LAC 48:I.19119. Destination Protocol: TRAUMA

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 Tension pneumothorax Traumatic cardiac arrest Burn patient without patent airway Burn patient > 40 percent BSA without IV | Yes→ | Closest ED/ Trauma Center ↓ No 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→ | 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 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→ | 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 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; > 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 | Yes→ | 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. ↓ No 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→ | 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. ↓ No Multi/Mass Casualty Incident | No→ | Transport according to protocol 2. When in doubt, transport to a trauma center. B. This protocol was published at LR 40:2710 (December 20, 2014).