By Jim Kendig, Field Director
Editor’s Note: Some of this information appeared in an article in the August 2021 edition of EC News.
Recent unforeseen disasters, including the tragic collapse of the 13-story condo building in Surfside, Miami, and Hurricane Irma, underscore the importance of having a family reunification plan.
Following the condo collapse , scenes at the ED became quite chaotic when victims appeared without identification and family members congregated to search for their loved ones. Family members expected answers from staff who were also handling unconscious patients. Historically, hospitals have naturally functioned as the congregating place in a community after a disaster. After 9/11, families dropped in at waiting rooms and called hospitals throughout the city in the hopes of finding loved ones. At that time, 20 years ago, the American Red Cross offered to establish a family reunification center within 24-48 hours. That’s far too late for anyone looking for a loved one.
This was one of the drivers for me to develop a team in Brevard County, Florida, that was building its own family reunification plan:the Brevard Victims Network, in which hospitals share images and descriptions of all unidentified victims within an hour of an event. The shared information includes the victim’s ID card that notes, for example, special tattoos or body features. Network team members would sit down with loved ones and only show them information specific to their missing family member’s gender, race, etc., to better assist them in identification. Sorting the photos by demographic information really saved a lot of time, not to mention frustration, for families.
This is why The Joint Commission recommends (but does not require) a family reunification plan.
With hospital staff at the hub of the disaster management wheel, it’s important that they’re effectively communicating with patients and families.
The Joint Commission requires policies and procedures to be in place for communicating with patients’ and residents’ family members during a disaster (or prior to the emergency if it’s foreseen, such as a hurricane) and establish backup communication channels. This requirement falls under Emergency Management (EM) Standard EM.02.02.01: As part of its Emergency Operations Plan, the [organization] prepares for how it will communicate during emergencies.
Per Element of Performance (EP) 5, the plan must address how the [organization] will communicate with patients and residents and their families, including how it will notify families when patients and residents are relocated to alternate care sites.
The family reunification plan should specify a defined activation point for the family reunification center, such as notification that the hospital will be receiving patients from a mass-casualty event. Once activation is authorized, appropriate staff can coordinate staffing needs, supplies, and setup for the center, and begin planning for a smooth demobilization to transition back to normal operations.
Staffing a Family Reunification Plan
One of the most important aspects of the family reunification plan is the involvement of staff and community partners in implementing the plan, regularly reviewing it, and creating practice drills. Drills should happen at regular intervals to ensure that new staff receive the appropriate training in family reunification before a disaster occurs.
When applicable, family reunification can be incorporated into Joint Commission-required functional or full-scale emergency exercises.
Designating a reunification center within the hospital environment is a leading practice. This area should be located somewhere inaccessible to curiosity seekers and should (if possible) be separated from the ED. A good overarching guideline is to ensure the site is easily accessible, with sufficient space and services (such as restrooms and electrical outlets) for both families and staff.
However, the designated family reunification center doesn’t have to be on-site at the hospital. A central community-based family reunification center and later a hotel was utilized during the condominium collapse in Miami.
While staffing the reunification center is dependent on the size/nature of the disaster, most include:
- social workers
- pastoral care staff
- clinical professionals
- translators or a sign language interpreter
The specific roles for staff will vary at each organization. In my experience at Brevard County Victims Network, we discovered that social workers and pastoral care professionals didn’t have a role at the beginning of the event, so we used them during events as well as during practice drills and exercises.
Involving Local Agencies & HIPPA Considerations
I cannot stress enough the importance of involving local agencies and community resources in your emergency planning long before an event actually occurs. The Brevard Plan included the American Red Cross, local Department of Health, Office of Emergency Management, and the Medical Examiner’s Office. One of the main advantages of advance planning is having sufficient time to complete prior Health Insurance Portability and Accountability Act (HIPAA) authorizations. Health care staff members also should be trained in how HIPAA can be applied during a disaster so that they do not mistakenly withhold important information.
According to the US Department of Health and Human Services, in a severe disaster “health care providers can share information as necessary to identify, locate, and notify family members, guardians, or anyone else responsible for the individual’s care [about] the individual’s location, general condition, or death.” Although medical reunification isn’t under the purview of a nationwide agency or service, the Post-Katrina Emergency Management Reform Act designated the National Center for Missing & Exploited Children to be responsible for supporting the reunification of unaccompanied minors with parents or legal guardians. The center’s resources include the National Emergency Child Locator Center, Team Adam, and the Unaccompanied Minors Registry.
Registration Set Up
A hospital reunification center’s registration process should serve as a clearinghouse for gathering all necessary information and assessing any special needs of family members. Staff should wear clearly visible badges to easily identify their function and it’s a best practice to have security available on standby.
Children’s National Hospital in Washington, D.C.—considered a thought leader in family reunification planning—asks parents to provide a child’s name and identifying features (such as what the child was wearing and whether the child has piercings, tattoos, or birthmarks) while social workers sometimes gather information from community partners (i.e., schools, day care centers, the police department, and child protective services) to help establish a patient’s identity and verify the identities of parents and legal guardians. Parents and guardians should receive a badge after they’ve been vetted.
Waiting & Reunification
Waiting for news is often the hardest part for families and support is always helpful in terms of:
- access to phone chargers
- reliable Wi-Fi
Consider specialized needs of individuals [during this time. Loved ones with dementia, for example, may be more comfortable waiting in a quiet area.
Staff who should be present at the reunification point include a nurse, physician, and patient access staff member, if possible. In the case of a deceased patient, a chaplain, a social worker, and a member of the medical team should take the family into a private location to inform them. Whenever possible, the family should be given an opportunity to be with or view their loved one. Even when the news is ultimately tragic, an appropriately staffed, well-run reunification center can make a big difference to families.