Optimizing the Prehospital-Hospital Emergency Care Path Application Value in Emergency Treatment of Patients with Cerebral Hemorrhage.

Objective: To explore the effect of optimizing the prehospital-hospital emergency nursing path on the rescue speed, rescue effect, and patient prognosis of patients with cerebral hemorrhage.
Methods: A retrospective study was performed to select 227 patients with acute cerebral hemorrhage who visited our hospital from August 2018 to October 2019, and we compared the optimization of the prehospital-hospital emergency nursing pathway (research group) with traditional prehospital time spent in the rescue and the prognosis of patients in the emergency care pathway (control group) in the hospital. The GOS score, FMA score, and Barthel index were used to compare the prognosis of the two groups of patients.
Results: The prehospital-hospital emergency nursing route was optimized compared with the traditional nursing route. The rescue time of patients in each link was shorter (P < 0.05), and the incidence of complications was low (P < 0.05). The scales and scores all suggested that patients had a better prognosis (P < 0.05).
Conclusion: Optimizing the prehospital-hospital emergency nursing path can significantly shorten the rescue time, improve the rescue effect, and improve the prognosis of patients.

1. Introduction

Acute Cerebral Hemorrhage (ACH) is caused by intracranial substantial arterioles, small veins' rupture, and other reasons, and the main disease that occurs in the brain basal ganglia, brain stem and thalamus, and other parts, with high mortality and high disability rate, is the most dangerous emergency in cerebrovascular diseases [1, 2]. The treatment window for acute intracerebral hemorrhage is within 6 hours of onset [3]. If the treatment is not timely, it will endanger the patient's life. For patients with acute cerebral hemorrhage before and after admission, the path of emergency care includes prehospital first aid and hospital first aid. Prehospital first aid mainly refers to the necessary treatment measures taken by emergency medical staff for the patients in the first time before they are transferred to the hospital for treatment. The onset of sudden acute intracerebral hemorrhage is urgent and the prognosis is poor, so timely treatment has an important impact on the quality of life of patients. Studies have shown that strengthening prehospital emergency care for patients with acute intracerebral hemorrhage can reduce the risk of complications and improve the prognosis of patients [4]. Hospital first aid is the first-aid nursing operation taken from the patient's first-aid admission to the patient's critical illness relieved from life danger [5]. Prehospital-hospital integrated emergency care is a kind of prehospital effective emergency care measures, and the prehospital emergency and hospital emergency for efficient connection of the emergency care mode can win the treatment time for patients in hospital emergency, conducive to improve the prognosis of patients [6, 7]. At present, the prehospital and intrahospital emergency nursing path has been widely used, but the reports on optimizing the emergency nursing process are rare. Therefore, the research on optimizing the emergency nursing process is very important. In this study, 367 patients with acute intracerebral hemorrhage admitted to our hospital from August 2018 to October 2019 were collected to study the effect of optimizing the application of the prehospital-hospital emergency care pathway in patients with acute intracerebral hemorrhage. This study is reported as follows.

2. Materials and Methods

2.1. General Information

A total of 227 cases of acute cerebral hemorrhage diagnosed in our hospital from August 2018 to October 2019 were collected by the prospective study method. Inclusion criteria [8, 9]: (1) not less than 18 years of age and not more than 70 years of age; (2) a history of hypertension; (3) the disease progresses rapidly; (4) the patients were cured within 24 hours after onset of cerebral hemorrhage; and (5) diagnosis was confirmed by CT and/or MRI imaging within 48 h. Exclusion criteria [9, 10]: (1) pregnant or lactating women; (2) combined with coagulopathy; (3) complicated with dysfunction of important organs; and (4) have a serious impairment of consciousness, gave full informed consent, and actively cooperated in the study. Patients with acute intracerebral hemorrhage were divided into the observation group and control group, and records were established. The control group took the conventional standard prehospital-hospital emergency care path without optimal treatment, and the observation group took the optimal treatment prehospital-hospital emergency care path. The study was approved by the ethics committee of our hospital and carried out in strict compliance with ethical standards. All the volunteers included in the study were fully informed and signed informed consent. There were 102 patients (65 males and 37 females) in the control group, with an average age of 67.9 ± 8.8 years; there were 125 patients (79, 46 females) in the observation group, with an average age of 68.2 ± 7.1 years. There was no significant difference in baseline data between the two groups (P < 0.05), indicating comparability.

