Louisiana Administrative Code
Title 48 - PUBLIC HEALTH-GENERAL
Part I - General Administration
Subpart 15 - Emergency Response Network
Chapter 191 - Trauma Protocols
Section I-19119 - Destination Protocol: TRAUMA

* Unmanageable airway

Yes [RIGHTWARDS ARROW]

Closest ED/ Trauma Center

* Tension pneumothorax

* Traumatic cardiac arrest

* Burn patient without patent airway

* Burn patient 40 percent BSA without IV

[DOWNWARDS ARROW] No

Measure vital signs and level of consciousness

* GCS <=13

Yes [RIGHTWARDS ARROW]

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

* SBP <90mmHg

* RR <10 or >29 breaths per minute, or need for ventilator Support (<20 in infant aged <1 year)

[DOWNWARDS ARROW] No

Assess anatomy of injury

* All penetrating injuries to head, neck, torso, and extremities proximal to elbow or knee

Yes [RIGHTWARDS ARROW]

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

* 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)

[DOWNWARDS ARROW] No

Assess mechanism of injury and evidence of high -energy impact

Yes [RIGHTWARDS ARROW]

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.

* 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

[DOWNWARDS ARROW] No

Assess special patient or system considerations

* Older Adults

Yes [RIGHTWARDS ARROW]

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.

- 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

[DOWNWARDS ARROW] No

Multi/Mass Casualty Incident

No

Transport according to protocol