Clinical Research On Emergency Medical Services Of Stroke

Objective: 1,To participate in stroke patient's emergency medical services (EMS) in Western Yunnan Province emergency center (that is, Yunnan Province Emergency Centre, 120 first-aid station of Second Affiliated Hospital of Kunming Medical University) ,and to investigate and assess process of stroke EMS and assess the stroke EMS; 2,To analyze stroke patients' current EMS in 120 first-aid station of Second Affiliated Hospital of Kunming Medical University of Yunnan Province Emergency Centre, improve the quality and efficiency of stroke EMS, provide the basis for the perfect EMS ; 3, Analysis affected factors of pre-hospital stroke patients' translocation efficiency in 120 first-aid station of Second Affiliated Hospital of Kunming Medical University of Yunnan Province Emergency Centre, in order to improve the efficiency of pre-hospital transfer;4,To increase awareness of first aid of public and medical professionals or not professionals by the investigation and evaluation.Method: the researcher personally involved in EMS process of 120 first-aid station of Second Affiliated Hospital of Kunming Medical University of Yunnan Province Emergency Centre. Pre-hospital EMS process will be subdivided into four stages as follows, EMS starts, EMS response, EMS on-site treatment, EMS transport. Including survey of stroke patients and their families and spectators' stroke awareness, evaluation of EMS personnel' reaction speed and responsiveness, evaluation of EMS personnel' ability to identify stroke patients and the measures at the scene, judges transit and so on according to 2007 cerebrovascular disease prevention and cure guideline of china,2007 guidelines for the early management of adults with ischemic stroke of U.S. and self-made questionnaire.Results: 1. Percentage of stroke EMS120 telephone called by the patients, their families and bystanders were 2.91%, 74.76%, 22.33%. Time with more than 6 hours when the patients called the 120 emergency phone was 12.62%, more than three hours was 21.36%. The visit time of 74.76% of the emergency vehicles was no more than 1 minute. 97.09% of the patients lived in urban areas, 71.84% of the patients got sick in families, 70.87% of the patients got sick in activity. 2. travel time of 63.11% of the emergency vehicle was no more than 15 minutes, 87.38% was no more than 30 minutes. The range of 91.26% of EMS to onset was no more than 10 kilometers. 3. Ddisease information from patients, family members and bystanders were 2.91%, 72.82%, 24.27%. 60.19% of the patients were not asked about the recent events (stroke, myocardial infarction, trauma, surgery, bleeding) by EMS personnel, 96.12% of the patients were not asked about drug use (antihypertensive drugs, anticoagulants, insulin), 92.23% of the patients were asked the past history (hypertension, diabetes, heart disease). EMS personnel did not use any pre-hospital stroke screening tool. 52.43% of the patients are not identified by EMS personnel, 36.89% of the patients did not establish intravenous access, 80.58% of patients had no measurement of blood glucose, 74.76% of patients had no measurement of arterial oxygen saturation, blood pressure was measured in all patients. Scene time of 91.26% of the EMS was no more than 15 minutes. 4, Transport time of 53.40% of the EMS was no more than 15 minutes, 87.38% was no more than 30 minutes, return range of 86.40% of the EMS was no more than 10 kilometers, 62.14% of the EMS did not noticed to medical institutions ahead of time, 9.71% of the patients' airway were cleared by EMS personnels, all patients were fasting, oxygen, ECG monitoring and pre-collected blood samples were not carried out. 95.44% of the EMS were delay, 85.44% of which were the traffic jams, there were bypass in 18.45% of the EMS. 71.84% of the patients arrived at the hospital 3 hours after onset, 84.47% were 6 hours. 5. EMS personnel' pre-hospital stroke accuracy was 79.61%, family members' was 22.33%, difference was statistical significant between the two groups by Chi-square test. 66.02% of the patients and their families do not know any symptoms of stroke, 45.63% of the patients called immediately the 120 emergency phone after onset.Conclusion: 1. Compared with the guidelines, in most cases, EMS personnel can set out quickly after received visits order within 1 minute, arrive at the scene or arrived at the hospital from the scene within 30 minutes, ask Most of the patients'past history, open majority of patients' venous access, and notice to advance hospital. Blood pressure measure, fasting, and oxygen treatment can be used in all patients. Pre-hospital stroke assessment tool should be vigorously promoted to use, all suspected stroke patients should be collected detailed medical history information and identify, ABC treatment should be quickly and effectively, monitoring of blood glucose and vital signs, etc.2. Pre-hospital EMS personnel identify suspected stroke patients was significantly higher than the patients and their families, the EMS can significantly shorten the hospitalization time of patients, patients can be at the shortest time to get to the hospital to be diagnosed and treated. 3. To strengthen communication and coordination between EMS personnel and medical institutions can improve stroke EMS, and enable suspected stroke patients to be diagnosed and treated early. 4. There were some factors affected stroke EMS pre-hospital transit efficiency. As follows, traffic jam factors, human factors, road factors, weather was not obvious. There were no ambulances quality problems in EMS process. 5. 120 emergency medical insurance costs is not the list, to some extent limited the widespread use of stroke EMS, and limited some of the diagnosis, monitoring and treatment. 120 Emergency medical insurance costs included in the scope are necessary.6. The people called 120 emergency phones were mainly urban and rural were rarely. Public lacked generally knowledge of stroke and sufficient attention of stroke dangers. The public's health education for stroke is imperative.