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Vol. 1 No. 2 (2024)

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July 26, 2026
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December 31, 2024

Copyright (c) 2024 Lafi Ali s Almutairi, Abdullah Naif Almutairi, Saeed Salem Salman Almalki, Mohammed Ahmed Ageeli, Ali Mohsen Ahmed Jaafari, Makki Abdul Raheem Ageeli, Hussain Abdu Khairy, Hani Mohammed Farhan Alanazi

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This work is licensed under a Creative Commons Attribution 4.0 International License.

The Golden Hour in Trauma Care: Integrating Prehospital Paramedic Assessment, Diagnostic Imaging, Laboratory Testing, Blood Bank Services, and Nursing Management

https://doi.org/10.64483/202412746
Lafi Ali s Almutairi
Wtheilan general hospital, Ministry of health, Saudi Arabia
Abdullah Naif Almutairi
Thadiq Hospital, Ministry of Health, Saudi Arabia
Saeed Salem Salman Almalki
Sabya General Hospital, Ministry of Health, Saudi Arabia
Mohammed Ahmed Ageeli
Jazan, Ministry of Health, Saudi Arabia
Ali Mohsen Ahmed Jaafari
Sabya General Hospital, Ministry of Health, Saudi Arabia
Makki Abdul Raheem Ageeli
Sabya General Hospital, Ministry of Health, Saudi Arabia
Hussain Abdu Khairy
Prince Mohammed Bin Nasser Hospital – Jazan, Jazan Health Cluster, Ministry of health, Saudi Arabia
Hani Mohammed Farhan Alanazi
Hospital Mental Health, Hafar Albatin, Ministry of health, Saudi Arabia

Corresponding Author(s) : Lafi Ali s Almutairi

mmkzo00011@gmail.com

Saudi Journal of Medicine and Public Health, Vol. 1 No. 2 (2024)

Abstract

Background: The "golden hour" concept remains a cornerstone of trauma care, positing that rapid, coordinated intervention within the first 60 minutes after injury significantly reduces morbidity and mortality. Achieving this requires seamless integration of multiple disciplines across the prehospital and in-hospital continuum. Aim: This narrative review synthesizes recent advances and evidence on integrating prehospital paramedic assessment, diagnostic imaging, laboratory testing, blood bank services, and nursing management to optimize trauma resuscitation during the critical golden hour. Methods: A comprehensive literature search of PubMed, CINAHL, and Scopus was conducted for English-language articles published between January 2015 and January 2025. Keywords included "golden hour," "trauma resuscitation," "prehospital care," "paramedic assessment," "trauma radiology," "point-of-care laboratory," "massive transfusion protocol," and "trauma nursing." Studies, systematic reviews, clinical guidelines, and meta-analyses were narratively synthesized. Results: The review identifies a paradigm shift from siloed, sequential care to a parallel, integrated, and data-driven trauma system. Key advances include prehospital ultrasound and whole blood transfusion by paramedics, immediate computed tomography (CT) scanning upon arrival, point-of-care viscoelastic testing for goal-directed hemostatic resuscitation, and nurse-led massive transfusion protocol activation. The trauma team's non-technical skills and shared mental models are critical to the success of this integration. Conclusion: The golden hour is maximized not by any single intervention but by the choreographed integration of prehospital and hospital disciplines into a cohesive, time-sensitive system. Future progress depends on closed-loop communication technologies, artificial intelligence-driven decision support, and continued emphasis on team-based training to transform the resuscitation from a process of steps into a symphony of coordinated, life-saving action.

