Texas sees its share of disasters and mass-casualty incidents. The Gulf of Mexico brings it hurricanes. Most of the state is at high tornado risk. A strong industrial base means occasional hazmat incidents.
When these things happen, incident commanders have their hands full coordinating operational resources, making critical go/no-go decisions and maintaining safety and accountability for their teams. But who’s managing the victims? Who’s making those go/no-go decisions about their care and where it happens?
In the aftermath of major events, a significant number of people may need to be moved, cared for and, importantly, accounted for. But that’s traditionally been a challenge in U.S. disaster response. In MCIs from the 2012 theater shooting in Aurora, Colorado, to the 2016 Pulse nightclub massacre in Orlando, Florida, patient tracking and family reunification have been cited as weak points in after-action reports.
There’s only so much fire and EMS providers can do about family reunifications, of course – those efforts will be driven at higher levels. But frontline responders can improve how they identify and track those patients from that time of first contact so they can be more easily located later.
Texas recently rolled out a novel new way to do just that.
THE BAND STAYS ON
Paper-based solutions have fulfilled the basic needs of triage for years, but they have some key drawbacks. They can be slow to apply and hard to keep current. They also provide no visibility of the patient within the system once the patient moves beyond prehospital care.
Texas’ alternative is preprinted wristbands, distributed in advance to response agencies to apply to disaster victims, evacuees and other patients. These provide a unified mechanism to track their care throughout their healthcare journey.
With a quick scan of the individual barcodes on these wristbands, any emergency provider on a scene will be able to begin a unique care file for that patient that contains their identifying and treatment information. They can record their interventions and add details like photos, descriptors and care notes. That file can then be accessed and updated by any other responder on scene with the same quick scan. The wristband stays with the patient to the hospital, where subsequent providers can see everything that’s been done and update it with their own treatment notes.
The barcode number is recorded in both the EMS ePCR and the hospital EMR. Using a single identifier from first response to EMS care to the emergency department creates a single integrated record for patients, rather than multiple disparate ones, and should reduce confusion and help prevent errors in transitions. It is intended to stay with the patient through any hospital transfers and tertiary care until discharge.
“Often you see people in these situations pass from hospital to hospital, and that’s where your track gets really hard to find,” said Texas emergency physician Angela Cornelius, M.D., FACEP, chair of the National Association of EMS Physicians’ Emergency Preparedness Committee and associate medical director at MedStar Mobile Healthcare in Fort Worth. “They were registered as John Doe over here, and over there they’re registered as Mike Arkansas or something. So it can become incredibly difficult to track people through ‘Doe’ names if you don’t have actual names, dates of birth or any of that.”
A 2022 study from Chicago trialed a wristband-based approach to track both routine and mass-gathering patients from prehospital to hospital. It concluded such systems may benefit prehospital event management. Texas’s system was implemented statewide in 2022 and became a required field in the state’s EMS and Trauma Registry this year.
WHAT ELSE CAN PREHOSPITAL PROVIDERS DO?
Of course, not every patient will be able to give you their name and information. In those cases, for reunification purposes and many others, document as much other information as possible – clothing, tattoos or scars, special features, etc. Include photos if possible; hospitals may be able to share these within their networks to help get people identified.
For unidentified children separated from families, a recent study considered the physical and verbal descriptors most likely to aid reunification. Study authors determined gender, eye color and race were likely to be most useful, and certain pieces of personal information, like the name of a pet, may help expedite reunions.
“It starts with some sort of identification, and that might not even be the patient’s name,” said Cornelius. “In the best of all worlds, you’d get the patient’s name and date of birth. If you can’t, you can get identifying marks, you can get where they were found, you can get a description of their clothing. It’s almost like doing a detective’s job – you may not be able to get the complete picture, but you can get pieces of it that maybe can be used to piece together who this person is.”
What else can first responders and fire/EMS providers do to improve patient tracking and aid eventual reunifications? Here are some areas to consider:
Keep families together when possible: It isn’t always. Patients may need care at specialized facilities (trauma, pediatric, etc.), they may have infection/contamination issues, and hospital loads must be balanced. But when you can keep family units intact, do so.
“If you have children, elderly people, incapacitated adults, those are the people who are going to get lost and be vulnerable,” said Cornelius. “If you can keep them with some family member, that is definitely optimal. But it’s not 100% a requirement, depending on your situation.”
Think about police: MCIs often see police and bystanders removing victims from scenes. These patients may not go through any prehospital triage or have their information recorded until they get to the ED. It’s not feasible to ask police and civilians to start medical records, but such patients could be captured by wristband-type systems initiated in the emergency department. This would connect them to the initial incident and get them into the reunification pool. Ambulatory patients who self-transport to hospitals can provide their own information.
Minimize their trauma: Disasters are traumatic, especially for children separated from parents. PBS’s “NOVA” summed up the harm in 2018:
“When a child is separated from his or her parents under chaotic circumstances, a monsoon of stress hormones (like cortisol) floods the brain and the body … In high doses, these chemicals – if hyperactive for a prolonged period of time – can increase the risk of lasting, destructive complications like heart disease, diabetes and even some forms of cancer. In addition, multiple instances of trauma early in life can lead to mental health problems like depression, anxiety and post-traumatic stress disorder.”
If you lack specific training in psychological first aid, you can still be an effective listener – that’s one thing such patients need.
“Most of these people don’t need a psychologist, they just need somebody to talk to,” Cornelius said. “They need somebody who’s going to listen and maybe give them a hug or put a hand on their shoulder and say, ‘Wow, that’s awful.’ They need validation that their feelings are reasonable. … Some people do need more help. And we have people in the disaster arena to address their needs for food, wellness, housing, shelter, etc. But I think a lot of times, as a disaster responder, just sitting down and listening to them will help a lot.”
EASIER NOW MEANS EASIER LATER
The go/no-go decisions to be made on major incident scenes involve patients too – not everyone you triage will require an ambulance to the hospital. But everyone who presents for care must be assessed and, as best you can, identified. The easier triage and tracking systems make it for responders to do a comprehensive job of that, the easier reuniting families will be afterward.
This article originally appeared in the May 2023 FireRescue1 Digital Edition.
