LAC 48:I.19123. LERN Destination Protocol: TRAUMA

A. On August 18, 2022, the Louisiana Emergency Response Network Board [R.S. 40:2842(1) and (3)] adopted and promulgated “LERN Destination Protocol: TRAUMA”, and replacing the “LERN Destination Protocol: TRAUMA” adopted and promulgated December 10, 2015, as follows: 1. Call LERN Communication Center at (866) 320-8293 for patients meeting the following criteria. Assess for Extremis Unmanageable airway Tension pneumothorax Traumatic cardiac arrest Burn patient without patent airway Burn patient > 40 percent BSA without IV or IO Access | Yes→ | Closest ED/Trauma Center No↓ Measure vital signs and Mental Status Unable to follow commands (Motor GCS < 6) RR <10 or > 29 breaths per minute (<20 in infant aged <1 year) Respiratory distress or need for support Room air pulse oximetry <90% Age 0-9: SBP <70 mmHG + (2 x age in years) Age 10-64: SBP <90 mmHG or HR > SBP Age ≥ 65: SBP <110 mmHG or HR > SBP | 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 Level 1 or 2, consider transport to a Level 3 Trauma Center/Trauma Program or most appropriate resourced hospital. No↓ Assess Injury Patterns All penetrating injuries to head, neck, torso, and extremities proximal to elbow or knee Chest wall instability or deformity or suspected flail chest Suspected fracture of two or more proximal long-bones Crushed, de-gloved, mangled, or pulseless extremity Amputation proximal to wrist or ankle Suspected pelvic fracture Skull deformity or suspected skull fracture Suspected spinal injury with new motor or sensory loss Active bleeding requiring a tourniquet or wound packing with continuous pressure | 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 I or a Level 2 Trauma Center or Trauma Program. * If distance or patient condition impedes transport to Level 1 or 2, consider transport to a Level 3 Trauma Center/Trauma Program or most appropriate resourced hospital No↓ Assess mechanism of injury Falls from height >10 feet (all ages) High-risk auto crash -- Intrusion, including roof: 12 inches occupant site; 18 inches any site; need for extrication for patient entrapped - Ejection (partial or complete) from automobile - Death in the same passenger compartment - Child (Age 0-9)unrestrained or in unsecured child safety seat - Vehicle telemetry data consistent with a high risk of injury Auto vs. pedestrian/bicyclist thrown, run over, or with significant (>20 mph) impact Rider separated from transport vehicle with significant impact (ex: motorcycle, ATV, Horse, etc.) | 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 - Age ≥ 65 with evidence of traumatic injury - Fall from any height with evidence of significant head impact - Use of anticoagulant or antiplatelet drugs Children - Age ≤ 5 with evidence of traumatic injury - Fall from any height with evidence of significant head impact Burns - In conjunction with trauma - High voltage electrical injuries Pregnancy >20 weeks Major joint dislocations (hip, knee, ankle, elbow) EMS provider judgment | Yes→ | Transport to Trauma Center/Trauma Program or hospital capable of timely and thorough evaluation and initial management of potentially serious injuries. Consider consultation with medical control. No↓ Multi/Mass Casualty Incident | No→ | Transport according to protocol 2. When in doubt, transport to a trauma center.