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In regard to "Rethinking the golden hour" (article, Aug. 26): I am a flight nurse living in Kalispell, Mont., and couldn’t help but notice this article, as it may be generating some conflict regarding destination decisions for wounded soldiers.

The concept of the "golden hour" was conceived by R. Adams Cowley at the Baltimore Shock Trauma Unit in Baltimore. This was the first clinical shock trauma unit in the nation. Cowley’s ideal later became the first statewide emergency medical service system in the U.S.

In 1969, the first civilian medical evacuation transport took place, bringing the patient to Cowley’s shock trauma unit. His lifelong research had always stated the necessity of transporting the injured to the "most appropriate care" facility within one hour of the onset of injury, regardless of passing by other, less-equipped, emergency departments. Cowley initially took a lot of heat for this concept, however, with perseverance, continued to publish his research indicating this vital need in efforts to save as many lives as possible.

I thought it interesting that the article mentions there are still questions, despite this ideal being a long-standing standard of care in the civilian sector of transport trauma medicine.

Many of the civilian prehospital medical ideals are taken from the hard work performed by our men and woman in the harsh line of duty. The immediate care provided to these soldiers on scene, followed by rapid transport to an appropriate facility equipped with a staff of trauma surgeons and vital equipment, is the final guard against an untoward outcome in the lives of the injured.

Stephen Poehls, registered nurse,Columbia Falls, Mont.

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