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%).