PATIENT TRACKING

&

FAMILY REUNIFICATION

PLAN

Revised: January, 2016

Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 2 of 21

Table of Contents

I. Introduction .......................................................................................................................................... 4

II. Purpose ................................................................................................................................................. 5

III. Assumptions ...................................................................................................................................... 5

IV. Authorities & Responsibilities ........................................................................................................... 6

A. Medical Health Operational Area Coordinator (MHOAC) Program .................................................. 6

C. Regional Disaster Medical Health Coordinator / Specialist (RDMHC/S) Program ............................ 6

D. Control Facility (Mark Twain Medical Center) .................................................................................. 6

E. American Red Cross .......................................................................................................................... 7

V. Patient Tracking .................................................................................................................................... 8

a. Pre-hospital (ambulance) .............................................................................................................. 8

b. Control Facility Patient Tracking ................................................................................................... 8

c. Hospital Patient Tracking .............................................................................................................. 9

VI. Family Reunification .......................................................................................................................... 9

a. Local Hospital Inquiries ................................................................................................................. 9

b. ARC Family Reunification ............................................................................................................ 10

VII. Appendices ...................................................................................................................................... 12

A. HIPAA PRIVACY and DISCLOSURES IN EMERGENCY SITUATIONS ............................................... 13

B. PATIENT TRANSPORTATION SUMMARY WORKSHEET (MCM 403)............................................. 15

C. PATIENT DESTINATION WORKSHEET .......................................................................................... 16

D. ARC MCI PATIENT DIRECTORY..................................................................................................... 17

E. ARC CALL INTAKE FORM.............................................................................................................. 19

F. CONTACT INFORMATION SHEET ................................................................................................. 20

Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 4 of 21

I. Introduction Ever since the events of 9/11 and the 2005 Hurricane Katrina, no national or statewide system for tracking displaced persons or patients has been developed. Although there are various systems that have been developed, including both manual and computerized tracking systems, most of these are still not used beyond individual facilities or organizations. Under the National Response Framework, some tracking responsibilities are assigned to specific Emergency Support Functions (ESF). ESF #6 Mass Care/Emergency Assistance is responsible for providing “...support to evacuations (including registration and tracking of evacuees)...”

ESF #6: (Mass Care/Emergency Assistance) states that FEMA is responsible for registering/tracking the general population (and service animals / household pets). A general population evacuee who becomes ill during evacuation will become the responsibility of ESF #8.

ESF #8: (Public Health & Medical Services) states that HHS is responsible for medical evacuees. Medical evacuees discharged/released from medical care become the responsibility of ESF #6

In California, the responsibility for patient tracking falls mainly on the local caregiver or provider agency.

Most pre-hospital providers and hospitals do have systems for tracking patients; however, there is

currently no system for linking or centralizing this information during a large-scale incident to facilitate

patient tracking and family reunification. Additionally, no single data-set has been agreed upon for

capturing or sharing information between jurisdictions.

Some of the systems that have been developed to assist in family reunification efforts include:

1. National Emergency Family Registry and Locator System

FEMA’s National Emergency Family Registry and Locator System (NEFRLS) helps reunite

families separated during a disaster. It allows displaced individuals to register and provide

information about their current location and situation. The system provides a secure web-

based environment where survivors and their loved ones can communicate their location as

well as provide a personalized message.

Affected individuals, or those seeking information about friends or family, can visit the

NEFRLS website or call the NEFRLS hotline (see Appendix G) to register themselves or

inquire about another person. The system is only activated at the request of a state to

support Presidentially-declared disasters.

2. National Emergency Child Locator Center

FEMA also works in collaboration with the National Center for Missing & Exploited Children

(NCMEC) to support the reunification of children under 21 years of age with their parent(s)

or legal guardian. Individuals reporting or searching for a child missing as a result of a

disaster should call the NCMEC National Emergency Child Locator Center (NECLC) (see

Appendix G). NECLC is only activated at the request of a state to support Presidentially-

declared disasters.

3. Unaccompanied Minors Registry

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NCMEC launched the Unaccompanied Minors Registry (UMR), the nation’s first national

repository created to collect, store, report, and act on information related to children

separated from their parent or legal guardian as a result of disaster. Reports to the UMR are

received directly by the NCMEC’s 24/7 call center staff. Individuals can log on to the

Unaccompanied Minors Registry (UMR). The registry is available for utilization 24 hours a

day/7 days a week.

