Study on the Effect of Prehospital Emergency Nursing Model Based on Network Information Sharing Platform in Acute Ischemic Stroke.

Background: Acute ischemic stroke is one of the most common emergencies in clinical medicine. Prehospital first aid of ischemic stroke has become the focus and focus of the global medical community. The combination of network information technology and prehospital first aid can better serve the treatment of ischemic stroke. Objective: To explore the effect of prehospital emergency nursing model based on network information sharing platform in acute ischemic stroke.
Methods: 78 patients with acute ischemic stroke from February 2020 to October 2021 were studied. Patients were randomly divided into study group (n = 39) and control group (n = 39). The control group was given routine first aid nursing. Prehospital first aid nursing based on network information sharing platform was used in the study group. Alarm response time, on-site first aid response time, hospital handover time, National Institutes of Health Stroke scale (NIHSS) at 12 and 24 hours after admission, Glasgow coma scale (GCS) at 12 and 24 hours after admission, incidence of poor prognosis, and nursing satisfaction score at 24 hours after admission were recorded.
Results: The emergency response time and hospital handover time in the study group were significantly shorter than those in the control group (P < 0.05). The NIHSS score and the incidence of poor prognosis at 12 and 24 hours after admission in the study group were lower than those in the control group (P < 0.05). The GCS scores at 12 hours and 24 hours after admission in the study group were higher than those in the control group (P < 0.05). The NSNS score of the study group was higher than that of the control group.
Conclusion: Prehospital first aid nursing based on network information sharing platform has great application value in patients with acute ischemic stroke. It can shorten the time of first aid, improve patients' consciousness, and reduce the incidence of poor prognosis.

1. Introduction

Acute ischemic stroke is one of the most obvious emergencies in clinical medical work, which accounts for 60-80% of all strokes [1]. It has the characteristics of high incidence, high disability rate, and high mortality, and most of them have poor prognosis [2, 3]. How to prevent and treat ischemic stroke has become the focus and hot spot in the medical field globally. Most of the stroke patients treated in emergency department are acute onset. Epidemiological investigation has shown that the case fatality rate of patients with severe stroke can reach 20.2% [4]. Thus, it can be noticed that the condition of emergency stroke patients is dangerous and makes rapid progress. According to the statistics of the World Health Organization, about 61/100000 will suffer from or recur ischemic stroke every year [5]. One person has symptoms of ischemic stroke every two seconds, and the number of deaths is about 22.45% of the total deaths [6]. More than 70% of the survivors have neurological disorders such as physical dysfunction or speech disorders, which bring great psychological harm and heavy human burden to human beings and society.

Studies have indicated that due to the acute onset and critical condition of cerebrovascular emergency, if the judgment is not accurate and the rescue is not timely, the rate of sudden death is very high [7-10]. 1/5 of patients with acute cardio-cerebrovascular emergency develop respiratory and circulatory failure within 60 minutes after onset and die before the arrival of prehospital first aid [11-13]. Therefore, the earlier treatment to patients with cardio-cerebrovascular emergency is particularly important. Patients within the effective time window must be treated as soon as possible, which attaches importance to saving lives and enhancing prognosis [14-18]. The prehospital emergency capabilities of medical staff can shorten the reperfusion time of brain tissue and heart muscle and improve patient outcomes. The guidelines have pointed out that prehospital first aid is very important. This puts forward higher requirements for the first aid ability of prehospital first aid personnel.

As a part of the social security system, prehospital first aid belongs to the basic public health medical service, which plays an increasingly important role [19]. Usually, the prehospital first aid environment is mixed, the disease is diverse, the condition is different, and there are many factors that affect the first aid effect and outcome. In the practical work of prehospital first aid, there are high requirements for the configuration of first aid network and hardware facilities, as well as the professional and technical ability of the first aid team. It is a great challenge to the experience, psychological confrontation ability, and emergency response ability of prehospital first aid workers. In the prehospital first aid work, the most critical first hour is divided into three minutes of diamond, ten minutes of platinum, and one hour of gold [20]. Some experts even have put forward slogans such as “time is myocardium, time is life” to highlight the value of prehospital first aid time [21]. The ability to diagnose and treat in the shortest and fastest time is an important factor in prehospital care and is the first indicator in the evaluation of emergency services [22]. Prehospital emergency care plays an important role in saving treatment time, saving lives, promoting prognosis and rehabilitation, and reducing the financial burden on patients and their families as the site where the first access to a professional medical team is available. With the development and application of network information technology in the world, the combination of network information technology and medical treatment can better serve the modern medical work. In prehospital emergency care, information and network technology is used as support to provide network information technology guarantee for prehospital emergency care, making the process of prehospital emergency care more reasonable and perfect, shortening the overall emergency care time, and thus improving the effectiveness of prehospital emergency care [23]. Therefore, this study was to explore the effect of prehospital emergency nursing model based on network information sharing platform in acute ischemic stroke.

