This document summarizes the role of nurses in the emergency room resuscitation room of Mubarak Al-Kabeer Hospital in Kuwait. It provides data on 712 trauma patients treated in the resuscitation room over one year, with the majority being victims of road traffic accidents. It describes the nursing interventions performed during the critical "golden hour" period, including airway management, monitoring, procedures, and coordination with other departments. Outcomes were generally positive when the interdisciplinary trauma team was able to intervene within the crucial 60 minute window after injury. Recommendations include increasing public education efforts to reduce accidents and studying quality of care for multi-trauma patients.

1. Nurse's Role in ER
Resuscitation Room
Prepared by : Ms.S Peter,
SDU, Mubarak Al-Kabeer Hospital Kuwait

2. This study and presentation is dedicated to
The Emergency room Health Team-
Doctors -and Especially Nurses
in Mubarak Hospital - for their sincere
effort and efficiency in saving
life-&-limb of each trauma victims

3. DEFINITION: TRAUMA
Trauma is a wound or injury characterized
by a structural alteration or
physiological imbalance resulting
from acute exposure to mechanical,
thermal, or chemical energy
TRAUMA --- BLUNT & OPEN injuries

4. Trauma has been long recognized as a
major cause of
morbidity and mortality
in all age groups

5. The time frame - patient in the
resuscitation
(Reso) room in Emergency
department
is called the 'Golden hour' for
victims.

6. The concept of the Golden Hour is
the window of
opportunity for the institution
of
Life–and–limb measures
60% of the hospital deaths from
trauma occurred this crucial
period

12. Data Collected for -
Duration : 1 year
January 1st
– December 31st
,2009
TOTAL CASES : 712
( in RESO Room)

13. Multiple trauma cases with EMERGENT
conditions only included in this
assessment
Road Traffic Accidents – Automobile
collisions / pedestrians
Motorcycle Accidents
Buggy (ATV) accidents
Fall from height / heavy object fall
Stab wound /blunt trauma – Quarrel/ self
induced
Gunshot

14. The injuries caused by-------
414
142
114
35
6 10
50
100
150
200
250
300
350
400
450
Gunshot ( 1 case)
ATV(Buggy)accidents(0.8%)
Motorcycle accidents(5%)
Stab/blunt injuries(16%)
Fall injuries(20%)
Road Traffic accidents
(58.2%)

15. Grand Total patients ( in all
categories)
received in Medical Surgical
ER Mubarak Hospital
1st Jan – 31st Dec 2009 :
241649
As per Interior Ministry statistic
Total accident victims brought to Mubarak
Hospital during this period = 1503

16. Let’s STOP ………a while ---- &
do a simple calculation…
– Emergent TRAUMA patients received Mubarak
Hospital resuscitation room = 712 for 1 year
If we calculate for 6 Regional Hospitals
It will be ----------
6X 700 = 4200 (approximate)

17. 234
275
174
29
Kuwaity(33%)
Arabs(39%)
Non Arabs(24%)
Unknown(4%)
Nationality

18. SEXSEX
535
177
Male (75%)
Female(25%)

19. Age Groups
223
119 115
82 70 69
0
50
100
150
200
250
51-65 yrs (10.4%)
2-11yrs (9.8%)
41-50 yrs (11.5%)
31-40yrs(16.2%)
11-20yrs ( 16.8%)
21-30yrs (31.3%)

20. Casualties brought to ER -
93 63
581
EMT(81.6%)
Relatives(13%)
Others(9%)

21. Upon Arrival in ER
518
208
50
66
7
0
100
200
300
400
500
600
Dead/Resuscitated(0.4%)
Progressed to unconsc(9.3%)
Unconscious/Gasping(7%)
confused/irritable(29%)
Conscious(81.6%)

22. Type of major Injuries -
97
38
192
27 32
0
50
100
150
200
1 2 3 4 5
Severe Cut
wounds(4.5%)
GI,G.U,/Bleeding
(4.5%)
#s Extremities (27%)
Chest (5.3%)
Head/spine(13.6%)