2.2. Method

The hospital medical personnel services rush to the scene after receiving emergency instructions, and basic life-support operation nursing such as oxygen inhalation and transfusion were given. After the patient admitted to the emergency department, monitoring the vital signs of the patient and establishing the intravenous channels, contacting the imaging department for imaging examination, to evaluate the injury and cooperate with the emergency department physician of the rescue work, were done [11]. Optimizing the path of emergency care: first, optimization before driving: the emergency nursing team consists of 10 nurses with rich experience in cerebral hemorrhage rescue system training and assessment. Before departure, they ensure that the ambulance has complete first-aid drugs and no expired drugs and ensure that the first-aid equipment and apparatus for cerebral hemorrhage are in good condition. The medical staff will depart within 3 minutes after receiving the first-aid instruction. The driver will select the optimal route according to GPS navigation and real-time road conditions and arrive at the first-aid site in the shortest time [12]. Second, first aid on the way of optimization [13]: members of the first-aid nursing team contact the field personnel during the ambulance to the scene, ask the patient's personal information, past medical history, symptoms and disease progress, and other information, assist the doctor to design the rescue plan, prepare the rescue equipment and drugs, and prepare for the transfer.

At the same time, they guide the field personnel timely and perform correct methods of first aid and avoid delayed rescue of patients or the progress of injury due to wrong rescue methods, such as asking the field personnel to loosen the collar of the coma patient's clothes, remove the corset, belt, and other bound clothes, lift the patient's head and tilt to one side, clean up oral foreign bodies, remove active dentures, and keep breathing. Third, first-aid site optimization: based on the patient's clinical manifestations, state of consciousness, positive signs of nervous system, respiration, heart rhythm, blood pressure, and other vital signs, the patient's condition was quickly preliminarized, the correct nursing measures were determined, the initial first aid was completed within 5 minutes, and the patient was quickly transferred to the ambulance [14]. Fourth, optimization on the way to hospital: venous access and oxygen inhalation were maintained, patients' vital signs such as respiration, heart rhythm, blood pressure, and body temperature were closely monitored, patients' basic conditions were comprehensively assessed, and the hospital emergency department, operating room, brain surgery or neurology, ICU, imaging, B ultrasound room, and laboratory departments were timely contacted to prepare for rescue [15]. Fifth, hospital rescue optimization: the green rescue channel was opened, the docking time between the hospital and the hospital was shortened, and the rescue with first-aid-related departments was further completed. The medication and treatment in first aid were recorded, and the handover work was carried out well.

2.3. Observational Index

The emergency intervention time, effective treatment time, waiting time for operation, and operative treatment time of patients in the two groups were recorded to evaluate the treatment efficiency [16]. Complications such as central high fever, subarachnoid hemorrhage, cerebral hernia, falling pneumonia, respiratory failure, acute heart failure, and gastrointestinal bleeding were recorded and compared between the two groups within 1 month after receiving emergency care [17]. The Glasgow Outcome Scale (GOS) was used 1 month after emergency care [18]. Motor function of limbs (FAM) [19] and daily living (Barthe1) are the same [19]. To assess the outcomes of both groups, GOS score included good (life returned to normal with no significant impact on daily life), mild disability (partial disability but able to live independently), severe disability (unable to live independently and requiring care from others), plant survival (persistent coma), and death. FAM consists of upper and lower limb motor scores with a total score of 100, with a higher score indicating better limb motor function and better prognosis. The total Barthe1 score is 100, and the higher the score is, the better the patient's ability to live daily and the better the prognosis.

2.4. Data Processing Statistical Software

SPSS 22.0 was used to analyze the data. The measurement data were expressed as (x ± s), the intergroup comparison was expressed as the T test, the count data were expressed as [N (%)], and the intergroup comparison was conducted by the χ2 test. The test level α = 0.05, and P < 0.05 indicated that the difference was statistically significant.