2. Patients and Methods

2.1. General Information

In total, 78 patients with acute ischemic stroke cured from Feb. 2020 to Oct. 2021 were enrolled in our hospital, all of which met the standard of Chinese guidelines for diagnosis and treatment of Ischemic Stroke 2018 [24]. Using double blind test, all patients with acute ischemic stroke were randomly divided into study group (n = 39) and control group (n = 39). In the research cohort, there were 20 males and 19 females with an average age of 58.45 ± 3.16 years old. In the control cohort, there were 19 males and 20 females with an average age of 58.48 ± 3.23 years old. None of significant differences were exhibited in gender, age, disease type, and NIHSS score on admission of patients (P > 0.05).

Inclusion criteria were as follows: (1) all patients with acute ischemic stroke underwent cranial CT to exclude hemorrhagic diseases, (2) the age was over 18 years old and under 80 years old, (3) cerebrovascular occlusion was confirmed by imaging examination, and (4) the informed consent form was signed by the patient or legal representative.

Exclusion criteria were as follows: (1) patients who refused to continue the treatment of stroke and refused to investigate during the treatment; (2) brain imaging examination found intracranial hemorrhage or large area cerebral infarction; (3) patients who may have the following cognitive diseases before onset, such as Alzheimer's disease, hydrocephalus or space occupying lesions, Parkinson's disease, Parkinson's syndrome, hypothyroidism, central system infection, metabolic encephalopathy, brain trauma, and cerebrovascular malformation; and (4) rescue patients who died immediately after the doctor's order.

2.2. Treatment Methods

Routine first aid nursing was carried out in the control group: 120 first aid process was adopted to carry out first aid nursing (as indicated in Figure 1).

Figure 1

120 first aid flow chart. Research group scheme: prehospital emergency nursing based on network information sharing platform.

Previous treatment: dispatching and receiving alarm+ dispatching car: dispatching and directing 10 seconds to pick up the alarm (that means the emergency call will be answered within 10 seconds) and the dispatcher will send the car within 1 minute after receiving the call. Get out of the car within 3 minutes after the dispatch is obeyed (the first line receives the dispatch instruction to the emergency departure time). Quickly rushed to the scene; on the way to contact the police in advance, ask the number of people who need to be treated, preliminary judgment of the disease, and know the exact location or the location of the accident site. Fully estimate the site according to known information and take personal protective measures. Before arriving at the scene, the dispatch and command center through the GPS navigation and positioning system inputs the site location into the vehicle navigation system through the vehicle first aid information system software and sends the location information to the first aid network WeChat group after reconfirmation by the center and the patient, quickly and accurately locate the location of the patient or the wounded, judge the road condition information in real time, and rush to the scene accurately and quickly

