Emergency incidents resulting in injuries – e.g., plane or subway crashes and hazardous materials spills – cause an influx of urgent demands flowing into healthcare “communities” of all sizes. In addition to caring for the injured, those communities – including local hospitals, free-standing emergency departments, and even local health departments – are quickly inundated on short or no notice with phone calls and visits from family members and friends who are searching for information about their lost and/or injured loved ones.
In the District of Columbia – i.e., Washington, D.C. – a new web-based communications system designed specifically to improve communications during and immediately after disaster situations has been implemented to disseminate patient information to healthcare facilities throughout the city. More specifically: The District’s Emergency Health Care Coalition (DCEHC) instituted what is called the DC ED-IT Connectivity Family Project – which enables emergency departments to post the names and other demographic data of registered disaster victims so that such information can be quickly shared with all eight of the city’s acute-care facilities. The initial result is that the DCEHC is now able to assist with family reunifications not only more quickly but also more efficiently.
In the past, not only in Washington but in many other cities as well, a number of approaches have been used to track the location of “missing” patients. In some communities, emergency medical services agencies use coded bracelets or triage tags, embedded with bar codes, that can be scanned by handheld devices that transmit selected real-time patient data to designated reception sites such as hospitals and alternative care centers. However, there are some deterrents to the widespread use of coded bracelets or triage tags: First, many are in the early stages of development; Second, the cost of these systems may exceed the budgets of at least some communities; Third, because web access may not always be readily available, transmission reliability may sometimes be problematic as well.
Routine Registration & the “Connectivity” Project
Another option for tracking patients is through routine hospital registration records. Almost all hospitals collect patient registration information, on admission, that can then be posted for viewing by specifically designated personnel. Many facilities also record the information to include it in the individual patient’s electronic medical record. Certain carefully selected information can then be extracted from the records on file and viewed by staff personnel assigned to the hospital’s alternative care centers. These persons can then respond later to inquiries from callers or visitors seeking the location of their missing friends or relatives.
Regardless of what patient tracking option is used, the key to rapidly reuniting loved ones is connectivity. Unless all of the healthcare facilities in a given geographic area are connected to a central information system, family members and friends anxious to receive information about their loved ones will still be forced to call one facility after another until their requests for information are answered.
In 2009, the DCEHC implemented a system to collect and post nonclinical patient data so that it can be available to and seen by designated personnel in all eight of the District’s acute-care facilities as well as the Emergency Command Center of the D.C. Department of Health (DOH). The system was designed by the IT/IS (Information Technology/Information Security) directors from the eight facilities and the DOH, working in cooperation with the District of Columbia Primary Care Association (DCPCA) – which serves as the system administrator.
Microsoft was contracted to provide the company’s Amalga software, which processes nonclinical patient demographic data for all registered emergency department patients from each facility’s IT/IS system. After being collected, that data is forwarded to a regional node where – until the complete system capability is “turned on” – it can be viewed only by the sending facility’s personnel.
A More Comprehensive Policy – Plus Improved Access
To help manage the system, the work group wrote a comprehensive policy manual – which includes, among other helpful information, the criteria required for activating the full capability of the system. The contributing facilities and DOH now have the ability, among other things, to view all patient records throughout the system. Each individual facility – and/or the DOH – can turn the system on, therefore. After the system is activated, authorized viewers are allowed: (a) to see which patients are being treated during the emergency at each facility; and (b) to search the records by using any of several common-sense approaches – e.g., the alphabetized listing of all patients and/or the gender, age, and/or date of birth of the individual patient. Starting- and ending-date filters also can be adjusted for used in “extended” incidents occurring over a relatively long operational time frame.
The end result is that the healthcare staff fielding calls at any of the participating facilities can quickly scan the system listings to find the location of a specific patient. A major fallout “bonus” is that the data picture created by the Connectivity Family Project can also be a useful tool for emergency managers – who, by monitoring the data picture, are now able to determine an incident’s overall impact on the D.C. healthcare system.
Daily operations and system performance are carefully monitored by DCPCA personnel. To review the system performance data, the work group meets regularly to discuss ongoing management issues. To monitor and/or improve the operational capability of the system, the work group also performs quarterly tests in addition to using the system during real-time emergency responses – a recent bus accident, to cite but example, that resulted in the system being turned on.
To summarize: The District of Columbia’s ED-IT Connectivity Family Project provides an invaluable new public service capability for the city’s healthcare system. The “Project” has already successfully united the existing IT/IS systems used by the District’s eight acute-care facilities. When the system is turned on, the informational picture provided offers greater visibility of the current emergency department status of the entire city. The fact that substantially more, and more detailed, information is now available at each participating facility significantly lessens the need for family members, friends, and/or healthcare personnel themselves having to make multiple calls asking for information about those who were “in that bad accident.”
Craig DeAtley, PA-C, is director of the Institute for Public Health Emergency Readiness at the Washington Hospital Center, the National Capital Region’s largest hospital. He also is the emergency manager for the National Rehabilitation Hospital, and co-executive director of the Center for HICS (Hospital Incident Command System) Education and Training. He previously served, for 28 years, as an associate professor of emergency medicine at The George Washington University. In addition, he has been both a volunteer paramedic with the Fairfax County (Virginia) Fire and Rescue Department and a member of the department’s Urban Search and Rescue Team. An Emergency Department PA at multiple facilities for over 40 years, he also has served, since 1991, as the assistant medical director for the Fairfax County Police Department.