The 'Golden Hour' is the critical first 60 minutes after a traumatic injury where medical care is most likely to save a life.

The concept of the Golden Hour was popularized by Dr. R Adams Cowley, the founder of the University of Maryland Shock Trauma Center, in the 1970s. Cowley observed that there is a direct correlation between the timing of definitive surgical intervention and the survival rates of trauma patients. His research suggested that the body's compensatory mechanisms for shock begin to fail rapidly after the first hour of injury.During this period, the body attempts to maintain blood pressure through vasoconstriction and increased heart rate. If blood loss is not controlled and fluid resuscitation is not started within 60 minutes, the patient may enter a state of irreversible shock. This leads to multi-organ failure as cellular metabolism shifts from aerobic to anaerobic, causing a buildup of lactic acid and permanent tissue damage.The implementation of this concept led to the development of modern Emergency Medical Services (EMS) and specialized trauma systems worldwide. A study published in the Journal of the American Medical Association (JAMA) highlighted that while the 'hour' is not a rigid mathematical cutoff, the risk of death increases significantly for every minute of delay in care. Today, trauma centers use this principle to streamline 'door-to-balloon' or 'door-to-surgery' times to maximize patient outcomes.