During the treatment: (1) on-site assessment: confirm the safety of the surrounding environment after arriving at the scene, quickly evaluate the patient, and determine the nature and mechanism of the disease and whether support is needed. Consider whether to give priority to emergency treatment according to the condition or injury mechanism and report the specific situation to the superior. If it is a large-scale disaster, it will be dealt with in the process of injury detection and classification. (2) Initial assessment: priority should be given to solving the problem of life in crisis. Determine reactions, levels of awareness, chief complaints, and life-threatening external factors. Evaluate the airway (check whether the airway is unobstructed, if there is a foreign body in the oropharynx, etc., if immediately stop the evaluation immediately, all patients routinely take oxygen), evaluate breathing (evaluate the frequency, depth, abnormal breathing sounds, etc.), and evaluate circulation (evaluate/control massive bleeding, evaluate pulse, and evaluate skin including color, temperature, and status). If the patient has unstable vital signs, the evaluation should be stopped immediately, and the relevant treatment should be done immediately [25]. (3) Reevaluation: focus on medical history inquiry and physical examination and detailed evaluation of the patient from the top of the head to the toe and should be dealt with in time when problems are found. Ask about the patient's past disease history, including “AMPLE” (history of allergy, medication, past history, eating, and inducing factors) and use professional instruments to evaluate the patient's basic vital signs, including respiration, heart rate, pulse rate, blood pressure, and oxygen saturation. (4) Routine treatment according to the actual condition of the patient, give oxygen inhalation (concentration adjustment), instrument monitoring, body position adjustment, establishment of single and double venous channels, drug treatment, necessary auxiliary examination, instrument treatment (such as brace and splint), and psychological nursing [25]. (5) Transfer: the above steps are completed continuously on the spot or on the way, and the patient's condition tends to be stable (or continuous treatment on the way), and the patient is transferred to a stretcher to be properly fixed. Continuously monitor the vital signs on the way to transport the patient, closely observe the changes of the patient's condition and give other symptomatic treatment in time if necessary. Decide whether to choose a specialist hospital according to the type of disease (such as infectious disease hospital, snake institute designated hospital, and psychiatric hospital). The nearby treatment would be chosen according to the severity of the disease or the wishes of the patients. After determining the place of treatment, the first responder will notify the receiving hospital in advance by telephone. According to the specific condition and injury of the patient, the information platform was connected with the receiving unit in the hospital. Through the prehospital network information sharing platform and multichannel contact methods, including each unit prehospital emergency WeChat group, “cloud diagnosis” APP, ECG real-time transmission equipment, wireless communication equipment, and in-hospital receiver, notify in-hospital reception and prehospital prenotification. Additionally, briefly and accurately inform the hospital of the number of patients in the receiving department, their main medical conditions, vital signs, examination reports, estimated arrival time, and the equipment and drugs to be prepared, whether consultation or specialist support is required. The above equipment is operated by trained first responders. (6) Ambulance drivers are trained to master APP, vehicle navigation, and other operations, according to the network information sharing platform to provide locations, plan routes, understand real-time road condition information, and quickly send patients to the hospital. (7) On arrival at the designated hospital, diagnostic and examination reports are transmitted to the hospital in advance as the ambulance equipment has communicated with the hospital in advance about the manner of treatment. As a result, the required personnel and equipment are largely on standby or ready to receive the patient or casualty. After the patient has been identified prehospital and in-hospital, the receiving department receives the patient and adds information on any changes in the patient's condition. (8) Charges for emergency patients should be entered into the green channel for priority payment or use the online automatic payment platform, etc. to simplify the charging process. (9) Return to the premises after the first aid mission to standby, clean and disinfect, replenish and grade first aid supplies, and complete the emergency medical records within the specified time

2.3. Observation Index

The main results are as follows:

Record the alarm receiving time, on-the-spot emergency treatment time, emergency response time, and hospital handover time

Fill in the National Institutes of Health Stroke Scale (National Institutes of health Stroke Scale (NIHSS)) score of 12 hours and 24 hours after admission. NIHSS [26] has a total of consciousness level (0-3 points), consciousness level questioning (0-2 points), consciousness level instructions (0-2 points), gaze (0-2 points), visual field (0-3 points), facial paralysis (0-3 points), upper limb movement (0-9 points), lower limb movement (0-9 points), limb ataxia (0-9 points), sensation (0-2 points), language (0-9 points), dysarthria (0-9 points), neglect (0-2 points), and other assessments. The higher the score, the more severe the neurological deficit

The Glasgow coma scale (GCS) scores of 12 hours and 24 hours after admission were studied. The total score of GCS is 15 marks [27]. 15 points represent a clear consciousness; 12-14 points represent mild disturbance of consciousness; 9-11 points represent moderate disturbance of consciousness; ≤8 points represent coma. The lower the total score, the more severe the disturbance of consciousness

To study the incidence of poor prognosis 24 hours after admission, NIHSS score was adopted to evaluate at admission. Before leaving the emergency department or 24 hours after admission, the short-term adverse prognosis of stroke was defined as no change in NIHSS score, deterioration, and death during hospitalization [28]

The score of nursing satisfaction was evaluated. Evaluation with Newcastle nursing satisfaction scale (NSNS), the NSNS has a total of 19 test items, which are graded on a 5-point scale from 1 to 5. One of them means very dissatisfied. 2 points indicate dissatisfaction. 3 points indicate general satisfaction. 4 points indicate satisfaction. 5 points indicate great satisfaction. The higher the score, the higher the satisfaction