Keywords

Golden Hour; Trauma Resuscitation; Prehospital Care; Point-of-Care Testing; Massive Transfusion Protocol
Almutairi, L. A. s, Almutairi, A. N., Almalki, S. S. S., Ageeli, M. A., Jaafari, A. M. A., Ageeli, M. A. R., … Alanazi, H. M. F. (2024). The Golden Hour in Trauma Care: Integrating Prehospital Paramedic Assessment, Diagnostic Imaging, Laboratory Testing, Blood Bank Services, and Nursing Management. Saudi Journal of Medicine and Public Health, 1(2), 2556–2564. https://doi.org/10.64483/202412746
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References
  1. 1. Abujaber, A., Fadlalla, A., Gammoh, D., Abdelrahman, H., Mollazehi, M., & El-Menyar, A. (2020). Prediction of in-hospital mortality in patients with post traumatic brain injury using National Trauma Registry and Machine Learning Approach. Scandinavian journal of trauma, resuscitation and emergency medicine, 28(1), 44.
  2. 2. Baksaas-Aasen, K., Gall, L. S., Stensballe, J., Juffermans, N. P., Curry, N., Maegele, M., ... & Brohi, K. (2021). Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. Intensive Care Medicine, 47(1), 49-59.
  3. 3. Barleycorn, D., & Lee, G. A. (2018). How effective is trauma simulation as an educational process for healthcare providers within the trauma networks? A systematic review. International emergency nursing, 40, 37-45.
  4. 4. Bawazeer, M., Ahmed, N., Izadi, H., McFarlan, A., Nathens, A., & Pavenski, K. (2015). Compliance with a massive transfusion protocol (MTP) impacts patient outcome. Injury, 46(1), 21-28.
  5. 5. Benovoy, M. (2016). Automatic spatiotemporal analysis of cardiac image series. Ecole Polytechnique, Montreal (Canada).
  6. 6. Bernard, S. A., Nguyen, V., Cameron, P., Masci, K., Fitzgerald, M., Cooper, D. J., ... & Judson, R. (2010). Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial.
  7. 7. Bøtker, M. T., Jacobsen, L., Rudolph, S. S., & Knudsen, L. (2018). The role of point of care ultrasound in prehospital critical care: a systematic review. Scandinavian journal of trauma, resuscitation and emergency medicine, 26(1), 51.
  8. 8. Convertino, V. A., Howard, J. T., Hinojosa-Laborde, C., Cardin, S., Batchelder, P., Mulligan, J., ... & MacLeod, D. B. (2015). Individual-specific, beat-to-beat trending of significant human blood loss: the compensatory reserve. Shock, 44, 27-32.
  9. 9. Convertino, V. A., Johnson, M. C., Alarhayem, A., Nicholson, S. E., Chung, K. K., DeRosa, M., & Eastridge, B. J. (2021). Compensatory reserve detects subclinical shock with more expeditious prediction for need of life‐saving interventions compared to systolic blood pressure and blood lactate. Transfusion, 61, S167-S173.
  10. 10. Cowan, S., Murphy, P., Kim, M., Mador, B., Chang, E., Kabaroff, A., ... & Widder, S. (2023). Paramedic to trauma team verbal handover optimization—a complex interaction. Canadian Journal of Surgery, 66(3), E290.
  11. 11. Curry, N. S., Davenport, R., Wong, H., Gaarder, C., Johansson, P., Juffermans, N. P., ... & Stanworth, S. J. (2023). Traumatic coagulopathy in the older patient: analysis of coagulation profiles from the Activation of Coagulation and Inflammation in Trauma-2 (ACIT-2) observational, multicenter study. Journal of Thrombosis and Haemostasis, 21(2), 215-226.
  12. 12. Dujardin, R. W., Kleinveld, D. J., Gaarder, C., Brohi, K., Davenport, R. A., Curry, N., ... & Juffermans, N. P. (2022). Coagulopathy underlying rotational thromboelastometry derangements in trauma patients: a prospective observational multicenter study. Anesthesiology, 137(2), 232-242.
  13. 13. Durr, K., Ho, M., Lebreton, M., Goltz, D., Nemnom, M. J., & Perry, J. (2023). Evaluating the impact of pre-hospital trauma team activation criteria. Canadian Journal of Emergency Medicine, 25(12), 976-983.
  14. 14. Fitzgerald, M. C., Lloyd-Donald, P., Mathew, J., Kim, Y., Tee, J., Dewan, Y., & Mitra, B. (2019). Prehospital ground transport rapid sequence intubation for trauma and traumatic brain injury outcomes. Annals of surgery, 269(3), e29-e30.
  15. 15. Ford, K., Menchine, M., Burner, E., Arora, S., Inaba, K., Demetriades, D., & Yersin, B. (2016). Leadership and teamwork in trauma and resuscitation. Western Journal of Emergency Medicine, 17(5), 549.
  16. 16. Guyette, F. X., Zenati, M., Triulzi, D. J., Yazer, M. H., Skroczky, H., Early, B. J., ... & Sperry, J. L. (2022). Prehospital low titer group O whole blood is feasible and safe: results of a prospective randomized pilot trial. Journal of Trauma and Acute Care Surgery, 92(5), 839-847.
  17. 17. Heron, R. L., Eisma, M. C., & Browne, K. (2022). Barriers and facilitators of disclosing domestic violence to the UK health service. Journal of Family Violence, 37(3), 533-543.
  18. 18. Holcomb, J. B., Tilley, B. C., Baraniuk, S., Fox, E. E., Wade, C. E., Podbielski, J. M., ... & van Belle, G. (2015). Transfusion of plasma, platelets, and red blood cells in a 1: 1: 1 vs a 1: 1: 2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. Jama, 313(5), 471-482.
  19. 19. Huber-Wagner, S., Biberthaler, P., Häberle, S., Wierer, M., Dobritz, M., Rummeny, E., ... & TraumaRegister DGU. (2013). Whole-body CT in haemodynamically unstable severely injured patients–a retrospective, multicentre study. PloS one, 8(7), e68880.
