LAC 48:I.19105. Standard LERN Entry Criteria; Standard Destination Protocol

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 CriteriaPre-Hospital and Hospital Triage Protocol Standard LERN Entry Criteria Pre-Hospital and Hospital Triage Protocol Unmanageable Airway Tension Pneumothorax Traumatic cardiac arrest Burn patient without patent airway Burn patient >40 percent BSA without IV | YES | Call LCC Neurologic Trauma GCS <14 + one or more of the following: 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) | YES | Call LCC Physiologic SBP <90 (adults and > 9 y/o) <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) | YES | Call LCC Anatomic All penetrating injuries to neck, torso and extremities proximal to elbow and knee 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.) | YES | Call LCC Mechanism Falls > 20 ft. (adults) > 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 | YES | Call LCC Special Pregnancy >20 weeks Burns (will follow ABA guidelines) | YES | Call LCC Other Age ≥ 55 y/o or <8 y/o Anticoagulation and bleeding disorders End stage renal disease Transplant patients | YES | Call LCC 2. Standard Destination Protocol Standard Destination Protocol Unmanageable Airway Tension Pneumothorax Traumatic cardiac arrest Burn patient without patent airway Burn patient >40 percent BSA without IV | YES | Closest ED NO Neurologic Trauma GCS <14 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) | YES | LERN Level I or II NO Physiologic SBP <90 (adults and >9 y/o) <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) | YES | LERN Level I, II or III NO Anatomic All penetrating injuries to neck, torso and extremities proximal to elbow and knee 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.) | YES | LERN Level I, II or III NO Mechanism Falls >20 ft. (adults) >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 | YES | LERN Level II or III NO Special Pregnancy >20 weeks Burns (will follow ABA guidelines) | YES | LERN Level II or III NO Other Age ≥ 55 y/o or <8 y/o Anticoagulation and bleeding disorders End stage renal disease Transplant patients | YES | LERN Level II, III or IV B. These protocols were published at LR 35:1409 (July 20, 2009).