Family ReunificationWhen hospital surges are more then just medical

Five Essential Elements

• Promote sense of safety.• Promote calming.• Promote sense of self and collective efficacy.• Promote connectedness.• Promote hope.

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Ref: Stevan Hobfoll et al, Five Essential Elements of Immediate and Mid–Term Mass Trauma Intervention: Empirical Evidence, Psychiatry 70(4) Winter 2007

The Social Reality

• Social Support is considered one of the most important elements in the recovery from trauma.

• Family and friends will surge on the hospital looking for loved ones.

• Reconnection with family members can be a greater priority then meeting individual basic needs.

• Information can be the most effective intervention on its own, provide it early and often. Providing consistent information builds relationship and trust with families

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Five Psychosocial Considerations

1. Perceptions Matter2. Routines predict behaviour3. People behave in Purposeful and Adaptive Ways4. People are differently affected5. People want to connect and help

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Family Information and Support Centre (FISC)• Though already observed anecdotally, it has been well

documented in several major incidents that families surge at hospitals looking for loved ones.

• Preparation for this surge includes planning for space, a FISC, where families can provide and receive information on a possible patient, hopefully to expedite reunification of family with the loved one.

• This Family Information and Support Centre (FISC) would provide information with regards to community resources, in addition to providing short term Psychological First Aid and emotional support.

• Staffing for FISC has typically been provided by Social Work, Chaplaincy and Volunteers.

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A FISC will provide:• Registration• Up to date Information• Psychological First Aid/counselling/chaplaincy• Resources on Traumatic Stress• Referral to community resources• Counseling breakout rooms• Child care?• Special Need services: ie translation, ambulatory issues, etc.

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Services Provided

Sample Documentation

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Other Issues to Consider• Remember there are already Patients in the hospital

and their families, how do you mitigate the affect of the Code Orange on them.

• There is currently no system in place to track the whereabouts of a patient through multiple hospitals. (G20 planning looked at family reunification plans)

• Providing families with ID (nametags/bracelets) after registration will increase security and safety.

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Other Issues to Consider (2)• Some families may not find their loved ones in the

first 24 hours. They may not find them at all. They may have died on the scene and may remain on scene for hours. When removed they would go straight to the city morgue or coroner.

• And in some cases though still alive it may take time to extract all patients from the scene.

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Family Separation9/11 Missing Persons Posters

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• The process for reuniting a family has changed over the years. The standard is for everyone to register with a response organization such as Red Cross and then over time match family members together.

• In recent years the online search engine Google’s Person Finder. It can be found at Google Crisis Response http://www.google.org/crisisresponse/index.html

• But in some cases searching for a loved one is not so straight forward.

The Common Process of Reunification

• Families can only register at one hospital at a time when looking for a loved one in code orange.

• If the person they are looking for is not found in the first hospital families can potentially, and in many cases, visit many different hospitals in their search.

• This searching surge has been known to go on for weeks in some circumstances.

Hospitals Reunification- Current Situation

• All participating hospitals must have a way of registering families, such as a Family Info and Support Centre (FISC)

• All hospitals must be willing and able to collect and share identifying info on patients involved in the event

• A way of communicating information between hospitals must be developed, such as an online portal

• Ideally the plan would also have a way of communicating the information to evacuation centres

Elements of a Hospital Reunification Plan

• There is a difference in information collected from conscious aware patients (identified) or unconscious unaware and without identification patients (unidentified)

• Privacy issues– Sharing patient info between hospitals– What info is to be shared– Scope and duration– Data sharing agreements– Where would the information be stored

The Information to Collect