.5 metres (20 feet)
  • 2) Severe deceleration caused by a high speed accident greater than 30 kph, or if one of the victims was killed." (Internal injuries aren't always obvious). "
  • 3) Injuries requiring Rapid Transport include:
    • i) A Severe Head Injury with a reduced level of consciousness,
    • ii) Penetrating injury to the head, neck, chest, abdomen or groin.
    • iii) Two or more proximal long-bone fractures
    • iv) Flail chest
    • v) Amputation
    • vi) Spinal cord injury, paraplegia or quadriplegia.
    • vii) Severe burns, including high voltage
  • 4) Partial or complete airway obstruction
  • 5) Respiratory rate less than 10 or more than 30 per minute or severe shortness of breath.
  • 6) Absent radial pulse (shock)
  • 7) Obvious circulatory shock. (Pale cool skin, sweating, can include cyanosis (blue lip etc. color)."
Seriously injured victims should be Helicopter Evacuated if; it will save 1/2 hour or more in transport time and if the (combined) travel and extrication time to the nearest hospital is estimated to be greater than one hour.

(There is no substitute for keeping a current First Aid ticket and carrying a minimum kit. If you own oxygen equipment, providing O2 to a seriously injured patient is very beneficial... Don't leave it at home!)

Now that you know you’ll have to provide fairly detailed information about the patient's condition, lets look at what steps can be taken before hand to speed up the rescue process and improve patient odds. Identify, record and provide essential information such as the site's Latitude, Longitude, Altitude, natural landmarks, and Hazards; Radio communication (Proven effective at the site) and clear directions to the nearest phone. (Arrange with agencies to make a test call out from the site. If there's a spot where a radio shadow affects 2 way communication, identify it for that type of communication equipment.)

Note: ambulance service will have real reservations about going into rough terrain. Most ambulances are 2WD with poor clearance. Clearly define the access into the area, including road quality, names, km up, which turnoffs to take and the total Km. State whether or not a vehicle will be sent to guide aid agencies in.

Estimate the total transport time by road to a hospital should a helicopter not be available AND be prepared to estimate the extrication time if applicable.

Locate the nearest suitable Helipad. "The landing zone must be firm ground at least 22 meters square or 22 meters in diameter (bigger is better in this case!) When selecting the landing zone, think in concentric circles: - The inner 22 meter circle ideally must be clear of anything over 0.3m in height, - The next 31 meter circle should ideally have nothing taller than 3m in it, - The next 40 meter circle should have nothing taller than 18 meters in it. This will allow the helicopter to approach the landing zone on a gradual descent. Descending straight down in a hover is difficult and hard on the aircraft."

Air Evac will require basic VFR weather information prior to dispatch such as Horizontal & Ceiling visibility, cloud cover, Wind speed & direction and the Altitude. Ensure that all spectators, vehicles and loose debris are greater than 100 feet away from the landing zone.

Please be aware that the BC Ambulance service, including Air Evac does not do any rappelling or winching. This is coordinated by the Provincial Emergency Program. (There is no charge at present should the RCC be called in due to terrain or extenuating circumstances. However the Federal Government has made clear indications that in the future they intend to have cost recovery.)

All this information can be condensed into a single Form, which is included for use at your sites. Emergency information kept readily at hand in a standardized, easily recognizable format will assist you in informing rescue agencies how to locate you quickly. (In panic or stress situations, basic information is often forgotten.)

This same Site Form can be used to inform unexpected visitors, preserve sites and indicate appropriate weather conditions for various skill levels. Photos or maps attached can mark hazards and approved or restricted areas. Site rules will keep landowners happy. Blow up the form onto larger paper stock if needed, laminate the form and post it up at appropriate take off and landing areas.

For your information, the (4/1998) EHS fees for B.C. residents are $54 for the first 40 km and $0.50 / km thereafter to a maximum total of $274 no matter what method is chosen. (BC EHS Fees for non residents are: $396 for ambulance, for Air Evac Helicopter $2400.00 / 1st hr then $40.00 per minute thereafter and for fixed wing cost: double the kilometer travelled by $3.73 per km (plus normally 2 road ambulance bills - one at each end.)

Extended Health Care benefits almost invariably cover these costs - less the deductible - but BC Medical Services does not. Note: for BC residents, the total (1998) cost will be $274 regardless of whether a Helicopter, ground ambulance or fixed wing is called.

(FINAL NOTE: Don't call Search and Rescue directly. Missing Persons is a Police matter, they have established procedures for searches and will contact the appropriate agencies.)


Quotations are from the"BCAS Helicopter Response Criteria" and "Ground Orientation to Helicopter Airevacuation"

This article was written with cooperation and permission of the British Columbia Emergency Health Service. It is provided for your information and use as a public service. It is freeware:You are permitted to reprint and publish this article however it would be appropriate to credit the source in the heading.

*** Editors: Please substitute relevant statistics from your State Emergency Health Services fees and; which Emergency Organizations provides Search and Rescue services in your State or Region.***


Site - Emergency Information Form (pdf)

Emergency information kept readily at hand in a standardized, easily recognizable format will assist you in informing rescue agencies how to locate you quickly. (In panic or stress situations, basic information is often forgotten.)

All this information can be condensed into a single Form. An example is attacheced. Print it off and use at your sites.

It can be used to inform visitors, preserve sites and indicate appropriate weather conditions for various pilot’s skill levels. Photos or maps attached can mark hazards and approved or restricted areas. Site rules will keep landowners happy. Blow up the form onto a larger paper stock if needed, laminate it and post it up at appropriate take off and landing areas.)

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