After trauma, it is often possible to prevent, or at least reduce the effect of, certain medical sequelae if intervention occurs within a particular time period: "the golden hour(s)". The possibility of a similar window of opportunity in posttraumatic stress disorder (PTSD) is discussed here. The essence of acute distress management should be to help contain and attenuate emotional reaction, and to encourage a return to full function and activity. Early intervention at this point could prevent the subsequent development of PTSD. Preclinical and clinical data suggest that amnesia of the traumatic event is associated with a decreased prevalence of PTSD, and that debriefing is not necessarily beneficial. Randomized, placebo-controlled studies are needed in order to examine what psychological and/or pharmacological interventions should or should not be made during the "golden hours" following trauma.