Background and Aim: Time is the main determinant factor for survival chance in trauma patients. Therefore, this study was performed to determine the effect of management programs in trauma patients on time indices of pre-hospital emergency missions.

Materials and Methods: In this controlled field trail, 60 pre-hospital emergency technicians were divided into two test and control groups, by means of stratified random sampling. Pre-hospital trauma management training programs which had been formulated on the basis of available national and global standards were implemented, by using a combination of training lecture and simulation methods for the test group. Research tools were demographic questionnaire and standard pre-hospital emergency care reporting form. Mean values for time indices were determined before, after, and also one month after intervention in both groups. Using SPSS 19, data were analyzed by independent t-test, Repeated Measures Analysis of Variance, and Bonferroni’s follow up test.

Results: Mean scene time in the test group (one month after intervention) was significantly lower than that in the control group (p=0.05). Also, mean and standard deviation of scene time in the test group decreased from 17.6±5.5 minutes (before intervention) to 12±3.8 minutes (one month after intervention), which showed a significant reduction (p˂0.001).
Conclusion: According to the results, performance of pre-hospital trauma management training programs can lead to reduction of scene time in pre-hospital emergency missions. Therefore, considering the role of reduced scene time in the prognosis of trauma patients, integration of the periodic training of the trauma management programs into pre-hospital emergency training programs seems necessary.

• Background and Aim: Anal fissure is one of the common anorectal disorders that there are various therapies for it. The aim of this study is to evaluate the effect of Nitroglycerin plus Diltiazem vs either topical Diltiazem and Bethanechol alone in the treatment of chronic anal fissure.
  Materials and Methods: The present randomized double-blind clinical trial was performed on 90 patients with chronic anal fissure referred to the gastroenterology clinic of Tohid Hospital, Sanandaj, Iran, from March 2016 to February 2017, That randomly were divided into three equal groups (n = 30): A: combination therapy (1% Nitroglycerin plus 5% Diltiazem gel), B: Diltiazem (5% Diltiazem gel) and C: Bethanechol (0.1% Bethanechol gel). The drugs were administered topically three times daily for 8 weeks. After 4 and 8 weeks’ administration wound condition, pain and bleeding were assessed. Data were analyzed by SPSS v.19 software with Chi-square test.
• At the beginning of the study, there was no significant difference in mean age, sex, fissure location, hemorrhoids, bleeding, and pain between the three groups (P> 0.05). Four weeks after treatment, there was no significant difference between the three groups in terms of Wound healing (P = 0.41), pain (P = 0.10), and bleeding (P = 0.07). After 8 weeks, there was a significant difference for pain in the treatment groups (P = 0.04), so that in the diltiazem group, the pain was significantly decreased in comparison to Betanchenol and There was no significant difference between the three groups in the case of Wound healing (P = 0.10) and bleeding (P = 0.69).
• Topical use of diltiazem is a more appropriate option for the treatment of chronic fissure than the other two drugs.