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