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Health Economics C O N S O R T I U M Y O R K Health Economics C O N S O R T I U M GSM ASSOCIATION The Golden Hour and Mobile Phones Final Report PETER WEST, Director SARAH REDMOND, Consultant JUNE 2004 ©GSMA Market Square, University of York, Vanbrugh Way, Heslington, York YO10 5NH Tel: 01904 433620 Fax: 01904 433628 Email: [email protected] http://www.york.ac.uk/inst/yhec/ York Health Economics Consortium is a Limited Company Registered in England and Wales No. 4144762 Registered office as above. Contents Page No. Executive Summary Acknowledgements Section 1: Introduction 1 1.1 Objective 1 1.2 Background 1 1.3 Aims of the Study 2 1.4 Structure of the Report 3 Section 2: Methods 4 2.1 Literature Search 4 2.2 Assessment of Retrieved Articles 5 Section 3: Results 7 3.1 The ‘Golden Hour’ 7 3.2 Mobile Phones 10 3.3 Conclusions 12 Section 4: Conclusions 13 4.1 Main Findings 13 4.2 Conclusions 13 References Appendices: Appendix A Search Strategies: Golden Hour Appendix B Search Strategies: Mobile Phones for Calling Ambulance Services Appendix C Golden Hour Template Appendix D Mobile Phones Executive Summary 1. OBJECTIVE The overall objective of the study was to identify literature on the use of mobile phones for calling for ambulance services and to identify literature on the ‘golden hour’, the crucial medical reference period in clinical emergencies. 2. BACKGROUND The ‘golden hour’ refers to the first 60 minutes after the onset of an acute illness. The chances of survival, if treatment is given, are greatest within this hour. The concept of the ‘golden hour’ had spread throughout the world with out-of-hospital care running on the principle of ‘scoop and run’ in order to get patients to hospital and treatment as fast as possible. 3. METHODS Two separate literature searches were undertaken: • To identify literature on the ‘golden hour’; • To identify literature on the use of mobile phones for calling for ambulance services. Key databases were searched limited only by date range and restricted to 1996- 2004. The databases included MEDLINE, PubMed and EMBASE. The Internet was also searched using general search engines Copernic and Google. The literature search provided a list of potentially useful papers. The list was assessed and papers that met the aims and objectives of the study were obtained from on-line journals, where possible. Relevant information from the available papers was entered into a pro-forma template, such as: • The complete reference; • The country the study was carried out in; • Any information related to the ‘golden hour’ or mobile phone use; • The objective of the study; • Whether the study was carried out in an urban or rural setting; • The response times; • The benefits of early treatment or the benefits of using a mobile phone to inform of an accident; • The conclusions. i 4. RESULTS AND CONCLUSIONS The on-line journals search produced 62 papers related to the ‘golden hour’ and 11 papers related to mobile phones. In conclusion the review found that there is a need for a quick response to traumas but this does not always have to be within an hour. In the case of cardiac arrests and myocardial infarctions, responses need to be within ten to fifteen minutes but for pneumonia it can be up to eight hours. There is a need to reduce response times further, especially for cardiac arrests and myocardial infarctions. Mobile phones have been shown to be used to call ambulance services but there is no information as to the health benefits this provides. It is unclear as to whether mobile phone use would enable the emergency services to reach patients any quicker than they currently do. Research should, therefore, focus on initiatives the emergency services could implement themselves to reduce response times, for example, by the use of targeted response systems and by increasing the number of ambulances. There is scope for mobile phone technology to be used by pre-hospital staff to reduce symptom-to-treatment times and research should focus on these areas. ii Acknowledgements The authors would like to thank Steven Duffy (Information Specialist) for assistance with the literature search. This research was conducted by York Health Economics Consortium Ltd for the GSM Association, however, the views expressed by the authors may not be those of the GSM Association or its members. Contact at the GSM Association, Dr Jack Rowley, Director Environmental affairs. Section 1: Introduction 1.1 OBJECTIVE The overall objective of the study was to identify literature on the use of mobile phones for calling ambulance services and to identify literature on the ‘golden hour’, the crucial medical reference period in clinical emergencies. 