4. American Red Cross Safe and Well

American Red Cross maintains Safe and Well, a web-based system that helps reunify friends

and family displaced by a disaster. The Safe and Well site is always available and can be

used by the public for any disaster, large or small. To speak with someone at the American

Red Cross concerning a missing friend or relative, please contact the local American Red

Cross chapter where you live or are staying (visit www.redcross.org to find a local chapter).

II. Purpose To develop a Patient Tracking & Family Reunification Plan that outlines a process to be used for

patient tracking and family reunification during an MCI or large-scale incidents.

III. Assumptions

Most persons involved in an emergency which results in the need for emergency medical care

desire to be found by friends, family members, and others who might be concerned for their

well being.

All pre-hospital providers (EMS/Fire) follow the OES Region IV Multiple Casualty Incident (MCI)

Plan for patient triage and tracking.

Hospitals within the region utilize the Hospital Incident Command System (HICS) and forms.

Each county in OES Region IV utilizes the SEMS/NIMS process for communicating / coordinating

information from the OA to the Region.

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IV. Authorities & Responsibilities

A. Medical Health Operational Area Coordinator (MHOAC) Program

The MHOAC Program, as described in Health and Safety Code §1797.153, is responsible to:

Plan for the provision of medical and health mutual aid within the operational area,

Assist the OES coordinator in the coordination of medical and health disaster resources

within the operational area.

Act as the 24-hour point of contact for coordination with the RDMHC/S, the State

Department of Public Health, and the State EMS Authority.

Provide medical-health situation status reports to County OES, regional and state agencies

during an unusual event, emergency system activation, or upon request of the state.

B. Mountain Valley EMS Agency (MVEMSA)

MVEMSA, as the local EMS agency, is responsible to:

Coordinate and direct the EMS system in the county.

Establish policies and procedures approved by the medical director of the local EMS agency

to assure medical control of the EMS system.

In collaboration with the Public Health Officer, act as the MHOAC.

Provide 24/7/365 Duty Officer coverage for the MHOAC Program.

C. Regional Disaster Medical Health Coordinator / Specialist (RDMHC/S)

Program

The Regional Disaster Medical Health Coordinator (RDMHC) is an appointed position in each of

the six Mutual Aid Regions, established by Health and Safety Code §1797.152. The RDMHC

coordinates disaster information and medical and health mutual aid and assistance within the

Mutual Aid Region or in support of other affected Mutual Aid Regions. The Regional Disaster

Medical Health Specialist (RDMHS) works as staff to the RDMHC program and is jointly funded

through the state CDPH and EMS Authority to accomplish objectives and activities developed

each year through contract with the sponsoring agency.

D. Control Facility (Mark Twain Medical Center)

Mark Twain Medical Center’s Emergency Department (ED) acts as the Control Facility for the

county (see the OES Region IV MCI Plan or Mountain-Valley EMS Agency Policy 820 for further

explanation of the role of Control Facilities). In this capacity, the ED staff is responsible to direct

ambulance patients during a multiple casualty incident to hospital destinations, including those

in neighboring counties. Although they document patient destinations, the only patient-

identifying information is typically: age, gender, and triage category.

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E. American Red Cross

The American Red Cross is the only non-governmental organization chartered by Congress to

provide relief to victims of disaster. Under the Federal Response Plan following a Presidential

declaration, the Red Cross and the Federal Emergency Management Agency (FEMA) work

cooperatively. The American Red Cross is a signatory to the Federal Response Plan and is

obligated as an agent of the federal government to coordinate all mass care response assistance

through Emergency Support function (EFS) #6. This means the Red Cross is the primary agent

designated to provide mass care relief including food, shelter, supplies, first aid and more. The

Red Cross also operates a Disaster Welfare Information System for the purpose of reporting

victim status and assisting in family reunification.

Red Cross responds to inquiries from immediate family members about the health and well

being of individuals and families within a disaster-affected area. Red Cross then collects

information about such persons and provides reunification services. Red Cross encourages

people to contact their local chapters to assist with this effort rather than the Red Cross chapter

in the disaster area.

F. Health Information Protection and Portability Act (HIPAA)

Disclosures to Family, Friends, and Others Involved in an Individual’s Care and for Notification A covered entity may share protected health information with a patient’s family members, relatives, friends, or other persons identified by the patient as involved in the patient’s care. A covered entity also may share information about a patient as necessary to identify, locate, and notify family members, guardians, or anyone else responsible for the patient’s care, of the patient’s location, general condition, or death. This may include, where necessary to notify family members and others, the police, the press, or the public at large. See 45 CFR 164.510(b). The covered entity should get verbal permission from individuals or otherwise be able to reasonably infer that the patient does not object, when possible; if the individual is incapacitated or not available, covered entities may share information for these purposes if, in their professional judgment, doing so is in the patient’s best interest. In addition, a covered entity may share protected health information with disaster relief organizations that, like the American Red Cross, are authorized by law or by their charters to assist in disaster relief efforts, for the purpose of coordinating the notification of family members or other persons involved in the patient’s care, of the patient’s location, general condition, or death. It is unnecessary to obtain a patient’s permission to share the information in this situation if doing so would interfere with the organization’s ability to respond to the emergency.

