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NTSB Perspectives on Victim Accounting Operational Challenges

Fundamental Concerns of Family Members Notification of Involvement • •

Initial notification Immediate information

Access to Resources • • • •

Disaster mental health Financial/Logistic Information regarding investigation Legal rights

Victim Accounting • • •

Search, rescue, hospitalization, release Search & recovery of fatally injured victims Identification, death certification and repatriation of remains

Personal Effects • •

Processing and return of personal effects Associated and unassociated

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Who are the victims? Fatalities

Injured - Admitted Injured – Treated & Released (Hospital) Injured – Treated & Released (Scene) Uninjured

Which agencies are responsible for victim accounting and addressing these questions?

A Local Responsibility! Accounting for all victims (fatal and non-fatal) is a local responsibility: • EMA • Fire/EMS With assistance from: • Law Enforcement • NTSB • Hospitals • Carrier/Operator • ME/C/JP • Other state & fed agencies

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The Accounting Process: Integration of data from multiple sources Manifests

LEO

EMS Patient Tracking

Full Accounting

Victim Data Hospital Records

ME/C/ JP Call Center Data

Manifests • A list of names of passengers, crew, and others aboard the vehicle • List is based on the best available information at the time of the request • A starting point to: – Notify family members of possible involvement – Begin the process of collecting antemortem data

Provision of Passenger List/Manifest Aviation: • Provided to:

Rail: •

Provided to: • • • •

• NTSB (legislated accidents) • Upon request

• Red Cross (upon request) •

NTSB (upon request) DOT Secretary DHS Secretary Red Cross (upon request)

Reasonable efforts to ascertain passengers’ names for unreserved trains

NTSB may provide to: FBI: security, fingerprint DOS: foreign nationals Medical Examiner/Coroner

NTSB never releases a manifest to the media or public

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What information is contained on an aviation manifest? Preliminary

Final

(1-3 hours)

(approximately 6-12 hours)

• • • • •

• Updated prelim information • Initial contact information for family members

Name of ticketed passenger Passenger’s PNR Passenger’s assigned seat Crew members’ names Total number on board – Lap children – Non revs

– Beginning of process

• • • •

Passport numbers Address Emerg. Contact name & # Sex, age (possibly)

EMS & Hospital Records: Seastreak Wall Street • • • • • •

January 9, 2013; 0841 hrs Highlands, NJ – Lower Manhattan Allided with pier 11 @ 12 kts 326 pax, 5 crew 400 person capacity No manifest

EMS & Hospital Records: Seastreak Wall Street • • • • • •

No fatalities 83 pax, 1 crew injured 77 xported to 7 hospitals 1 walk-in Patient Care Reports received ~40 hrs Hospital Records  subpoena

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Asiana Flight 214

• Boeing 777-200ER • 291 passengers • 16 crew

The Challenge… Fatalities

• 11:28:07AM, aircraft comes to rest • High number of survivors (304) • Closed pop. with rapid diaspora

Injured‐Admitted Injured – Treated &  Released (Hospital) Injured – Treated  & Released (Scene) Uninjured

How many patients were transported to hospitals? (Error Rich Data ~48 hrs)

198 Total

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Victim Accounting Timeline 7/06/2013 11:28AM Accident

7/10-11/2013 NTSB issues subpoenas to hospitals to facilitate victim accounting and family 7/07/2013 reunification 3:48AM FBI/DHHS Victim List

7/06/2013 3:22PM Asiana Manifest

7/06/2013 2:02PM Cal OES Victim Estimate

7/07/2013 3:21AM Virgin America FRC Victim List

7/06/2013 8:40PM SFO Victim #s

7/09/2013 NTSB decides to issue subpoenas to hospitals 7/08/2013 ARC Bay Area chapter determined it could not share name data (from its victim list) with the NTSB

All times are provided in Pacific Time

Operational Challenges • EMS Patient Tracking

• Foreign passengers

 Not standardized  No name capture

•

 Language barrier  Translation services  Embassy & consulate Multiple EOCs involvement  Local, county, state government  Carrier/operators  Airports

• Numerous victim lists  Sourcing  Error rich data

• Hospital surge  HIPAA Privacy Rule  American Red Cross interface

HIPAA Privacy Rule •

Health Insurance Portability and Accountability Act (1996).

•

Federal protection of individually-identifiable health information.

•

Department of Health and Human Services, Office for Civil Rights (OCR)

Protected Health Information (PHI) held by “covered entities.”

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What should hospitals be prepared to disclose directly to the NTSB and/or an air/rail carrier? •

•

HIPAA Privacy Rule 45 CFR 164.510: • Facility Directory o Except when an objection is expressed by the patient, a covered entity may include the individual’s name, location in the facility, and general condition within its directory. o In emergency circumstances when the opportunity for the patient to object cannot be provided (because his/her incapacitation or an emergency treatment), a covered entity may use or disclose the above information for its directory. o And it may disclose this information from its directory to clergy and to those who ask for the individual by name.

