Children in Disaster · children in a disaster, in view of your role, institution, and ... to take report on the firefighters, triage them, and assure they get evaluated expeditiously

Children in Disasters-Reunification

UCSF Benioff Children’s Hospital Oakland

June 2019

MD HeckleUniversity of California San Francisco Police DepartmentHomeland Security Emergency Management Division

MD Heckle, Emergency Management

UCSF Benioff Children’s Hospitals

How Prepared Are YOU?

Safety Information

You came into this room -did you size up?

• Exit Points, Fire Extinguishers,1st Aid

and Defibrillators locations, and

Assembly Area

Do you sponsor a culture resiliency?


ObjectivesAt the conclusion of this activity, the participant will be able

to:

• State the key tasks for tracking and reunification of children in a disaster, in view of your role, institution, and state/local contexts.

• Identify designated individuals and/or agencies for assistance on tracking and reunification of children in a disaster, in view of your role, institution, and state/local contexts.

• Access information on key tasks and contacts on tracking and reunification of children in disasters using the reference card provided.


Children in Disasters:

Reunification

• "Reunification is defined as the process of

assisting displaced disaster survivors,

including children, in voluntarily

reestablishing contact with family and

friends after a period of separation." • Post Disaster Reunification of Children: A Nationwide Approach, November 2013



Reunification

• Unaccompanied minors are defined as

"Children who have been separated from

both parents, legal guardians, and other

relatives and are not being cared for by an

adult who, by law or custom, is

responsible for doing so." • Post Disaster Reunification of Children: A Nationwide Approach, November 2013



Reunification

Source: Minor Separated from Parent or Legal Guardian-Post Disaster

Reunification of Children: A Nationwide Approach, November 2013



Reunification

Source: Child reported missing by Parent or Legal Guardian-Post Disaster

Reunification of Children: A Nationwide Approach, November 2013


Case Study #1

• A severe thunderstorm struck without warning and spawned a tornado, which has damaged several buildings and homes at the edge of town. You are a paramedic who is first on the scene of a middle school with a roof that was partially damaged by the tornado.

• Your initial assessment of the scene reveals damage to one corner of the building. This was the cafeteria, and many windows were blown out during the storm as a result of the roof being torn away. Luckily, most of the children were in class and no events were taking place in the lunchroom. However, a group of five children were studying in the cafeteria near the windows when the storm came through. The kitchen is located at the other end of the cafeteria and the cooks and lunch volunteers only sustained minor cuts and bruises.

• Three of the children are already standing up and talking when you arrive. The school nurse states that they are okay but scared their friends may be hurt. You and your colleague evaluate the other two children and agree that they need to be transported to the nearest emergency department for further evaluation and treatment.


Case Study #1

• Before you place these children in the

ambulance for transport, what

information do you need to gather to

facilitate reunification?


Case Study #1

• When you drive away from the school,

you are assuming responsibility for

these children. How will you assure

that they do not get lost in the system?


Case Study #1

• Can you legally leave the children at

the hospital?


Case Study #1

• Now that the charge nurse has

assumed responsibility, what is her

first step to continue the process of

reunifying these children with their

parents?


Case Study #1

• What information needs to be gathered

prior to releasing patient A into the

custody of a woman claiming to be the

parent?


Case Study #1

• What are the next steps to assure

reunification of this unaccompanied

minor with her parents?


Case Study #2• An earthquake has hit your city. Several buildings have been damaged and

a major bridge has collapsed, bringing traffic to a standstill. You are a physician at an ambulatory care clinic located near an area that sustained significant damage.

• The clinic waiting room is chaotic. Several people in the neighborhood have walked in from their homes, which were damaged in the earthquake. Looking around the room, you do a brief visual triage and see that these people fall into the category of "walking wounded." Their injuries appear to be mostly cuts and bruises. One older man walked in from the parking lot and is holding his arm, which appears deformed.

• You gather your team together for a huddle and assess the situation. As you are initiating your disaster procedures, one of the workers from the early education and child care program nearby comes into the clinic holding a boy. As she was gathering the children outside the center, which had partially collapsed, she found this child, whom she did not recognize, alone on the street. He has been unable to tell her what happened. She was concerned the child was injured and wanted a medical assessment. She attempted to call 911, but her cell phone service is out.


Case Study #2

• What are some techniques you can

utilize to put children at ease when

trying to gather information from them

to aid in your tracking and reunification

efforts?


Case Study #2

• What should you do to help track this

child?


Case Study #2

• What is the next thing you need to do

to begin reuniting this child with his

parents? If you are able to get one call

through who would you call?


Case Study #2

• By late afternoon, things at the clinic

have settled down. No adult has

correctly identified the child you are

caring for.

• What is the accurate definition of the

status of this child now?


Case Study #2

• What is the next step to assure the

reunification process continues to

move forward? Who do you call now?

