Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part I - General Administration › Subpart 15 - Emergency Response Network › Chapter 191 - Trauma Protocols › Section I-19121 - LERN Destination Protocol: TRAUMA

Current through Register Vol. 50, No. 6, June 20, 2024
A. On
				  December 10, 2015, the Louisiana Emergency Response Network Board
				  [R.S. 40:2842(1) and
				  (3)] adopted and promulgated "LERN
				  Destination Protocol: TRAUMA", which replaces the "LERN Destination Protocol:
				  TRAUMA" found in §19121 adopted and promulgated November 20, 2014, as
				  follows.
1. Call LERN communication center at
				  (866) 320-8293 for patients meeting the following criteria.
* Unmanageable airway
* Tension pneumothorax
* Traumatic cardiac arrest
* Burn patient without patent airway
* Burn patient > 40 percent BSA without
								IV
Yes [RIGHT ARROW]
Closest ED/Trauma Center
No
[DOWN ARROW]
Measure vital signs and level of
								consciousness
* GCS <=13
* SBP <90mmHg
* RR <10 or >29 breaths per minute, or need
								for ventilator
Support (<20 in infant aged <1 year)
Yes [RIGHT ARROW]
Transport to Trauma Center/ Trauma
								Program
These patients should be transported to the highest
								level of care within the defined trauma system. This is a Level 1 or a Level 2
								Trauma Center or Trauma Program.
* If distance or patient condition impedes
								transport to trauma facility, consider transport to most appropriate resourced
								hospital.
No
[DOWN ARROW]
Assess anatomy of injury
* All penetrating injuries to head, neck, torso,
								and extremities proximal to elbow or knee
* Chest wall instability or deformity (e.g. flail
								chest)
* Two or more proximal long-bone fractures
* Crushed, degloved, mangled, or pulseless
								extremity
* Amputation proximal to wrist or ankle
* Pelvic fractures
* Open or depressed skull fracture
* Paralysis
* Fractures with neurovascular compromise
								(decreased peripheral pulses or prolonged capillary refill, motor or sensory
								deficits distal to fracture)
Yes [RIGHT ARROW]
Transport to Trauma Center/ Trauma Program These
								patients should be transported to the highest level of care within the defined
								trauma system. This is a Level 1 or a Level 2 Trauma Center or Trauma
								Program.
* If distance or patient condition impedes
								transport to trauma facility, consider transport to most appropriate resourced
								hospital.
No
[DOWN ARROW]
Assess mechanism of injury and evidence of
								high-energy impact
*
Falls
-Adults: >20 feet (one story is equal to 10
								feet)
-Children: >10 feet or two or three times the
								height of the child
*
High-risk auto crash
-Intrusion, including roof: >12 inches occupant
								site;
Yes [RIGHT ARROW]
Transport to Trauma Center/Trauma
								Program
which, depending upon the defined trauma system,
								need not be the highest level trauma center/program. If no Trauma Center/Trauma
								Program in the region, LCC may route to the most appropriate resourced
								hospital.
> 18 inches any site
-Ejection (partial or complete) from
								automobile
-Death in the same passenger compartment
-Vehicle telemetry data consistent with a high risk
								of injury
*
Auto vs. pedestrian/bicyclist/AT V thrown,
								run over, or with significant (>20 mph) impact
*
Motorcycle crash >20mph
No
[DOWN ARROW]
Assess special patient or system
								considerations
*
Older Adults
-Risk of injury/death increases after age 55
								years
-SBP <110 may represent shock after age
								65
-Low impact mechanisms (e.g. ground level falls)
								may result in severe injury
*
Children
-Should be triaged preferentially to pediatric
								capable trauma centers
*
Anticoagulants and bleeding
								disorders
-Patients with head injury are at high risk for
								rapid deterioration
*
Burns
-With trauma mechanism: triage to trauma
								center
*
Pregnancy 20 weeks
* Hip Fractures (hip tenderness, deformity, lateral
								deviation of foot) excluding isolated hip fractures from same level
								falls
* Major joint dislocations (hip, knee, ankle,
								elbow)
* Open Fractures
* EMS provider judgment
Yes [RIGHT ARROW]
Transport to Trauma Center/Trauma
								Program
or hospital capable of timely and thorough evaluation and
								initial management of potentially serious injuries. Consider consultation with
								medical control.
No
[DOWN ARROW]
Multi/Mass Casualty Incident
No [RIGHT ARROW]
Transport according to protocol
2.
				  When in doubt, transport to a trauma center.