HIPAA Privacy Rule 45 CFR 164.510: • Notification o A covered entity may also disclose to notify or assist in the notification of (including identifying or locating) a family member, a personal representative, or another person responsible for the care of the individual of that individual’s location, general condition, or death. o

Covered entities must use their professional judgment to decide whether to disclose information based on what they consider to be in the best interest of the patient.

Permissible Disclosure •

NTSB is recognized as a public health authority for the purposes of HIPAA • 45 C.F.R. §164.512 (b) (1)(i); 64 Fed. Reg. 59918, 59956 November 3, 1999

•

NTSB will provide subpoena if necessary, but seeks to avoid this approach. • Victim accounting • Medical/Survival Factors investigation

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Accounting Data Needed from Hospitals • Name • Emergency contact information • Phone • Email • Physical address

Call Centers • Call Center # published ASAP after incident • Objective is to: – Collect missing persons information – Collect reported contact information – Assess likelihood of involvement – Minimize data collection errors Minimize Time/Call

Maximize Data Capture

Reno National Championship Air Races Galloping Ghost Sept. 16, 2011, 1626 hrs PDT North American P-51D ~200,000 attendees annually

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11 fatalities 66 serious injuries 4 hospitals received patients

Reno National Championship Air Races: Call Center – Missing Person Reports • Nevada 2-1-1 activated ~2040 hrs • Missing persons reports & requests for information received by: – – – –

Medical Examiner’s Office Crisis Call Center volunteers Trauma Intervention Program Regional Emergency Operations Center

• •

1498 missing persons reports 77 calls for the 11 fatalities

•

45% of reported missing involved in incident

Call Center Data

– Avg. 7 calls/fatality – Range: 1-16 calls

– Fatal – Hospitalized – Returned home

• • •

71% of calls from Washoe County 22% of calls from outside Nevada 7% of calls from other counties within Nevada

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Call Center Case Study: 7 July 2005 London Bombings • • • • • •

3 bombs detonated aboard London Underground 1 bomb on double-decker public bus 52 civilians fatal 4 bombers fatal 700+ injured UK Casualty Call Bureau – –

Established in England during WWII Staff from 21 UK Police Forces

Call Center Case Study: 7 July 2005 London Bombings

UK Casualty Call Bureau 43,701 calls from1500-1600 hrs (7/7) 111,000 calls on 7/7 121,146 calls 7/7-7/25 (18 days) 1,300 Priority-1 calls 12,000 missing persons reports

Call Center Case Study: 100000

7 July 2005 London Bombings

10000

# calls/hour 1000

100

10

1

0000-0059 1100-1159 2200-2259 0900-0959 2000-2059 0700-0759 1800-1859 0500-0559 1600-1659 0300-0359 1400-1459 0100-0159 1200-1259 2300-2359 1000-1059 2100-2159 0800-0859 1900-1959 0600-0659 1700-1759 0400-0459 1500-1559 0200-0259 1300-1359 0000-0059 1100-1159 2200-2259 0900-0959 2000-2059 0700-0759 1800-1859 0500-0559 1600-1659 0300-0359 1400-1459 0100-0159 1200-1259 2300-2359 1000-1059 2100-2159 0800-0859 1900-1959

• • • • •

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Call Center Case Study: 100000

7 July 2005 London Bombings

10000

Does your jurisdiction have a system in place to receive missing 1000 persons reports? 100

If not, how will you obtain the data?

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0000-0059 1100-1159 2200-2259 0900-0959 2000-2059 0700-0759 1800-1859 0500-0559 1600-1659 0300-0359 1400-1459 0100-0159 1200-1259 2300-2359 1000-1059 2100-2159 0800-0859 1900-1959 0600-0659 1700-1759 0400-0459 1500-1559 0200-0259 1300-1359 0000-0059 1100-1159 2200-2259 0900-0959 2000-2059 0700-0759 1800-1859 0500-0559 1600-1659 0300-0359 1400-1459 0100-0159 1200-1259 2300-2359 1000-1059 2100-2159 0800-0859 1900-1959

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Operational Considerations... • • • •

When to activate Call Center? How to publicize contact information? Capacity threshold and sustainability? What information should be collected? • • •

Informant name and contact info. Name of person missing Prioritization information

• QC data? • “Proof-reading” contact information prior to getting off the initial report taking call

• Amount of time spent with each caller? • Who receives data obtained by Call Center?

Key Points

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…for EM’s, LEO, ME/C’s, & Hospitals  Victim accounting is the responsibility of the jurisdiction in which the disaster has occurred.  Accounting for all victims requires the integration of data from multiple sources.  Hospitals should have a plan for notifying the appropriate local/state EMA, LEO, or other pre-designated entity (e.g. ARC) when their facilities receive a surge in “unknowns.”  Hospitals should notify one of the following official channels when their facility may have accident passengers as patients: o EMA or EOC that has been activated to respond to the accident (city, county, or state level) o Law enforcement o American Red Cross o NTSB

…continued  Air and rail carrier/operators have a federally-legislated requirement to provide assistance to victims and their family members.  They need to know the whereabouts of survivors in order to offer assistance to those patients and their families.  They should be reaching out to hospitals if those facilities have admitted any of their passengers as a patient following an accident.

Questions?

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