23. Primary Nursing Survey &
Stabilizing
Emergent Casualty
A : Airway Maintenance &
Cervical
spine protection
B : Breathing & Ventilation
C : Circulation & Hemorrhage
control
D : Disability – Neurological
Status

24. Nursing Interventions :
Non-invasive & Invasive procedures :
Monitoring – ECG,BP,SPO2 (97%)
Oxygen administration (97%)
Intra Venous access (97%)
Blood extraction ( 97%)

25. Preparing /Assisting/performing
invasive procedures
 Blood Transfusion (12%)
 E.T Intubation & Ventilatory support (11%)
 ABG Assessment (12%)
 Chest Tube insertion (3%)
 Naso Gastric Tube insertion (10%)
 CVP insertion (3%)
 Foley’s Catheter Insertion (23%)
 Control of bleeding, Suturing in Reso room – (26%)
 Dressing (33%)

26. Contacting Other Departments
46%
48%
3%
3%
0%
Orthop(338)
Surgery(351)
Neurology(20)
F.Maxillary(23)
Spine (7)

27. Transporting/transferring victims
Inside Hospital
Radio-diagnostic studies /Ultrasound :97%
Main OT : 4%
ICU : 13%
Surgical Wards : 13%
Outside Hospital
Razi Hospital : 19%
Ibnsina Hospital : 2%

28. Duration of stay in Reso room
228
185
116
61
43
37
11
0
50
100
150
200
250
1-2hrs 2-3hrs 3-4hrs 4-5hrs 5-6hrs 6-7hrs >7hrs
>7hrs (2%)
6-7hrs (5.1%)
5-6hrs (6%)
4-5hrs (8.6%)
3-4hrs(16.2%)
2-3 hrs (26%)
1-2 hrs (32%)

29. The expected outcome is positive
for each client.
If succeed each of the team will say-
Otherwise –
“We tried our maximum, but -
we could not make it “

30. WE did It …………
( or ) “We tried our maximum, but -
we could not make it “

31. Suggestions & Recommendations:
 Public awareness to the types of emergencies and its
impacts – to reduce the incidence of accidents and strict
implementation of rules and regulation in collaboration
with different ministries
Education of public through different media , especially
for school children
Conduct study on the Quality-Care- cost
of hospitalizing multiple trauma victims
and their rehabilitation

32. News clip from KUNA
KUWAIT, March 1 (KUNA) –
Road accidents in Kuwait have claimed the lives
of 77 people in January and February
2010, a senior security official said here
Monday. Extremely concerned over the growing
number of victims of car accidents in Kuwait .
REMEMBER –
This is the Traffic Awareness Period in Kuwait

33. Sincere thanks to:
Ms Awatef Al-Qatan
(Director Nursing Department)

34. REFERENCES:
 Sowell, R., & Meadows, R. (1994). An integrated case management model:
developing standards, evaluation and outcome criteria. Nursing Administration
Quarterly, 18(2), 53- 64.
 PAMELA J. HOLMQUIST, MBA, BSN, RN, is Director, Trauma, Utilization
Management, Social Work, Mercy Hospital and Medical Center, San Diego, CA.
 Holmquist, P., Songne, E.A., Shaver, T.E., & Peirog, L.J. (1991). Trauma case
manager development and implementation as a nursing role in a community
trauma center. The Journal of Trauma, 1001(31),103-106.
 Kenneth L Mattox, David V etal, , Trauma 4th Edn McGraw-Hill, NY,2000
 Thomas AC ,Jefrry : 2nd Edn , Emergent management of Trauma , Mcgraw hill
2001
 William PB, David C Yearbook of Emergency Medicine 2001
 J Emergency Nursing:Vol 32,issues 4, Aug 2006
Web sites:
www.caraccidentskwt.com
www.traumanurses.org