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V. Patient Tracking

a. Pre-hospital (ambulance)

Ambulances and hospitals in the county are required to follow the California Mutual Aid Region IV MCI Plan. This plan was adopted as policy by the Mountain-Valley EMS Agency (policies 810, 820, 830). An intricate part of the continuum of care from the prehospital setting to the hospital involves patient transportation. As outlined in the California Mutual Aid Region IV MCI plan, communication is made by the prehospital provider to the Control Facility (CF) to obtain patient destinations for transportation.

During an MCI, providers currently use the MCM 403 Form (Patient Transportation Summary Worksheet) in Region IV as a worksheet to record patient transportation destinations. These are pen and paper forms (see Appendix B), and contain:

Patient triage status / injury

Mode of transportation

Hospital Destination

Ambulance company and ID

Patient Name / Triage Tag #, and

ETA to hospital

Patient tracking during an MCI is achieved by a pre-hospital provider completing a Patient Transportation Summary Worksheet form. This form is completed by the Patient Transportation Unit Leader/Group Supervisor or designee. The completed Patient Transportation Summary Worksheet shall be provided to the Control Facility within 2 hours following transport of the last patient. Consider sending camera phone snapshot of the form to the Control Facility via email.

b. Control Facility Patient Tracking

The Control Facility function at Mark Twain Medical Center’s Emergency Department follows the Region IV MCI Plan to assess hospital emergency department capacities throughout the region and provide destinations to ground and air ambulances during an MCI. The Patient Destination Worksheet used by Control Facility staff is designed to capture the patient age/gender, triage tag number, and destination.

Upon conclusion of an MCI, the Control Facility staff should request the Patient Transportation Summary Worksheet from the field Medical Group Supervisor. Copies of the Control Facility Patient Destination Worksheet and the field Patient Transportation Summary Worksheet should be provided to those individuals involved in Family Reunification activities (i.e. hospital staff or volunteers answering patient inquiry calls).

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c. Hospital Patient Tracking

Hospitals in the Region are required to follow the California Mutual Aid Region IV MCI Plan during an MCI or disaster. Hospitals also have their own Emergency Operations Plan (EOP) and utilize principals founded in the Hospital Incident Command System (HICS). The standardized HICS forms include: • HICS 254 - DISASTER VICTIM/PATIENT TRACKING FORM: used to document the

Medical Record #/ Triage Tag #, Name, Sex, DOB/Age, Area Triaged to, and Disposition.

• HICS 255 - MASTER PATIENT EVACUATION TRACKING FORM: used to document the patient Name, Medical Record #, and Disposition.

Additionally, the Region IV MCI Plan requires the tracking of triage tag numbers in the patient’s chart/record along with the medical record number. This is useful for post hospital arrival tracking purposes.

During or following a significant incident, the HICS 254 and HICS 255 forms will be provided to those individuals involved in Family Reunification activities (i.e. hospital staff or volunteers answering patient inquiry calls). Facesheets from patients received from an MCI from outside the county shall be faxed to the Control Facility of the source county of the MCI after patients have been identified, in order to assist Family Reunification as well as transporting providers with patient information.

VI. Family Reunification

As outline in the Bulletin from the US Department of Health and Human Services from September 2,

2005 (see Appendix A: HHS Bulletin), health care providers can share patient information as

necessary to identify, locate and notify family members, guardians, or caregivers of the individual’s

location, general condition, or death.

In addition, when a health care provider is sharing information with disaster relief organizations

such as the American Red Cross, it is unnecessary to obtain a patient’s permission to share the

information if doing so would interfere with the organization’s ability to respond to the emergency.

a. Local Hospital Inquiries

1. Registered/Admitted Patients

When a call is received by the hospital switchboard, inquiring about a patient in the

Emergency Department or in-house, the call is forwarded to the house supervisor. The

house supervisor will verify:

1. Name of person calling

2. Relationship to patient

3. Call-back telephone number

4. Patient name

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The house supervisor will obtain patient’s consent prior to providing status information

regarding the patient.

