An excellent training manual for healthcare professionals in Trauma Management


 Top to Toe TRAUMA CARE by Prof. Saeed Minhas

An excellent training manual for healthcare
professionals in Trauma Management

KARACHI: Prof. Saeed Minhas is a noted orthopedic surgeon, faculty member at country’s premier postgraduate medical Centre Jinnah Postgraduate Medical Centre/Jinnah Sindh Medical University, Karachi. For the last many years he is actively involved in teaching and training of healthcare professionals in Primary Trauma Care. He is affiliated with World Council of Primary Trauma Care Foundation UK. He has also trained about ten instructors. Having trained a large number of healthcare professionals in Primary Trauma Care not only all over Pakistan but in numerous provinces of China, Iraq, Jordan, Afghanistan, Nepal, Sri Lanka, Bangladesh and India, he has accumulated a wealth of firsthand experience. He has now documented all this in the form of a book “Top to Tow TRAUMA CARE” which is an excellent training manual for training of healthcare professionals in trauma management.


This 356-page book has been divided in to six sections in which integrated Trauma Care System, Mass Casualty incidents and disaster response, approach to seriously injured patient, regional trauma, extremity and pelvic trauma besides trauma scenarios have been discussed in detail. As pointed out by the author, trauma remains the most under-recognized health problems facing our society today. Potential injury hazards exist everywhere. Pakistan is reported to have one of the highest mortality figures resulting from Road Traffic Accidents, armed conflicts and natural disasters. This highlights the need to train the healthcare personnel in trauma and disaster. Most of the low income countries have over 90% deaths related to Road Traffic Accidents and this calls for working-out improved injury prevention strategies.

According to Prof. Saeed Minhas working in the field of trauma care for the last thirty three years,  teaching basic trauma care for the last over two decades enabled him to document all his experience and this book is the result of all this. For an effective trauma care system, development and training of human resource is extremely important. He has endeavored to provide a comprehensive overview and Introduction of integrated trauma care system besides highlighting the trauma care in “Golden Hours.” Integrated trauma care system, he writes can reduce mortality and morbidity of trauma victims. It is unfortunate to note that even in well-established centers, emergency care is most often performed by House Officers and postgraduate students who are not well trained to manage trauma. Prof. Saeed Minhas believes that a trauma training programme should be mandatory for all house surgeons and postgraduates of allied specialties and they should join hands to work as a team. Trauma team should consist of group of healthcare professionals with specific training in resuscitative trauma management. It should include physicians, nurses and paramedics. A qualified consultant anesthetist and a trauma surgeon should be present in-house who should function as a team leader. This team should also have access to orthopedic surgeons, neurosurgeons, general and vascular surgeons, plastic and thoracic surgeons that are able to make decisions and are also capable of intervening surgically when required. Most of the preventable post traumatic deaths and disability is the result of inadequate resuscitation and delay in proper surgical care which can be reduced through a trauma care system managed by trauma care team.

The important components of Trauma Care System mentioned in the book include Prevention, Trauma Registry, Pre Hospital Care, Effective and coordinated Transfer system and Triage System. Trauma is defined as a serious or critical bodily or physical injury which may be blunt, penetrating or burn injury which requires immediate medical treatment to ensure that the victim survives. Various levels of trauma level, Trauma Center categorization have been discussed in detail. Trauma Center Prof. Saeed Minhas writes is the crown jewel of the Integrated Trauma Care System. The Core Trauma Team should include Team Leader, Anesthetist, Anesthetic Assistant, General Surgeon, Orthopedic Surgeon, Emergency Room Physician, at least two nurses and Radiographer. If need be Neurosurgeon, Thoracic Surgeon, Plastic Surgeon and Radiologist should also be available immediately when their need arises. CT scan, intensive Care and Operation Theatres needs to be immediately informed to ensure good care of trauma victims.

Using different colors in the illustrations, the Primary Triage and Hospital Incident Command System with Victims Flow has been highlighted. Different colors are used i.e.  Red for immediate attention of patients with life threatening injuries, Delayed Yellow color for those who do not have life threatening injuries,  Green for Walking Wounds i.e. patients who are ambulatory while Black color is used for those victims who have expired. Safe transfer of trauma victims, how to break the bad news, Safety Culture in Operation Theaters also provide lot of useful information. How to handle mass casualties and Disaster Response has been covered in Chapter-10. Indigenous pictures of actual trauma have been used extensively to supplement the useful information provided in the book which is extremely useful to understand the trauma care. This chapter also covers the problems faced in managing Bomb Blast Victims in Accident and Emergency Center. The importance of communication from the site of incident and ambulances to hospitals has also been emphasized as an efficient communication system between the ambulances and hospitals is extremely important. Gun Short injuries management, signs of internal bleeding i.e. decreasing alertness, Nausea and Vomiting, Weak Pulse, Lowering Blood Pressure or faster pulse, low body temperature, cold/clammy skin have been mentioned in detail which will help the healthcare professionals to identify such victims easily.

Principles of Damage Control Surgery, Wound Care Guidelines, Approach to seriously injured patients, Primary and Secondary survey, importance of establishment and maintenance of Airway Patency, signs of airway obstruction, Blood Transfusion,  Cardio Pulmonary Resuscitation, Trauma to different body organs like Head, Spinal, Maxillofacial Ares, Ocular Trauma, Neck, Chest, abdomen,  Trauma during pregnancy, Burn injuries, Management of Psychiatric trauma, Extremity and  Pelvic trauma, Crush Syndrome, Traumatic Amputation and Replantation, Pain Relief in Trauma Care and Ketamine have been discussed in separate chapters.  It has been pointed out that often analgesics will not produce sedation and sedatives will never produce analgesia.

Medical students, postgraduates and all those who are interested in understanding trauma and its management will find this book extremely useful and goldmine of information. It can also be extremely informative for those preparing for Fellowship examination while it can also serve as a useful reference source while dealing with day to day trauma patients in emergency departments of healthcare facilities. Prof. Saeed Minhas has been very generous in acknowledging all those who made useful contributions to this book and they include Prof. Rashid Jooma, Prof. Tipu Sultan, Dr. Seemin Jamali, Prof. Saira Haider, Dr. Rashid Aqeel, Prof. Gen. Shahab Naqvi, Prof. Lubna Baig, Prof. Iqbal Afridi, Prof. Brig. Arslan Bukhari, Dr. Ali Zia, Dr. Syeda Zahreen Raza, Dr. Mansoor and Ms. Bushra Umar. ISBN: 978-9-92-30002-5 Price. Rs. 700/- Those interested can contact the author at e mail: This email address is being protected from spambots. You need JavaScript enabled to view it.   SAJ

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