الفهرس 
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Abstract
Context: Trauma is the leading cause of death worldwide. Effective trauma system is vital to minimize mortality and morbidity. In this work the concentration was on the initial assessment of severely traumatized patients at the site of the accident; Pre-hospital care; and in the emergency room and the severity of the admitted patients, the time spent in the emergency room, the type of physician that accepted and initially managed the patient, the kind of care that was provided and the patterns of intra-hospital transportation.
In Egypt, no formal trauma system has been developed. Moreover, in the emergency room of most hospitals, the initial assessment and management is performed by relatively junior doctors. Furthermore, there is no registry of trauma, for that reason we conduct such study to create and design a protocol of management and perform a training program with the staff for ER.
Objectives:
• Design a protocol of management of severely traumatized patients.
• Assess what exists in comparison to the modified protocol.
• Perform training program for the ER physicians on the protocol.
• Evaluate the effect on management of severely traumatized patients.
• Prevalence and common causes of severely traumatized patients in Ismailia governorate.
Design: clinical self-control study
Setting: Emergency Department of Suez Canal University Hospital in Ismailia
Study population: All severely traumatized patients, of all ages and both sexes who attend the Emergency department, Suez Canal University Hospital, Ismailia
Study methods: At first an assessment was done to evaluate the existing situation in Emergency department by using a modified UK protocol.
Then a training course was performed for one month for ER physicians on the modified UK protocol, with the support from Suez Canal hospital authority.
Results: The aim of the study was to assess the impact of applying the training program (modified ATLS protocol) on the performance of ER physicians to improve the management of severely traumatized patients.
We performed a clinical self-control study, the study composed of two phases, one before applying the training program and the other after applying the training program, each of these groups were performed by the same ER physicians.
The pre-training phase carried out along three month interval from April to June 2011,10 ER physicians shared in this phase , then we carried out the intervention training program for 10 ER physicians on how to deal with the severely traumatized patients , then we made an evaluation after the clinical course( post ATLS) from August to October 2011.
The training program aimed to improve the skills of the ED physicians on how to deal with severely traumatized patient regarding the protocol of management of severely traumatized patients:( on resuscitation skills A (airway, cervical spine control), B (breathing) ,C (circulation) and D (disability), there was a score for each item to determine what was done properly and what was not done properly , this study revealed that the resuscitation skills of ED physicians improved at the post training period compared to the pre-training period.
The 10 ER physicians shared in this study of different seniorities (4 junior residents, 3 mid senior residents and 3 senior residents).
In the pre-training phase, the performance of ER physicians was good in cervical spine control and breathing management, (60%) in both, fair in airway management (50%) and bad in circulation and disability (30%)
In the Post training phase , the performance was markedly improved in the 10 ER physicians , the performance was excellent in cervical spine control (90%) , very good in airway management , breathing management and circulation (80%) and good in disability, (70%)
Selective repetition of the training program was essentially done for 1-3 ER physicians whose their performance wasn’t good after training like (3 physicians in disability, 2physicians in airway management ,breathing management and circulation, one physician in cervical spine control)
this course improves the initial assessment of severely traumatized patients, and declines the preventable cause of death like tension pneumothorax and shock, this study show improvement the hand skills when dealing with trauma patients like endotracheal intubation, IV cannulation and chest tube insertion
This course introduce the systematic schedule in management of severely traumatized patients and improved the outcome of mortality and morbidity , there were 23 cases out of 77patients in group A regard 14 out of 84 patients in group B
Head injuries are the most common cause of death in group A (7cases, 30.43% ) due to inefficient resuscitation and long time lag in emergency department , but in group B the most common cause of death was head injury ( 5cases , 35.71% )due to severity of the trauma in which there were association with chronic illness like , DM with acidosis in 3 patients, chronic liver disease with bleeding tendency in 2 patients and chronic renal failure on dialysis in 2 patients and bad performance of ER physicians who failed in the training program through delayed surgical intervention
The training program had the great impact in decreasing the preventable cause of death like shock (6 cases, 26.09 in group A and 2 cases, 14.29% in group B with P value, 0.003) , tension pneumothorax (3 cases, 13.04% in group A and one case, 7.14% in group B with P value( 0.02) and cardiac tamponade (3 cases ,13.04% in group A and 2 cases , 14.28% in group B) .
In our study we received 77 patients in emergency with 31 patients received emergency operation, the time lasted in causality and from admission to operation has evidently been cut down (in group A was 71.5±9.5 and 92.5±10 respectively and in group B was 50.6±7 and 65.3±11.7 respectively) with P value 0.001 it is significant and revealed good time management and success of protocol to introduce ascduled management of trauma patients
Conclusion: On the basis of the results obtained in this work, we can conclude that a theoretical and practical course, such as the ”Advanced trauma life support”, with modifying it is a good updating tool on the management of severely traumatized patients, for ED doctors who work in Suez Canal University Hospital.