Should response to patient location inquiries cause a burden to Control Facility or

hospital staff, they may activate the Family Reunification service offered by the

American Red Cross (Mon-Fri 8:00 AM-4:00 PM: (916) ) After Hours/Holidays

Contact (855) .

2. Patients transported out-of-county

When a call is received by the hospital switchboard, inquiring about a patient

transported during a multiple/mass casualty incident, that has not been registered at

the hospital, staff will:

a. Obtain call-back information from the caller, including:

Name of person calling

Relationship to patient

Call-back telephone number

Patient name

b. Compare requested patient information against patient tracking forms

obtained from hospital (Control Facility) Emergency Department staff.

c. Provide any known destination information to calling parties regarding patients

transported to outside facilities

d. Contact American Red Cross to request Family Reunification function should

response to patient location inquiries cause a burden to Control Facility or

hospital staff (Mon-Fri 8:00 AM-4:00 PM: (916) ) After Hours/Holidays

Contact (855) .

b. ARC Family Reunification

Upon request of a local hospital or jurisdiction, the local chapter of the American Red Cross

will seek to activate their Family Reunification Services. This activation will include:

1. Notifying local healthcare entities of this activation and providing a local or toll-free

telephone number to respond public inquiries regarding patient locations and general

condition.

2. Obtain the copies of the Patient Destination Worksheets and the field Patient

Transportation Summary Worksheets from local Control Facility(ies). Coordinate with

the impacted jurisdiction(s) MHOAC Program, and regionally with the RDMHC/S

program as needed.

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3. Develop a directory of patients involved in the MCI or disaster (see Appendix D: ARC

MCI Patient Directory).

4. Respond to patient inquiries

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VII. Appendices

A. HHS Bulletin: HIPAA PRIVACY and DISCLOSURES IN EMERGENCY SITUATIONS B. Patient Transportation Summary Worksheet C. Patient Destination Worksheet D. ARC Patient Directory E. ARC Call Intake Form F. Contact Information Sheet G. Additional Information

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A. HIPAA PRIVACY and DISCLOSURES IN EMERGENCY SITUATIONS

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Additional information can be found on the HHS website at:

http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/emergency/emergencysituations.pdf

B. PATIENT TRANSPORTATION SUMMARY WORKSHEET (MCM 403)

C. PATIENT DESTINATION WORKSHEET

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D. MCI PATIENT DIRECTORY

1. Incident:

2. Incident Date/Time: 3. Incident Location:

* Last Name First Name Age Gender Triage Tag # Condition Location

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* restrictions

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MCI Patient Directory

INSTRUCTIONS

1. Brief description of the current incident or disaster (e.g. motor vehicle collision, fire, etc.)

2. Approximate date and time of the incident, if known

3. Incident location, if known, including city and county.

4. Patient Information: Obtain copies of the Patient Destination Worksheets and the field Patient

Transportation Summary Worksheets from local Control Facility(ies). Coordinate with the impacted

jurisdiction(s) MHOAC Program, and regionally with the RDMHC/S program as needed.

5. Restrictions (*): If any restrictions for providing patient location or conditions exist, indicate with an

asterisk, and list restrictions under Notes. Restrictions may include such things as: patient request

location or condition information not be shared, or patient requests any inquiries be routed to

patient representative at (phone #).

6. Notes: Notes include any additional information regarding the patient condition or restrictions, e.g.

patient representative telephone number, or patient requests no information to be shared, etc.

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E. CALL INTAKE FORM

Name of Caller:

Phone Number for Call Back:

Address of Caller:

Caller’s Relationship to Victim/Family Member:

Victim/Family Member Information:

Name:

Gender:

Age:

DOB:

Height/Weight:

Race:

Hair Color:

Eye Color:

Tattoos/Other Identifiers:

Occupation:

Primary Language:

Notes:

Call Taker Name________________________________________________________________________

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F. CONTACT INFORMATION SHEET

Jurisdiction Lead Contact Contact Number Email

Reunification Branch Director

Law Enforcement Liaison

Fire Department Liaison

Public Information Officer

Call Center Contact Contact Number Email

Hospital Reception Site Contact Contact Number Email

Coroner’s Officer Contact Contact Number Email

School Contact Contact Number Email

Animal Tracking Contact Contact Number Email

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G. ADDITIONAL INFO

1. FEMA’s National Emergency Family Registry and Locator System-

NEFRLS hotline at 1-800-588-9822

2. National Center for Missing & Exploited Children (NCMEC)-

1-866-908-9570 or 1-877-908-9570

3. American Red Cross Safe and Well- https://safeandwell.communityos.org/cms/index.php