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It feels like yesterday that we wrote the editorial related to the previous issue of the Qatar Health 2020 Conference!¹. 2020 is clearly a year to remember globally as a challenging one and this probably contributed to time passing so rapidly keeping everyone so busy caring for patients and conducting research². COVID-19 has had a big impact on all aspects of our lives from the way we deliver patient care and work to how we socialize and plan for the future in general. The past year has certainly provided an opportunity for the State of Qatar to demonstrate its resilience its ability to rapidly adapt to new circumstances and to find effective solutions to new problems³⁴. Although very concerned by the current pandemic our focus needs to also concentrate on the forthcoming FIFA World Cup in 2022 and every possible health related aspects to ensure the event is safely hosted for everyone’s enjoyment. This has been clearly reflected in the Qatar Health 2021 conference program and call for abstracts (Table 1) which was organized into four parallel tracks fully hosted online for everyone’s safety. This issue of the Journal of Emergency Medicine Trauma and Acute Care contains an extensive selection of 38 out of the 94 abstracts that have been accepted for oral or poster presentation during the conference. The abstract themes are summarized in Table 2 and range from the impact of the pandemic on delivering primary care to Qatar’s preparedness to dealing with hazardous and chemical biological radiological and nuclear incidents⁵⁶. Notably 48 (51.06%) of the abstract titles contained the word COVID-19 or pandemic while only 4 abstracts (4.25%) were related to mass gatherings and sporting events. The later topics were primarily covered by multiple invited speakers with the relevant experience and proved to be the most attended conference sessions. It is worth noticing that the event attracted just over of 5400 delegates and speakers from a total of 40 countries and has received highly positive feedback. We look forward to welcoming everyone again next year as we come closer to the FIFA World Cup 2022 with many more topics partner organizations and attendees.

Welcome to this special issue of JEMTAC dedicated to the selection of 74 abstracts submitted to the Qatar Health 2022 online conference. The years are passing and the COVID-19 pandemic situation has not changed much globally. Although new vaccines have been developed and several restrictive measures have been rolled out in most countries to protect people thousands are still succumbing to the effects of COVID-19¹². Similar to the Qatar Health 2021 conference³ among the abstract submissions there is still much emphasis on how healthcare systems and services are dealing with the situation to mitigate the spread of the disease among patients and healthcare professionals while still trying to deliver physical or mental care to those in need^4–6. It is also important to point out that the same needs and concerns apply to both the general public as well as the healthcare workforce⁷⁸. From a preparedness point of view continuing professional development and testing of new processes and facilities are key to ensuring clinicians are ready to take on new roles in new environments and that technology can play a significant role in a pandemic context^9–11. This is not only true in relation to clinical facilities but as Qatar prepares to host the 2022 World Cup it is also highly relevant to sporting events during which multiple agencies need to work together collaboratively and as a multidisciplinary team as per the theme of Qatar Health 2022 and the 2^nd Qatar Public Health Conference^12–13.

The online conference has again been organized into four parallel tracks. It is dedicated to showcasing the work and opinions of leaders in their respective domains as well as the 112 abstracts that have been accepted for oral or poster presentation. The abstract themes are summarized in Table 1 and most of the corresponding abstracts are published in this special issue of JEMTAC. Submissions related to mass gatherings and sporting events were shy again this year but it is expected to be a highly prominent topic for the next edition of the conference after the 2022 World Cup. We hope you enjoy this early content preview of the conference and that it will make it even more engaging for everyone at the time of the question and answer sessions and on the poster boards. See you all online on the 10^th-12^th of February 2022!

Editorial

Trauma is a leading cause of mortality and morbidity worldwide and thus represents a great global health challenge. The World Health Organization (WHO) estimated that 9% of deaths in the world are the result of trauma.¹ In addition approximately 100 million people are temporarily or permanently disabled every year.² The situation is no different in Qatar and injury related morbidity and mortality is increasing in the entire region with road traffic collisions (RTCs) being the most common mechanism.¹

It is well recognized now that trauma care provided in high-volume dedicated level-one trauma centers improves outcome. Studies have also looked at what are the components of a trauma system that contribute to their effectiveness². However in general it usually implies a high-volume of cases dedicated full-time trauma qualified professionals a solid pre-hospital system a multidisciplinary team and excellent rehabilitation services.

Similarly critically injured trauma patients managed in a dedicated trauma intensive care unit (TICU) has been shown to improve outcomes especially for polytrauma patients with traumatic brain injury (TBI).³ In fact the American College of Surgeons (ACS) Committee on Trauma requires verified trauma centers to have a designated ICU and that a trauma surgeon be its director.⁴ Furthermore studies have shown that for TBI it is not necessary for this ICU to be a neurocritical care unit but rather it should be a unit that is dedicated to trauma that has standardized protocols for TBI management.⁵⁶ In fact the outcomes are better in the latter with lower mortality in multiple-injured patients with TBI when admitted to a TICU (versus a medical-surgical ICU or neurocritical care unit).³ These benefits were shown to increase with increased injury severity. The proposed reason for this is thought to be due to the associated injuries being managed better.⁷

The aim of this editorial is to describe the TICU at Hamad General Hospital (HGH) at Hamad Medical Corporation (HMC) including a comparison of its data and outcomes with other similar trauma centers in the world. The Qatar Trauma Registry as well as previous publications from our Trauma Center¹⁸ were used to obtain HGH TICU and worldwide Level-1 Trauma Center standards respectively.

