MCI: The Critical Role of EMS in Family Assistance Operations
The TV show you’re watching is interrupted by breaking news: There’s been a horrible train accident with multiple fatalities in a city where you have family and friends. Your first thought is, Are my loved ones involved? When these events occur, loved ones need to know what happened. This is part of assistance operations that may fall to EMS.
The National Transportation Safety Board (NTSB) is charged by Congress with investigating air accidents to determine what happened and why. The NTSB also investigates significant accidents in other modes of transportation: railroad, highway, marine, and pipeline. The goal of an NTSB investigation is to improve transportation safety—the agency does not enforce regulations or investigate criminal events.
The NTSB has an additional important responsibility: to coordinate the resources of the federal government and other organizations to assist victims and family members affected by major transportation disasters. The Aviation Disaster Family Assistance Act of 1996 tasked the NTSB with coordinating federal government resources in support of local and state governments, disaster relief organizations, and air carriers to address the concerns of families following commercial air carrier accidents resulting in a major loss of life. This requires domestic and foreign air carriers operating in the United States to meet various obligations, including notification of family members following an accident; submission of flight manifests to the NTSB; logistical support to family members; management of personal effects; and commitment of sufficient resources and personnel to carry out the air carrier’s family support obligations. In 2008 similar legislation was enacted for rail passenger accidents.
The NTSB’s Transportation Disaster Assistance (TDA) Division is responsible for managing the agency’s family assistance program. TDA consists of specialists with backgrounds in disaster mental health, emergency management, hospitals/healthcare, and medicolegal operations/disaster victim identification.
Since the division’s inception, its team has assisted thousands of family members associated with over 1,000 accidents. While its experience is focused specifically on transportation accidents, basic concepts regarding family member concerns are applicable to any MCI.
Comprehensive family assistance programs address the fundamental concerns of family members who have experienced an unexpected loss. These concerns transcend socioeconomic and cultural boundaries. No single agency is responsible for addressing every concern. A comprehensive family assistance program requires collaboration among local, state, and federal agencies, nongovernmental organizations, the private sector, and transportation operators.
A critical aspect of preparing for an MCI is determining where your organization fits into the overall family assistance response. Which concerns are your organization responsible for? How will you work effectively with other organizations, and what support can your organization offer? The following four fundamental concerns can serve as the cornerstones of a family assistance operation.
Notification of involvement—Learning that a loved one is involved in an MCI requires immediate attention. Responsibility for providing timely and accurate information to family members depends in large part on circumstances. Federal family assistance legislation requires air and rail passenger carriers to notify family members of their loved one’s involvement; however, only a small subset of transportation accidents meet the criteria established by the family assistance legislation.
If an accident doesn’t meet that criteria, notifying family members typically becomes the responsibility of the local public safety community. This, and determining who is involved, requires close collaboration among first responder agencies such as EMS, fire, and law enforcement as well as hospitals, treating providers, and the local office of emergency management. If a manifest (i.e., a list of those on board the vehicle) is available and accurate, this allows authorities to begin the notification process relatively quickly. If the names of victims are unknown, notifications may not occur for some time, as local authorities will have to use other methods to determine the victim population (e.g., call center data, missing-persons reports, identification media on the victims, or other documentation). Once a victim list is created, authorities can initiate the family assistance process.
EMS personnel faced with questions from family members should be prepared to provide factual information and avoid making assumptions, speculating, or providing a false sense of hope. Develop an understanding of the overall response process so you can direct inquiring family members to the appropriate agency. Follow your agency’s protocols for communicating with families. Know where in your jurisdiction to direct families seeking information, as you’re likely to encounter them at the hospital or even on the scene.
Accounting for victims—Once family members learn their loved one is involved, their need to find their loved one will become their main priority. Their questions will focus primarily on whereabouts and welfare. If victims are fatally injured, the medical examiner or coroner is typically responsible for addressing these questions.
If the victims are injured and admitted, this responsibility falls to hospitals. Identification of these patients usually starts around the triage and transport stage, which then feeds into the larger victim accounting or patient-tracking process. For victims not taken to hospitals, the reunification process can be variable. EMS and hospitals play a key role in the victim accounting process, which is ultimately the responsibility of the jurisdiction where the incident occurs. Many regions or jurisdictions have a patient tracking system that starts with EMS and concludes at the treating facility or with the medical examiner/coroner. However, these systems often require manual input of data and, because they aren’t typically used every day, can be challenging to use during a mass-casualty response. Ensuring that accurate data is provided to the treating facility, through electronic tracking devices or via paper, is vital to victim accounting.
Upon learning that their loved one has survived, a family member’s next action will be to go to where that person is—most likely a hospital. To be able to report exactly where that person is can help ease the stress that family member is experiencing. Understand your agency’s procedures for patient identification and follow those to the extent practicable during an MCI. If you don’t know your agency’s role in patient tracking during an MCI, learn the plan ahead of time. Inquire whether your jurisdiction has a healthcare coalition and if EMS is part of it.
Return of personal effects—Personal items that were with an individual at the time of the accident often become highly significant to family members, regardless of their value or condition. Have a plan in place to manage the return of these items. Personal effects can be categorized as either associated (in direct physical contact with the victim—for instance, a wedding ring) or unassociated (separated from the victim and with or without identifying information). In most U.S. jurisdictions the medical examiner or coroner oversees the collection, chain of custody, and final disposition of associated items for the fatally injured. Such items hopefully accompany survivors to the treating facility.
Federal family assistance legislation requires air and rail passenger carriers to consult with the families of passengers regarding the disposition of unassociated personal effects in their possession and return those items if requested by the family. For situations outside the scope of the legislation, unassociated items will be managed by either the transportation operator or insurance company responsible for the vehicle. If there is no insurance company, local law enforcement will typically take custody of these items and coordinate their return to family members; however, there is significant variation regarding management of unassociated personal effects.
Think about the clothes you’re cutting off or the purse that was over the patient’s shoulder. Preserving them can mean the world to a family member. If you don’t have a standard practice, consider developing one with other agencies that could be involved.
Access to resources—Family members who have experienced an unexpected loss often have a lot of questions and needs. An effective family assistance operation efficiently delivers accurate and timely information, often in the form of briefings or referrals to appropriate entities. Where this can become problematic is when the information provided is not correct.
In the early stages of a disaster, sharing information you haven’t heard from official sources can start unnecessary rumors. Have an accurate understanding of the response. It’s OK to tell a family member you don’t know the answer to their question, but follow it up by finding someone who does.
First responders are often the first person family members see following an MCI. First impressions are lasting, so it’s critical to understand that your actions can drastically improve the experience of people facing the worst moments of their lives.
Cyndi Lake, MPH, CEM, EMT, is an emergency operations coordinator with the NTSB’s Transportation Disaster Assistance Division and an EMT with the Alexandria (Va.) Volunteer Fire Department.