LAC 48:I.19113. LERN Entry Criteria: Trauma; LERN Destination Protocol: Trauma

A. On January 20, 2011, the Louisiana Emergency Response Network Board [R.S. 40:2842(1) and (3)] adopted and promulgated "LERN ENTRY CRITERIA: Trauma; Pre-Hospital and Hospital Triage Protocol" and "LERN DESTINATION PROTOCOL: Trauma" replacing the "Standard LERN Entry Trauma Criteria" and "Standard LERN Entry Trauma Criteria Destination Protocol" adopted and promulgated January 20, 2011, as follows. 1. LERN Entry Criteria: Trauma a. Pre-Hospital and Hospital Triage Protocol Call LERN Communications Center for: Unmanageable Airway Tension Pneumothorax Traumatic cardiac arrest Burn Patient without patent airway Burn patient >40 percent BSA without IV Physiologic GCS <14 SBP <90 (adults and > 9 y/o) <70 + 2 [age (yrs)] (age 1 to 8 y/o) <70 (age 1 to 12 months) <60 (term neonate) RR <10 or >29 (adults & ≥ 9 y/o) <15 or >30 (age 1 to 8 y/o) <25 or >50 (<12 m/o) Anatomic Open or depressed skull fractures Open head injury with or without CSF leak Lateralizing signs or paralysis (i.e., one-sided weakness, motor, or sensory deficit) All penetrating injuries to head, 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 Fractures 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 Fractures with neurovascular compromise (decreased peripheral pulses or prolonged capillary refill, motor or sensory deficits distal to fracture) Mechanism Falls >20 ft. adults >10 ft. (child) or 2 to 3 times height Auto vs. pedestrian/bicyclist thrown, run over or significant (>20 MPH) impact Motorcycle crash >20 MPH High-risk auto crash Intrusion >12 in, occupant site >18 in. any site Ejection, partial or complete from automobile Death in same passenger compartment Other Pregnancy >20 weeks Burns (follow ABA guidelines) Age ≥ 55 y/o or <8 y/o Anticoagulation and bleeding disorders End stage renal disease Transplant patients Multi/Mass Casualty Incident (MCI) 2. LERN Destination Protocol: Trauma LERN Destination Protocol: Trauma Unmanageable Airway Tension Pneumothorax Traumatic cardiac arrest Burn patient without patent airway Burn patient >40 percent BSA without IV | YES | Closest ED Physiologic GCS < 14 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 Anatomic Open or depressed skull fractures Open head injury with or without CSF leak Lateralizing signs or paralysis (i.e., one-sided weakness, motor, or sensory deficit) 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) excluding isolated hip fractures from same level falls 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 | YES | LERN Level I, II, or III 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 Other Pregnancy > 20 weeks Burns (follow ABA guidelines) 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 MULTI/MASS CASUALTY INCIDENT (MCI) | YES | LERN Level I, II, III, or IV B. These protocols were published at LR 37:1466-1468 (April 20, 2011).