Louisiana Administrative Code
Title 48 - PUBLIC HEALTH-GENERAL
Part I - General Administration
Subpart 15 - Emergency Response Network
Chapter 191 - Trauma Protocols
Section I-19121 - LERN Destination Protocol: TRAUMA

* Unmanageable airway

* Tension pneumothorax

* Traumatic cardiac arrest

* Burn patient without patent airway

* Burn patient > 40 percent BSA without IV

Yes [RIGHT ARROW]

Closest ED/Trauma Center

No

[DOWN ARROW]

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 [RIGHT 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.

No

[DOWN ARROW]

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 [RIGHT 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.

No

[DOWN ARROW]

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;

Yes [RIGHT 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.

> 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/AT V thrown, run over, or with significant (>20 mph) impact

*Motorcycle crash >20mph

No

[DOWN ARROW]

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 [RIGHT ARROW]

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

[DOWN ARROW]

Multi/Mass Casualty Incident

No [RIGHT ARROW]

Transport according to protocol