Name: How Air Ambulances (Don't) Work
Uploaded: 2021-06-10T11:38:23.000Z
Duration: 22 min 34 s
Description: VoiceTubeの動画で発音を聞きながら英語表現を覚えよう！学べる英語：

基礎受動態

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Back during World War Two, a young doctor named R Adams Cowley spent his deployment

on the battlefields of Europe, treating patients on the precipice between life and death.

He observed, through this experience, that those suffering the medical state of “shock”

following a traumatic injury were placed on an often certain, but not immediate, path

This exposure to those patients developed his life's goal: he sought to take those

on that certain path towards death, and nurse them back to life.

He wanted to be able to treat then-untreatable major traumatic injuries.

Some years later, in 1960, he neared closer to this goal by opening, in some corner of

the sprawling University of Maryland Medical Center, a two-bed unit dedicated to treating

major trauma patients—the first such department in the country.

Cowley started with about a 40% survival rate, but as his experience accumulated, and his

techniques refined, more and more patients survived.

It turned out that the certain path towards death for major trauma patients was not so

However, he also observed that even his reliable techniques couldn't reverse the course of

death if a patient took too long to get to him.

He posited that once someone experienced major trauma, they had a roughly 60-minute window

The problem was that, by the time other doctors transferred a patient to Cowley, that window

The system just wasn't suited for this sort of speed.

First, he lobbied for ambulances to bring trauma patients directly to him—or, eventually,

other trauma units—rather than just to the nearest, potentially unequipped hospital,

Second, he convinced the Maryland State Police to use their helicopters to bring trauma patients

to his unit—dramatically reducing the average time to care.

Cowley dubbed this 60-minute window the Golden Hour and the principles behind it are now

the central, guiding light of the Emergency Medical Service system—its purpose is to

stabilize, triage, and transport as fast as possible because, according to this Golden

Hour principle, faster is always better in trauma medicine.

The vast majority of the American population can reach their nearest hospital within the

Golden Hour with a traditional, ground-based ambulance system, but not all.

This is a map of the US, and these are the areas more than a sixty-minute round-trip

There are vast swaths of the sparsely-populated American west where ground ambulances cannot

fulfill the golden hour principle, especially given the recent spate of closures of unprofitable

In fact, it's not even very difficult to run into this problem.

If you were to drive from Denver to Las Vegas—two major American cities—most of your trip

would take place on Interstate 70, which would lead you through the desolate area of the

If your car were to crash here, your nearest hospital would be over ninety minutes away

in Moab, and this is just on the interstate—the central circulatory system of the US.

It's plenty possible to get much, much further from medical care and so, to plug these gaps,

to get patients in the most rural areas and dire circumstances to care as fast as possible,

that's where the country's air ambulance system steps in.

Across the nation, there are some 900 air ambulances stationed at hundreds of bases,

each of which expands the number of people able to reach hospital within an hour.

Each of these aircraft have the potential to change lives each and every day, and play

When your life is on the line, every minute counts, so these aircraft save life and limb

Well, to a certain person, maybe an executive at an air ambulance company, for example,

the 702 words up until now probably all sound correct, but are they really?

Everything up until now covered one simple principle: more trauma patients brought to

the hospital within sixty minutes equals more lives saved?

It can't possibly be that the central tenant of emergency medicine, the Golden Hour principle,

Well, in 2001, an academic review posed that exact question and found, “no large, well-controlled

studies in the civilian population that either strongly support or refute the idea that faster

Essentially, it said that the Golden Hour principle could be true, but despite the fact

that the entire EMS system operates on the collective assumption that it is true, we

So, in response, researchers sought an answer.

Plenty found that the answer was yes—as one would expect, faster transport to the

hospital does improve survival outcomes—but plenty others… didn't.

This one found that, “the time factor involved in managing and transporting hypotensive penetrating

injury victims directly to a regional trauma center does not appear to be related to an

This one concluded with, “no prehospital time less than 90 minutes exerted a significant

adverse effect upon survival,” while this one found, “no significant difference in

survival after traumatic injury when the 8 minute ambulance response time criteria was

Similar results, failing to find a statistically significant link between total pre-hospital

time and survival outcomes, were found in this study, and this one, and this one, and

Twenty years onwards from that academic review, the only certainty here is uncertainty: there

is no scientific consensus on whether the Golden Hour is truly relevant today.

Uncertainty is fine—it's part of the scientific process—but the entire American air ambulance

industry is built on a collective, unverified assumption that the Golden Hour principle

However, since we're dealing with assumptions, let's tackle another one.

When you think of air ambulances, you probably imagine a flight from here to here: scene

Of course, that's what you see in the movies, but these sorts of flights only account for

The vast majority of their business involves hospital to hospital transfers.

You see, the trauma care system that Doctor Cowley innovated evolved into a nationwide,

Essentially, there are five levels of trauma centers—hospitals certified to treat patients

with major traumatic injuries—and as you go up in the levels, the centers become more

Levels V and IV mainly deal with stabilization and initial evaluation prior to transport

to a higher level center, while Level III centers will have on-call surgeons who could

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How Air Ambulances (Don't) Work

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