Alan Dick has 21 years experience as a social worker and is currently with Sunnybrook Health Science Centre in Toronto, Ontario. Alan’s interest in disaster response was developed through a variety of psychosocial response training programs, but it was the opportunity to respond to the 9/11 attack in New York that got his interest locked in. For this event, Alan was honoured to work for the National Organization for Victims Assistance (NOVA) with the families impacted by the tragedy, including accompanying them to the Ground Zero. He is the PS end-user lead for the CBRNE Collaborative and PS Supervisor for Ontario’s Emergency Medical Assistance Team. Alan is considered a subject matter expert with regards to the psychosocial issues involved in hospital responses to major incidents including mass casualty incidents.
2. Five Essential Elements
• Promote sense of safety.
• Promote calming.
• Promote sense of self and collective efficacy.
• Promote connectedness.
• Promote hope.
Ref: Stevan Hobfoll et al, Five Essential Elements of Immediate and Mid–Term Mass Trauma Intervention:
Empirical Evidence, Psychiatry 70(4) Winter 2007
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3. The Social Reality
• Social Support is considered one of the most
important elements in the recovery from trauma.
• Family and friends will surge on the hospital looking
for loved ones.
• Reconnection with family members can be a greater
priority then meeting individual basic needs.
• Information can be the most effective intervention
on its own, provide it early and often. Providing
consistent information builds relationship and trust
with families
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4. Five Psychosocial Considerations
1. Perceptions Matter
2. Routines predict behaviour
3. People behave in Purposeful and Adaptive Ways
4. People are differently affected
5. People want to connect and help
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5. Family Information and Support Centre (FISC)
• Though already observed anecdotally, it has been well
documented in several major incidents that families surge at
hospitals looking for loved ones.
• Preparation for this surge includes planning for space, a FISC,
where families can provide and receive information on a
possible patient, hopefully to expedite reunification of family
with the loved one.
• This Family Information and Support Centre (FISC) would
provide information with regards to community resources, in
addition to providing short term Psychological First Aid and
emotional support.
• Staffing for FISC has typically been provided by Social Work,
Chaplaincy and Volunteers.
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6. A FISC will provide:
• Registration
• Up to date Information
• Psychological First Aid/counselling/chaplaincy
• Resources on Traumatic Stress
• Referral to community resources
• Counseling breakout rooms
• Child care?
• Special Need services: ie translation, ambulatory issues,
etc.
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Services Provided
8. Other Issues to Consider
• Remember there are already Patients in the hospital
and their families, how do you mitigate the affect of
the Code Orange on them.
• There is currently no system in place to track the
whereabouts of a patient through multiple hospitals.
(G20 planning looked at family reunification plans)
• Providing families with ID (nametags/bracelets) after
registration will increase security and safety.
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9. Other Issues to Consider (2)
• Some families may not find their loved ones in the
first 24 hours. They may not find them at all. They
may have died on the scene and may remain on
scene for hours. When removed they would go
straight to the city morgue or coroner.
• And in some cases though still alive it may take time
to extract all patients from the scene.
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11. The Common Process of Reunification
• The process for reuniting a family has changed over
the years. The standard is for everyone to register
with a response organization such as Red Cross and
then over time match family members together.
• In recent years the online search engine Google’s
Person Finder. It can be found at Google Crisis
Response
http://www.google.org/crisisresponse/index.html
• But in some cases searching for a loved one is not
so straight forward.
12. Hospitals Reunification- Current Situation
• Families can only register at one hospital at a time
when looking for a loved one in code orange.
• If the person they are looking for is not found in the
first hospital families can potentially, and in many
cases, visit many different hospitals in their search.
• This searching surge has been known to go on for
weeks in some circumstances.
13. Elements of a Hospital Reunification Plan
• All participating hospitals must have a way of
registering families, such as a Family Info and Support
Centre (FISC)
• All hospitals must be willing and able to collect and
share identifying info on patients involved in the event
• A way of communicating information between
hospitals must be developed, such as an online portal
• Ideally the plan would also have a way of
communicating the information to evacuation centres
14. The Information to Collect
• There is a difference in information collected from
conscious aware patients (identified) or unconscious
unaware and without identification patients
(unidentified)
• Privacy issues
– Sharing patient info between hospitals
– What info is to be shared
– Scope and duration
– Data sharing agreements
– Where would the information be stored
Editor's Notes
So important is reunification people will do whatever they can to find their missing loved ones. As the days went by in New York after 9/11 attacks families stuck up posters of their missing loved ones on any blank surface they could find. So great is their hope that this went on for many days and weeks. Without clear evidence that their loved is deceased they continued to hope they would be found. Some went to every hospital in the area. Some did not accept their loved one was gone until finally being given a chance to see Ground Zero weeks after the attacks.
Once separated, a family can use several ways to make contact or be reunited. The easiest is to make your way to your nearest Reception/Evacuation centre. In Canada, Red Cross is contracted in most municipalities to operate reception centres in major emergencies. Red Cross takes down names of impacted individuals and families and all have submitted the registration forms the matches will be made though it does not happen very quickly. A relatively new reunification tool has been created by Google and is effective even if the disaster has happened on the other side of the world. Person Finder can be found on Google’s Crisis Response website. Once again the tool requires both the person missing and the person searching to fill out forms. First used after Chile’s earthquake it has also been used in New Zealand and Japan as well as other large scale incidents. Unfortunately the strength of both these tools are also their weaknesses. They require the person missing to also register. The other short coming is that it does not include person in medical facilities due to privacy issues.
Hospitals are where reunification becomes difficult. For the most part the stumbling block in medical care is privacy. There is no simple reunification in place in Canada, and most if not all North America, at this point that makes it easy for hospital to share patient identification so that families can easily identify if there loved ones have been brought to hospital during a mass casualty incident, known in most hospitals as a Code Orange. As a result searching families may need to travel from hospital to hospital searching and asking. After 9/11 some families spent weeks visiting hospitals just for the hope they will find who they are looking for.
When Toronto hosted the G20 in 2010 a Family Reunification plan was created for the city’s hospitals. It was a simple concept. All of the Central Hospitals and Toronto Public Health, through possible reception centres if needed, agreed that in a major code orange incident a central online portal would be implemented to share patient identification. This portal would enable families to go to one hospital receiving patients and if their loved one is not at the hospital they have just registered at a health care professional at the Family Centre could look at the Family Reunification Portal and let the family know if someone fitting their loved one had been admitted to another hospital. The portal due to privacy issues did not have direct access to the portal themselves. The portal was up and available for 2 weeks during the G20. there was no major incident. The portal was never used.
Hospital Privacy officials struggled with the G20 portal. They agreed with the need for something to make reunification easier but struggled with the issues it created.
Under Ontario rules it was determined that conscious and capable code orange patients would need to give their consent (verbal at least) before their identification info could be put Family Reunification portal. This was not the case with unconscious or incapable patients of whom hospitals strive to find a substitute decision maker at the best of times.
The other big issues included the sharing of info between hospitals and what info. Under normal situations anyone can contact a hospital and find out if they have a specific patient, where the patient is and basic condition but hospitals can not share this between their facilities. Code Orange is considered a special situation under which the sharing of identifying info could be shared between staff who have normal access to patient information.
The portal was set up in the computer system of one specific hospital, the scope was determined to be two weeks surrounding the G20 and the scope would be only Code Orange patient’s and only identification and general condition. Data sharing agreements were signed by all hospital and the Toronto Medical Director on behalf of Toronto Public Health. Access to the portal was only given to specific people in each facility. The information would only be kept on the portal for up tile 6 months and then removed by the hospital that put it there.