Since Cowley et al¹ introduced the concept of the golden hour of shock in the mid-1970s, there has been an ongoing discussion about what constitutes an optimized emergency medical system (EMS). Physician-staffed EMS are continuously undergoing critique for missing this golden hour because of additional actions or interventions performed on scene, which supposedly prolong prehospital rescue times.² Vice versa: paramedic-staffed EMS that follow a so-called scoop-and-run principle are credited with producing shorter prehospital rescue times.³ With their contribution in this issue of JAMA Surgery, Gauss et al⁴ add more fuel to this vivid discussion. Using retrospective registry data from 2 French trauma cohorts and a range of statistical models, the authors⁴ assessed the association between increasing prehospital times and increasing in-hospital all-cause mortality in trauma patients treated within 2 physician-staffed EMS in central Europe; the odds of death increased by 9% for each 10-minute increase in prehospital time and, after adjustment, by 4% for each 10-minute increase.⁴

自从Cowley等人¹在1970年代中期引入电击黄金时光的概念以来，一直在讨论什么构成最佳的紧急医疗系统（EMS）。配备医疗人员的EMS由于错过了这一黄金时段而不断受到批评，因为现场采取了其他行动或干预措施，这可能会延长院前抢救时间。²反之亦然：遵循所谓的“即取即跑”原则的配备医护人员的EMS可以缩短院前抢救时间。³高斯等人在本期《美国医学会杂志》上的贡献⁴为这个生动的讨论增加更多动力。使用2个法国创伤回顾性队列注册表数据和各种统计模型，作者⁴评估院前增加时间和住院增加之间的关联的全因死亡率在欧洲中心2医生人手EMS内治疗外伤患者; 院前时间每增加10分钟，死亡几率增加9％，调整后，每增加10分钟，死亡几率增加4％。⁴