the Golden Hour is quite a key unique study as far as we know there's only one of the study that's managed to look at patients within the first hour of injury and that seems quite small it only looks at 7 plus samples and it also didn't look at the function of the immune system so we know how many cells they were but not how well they were behaving the golden hour is going to get round that by looking at 200 patients and that will really give us some firm conclusions about what's happening to your immune system in the hour after an injury so one of the main findings of this study is that we've been able to show you get evidence of both the immune activation and immune suppression within minutes of injury it was previously been shown in the literature that you do get evidence of immune activation within hours of injury but it was thought that the immune suppression takes days or even weeks to develop however using a unique 60 minute blood samples we've been able to find evidence of both immune activation and immune suppression before the patient even arrives to hospital and interestingly preliminary data suggests that those patients have a more active immune response within one area of injury may be at risk of poor outcome once in hospital they're quite an important part of this study has been our interactions with both the West Midlands air ambulance service the Merrick team and also the trauma research team that we have here based at the Queen Elizabeth we've been able to work on a 24/7 basis meaning we'd be set on very few patients that are eligible to form in our study it's also been quite beneficial that we've been able to interact between the nurses and also the paramedics in quite a difficult scenario when when the paramedics first arrived at the injury scene and they have been able to take blood samples which we can analyze within two hours of the blood samples being taken the most immediate implication of the findings of the golden hour study that we now have a test that can identify patients who are most likely to develop sepsis on multi organ failure and so we can treat those appropriately and rapidly