Identify, Notify, How?

During a recent planning session for a Catastrophic Health Incident Response Plan work shop the problem of victim identification / family notification was identified. What is your solution?

Your question touches on the key issue of priorities during a disaster response, most significantly in the initial hours after an event (when resources and information are most limited). Given the limited resource environment, any solution must conform to a resource allocation (business triage) model.

Most in disaster and emergency management would agree that the most important goal during the response to an event is the preservation of life. Close behind in importance is the prevention of further loss (preservation of property and resources); then the dissemination of information. Somewhere after these three (and perhaps a dozen more priorities) is the identification of the dead and the notification of families. The problem is that the notification of the families of survivors and the notification of the families of patients is too often lumped into the same priority category with the notification of the deceased. This means that families remain separated from survivors and patients increasing the psychological impact and pain caused by the disaster. Counterbalancing this need to reunite is the fact that the most limited resource in the early hours and days of a disaster response is people. Given the relative priorities of preserving life and mitigating loss, diverting resources to reunification is difficult to justify operationally while it is simultaneously difficult to delay morally.

The most obvious solution is to utilize resources not already dedicated to other early response activities. Unfortunately, untrained volunteers are of little assistance in the notification process and may inadvertently create hardship and confusion with a mistaken notification. Automation of the notification process using systems such as EMSystems, EMTrack, IRIS, or KatrinaSafe.org is less resource (personnel) intensive and in the case of KatrinaSafe.org, requires minimal orientation (great for those volunteers above). The problem with automated systems is that the system must know where to send the information so that the families can find it. EMSystems, EMTrack and IRIS collect information as part of other functions (effectively resource neutral) and send information to the Joint Information Office or the Emergency Operations Center. The JIO and/or EOC then must deal with notification and the resources required for that process. KatrinaSafe.org requires resource utilization to enter the survivor information, but notification is via a computer matching system in which the family enrolls on the internet (effectively resource neutral). The ideal would be some merger of these existing systems such that the already collected information were filtered to KatrinaSafe.org or another similar national system and then matched to the searching families without further resource utilization.

Question Submitted via Ask@MauriceARamirez.com

Comments

[Rick Rhodes]

The big question we have is with HIPAA Rights. THe hospitals are concerned that they would be violating patient rights by releasing information. There have been some consessions made during Katrina for instance, but we have not found anything permanent as far as disasters and notifying families. Is there legislation to cover this?

[Dr. Maurice A. Ramirez]

In its simplest and purest interpretation, HIPAA (the Health Information Portability and Accountability Act) prohibits the willful or negligent release of patient information to unauthorized parties. While much debate, controversy and regulation swirl around what constitutes “willful,” “ negligent,” “release” and “patient information” there is little debate or even disagreement on what constitutes “unauthorized parties” and conversely “authorized parties.”

HIPAA allows for the sharing of patient identifiers to public health and public safety officials for the purpose of meeting public reporting requirements. A prime example is the release of patient information in cases of reportable sexually transmitted disease. In this example, the patient’s contact information, demographics and diagnosis are shared with the local public health unit. This is the so called “public interest / public health reporting” exception to HIPAA. Mass casualty and disaster survivor and decedent reporting is also a recognized public health function under the National Response Plan and the National Incident Management System. FEMA and other federal / state disaster response agencies rely on this information to adapt response plans and efforts.

The release of patient name, condition and location to the empowered local emergency management agency (or their designee) is thus covered under the “public interest / public health reporting” exception. Similarly, reporting injury types and totals without patient names is permissible. The reporting of patient diagnosis linked to name and other demographics falls into the prohibited or potentially prohibited area.