  20. 20. Huo, Y., Couzner, L., Windsor, T., Laver, K., Dissanayaka, N. N., & Cations, M. (2023). Barriers and enablers for the implementation of trauma-informed care in healthcare settings: a systematic review. Implementation science communications, 4(1), 49.
  21. 21. Jamshidi, H., Jazani, R. K., Alibabaei, A., Alamdari, S., & Kalyani, M. N. (2019). Challenges of Cooperation between the Pre-hospital and In-hospital Emergency services in the handover of victims of road traffic accidents: A Qualitative Study. Investigación y educación en enfermería, 37(1), 70-79.
  22. 22. Johnson, M. C., Alarhayem, A., Convertino, V., Carter III, R., Chung, K., Stewart, R., ... & Eastridge, B. (2018). Compensatory reserve index: performance of a novel monitoring technology to identify the bleeding trauma patient. Shock, 49(3), 295-300.
  23. 23. Johnsen, B. H., Westli, H. K., Espevik, R., Wisborg, T., & Brattebø, G. (2017). High-performing trauma teams: frequency of behavioral markers of a shared mental model displayed by team leaders and quality of medical performance. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 25(1), 109.
  24. 24. Mitura, K., Celiński, D., Hawrylewicz-Łuka, A., Pilip, S., Szpakowski, L., Jarzębowska, M., ... & Szajda, S. (2021). Life-saving procedures and cardiopulmonary resuscitation from the ancient history to the present day. Emergency Medical Service, 8(4), 274-283.
  25. 25. O’Dochartaigh, D., & Douma, M. (2015). Prehospital ultrasound of the abdomen and thorax changes trauma patient management: a systematic review. Injury, 46(11), 2093-2102.
  26. 26. Peng, H. T., Siddiqui, M. M., Rhind, S. G., Zhang, J., da Luz, L. T., & Beckett, A. (2023). Artificial intelligence and machine learning for hemorrhagic trauma care. Military Medical Research, 10(1), 6.
  27. 27. Perlman, R., Callum, J., Laflamme, C., Tien, H., Nascimento, B., Beckett, A., & Alam, A. (2016). A recommended early goal-directed management guideline for the prevention of hypothermia-related transfusion, morbidity, and mortality in severely injured trauma patients. Critical care, 20(1), 107.
  28. 28. Ralph, N., Gow, J., Conway, A., Duff, J., Edward, K. L., Alexander, K., & Bräuer, A. (2020). Costs of inadvertent perioperative hypothermia in Australia: a cost-of-illness study. Collegian, 27(4), 345-351.
  29. 29. Rogers, F. B., Rittenhouse, K. J., & Gross, B. W. (2015). The golden hour in trauma: dogma or medical folklore?. Injury, 46(4), 525-527.
  30. 30. Shea, S. M., Staudt, A. M., Thomas, K. A., Schuerer, D., Mielke, J. E., Folkerts, D., ... & Spinella, P. C. (2020). The use of low‐titer group O whole blood is independently associated with improved survival compared to component therapy in adults with severe traumatic hemorrhage. Transfusion, 60, S2-S9.
  31. 31. Spahn, D. R., Bouillon, B., Cerny, V., Duranteau, J., Filipescu, D., Hunt, B. J., ... & Rossaint, R. (2019). The European guideline on management of major bleeding and coagulopathy following trauma. Critical care, 23(1), 98.
  32. 32. Sperry, J. L., Guyette, F. X., Brown, J. B., Yazer, M. H., Triulzi, D. J., Early-Young, B. J., ... & Zenati, M. S. (2018). Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. New England Journal of Medicine, 379(4), 315-326.
  33. 33. Treskes, K., Sierink, J. C., Edwards, M. J. R., Beuker, B. J. A., Van Lieshout, E. M. M., Hohmann, J., ... & Dijkgraaf, M. G. W. (2020). Cost-effectiveness of immediate total-body CT scanning in severe trauma patients (REACT-2 trial). IMMEDIATE, 41.
  34. 34. van der Ster, B. J., Bennis, F. C., Delhaas, T., Westerhof, B. E., Stok, W. J., & Van Lieshout, J. J. (2018). Support vector machine based monitoring of cardio-cerebrovascular reserve during simulated hemorrhage. Frontiers in physiology, 8, 1057.
  35. 35. van Turenhout, E. C., Bossers, S. M., Loer, S. A., Giannakopoulos, G. F., Schwarte, L. A., & Schober, P. (2020). Pre‐hospital transfusion of red blood cells. Part 1: a scoping review of current practice and transfusion triggers. Transfusion Medicine, 30(2), 86-105.
  36. 36. Vianen, N. J., Van Lieshout, E. M., Vlasveld, K. H., Maissan, I. M., Gerritsen, P. C., Den Hartog, D., ... & Van Vledder, M. G. (2023). Impact of point-of-care ultrasound on prehospital decision making by HEMS physicians in critically ill and injured patients: a prospective cohort study. Prehospital and Disaster Medicine, 38(4), 444-449.
  37. 37. Wilson, S., Rixon, A., Hartanto, S., White, P., & Judkins, S. (2020). Systematic literature review of leadership in emergency departments. Emergency Medicine Australasia, 32(6), 935-952.
  38. 38. World Health Organization. (2022). World health statistics 2022: monitoring health for the SDGs, sustainable development goals.
  39. 39. Yusoff, H. M., Ahmad, H., Ismail, H., Reffin, N., Chan, D., Kusnin, F., ... & Rahman, M. A. (2023). Contemporary evidence of workplace violence against the primary healthcare workforce worldwide: a systematic review. Human resources for health, 21(1), 82.
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