3. Results

3.1. Time of Emergency Care

The time of emergency intervention in the study group was 12.37 ± 5.9 min earlier than that in the control group (30.48 ± 7.2 min), and the difference was statistically significant (P < 0.05). The effective treatment time of the study group was 1.02 ± 0.3 h, which was lower than that of the control group (1.54 ± 0.4 h), and the difference was statistically significant (P < 0.05). The operation time of the control group (47.82 ± 5.1 min) was significantly longer than that of the study group (21.64 ± 6.2 min), and the difference was statistically significant (P < 0.05). There was no significant difference in the time of surgical treatment between the two groups (P=0.527). The results are shown in Table 1.

Table 1

Comparison of emergency nursing procedure time between the two groups (X ± s).

	Research group (n = 125)	Control group (n = 102)	P
Emergency intervention time (min)	12.37 ± 5.9	30.48 ± 7.2	<0.05
Effective treatment time (h)	1.02 ± 0.3	1.54 ± 0.4	<0.05
Waiting time for surgery (min)	21.64 ± 6.2	47.82 ± 5.1	<0.05
Operative treatment time (h)	3.79 ± 0.9	3.92 ± 0.4	0.527

3.2. Complications after Emergency Care

The incidence of complications of central high fever, subarachnoid hemorrhage, cerebral hernia, falling pneumonia, respiratory failure, acute heart failure, and gastrointestinal bleeding in the study group was significantly lower than that in the control group (P < 0.05). The results are shown in Table 2.

Table 2

Comparison of complications between the two groups.

	Research group (n = 125)	Control group (n = 102)	P
Central high fever (n, %)	7 (5.6)	15 (14.7)	<0.05
Subarachnoid hemorrhage (n, %)	2 (1.6)	7 (6.9)	0.034
Cerebral hernia (n, %)	2 (1.6)	4 (3.9)	0.047
Hypostatic pneumonia (n, %)	5 (4)	13 (12.7)	<0.05
Respiratory failure (n, %)	6 (4.8)	17 (16.7)	<0.05
Heart failure (n, %)	6 (4.8)	15 (14.7)	<0.05
Digestive tract hemorrhage (n, %)	4 (3.2)	9 (8.8)	0.019

3.3. The Efficiency of First Aid

The first-aid efficiency of the study group and the control group was compared. The first-aid triage time, first CT completion time, biochemical index test time, and total first-aid time of the study group and the control group were counted, respectively. The first-aid efficiency of the two groups was compared from these four indicators. The first-aid triage time of the two groups was shorter in the study group (5.45 ± 3.6 min) than in the control group (8.39 ± 4.8 min), and the difference was statistically significant (P < 0.05). The first CT completion time of the study group was 6.13 ± 1.7 min, which was smaller than that of the control group (9.64 ± 2.3 h), and the difference was statistically significant (P < 0.05). The test time of biochemical indexes in control group (18.72 ± 5.1 min) was significantly longer than that in study group (10.68 ± 3.2 min), and the difference was statistically significant (P < 0.05). The total time of emergency treatment in the study group (1.02 ± 0.3 h) was lower than that in the control group (1.54 ± 0.4 h) (P=0.527). The results are shown in Table 3.

Table 3

Comparison of first-aid efficiency between the two groups.

	Research group (n = 125)	Control group (n = 102)	P
First-aid triage time (min)	5.45 ± 3.6	8.39 ± 4.8	<0.05
Time of completion of the first CT (min)	6.13 ± 1.7	9.64 ± 2.3	<0.05
Biochemical test time (min)	10.68 ± 3.2	18.72 ± 5.1	<0.05
Total first-aid time (h)	1.02 ± 0.3	1.54 ± 0.4	<0.05

3.4. Prognosis Score of Emergency Nursing

GOS score results of the two groups showed that the proportion of patients with good rating in the study group (56.0%) was significantly higher than that in the control group (30.4%), and the difference was extremely significant (P < 0.05). The proportion of patients with mild disability, severe disability, plant survival, and death in the study group was lower than that in the control group, and the differences were significant (P < 0.05), as shown in Table 3. The comparison results of FMA score, Barthel index score, and the difference between the two groups before and after nursing are shown in Table 4. FMA score and Barthel index score after emergency nursing were significantly higher than those of the control group. The difference between the two groups before and after nursing was statistically compared, and the differences were statistically significant (P < 0.05) (Table 5).

