Pre-hospital emergency intervention for coma patients: strategy analysis

Abstract

Objective To analyze the clinical intervention strategy of pre-hospital first aid for coma patients. Methods A total of 208 cases of pre-hospital emergency patients called for coma from June 2017 to May 2018 in nine hospitals under the jurisdiction of Zhenjiang were analyzed retrospectively, including 116 males and 92 females, aged 18~98 years [(54.5±8.5) years]. More males than females were included in the standard cases (GCS score of 3~14), and the onset age was concentrated in 45~65 years old, with 67 cases (23.93%) of cerebrovascular accidents, 45 cases (21.63%) of severe trauma, 28 cases (13.46%) of cardiovascular diseases, 33 cases (15.87%) of acute poisoning, and 15 cases (7.21%) of diabetes complications. The progress of coma patients (clinical improvement, no change, deterioration, and death) was taken as the observation index. Comprehensive clinical data (sex ratio, age structure, pre-hospital diagnosis, treatment effect, disease incidence factors, disease prognosis, education, health education, etc.) were analyzed to accumulate clinical experience, pre-hospital first-aid route management, health education intervention and other measures. Results There were more males than females in the standard cases (GCS score ranged from 3 to 14). The age of onset was concentrated in 45 to 65 years. 67 cases of cerebrovascular accident (23.93%), 45 cases of severe trauma (21.63%), 28 cases of cardiovascular disease (13.46%), 33 cases of acute poisoning (15.87%) and 15 cases of diabetes mellitus complicated with various complications (7.21%) were the main cases. After on-site first aid, 108 cases (51.92%) were conscious. Rapid recovery, 169 cases (81.25%) were stable and safely transferred to hospital, 37 cases (17.79%) died on the site, 2 cases (0.96%) died on the way of transfer, 13 cases (6.25%) worsened, and 26 cases (12.50%) unchanged. 104 cases (50.00%) were effective, including remarkably effective in 26 cases (12.50%), and the success rate of rescue on the site was 81.25%; 80 cases (38.76%) had secondary school education or above from the investigated cases. 128 cases (61.24%) had their education below the secondary school; 26 cases (23.21%)did not accept any health education, 45 cases (21.63%) had individualized health education and 103 cases (49.52%) had public health consultation, and 34 cases (16.35%) had both. Conclusions Most of the causes of pre-hospital emergency coma patients are cardiovascular and cerebrovascular diseases, severe trauma, acute poisoning, diabetic complications and other emergencies. If early measures can be taken, the mortality and disability rate can be reduced. By accumulating clinical experience, pre-hospital emergency path management and health education intervention, the combination of peace and war can help to improve the success rate of rescue and is worth promoting. Key words: Pre-hospital first aid; Coma patients; Clinical analysis; Intervention strategy