LAC 48:I.19303. LERN Destination Protocol: Stroke

A. On April 21, 2017, the Louisiana Emergency Response Network Board [R.S. 40:2842(1) and (3)] adopted and promulgated “LERN Designation Protocol: Stroke”, amending and replacing the previous “LERN Designation Protocol: Stroke” adopted on November 21, 2013 and set out in Section 19301, as follows. LERN Destination Protocol: Stroke LERN Call Center: (866) 320-8293 The following protocol applies to patients with suspected stroke: Compromise Of: Airway Breathing Circulation | Closest ED for stabilization and then triage to closest appropriate hospital All other patients with suspected stroke, determine time last seen normal (LSN) and screen for large vessel occlusion (LVO) LSN < 6 hours* AND screen for LVO is positive | LSN > 6 hours OR screen for LVO is negative Transport to LERN Stroke Level I, II, or III Center If < 15 minutes of additional transport time to reach Level I or endovascular capable Level II Center, transfer to the Level I or endovascular capable Level II Center | Transport to LERN Stroke Level I, II, or III Center If > 15 minutes of additional transport time to reach Level I, II, or III Center than to reach stroke capable Off Site ED, it is acceptable to transport to a stroke capable Off Site ED * The LSN < 6hrs should include patients without a definite time of LSN, but who could reasonably be assumed to be within 6 hrs of onset, including patients who wake-up with stroke symptoms. Guiding Principles: Time is the critical variable in acute stroke care Protocols that include pre-hospital notification while en route by EMS should be used for patients with suspected acute stroke to facilitate initial destination efficiency. Treatment with intravenous tPA is the only FDA approved medication therapy for hyperacute stroke. EMS should identify the geographically closest hospital capable of providing tPA treatment. Transfer patient to the nearest hospital equipped to provide tPA treatment. Secondary transfer to facilities equipped to provide tertiary care and interventional treatments should not prevent administration of tPA to appropriate patients.