With respect to HGH the TICU is part of an integrated trauma program the only level-1 trauma centre in Qatar. It provides the highest standard of care for critically-ill trauma patients admitted at HGH striving to achieve the best outcomes excellence in evidence-based patient care up to date technology and a high level of academics in research and teaching. This integrated program includes an excellent pre-hospital unit emergency and trauma resuscitation unit TICU trauma step-down unit (TSDU) inpatient ward and rehabilitation unit.

The new TICU is a closed 19-bed unit that was inaugurated in 2016 is managed 24/7 by highly qualified and experienced intensivists (9 senior consultants and consultants) along with 24 well-trained and experienced associate consultants or specialists and fellows and residents in training as well as expert nursing staff (1:1 nurse to patient ratio) and allied health professionals (respiratory therapists pharmacists dieticians physiotherapists occupational therapists social workers case managers and psychologists). It is supported by all medical and surgical subspecialty services.

It is equipped with the latest state-of-the-art technology and equipment including ‘intelligent ventilators” neuro-monitoring devices ultrasound point-of-care testing such as arterial blood gas and rotational thromboelastrometry (ROTEM) and video airway devices.

The TICU is a teaching unit linked to the HMC Medical Education department with presence of fellows and residents (see below for details). Medical students (Clerkship level) from Weill-Cornell Medicine Qatar also complete a one-week rotation in the TICU as part of their exposure to critical care. The first batch of clerks from Qatar University College of Medicine are expected to start rotating in the TICU soon.

The Trauma Critical Care Fellowship Program (TCCFP) is an ACGME (Accreditation Council for Graduate Medical Education) fellowship that was established over seven years ago. To date over 40 physicians from both within and out of the trauma department have completed the program. Up to seven fellows including international candidates are trained each year. A number of physicians have succeeded in gaining the European Diploma of Intensive Care Medicine (EDIC). The program continues to attract many applicants from various specialties including surgery anesthesia and emergency medicine. An increasing number of international physicians from Europe and South America have expressed interest in applying for our fellowship. The first international fellows are likely to join us from early 2020.

Residents (from general surgery ER ENT plastics orthopedics and neurosurgery) rotate (one to three months’ rotations) in the TICU and are actively part of the clinical team.

There were 568 admissions to the TICU in 2018. The patients admitted were either mainly polytrauma patients with varying degrees and combinations of head chest abdominal pelvic spine and orthopedic injuries or isolated-TBI. Of these patients 378 were severely injured with an injury severity score (ISS)⁹ greater than 16.

According to previously published data from our Trauma Centre¹⁸ our mortality rates (overall approximately 6-7% as well as when looked at in terms of early and late deaths) compare favorably with other trauma centers around the world when looking at similarly sized retrospective studies.

The TICU continues to be an active member of the Critical Care Network of HMC.¹⁰ This network involves all of the ICU's in all the HMC facilities. The main processes that the TICU is presently involved in as part of this network are: patient flow clinical practice guidelines evaluation and procurement of technologies HMC sepsis program and in general taking part in any process that pertains to critical care at HMC.

A number of quality improvement projects are being undertaken in the TICU. Examples of such projects include:

- Decreasing rates of infection in TICU - Score-guided sedation orders to decrease sedation use ventilator days and length of stay - Reducing blood taking and associated costs - Sepsis alert response and bundle compliance - Medical and surgical management of rib fractures

A multidisciplinary team of physicians nurses and allied health professionals participate in these projects and meet once a month to review all projects.

Similarly many research projects are taking place in the TICU in coordination with the Trauma Research program and often in collaboration with other departments (local and international). Examples of some of the research projects include:

- The “POLAR” study (RCT on Hypothermia in TBI)¹¹ - B-blockers in TBI (RCT-ongoing) - Tranexamic acid (TXA) for bleeding in trauma (RCT-ongoing)

The team is also involved in conducting systematic reviews in relation to the role of transcranial doppler in TBI¹² sepsis in TBI patients (ongoing) self-extubation in TBI patients¹³ safety and efficacy of phenytoin in TBI (ongoing) and optic nerve diameter for predicting outcome in TBI (submitted).

The TICU at HGH is a high-volume high acuity unit that manages all the severely injured trauma patients in Qatar. It is well staffed with highly trained and qualified personnel and utilizes the latest in technology and state-of-the-art equipment.

It performs very well when compared to other similar units in the world and achieves a comparable or even lower mortality rate.

With continued great support from the hospital corporation administration and Ministry of Public Health the future goals of the TICU will be to maintain and improve upon the high standards of clinical care it provides as well as perform a high quality and quantity of research quality improvement initiatives and educational work in order for it to be amongst the best trauma critical care units in the world.