What is 'golden hour' in medical science?

Rishabh Pant broke the window and escaped. So, was it really the 'golden hour'? Golden hour is the first 60 minutes of a severe accident and the aid provided now often decides the medical fate of the victim.

For the last few days, Indian media has been flooded with the news of how Indian wicket keeper Rishabh Pant was rescued from his fire-ravaged car during the 'golden hour' and is finally safe. While the fact that the Indian cricketer is safe is welcoming, the hullabaloo around him being saved during the 'golden hour' needs some scrutiny.

Golden Hour: It's a situation of life & death

Merriam-Webster dictionary defines 'golden hour' as "the hour immediately following traumatic injury in which medical treatment to prevent irreversible internal damage and optimize the chance of survival is most effective."

In simpler terms, the first one hour, i.e. the 'golden hour', of any accident or trauma is the most crucial and defining time for the victim. It is the time between life and death and if a severely injured person is attended to by emergency services, the chances of their survival increase dramatically.

The concept of the 'golden hour' was first introduced by Dr. Adam Cowley in 1960, who said in an interview, "If you are critically injured, you have less than 60 minutes to survive. You might now die right then, it may be 3 days or 2 weeks later - but something has happened in your body that is irreparable."

Was it really golden hour for Pant?

According to reports, Rishabh Pant was driving his car from Delhi to his hometown Roorkee early on Friday. The accident happened about 90 km from Dehradun and the vehicle reportedly went up in flames moments later.

Pant, however, managed to break the windscreen and escape from the burning vehicle. He was then helped by passers-by and was conscious enough to ask them to call his mother.

According to a medical bulletin issued by the BCCI in coordination with the hospital, Pant has suffered two cuts on his forehead, a ligament tear in his right knee along with injuries on his wrist, ankle, toe and back.

Since Pant was conscious enough to break the screen and escape from the vehicle, the question remains if it indeed was 'golden hour'. He was definitely injured but could there be risk to life if immediate help hadn't arrived?

How to make golden hour count?

Nobody wants to be in a situation of life and death, worse still nobody wants to be the one deciding about someone else's life and death. However, if one is in a place where they can help someone survive, they must know the right things to do and steps to take.

The most basic principle in the event of a road accident is the three-fold mantra of "Protect, Alert, Aid".

• To begin with, protect the area by marking it somehow as the area of accident to avoid further damage or secondary accidents.
• Once the area is secured, it is time to call the emergency services. Call them up and calmly and clearly explain the situation. Be very concise and clear about the location of the accident, the number of victims and the conditions they are in.
• If someone is still trapped inside, make sure to highlight this fact too. Fire brigade would be needed at the site so this is an important part of the information.
• Give your contact number too so that in case they are not able to locate you or need to guide you about what to do while they arrive.

Do's and Don'ts while you wait for help to arrive:

Don't panic: Everyone knows the importance of not panicking, yet staying calm in such situations is not an easy feat. Deep breathing and self-talk may help you stay calm.

Remove tight clothing: If the victim is finding it difficult to breathe, loosening their clothing will help them feel better.

Try to stop bleeding: In case the victim is bleeding profusely, tightly wrap the bleeding part with a clean cloth.

Cover the open wound: If there are any open wounds, look for a clean cloth and cover the wound. Many victims also have fractured bones so don't try to move them. Instead try to immobilize the body part you think is fractured with any hard material you can lay your hands on.

Don't give any food or water to the victim: Chances of the victim choking on food or water is very high in case of unconscious or semi-conscious victims.

Keep the victim warm: Most of the victims in a trauma incident suffer lowering blood pressure. If you find their hands and feet cold, cover them with extra layers of clothing and keep them warm.

While golden hour is loosely defined as the first one hour, sometimes the severity of the accidents can squeeze this hour to minutes. Acting immediately, clearly and aptly are the key to saving lives if one ever has the opportunity to do so.