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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
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 5 of 21
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.
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 6 of 21
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.
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 7 of 21
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.
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 8 of 21
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).
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 9 of 21
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
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 10 of 21
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.
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 11 of 21
3. Develop a directory of patients involved in the MCI or disaster (see Appendix D: ARC
MCI Patient Directory).
4. Respond to patient inquiries
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 12 of 21
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
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 13 of 21
A. HIPAA PRIVACY and DISCLOSURES IN EMERGENCY SITUATIONS
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 14 of 21
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
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 17 of 21
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
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 18 of 21
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.
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 19 of 21
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________________________________________________________________________
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 20 of 21
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
Calaveras County Patient Tracking Plan Revised: 1/15/16 Page 21 of 21
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