2.4. Statistical Analysis

The SPSS24.0 software was used for statistical analysis of data, and the GraphPad Prism 8.0 software was used to draw statistical charts. The measurement data in accordance with normal distribution were presented by mean ± standard deviation (). Paired sample t-test was adopted for intragroup comparison, and independent sample t-test was adopted for intergroup comparison. P < 0.05 exhibited statistically significant. If it was not consistent, it was presented by the median (lower quartile to upper quartile). Paired sample nonparametric test was adopted for intragroup comparison, and independent sample nonparametric test was adopted for intergroup comparison. The grade data were examined by FISHER accurate method, and P < 0.05 exhibited statistical significance.

3. Results

3.1. The Alarm Receiving Time, On-Site First Aid Disposal Time, Emergency Response Time, and Hospital Handover Time between Both Groups

The emergency response time and hospital handover time in the study group were shorter compared to the control group (P < 0.05), indicating that the study group is better than the control group, as indicated in Table 1.

Table 1

The alarm response time, on-site first aid disposal time, emergency response time, and hospital handover time.

Grouping	Time to answer alarm(s)	On-site first aid disposal time(s)	Emergency response time(s)	Hospital handover time(s)
C group (n = 39)	59.54 ± 13.19	585.82 ± 175.11	14.54 ± 3.19	140.82 ± 35.11
R group (n = 39)	42.55 ± 10.12	500.69 ± 168.23	3.55 ± 1.12	111.69 ± 30.23
t value	6.269	2.189	20.300	3.926
P value	<0.01	0.032	<0.01	<0.01

3.2. The Scores of NIHSS at 12 Hours and 24 Hours after Admission

The NIHSS scores of 12 hours and 24 hours after admission in the study group were lower compared to the control group (P < 0.05), indicating that the study group is better than the control group, as indicated in Table 2.

Table 2

The scores of NIHSS at 12 hours and 24 hours after admission.

NIHSS score (points)	12-hour admission	24-hour admission
C group (n = 39)	29.78 ± 3.47	21.33 ± 2.08
R group (n = 39)	24.55 ± 2.25	15.45 ± 1.14
t value	7.898	15.481
P value	<0.01	<0.01

3.3. The Scores of GCS at 12 Hours and 24 Hours after Admission

The GCS scores at 12 h and 24 h of admission in the study group were higher compared to the control group (P < 0.05), indicating that the study group is better than the control group, as indicated in Table 3.

Table 3

The scores of GCS at 12 hours and 24 hours after admission.

GCS score (points)	12-hour admission	24-hour admission
C group (n = 39)	5.54 ± 1.19	8.45 ± 1.33
R group (n = 39)	7.55 ± 1.12	10.11 ± 0.23
t value	7.6813	7.681
P value	<0.01	<0.01

3.4. The Incidence of Poor Prognosis 24 Hours after Admission

The incidence of poor prognosis in the study group was lower compared to the control group 24 hours after admission (P < 0.05), indicating that the study group is better than the control group, as indicated in Table 4.

Table 4

Study the incidence of poor prognosis 24 hours after admission.

Grouping	Number of cases of poor prognosis 24 hours after admission			Total cases	Incidence of poor prognosis 24 hours after admission (case/%)
	NIHSS the score does not change	NIHSS score deterioration	Pass away
C group (n = 39)	10	5	2	17	43.59
R group (n = 39)	5	2	0	7	17.95
χ 2 value					6.019
P value					0.014

3.5. The NSNS Score of Two Groups

The NSNS score of the study group was higher compared to the control group (P < 0.05), indicating that the study group is better than the control group, as indicated in Table 5.

Table 5

The NSNS scores of the two groups.

Grouping	NSNS score (points)
C group (n = 39)	84.11 ± 1.15
R group (n = 39)	91.14 ± 2.26
t value	17.313
P value	<0.01

4. Discussion

With the acceleration of population aging, the problem of acute ischemic stroke has become increasingly serious. The concept of “time is the brain” has been recognized by more scholars [29]. How to recanalize blood vessels in the shortest time and interrupt the pathological process of patients with ischemic stroke is the key to rescue acute ischemic stroke.

