Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part I - General Administration › Subpart 15 - Emergency Response Network › Chapter 191 - Trauma Protocols › Section I-19119 - Destination Protocol: TRAUMA

Current through Register Vol. 50, No. 6, June 20, 2024
A. On
				  November 20, 2014, the Louisiana Emergency Response Network Board
				  [R.S. 40:2842(1) and
				  (3)] adopted and promulgated "Destination
				  Protocol: Trauma" to be effective January 1, 2015, and replacing the "LERN
				  Destination Protocol: Trauma" adopted and promulgated November 21, 2013, as
				  follows.
1. Call LERN communication center at
				  (866) 320-8293 for patients meeting the following criteria.
* Unmanageable airway
Yes [RIGHTWARDS ARROW]
Closest ED/ Trauma Center
* Tension pneumothorax
* Traumatic cardiac arrest
* Burn patient without patent airway
* Burn patient 40 percent BSA without IV
[DOWNWARDS ARROW] No
Measure vital signs and level of
								consciousness
* GCS <=13
Yes [RIGHTWARDS 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
* SBP <90mmHg
* RR <10 or >29 breaths per minute, or need
								for ventilator Support (<20 in infant aged <1 year)
[DOWNWARDS ARROW] No
Assess anatomy of injury
* All penetrating injuries to head, neck, torso,
								and extremities proximal to elbow or knee
Yes [RIGHTWARDS 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
* 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)
[DOWNWARDS ARROW] No
Assess mechanism of injury and evidence of high
								-energy impact
Yes [RIGHTWARDS 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.
* 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;
>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/ ATV thrown, run
								over, or with significant (20 mph) impact
* Motorcycle crash 20mph
[DOWNWARDS ARROW] No
Assess special patient or system
								considerations
* Older Adults
Yes [RIGHTWARDS 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.
- 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
[DOWNWARDS ARROW] No
Multi/Mass Casualty Incident
No
Transport according to protocol
2.
				  When in doubt, transport to a trauma center.