Louisiana Administrative Code
Title 48 - PUBLIC HEALTH-GENERAL
Part I - General Administration
Subpart 15 - Emergency Response Network
Chapter 191 - Trauma Protocols
Section I-19123 - LERN Destination Protocol: TRAUMA

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 [RIGHT ARROW]

Closest ED/Trauma Center

No [DOWN ARROW]

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)

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.

* 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 [GREATER THAN EQUAL TO] 65: SBP <110 mmHG or HR SBP

* 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 [DOWN ARROW]

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 [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 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 [DOWN ARROW]

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 [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.

No [DOWN ARROW]

Assess special patient or system considerations

* Older Adults

- Age [GREATER THAN EQUAL TO] 65 with evidence of traumatic injury

- Fall from any height with evidence of significant head impact

- Use of anticoagulant or antiplatelet drugs

* Children

- Age [LESS THAN EQUAL TO] 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 [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

Transport according to protocol