It has been found that in recent years, arterial thrombolysis, combined arteriovenous thrombolysis, endovascular angioplasty, stenting, mechanical thrombolysis, and mechanical thrombolysis combined with urokinase arterial thrombolysis have become increasingly popular with a wide range of medical professionals. Because there is a strict time limit for arterial thrombolytic therapy, many clinical trials of cerebral infarction use 6 hours as the treatment time window [30]. The time window of arterial thrombolysis is within 6 hours of the onset of the anterior circulation, and the posterior circulation can be extended to 24 hours [31]. Beyond this time window, the treatment will be delayed, and the disease will be delayed. Of note, standard thrombolytic therapy will increase the risk of rebleeding after thrombolysis in ischemic stroke and even endanger the life of patients [32]. Therefore, early arrival at the hospital and standardized treatment is particularly important to enhance the prognosis of patients with acute ischemic stroke.

Due to the uneven development of each region and the influence of many aspects such as policy, economy, environment, and population, the hardware facilities and software strength of first aid in many cities cannot meet the actual needs. In addition, there is a lack of a standardized model for prehospital resuscitation of ischemic cardiovascular emergencies in most countries. There is still a lack of experience in the treatment of ischemic cardiovascular emergencies, mainly in terms of deviations in information transfer and treatment techniques. The ambulance information cannot establish an effective connection with the information of the emergency department of the platform hospital. Therefore, shortening the prehospital emergency time and the interface between prehospital and in-hospital, improving the effectiveness of emergency care, and establishing a rational, standardized, and scientific emergency procedure are a pressing issue [33]. With the strong support of the state to the network information technology, the arrival of the 5G commercial era has promoted the development of information-based medical treatment. Big data, Internet, artificial intelligence (AI), and regional connection enable information to be fully integrated and shared [34]. The proposal of “5G medical treatment, intelligent medical treatment” is the product of the combination of information network technology and medical treatment, which leads China's medical treatment into a new period of development [35]. Therefore, this paper carried out a randomized controlled study to explore the effect of prehospital emergency nursing model based on network information sharing platform in acute ischemic stroke.

This paper finds that the emergency response time and hospital handover time in the study group were shorter compared to the control group (P < 0.05), indicating that the study group is better than the control group. The NIHSS scores of 12 hours and 24 hours after admission in the study group were lower compared to the control group (P < 0.05), indicating that the study group is better than the control group. The GCS scores at 12 h and 24 h of admission in the study group were higher compared to the control group (P < 0.05), indicating that the study group is better than the control group. The incidence of poor prognosis in the study group was lower compared to the control group 24 hours after admission (P < 0.05). The NSNS score of the study group was higher compared to the control group (P < 0.05), indicating that the study group is better than the control group. The results further confirmed the significant application value of prehospital first aid nursing based on network information sharing platform in patients with acute ischemic stroke. This is mainly because (1) network information construction provides strong support for the development of prehospital first aid work [36]. With the support of network information technology, the regional emergency linkage is adopted as the first aid guarantee, so that the center and the prehospital and in-hospital can grasp the prehospital emergency call, geographical location, patient's condition information, diagnosis, and treatment; diagnosis and examination report can be shared real-time and quickly. Smooth and effective communication opens up life paths for critically ill patients, thereby reducing response times, on-site emergency response times, and hospital handover times [37]; (2) the prehospital first aid nursing mode based on the network information sharing platform can communicate closely in real time, share information, and realize the seamless docking of each link through multiple channels. It can effectively treat the patients and reduce the nerve defect and the incidence of poor prognosis in 24 hours after admission to protect the life of the patients [38]; (3) through the business learning of the first aid process on the network information sharing platform, the operation of the prehospital first aid process is more standardized and reasonable. In the meantime, to reduce the occurrence of prehospital accidents and medical disputes, provide quality prehospital emergency and nursing services to patients and improve the satisfaction of patients and their families [39, 40]. There are some limitations in this study. First, the sample size of this study is not large, and it is a single-center study, so bias is inevitable. In future research, we will carry out multicenter, large-sample prospective studies, or more valuable conclusions can be drawn.

In summary, the application value of prehospital first aid nursing based on network information sharing platform in patients with acute ischemic stroke is more significant, which can optimize the first aid process, shorten the prehospital, and emergency response time. Thus, it shortens the overall emergency time, helps to improve the degree of neurological deficit, promotes patient self-awareness, reduces the incidence of poor prognosis, and enhances patient satisfaction with care.