1.2 BACKGROUND The ‘golden hour’ refers to the first 60 minutes after the onset of an acute illness. The chances of survival, if treatment is given, are greatest within this hour [1]. The concept of the ‘golden hour’ has spread throughout the world with out-of-hospital care running on the principle of “scoop and run “ in order to get patients to hospital and treatment as fast as possible [1]. Lerner et al. [1] conducted a literature review, in 2001, to establish the origins of the ‘golden hour’. They concluded that Cowley was the first person to introduce the concept in 1975 when he stated that “the first hour after an injury will largely determine a critically-injured person’s chances of survival,” in a further article, in 1976, he goes on to mention the ‘golden hour’ directly. Another early advocate of the ‘golden hour’ was Trunkey [2], who in his 1983 paper detailed the numbers of deaths from trauma in the US. In 1982 it was 165,000 people and $62 million per day was lost in wages as a result. Trunkey noted that, at the time of the article, “physicians, hospital administrators, government officials and the general public” largely neglected trauma. Trunkey detailed the three main peaks of deaths following a trauma: • The first peak occurs very soon after trauma and is almost always not preventable. Here death is caused by lacerations to the brain or brain stem or spinal cord and by major blood loss; • The second peak occurs within the first few hours after a trauma and is treatable. The time between the trauma and treatment is critical in determining outcome. Here death is caused by internal haemorrhages of the head, respiratory system or abdominal organs or by severe blood loss; Section 1 1 • The third peak occurs in people who die days or weeks after. Quality of medical care, rather than the initial speed of treatment, is crucial here, as death is caused by infection or multiple organ failure. It is patients within the second peak that would benefit from a rapid response to treatment, especially but not exclusively during the first hour after a trauma. The advanced trauma program is a course for doctors which provides details on the correct way to deal with an trauma [3]. This emphasises the point that the ‘golden hour’ is not limited to 60 minutes but to the first few hours after a trauma. They reiterate Trunkey’s point that trauma is a major cause of death and in 1997 they estimated trauma related costs (lost wages, medical expenses, insurance administration costs, property damage, fire loss, employer costs, and indirect costs) at $400 billion annually, in the US. 1.3 AIMS OF THE STUDY This study aimed to search the literature for information concerning the ‘golden hour’ paying particular attention to: • Benefits of rapid responses to trauma, for example, lives saved and any economic benefits; • Cardiac events and early response; • Reduced ambulance response times; • 999 research; • Urban versus rural outcomes; • Traffic accident notification. The study also aimed to search the literature for information concerning mobile phones for calling ambulance services paying particular attention to: • Emergency contacts, especially ambulance services; • Health benefits caused by mobile phones calling the emergency services; • 911, E911, EMS (Emergency Management Systems) and 999 research; • Information technology and emergency outcomes. This study is focussed on potential areas of benefit so two areas within the mobile phones literature were excluded. These were: • Driver distraction effects; • Possible health effects. Section 1 2 1.4 STRUCTURE OF THE REPORT The remainder of the report compromises the following sections: • Section 2: Methods, detailing the literature search; • Section 3: Results, the findings of the literature review will be detailed; • Section 4: Conclusions, the conclusions will be summarised; • Appendices, the pro-forma used to summarise the articles are included. Section 1 3 Section 2: Methods 2.1 LITERATURE SEARCH Two separate literature searches were undertaken: • To identify literature on the ‘golden hour’; • To identify literature on the use of mobile phones for calling ambulance services. The database searches were limited by date range and restricted to 1996-2004; no further limitations by study design or language were used. The following databases were searched for both questions: MEDLINE (1996-2004) and PubMed (2004); EMBASE (1996-2004); Cinahl (1996-2004); Health Management Information Consortium (HMIC) (1996-2004) WebSPIRS); British Nursing Index (BNI) (1996-2004); Database of Abstracts of Reviews of Effects (DARE) (1996-2004); NHS Economic Evaluation Database (NHS EED) (1996-2004); Health Technology Assessment database (HTA) (1996-2004/03); Cochrane Database of Systematic Reviews (CDSR) and Cochrane Central Register of Controlled Trials (CENTRAL) (1996-2004; OHE Health Economic Evaluation Database (HEED) (1996-2004); PsycINFO (1996-2004); Science Citation Index and Social Science Citation Index (1996-2004). The Internet was also searched. General search engines Copernic (http://www.copernic.com/en/index.html) and Google (http://www.google.com/) were used. Details of the search terms used in the literature search for the ‘golden hour’ and mobile phones are provided in Appendix A and in Appendix B respectively.
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