The Effect of Optimizing Pre-Hospital First Aid Process on the Efficacy of Rescue and Treatment for Patients with Acute Coronary Syndrome

Objective: To explore the effect of optimizing pre-hospital first aid procession the rescue efficacy of patients with acute coronary syndrome (ACS) in the construction of chest pain center in general hospital. Methods: A total of 214 patients with ACS admitted to our hospital from 2017 to December 2018 were selected (45 before the establishment of chest pain center and 132 after the establishment of chest pain center). To observe the effect of optimizing pre-hospital first aid process on shortening the time from entry to first balloon dilatation (D-to-B) and from first medical contact to first balloon dilatation (FMC-to-B) of ACS patients and improving the prognosis of STEMI patients. Results: Compared with the operation of chest pain center, D-to-B time (41.82+4.23 vs 90.09+5.26; P >0.05) and FMC-to-B time (81.91 +4.43 vs 143.33 +3.54; P>0.05) were significantly shortened; the incidence of cardiovascular events was significantly reduced (P>0.05), and hospitalization days were significantly shortened. Conclusion: In the pre-hospital first aid process, it is of great significance to optimize 120 departure process, pre-hospital ECG transmission process, referral and reception process improvement in the construction of chest pain center in general hospitals.


Patients Selected
A total of 214 ACS patients admitted to our hospital from 2013 and 2018 were selected (45 before the construction of chest pain center in 2013 and 132 after the establishment of chest pain center in 2018). ACS patients were defined as those with abnormal ECG or myocardial enzymes within 12 hours of acute chest pain, and all of them underwent coronary intervention.

Process Improvement
According to the analysis of the joint regular meeting of the chest pain center, the Committee of the chest pain center constantly formulates and revises the pre-hospital first aid process, especially optimizes the 120 out-of-car and pre-hospital ECG transmission process, referral and reception process improvement. The process improvement highlights the responsibilities of pre-hospital emergency personnel, requiring pre-hospital emergency medical personnel to optimize the 120 out-of-car process, pre-hospital ECG transmission process, complete ECG collection within 10 minutes, and transmit it to the mobile phone on duty in the Chest Pain Center of Xuzhou Mining Group General Hospital, so as to reduce it as quickly as possible. The occurrence of pre-hospital delay.

Observation Indicators
To observe the changes of each time point during the treatment of chest pain center, the time of first medical contact with electrocardiogram, the time of first medical contact with physician's interpretation of electrocardiogram, the time of door-enzyme, that is, the time from entry to biochemical markers, especially to observe and optimize the pre-hospital first aid process to shorten the D-to of ACS patients. B time, FMC-to-B time, transmission electrocardiogram ratio, ratio of bypass to emergency room, length of hospitalization and incidence of cardiovascular events were observed to observe the effect of process improvement on the prognosis of ACS patients.

Results
The number of patients with acute coronary syndrome in-

Discussions
The concept of chest pain center originated in the United States.
The first "chest pain center" was established in 1981 at St. ANGLE Hospital in Baltimore, USA. At present, the number of "chest pain centers" in the United States has reached more than 5,000. In a narrow sense, the main purpose of establishing chest pain centers can be summarized in 16 words: "rapid diagnosis [2], timely treatment, reduction of death and avoidance of waste". At present, the chest pain centers in our hospital have been running for more than 4 year.
Because of the establishment of green channels, and the fact that the main class and reserve Doctor of Emergency Surgery in the Department mostly live near the hospital, so the total starting time of catheter room is about 30 minutes, and the D-to-B time is basically less than 90 minutes. In order to (Better)save patients 'lives and make rapid diagnosis, more work should focus on the improvement of pre-hospital first aid process and shorten the pre-hospital delay to the maximum extent. Therefore, the center mainly carries out pre-hospital staff training, continuously improves the pre-hospital process, accurately records each time node and key indicators and constantly shorten the treatment time, reduce the occurrence of cardiovascular events.

Formulation and Improvement of Pre-Hospital Process
Continuous improvement is the essence of the work of the Chest Pain Center of Xuzhou Mining Group General Hospital. The management organization of the Chest Pain Center constantly summarizes and collates the data and implements the corresponding process improvement plan. In order to reduce the uncertainty and randomness in the ACS treatment process, PDCA management method was applied to develop and improve the process. The goal of process formulation is to shorten the critical time nodes in the process of ACS first aid, to implement various measures to shorten the time of ACS first aid smoothly, and to adopt the corresponding assessment mechanism and incentive mechanism. The characteristics of general hospitals are still the traditional treatment methods, which is mainly manifested in the low proportion of ECG transmission before hospital, the insufficient proportion of bypassing emergency room, which leads(leading) to delayed treatment of ACS and doctors in our hospital cannot diagnose ACS in the first time. There are many similarities between our hospital and other general hospitals. As many as 70% of primary hospitals refer emergency PCI patients. Therefore, training doctors in grass-roots hospitals, transmitting electrocardiogram at the first time, shortening the start-up time of catheter room, and increasing the number of patients in bypass catheter room can improve the treatment level of patients and shorten the pre-hospital start-up delay [3].
The process improvement of our hospital has the following characteristics: infarct-related blood vessels should be opened as soon as possible, and myocardial perfusion recovery is undoubtedly feasible way to maximize the protection of viable myocardium. However, whether thrombolysis is successful or not, patients should be transported to higher hospitals for PCI treatment as quickly and safely as possible after thrombolysis, to truly play an important role in STEMI treatment in primary hospitals. Therefore, primary hospitals must constantly be familiar with improving the ACS treatment and referral process [5].
In order to shorten the time of pre-hospital first aid, the center continuously enters the grass-roots hospitals for training and drilling.
Develop a practical training program for STEMI patients 'treat-   In short, the Chest Pain Center is a concept for reducing the morbidity and mortality of acute myocardial infarction [6]. Through multidisciplinary cooperation (including Emergency Medical System (EMS), Emergency Department, Cardiology and Imaging), it provides rapid and accurate diagnosis, risk assessment and appropriate treatment. Therefore, in order to improve the treatment course of patients with chest pain simplification and optimization of the process of diagnosis and treatment simplify and optimize the treatment process, in all hospitals, especially in general hospitals at the grass-roots level, the chest pain center only pays attention to every link from the onset to the opening of infarction-related blood vessels. Extending the first aid service from optimizing the process of in-hospital treatment to pre-hospital first aid and transshipment will be the lessons faced by major PCI centers question. In the construction of chest pain center, continuous improvement of pre-hospital first aid process is carried out to classify and treat patients with chest pain effectively, so as to improve the ability of early diagnosis and treatment of ACS [7], reduce the possibility of occurrence of myocardial infarction or avoid occurrence of myocardial infarction, accurately screen out low-risk patients with myocardial ischemia, to reduce misdiagnosis and missed diagnosis, and The aim of overtreatment and improvement of clinical prognosis of patients.