Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part I - General Administration › Subpart 15 - Emergency Response Network › Chapter 191 - Trauma Protocols › Section I-19105 - Standard LERN Entry Criteria; Standard Destination Protocol

Current through Register Vol. 50, No. 6, June 20, 2024
A. On June 18, 2009, the Louisiana Emergency
				  Response Network Board (R.S.
				  40:2842(1)) adopted and
				  promulgated "Standard LERN Entry Criteria" and "Standard Destination Protocol"
				  for use in all regions, except region 7, of the Louisiana Emergency Response
				  Network (R.S.
				  40:2842(3)), replacing the
				  "LERN Entry Criteria" and "LERN Region 4 LCC Destination Protocol," adopted and
				  promulgated November 15, 2007, as follows.
1.
				  Standard LERN Entry Criteria-Pre -Hospital and Hospital Triage Protocol
Standard LERN Entry Criteria
Pre -Hospital and Hospital Triage
								Protocol
[] Unmanageable Airway
YES [RIGHTWARDS ARROW]
Call LCC
[] Tension Pneumothorax
[] Traumatic cardiac arrest
[] Burn patient without patent airway
[] Burn patient >40 percent BSA without
								IV
Neurologic Trauma
[] GCS <14 + one or more of the
								following:
YES [RIGHTWARDS ARROW]
Call LCC
[] Penetrating head injury or depressed skull
								fracture
[] Open head injury with or without CSF
								leak
[] Deterioration of the GCS
[] Lateralizing signs or paralysis (i.e., one-sided
								weakness, motor, or sensory deficit)
Physiologic
[] SBP <90 (adults and 9 y/o)
YES [RIGHTWARDS ARROW]
Call LCC
<70 + 2 [age (yrs)] (age 1 to 8)
<70 (age 1 to 12 months)
<60 (term neonate)
[] RR <10 or >29 (adults and> 9
								y/o)
<15 or >30 (age 1 to 8)
<25 or >50 (<12 m/o)
Anatomic
[] All penetrating injuries to neck, torso and
								extremities proximal to elbow and knee
YES [RIGHTWARDS ARROW]
Call LCC
[] Flail Chest
[] 2 or more proximal long-bone fractures
[] Crush, degloved or mangled extremity
[] Amputation proximal to wrist and ankle
[] Pelvic Fracture
[] Hip fractures (hip tenderness, deformity,
								lateral deviation of foot)
[] Major joint dislocations (hip, knee, ankle,
								elbow)
[] Open Fractures
[] Fractures with neurovascular compromise
								(decreased peripheral pulses or prolonged capillary refill, motor or sensory
								deficits distal to fracture, etc.)
Mechanism
[] Falls >20 ft. (adults)
>10 ft. (child) or 2 to 3 times height
YES
Call LCC
[] High-risk auto crash
Intrusion >12 in, occupant site:
>18 in. any site
* Ejection, partial or complete from
								automobile
* Death in same passenger compartment
[] Auto vs. pedestrian/bicyclist thrown, run over
								or significant (>20 MPH) impact
[] Motorcycle crash >20 MPH
Special
[] Pregnancy >20 weeks
YES [RIGHTWARDS ARROW]
Call LCC
[] Burns (will follow ABA guidelines)
Other
[] Age >=55 y/o or <8 y/o
YES [RIGHTWARDS ARROW]
Call LCC
[] Anticoagulation and bleeding disorders
[] End stage renal disease
[] Transplant patients
2.
				  Standard Destination Protocol
Standard Destination Protocol
[] Unmanageable Airway
YES [RIGHTWARDS ARROW]
Closest ED
[] Tension Pneumothorax
[] Traumatic cardiac arrest
[] Burn patient without patent airway
[] Burn patient >40 percent BSA without
								IV
NO
[DOWNWARDS ARROW]
Neurologic Trauma
[] GCS <14
YES [RIGHTWARDS ARROW]
LERN Level I or II
[] Penetrating head injury or depressed skull
								fracture
[] Open head injury with or without CSF
								leak
[] Deterioration of the GCS
[] Lateralizing signs or paralysis
(i.e., one-sided weakness, motor, or sensory
								deficit)
NO
[DOWNWARDS ARROW]
Standard Destination Protocol
Physiologic
[] SBP <90 (adults and >9 y/o)
YES [RIGHTWARDS ARROW]
LERN Level I, II or III
<70 + 2 [age (yrs)] (age 1 to 8)
<70 (age 1 to 12 months)
<60 (term neonate)
[] RR <10 or >29 (adults and >9
								y/o)
<15 or >30 (age 1 to 8)
<25 or >50 (<12 m/o)
NO
[DOWNWARDS ARROW]
Anatomic
[] All penetrating injuries to neck, torso and
								extremities proximal to elbow and knee
YES [RIGHTWARDS ARROW]
LERN Level I, II or III
[] Flail Chest
[] 2 or more proximal long-bone fractures
[] Crush, degloved or mangled extremity
[] Amputation proximal to wrist and ankle
[] Pelvic Fracture
[] Hip fractures (hip tenderness, deformity,
								lateral deviation of foot)
[] Major joint dislocations (hip, knee, ankle,
								elbow)
[] Open Fractures
[] Fractures with neurovascular compromise
(decreased peripheral pulses or prolonged capillary
								refill, motor or sensory deficits distal to fracture, etc.)
NO
[DOWNWARDS ARROW]
Mechanism
[] Falls >20 ft. (adults)
YES [RIGHTWARDS ARROW]
LERN Level II or III
>10 ft. (child) or 2 to 3 times height
[] High-risk auto crash
* Intrusion >12 in. occupant site:
* >18 in. any site
* Ejection, partial or complete from
								automobile
* Death in same passenger compartment
[] Auto vs. pedestrian/bicyclist thrown, run over
								or significant (>20 MPH) impact
[] Motorcycle crash >20 MPH
NO
[DOWNWARDS ARROW]
Special
[] Pregnancy >20 weeks
YES [RIGHTWARDS ARROW]
LERN Level II or III
[] Burns (will follow ABA guidelines)
NO
[DOWNWARDS ARROW]
Other
[] Age >=55 y/o or <8 y/o
YES [RIGHTWARDS ARROW]
LERN Level II, III or IV
[] Anticoagulation and bleeding disorders
[] End stage renal disease
[] Transplant patients