Table 4

GOS rating of patients in the two groups after emergency treatment.

	Research group (n = 125)	Control group (n = 102)	P
Fine (n, %)	70 (56.0)	31 (30.4)	<0.05
Mild disability (n, %)	26 (20.8)	27 (26.5)	0.472
Severe disability (n, %)	14 (11.2)	1 (18.6)	0.328
Human vegetable (n, %)	9 (7.2)	14 (13.7)	0.063
Dead (n, %)	6 (4.8)	11 (10.8)	0.054

Table 5

Comparison of FMA score and Barthel index between the two groups before and after emergency care (X ± s).

	Before care	After care	Difference before and after nursing	P
FML grade
Research group (n = 125)	31.94 ± 8.1	63.58 ± 5.3	31.64 ± 7.4	0.274
Control group (n = 102)	32.14 ± 6.3	52.49 ± 7.2	20.35 ± 7.5
Barthel grade
Research group (n = 125)	34.74 ± 6.1	73.48 ± 6.5	38.74 ± 6.2	0.319
Control group (n = 102)	35.02 ± 7.3	62.79 ± 7.1	27.77 ± 7.3

4. Discussion

Acute intracerebral hemorrhage (ACI) usually comes on rapidly and can develop into a critical state rapidly due to the rupture of intracranial arterioles caused by the sudden increase in blood pressure in a short period of time. Patients may experience symptoms such as dizziness, nausea and vomiting, and even coma, temporary blindness, confusion, aphasia, and paralysis [20]. Cerebral hemorrhage can cause mechanical damage of brain tissue and mass effect of hematoma, which can lead to a large number of apoptosis of nerve cells. With the progress of the disease, hemorrhagic injury aggravates, and nerve cells begin to show necrosis [21]. Therefore, patients with intracerebral hemorrhage may cause irreversible brain injury or even disability or death if they cannot be treated timely and effectively. In the process of emergency treatment for patients with cerebral hemorrhage, the rescue team needs to rush to the scene in the shortest time and give rapid and efficient emergency treatment according to the patient's condition and then transfer the patient to the hospital for further rescue treatment [22]. The prehospital-in-hospital nursing path is a time-saving and efficient rescue mode. Rescue time and efficiency are closely related to the prognosis of patients with cerebral hemorrhage, so it is particularly important to optimize the whole nursing path in the rescue process.

The study compared the optimal first-aid nursing pathway (study group) with the traditional first-aid nursing pathway (control group). In all aspects of emergency nursing procedures, emergency intervention time, effective treatment time, waiting for operation time, and surgical treatment time, the study group was shorter than the control group, and the difference was statistically significant (P < 0.05). The results showed that the optimized first-aid nursing path was better than the traditional first-aid nursing path in the rescue speed. The incidence of complications of central high fever, subarachnoid hemorrhage, cerebral hernia, falling pneumonia, respiratory failure, acute heart failure, and gastrointestinal bleeding in the study group was significantly lower than that in the control group (P < 0.05). Therefore, optimizing the nursing emergency path can significantly reduce the prognosis of patients with complications. After emergency care, the proportion of patients with good GOS rating in the study group was significantly higher than that in the control group, and the proportion of patients with mild disability, severe disability, plant survival, and death in the study group was lower than that in the control group, with significant differences (P < 0.05). After emergency care, FMA score and Barthel index score in the study group were significantly higher than those in the control group, with statistical significance (P < 0.05). GOS rating, FMA score, and Barthel index score all showed that the optimized first-aid nursing pathway could significantly improve the prognosis of patients compared with the traditional first-aid nursing pathway.

In conclusion, the optimized prehospital-in-hospital emergency care path has more advantages than the traditional prehospital emergency care path, which can significantly shorten the rescue time, improve the rescue effect, and improve the prognosis of patients. Therefore, the optimization of the prehospital-in-hospital emergency mode is worth promoting in hospitals.