Forms: ARC


In shelter environments: DCS JT-F RES Sheltering Unaccompanied Minor and Separated Child

Report Form V.1.0.2016.07.18


Case Study #3

• Wildfires have spread more rapidly than expected, invading communities, igniting homes, and cutting off transportation routes. You are the charge nurse in the emergency department of a local hospital.

• You are in the parking lot awaiting an ambulance when a school bus unexpectedly arrives. After you identify yourself, the driver reports the school dismissed the children early due to increasing hazard from the wildfire. He was driving the children home with six remaining to drop off. The route he needed to take into their neighborhood was blocked off by fire crews. The driver tried to contact the school, but communications were down. He was unsure where to take the children and diverted course to your hospital.

• You note the driver looks pale and sweaty. He is breathing heavily and clutching his chest. Fearing for his health, you alert one of the paramedics nearby and they take him into the emergency room for further medical evaluation. For the purposes of this case, the children are now considered unaccompanied minors. You verify that six children are aboard the bus, and they appear to be elementary school age.


Case Study #3

• What information do you need from the

kids to begin the tracking and

reunification process?


Case Study #3

• How will you account for the children?


Case Study #3• You suddenly realize that you are responsible for the six children on

the bus. Meanwhile, the ambulance you were expecting approaches the ED carrying injured firefighters. As the charge nurse, you need to take report on the firefighters, triage them, and assure they get evaluated expeditiously. While you attend to these duties, you need to figure out how and to whom you will delegate responsibility for the children.

• Elizabeth is a Child Life Specialist and is great with children. She has worked at the hospital for years and is calm, organized, and responsible. She has also been vetted to supervise unaccompanied minors (background check and fingerprints). You see one of your physicians coming in to start her shift. After briefly conveying the story, you ask her to send Elizabeth out to the bus.

• When Elizabeth arrives, you review her key tasks with regard to tracking the children and continuing reunification efforts.


Case Study #3

• What steps will you have her take to

assure accurate tracking? What

information does she need to identify

the children? Who should be called

next to begin reuniting the children

with their caregivers?


Case Study #3• Elizabeth takes the children to the well child waiting area on the

pediatric ward, a designated pediatric safe area. She counts heads to assure she still has all six of them. By activating the hospital's emergency plan, access to this area is secured.6 While the children are playing, she talks with each one in turn. Smiling and kneeling down to put them at ease, she asks each child their age, name, parent's names, phone number, and address. She records this information and puts a wristband on each child. One of the older children was able to provide the name of the school they attend.

• Elizabeth asks the pediatric social worker to assist her by calling the school. The school nurse gets on the line. He is busy working the reunification process at the school as the wildfires are headed that way. He clarifies the identity of some of the smaller children who only knew their first names and relays the information needed to contact their parents.

• One by one, the children's parents arrive. At the end of the day, Elizabeth has yet to reunite two children with their parents.


Case Study #3

• Continuing to collaborate with the

school, what are other resources she

can use to assist with reunification of

these unaccompanied minors?


Summary

• Throughout this lesson, you studied topics related to a key issue in disasters, tracking and reunification of children. You also were presented with the Tracking and Reunification of Children in Disasters Cardand were taught how the use of that card assists in handling cases by providing a uniform format in which to record your specific key contacts and tasks for each situation.


Summary (cont.’d)

• By applying what you learned in the case

study examples, you should now be better

prepared to execute response steps when

a child is encountered in a disaster

separated from a parent or legal guardian.


References• Walsh L, Subbarao I, Gebbie K, et al. Core competencies for disaster

medicine and public health. Disaster Med Public Health Prep. 2012;6(1):44-52.

• Schultz CH, Koenig KL, Whiteside M, Murray R, for the National Standardized All-Hazard Disaster Core Competencies Task Force. Development of national standardized all-hazard disaster core competencies for acute care physicians, nurses, and EMS professionals. Ann Emerg Med. 2012;59(3):196-208.e1.

• Brandenburg MA, Watkins SM, Brandenburg, KL, Schieche C. Operation Child-ID: reunifying children with their legal guardians after Hurricane Katrina. Disasters. 2007;31(3):277-287.

• Broughton DD, Allen EE, Hannemann RE, Petrikin JE. Getting 5000 families back together: reuniting fractured families after a disaster: The role of the National Center for Missing & Exploited Children. Pediatrics. 2006;117(5):S442-S445.

• Jemtrud SM, Rhoades RD, Gabbai N. Reunification of the child and caregiver in the aftermath of disaster. J Emerg Nurs. 2010;36(6):534-537.

• Post-Disaster Reunification of Children: A Nationwide Approach. 2013.

• Media Sources: Provided by UCSF Benioff Children’s Hospitals Oakland


Questions?

Michelle D. Heckle, CHEP

•Emergency Management

•UCSF Police Department

•654 Minnesota Street

•San Franicisco

•415.933.9774

[email protected]

James Betts, MD

•[email protected]

Documents

Children in Disaster · children in a disaster, in view of your role, institution, and ... to take report on the firefighters, triage them, and assure they get evaluated expeditiously