GNYHA offers the guidance below to member hospitals and health systems about naming conventions and associated protocols for identifying, tracking, and caring for unidentified patients during a mass casualty incident (MCI) response. This guidance was collaboratively developed by hospital representatives involved in mass casualty response planning, and government agency representatives. It is designed to support clinical care and family reunification at the facility level, while enabling broader citywide or regional manifests to be created for incidents that result in large numbers of unidentified patients across multiple hospitals.
While implementation of this guidance is voluntary, GNYHA urges all member hospitals to bring together a multidisciplinary team to review and consider integration with current protocols and practices. The multidisciplinary team should involve the following departments at a minimum: Emergency Department, Patient Registration, Trauma, Radiology, Laboratory, Critical Care, Nursing, Social Work, Child Life, Perioperative, and Public Affairs. Hospitals are encouraged to implement these protocols using the suggested first and last names found in the accompanying tool, with implementation complete by March 31, 2019. To track implementation, all participating hospitals are asked to e-mail a copy of their Mass Casualty Incident Registration Policy to Jenna Mandel-Ricci.
Importance of Protocols for Unidentified Patients
GNYHA coordinated a delegation visit to Las Vegas in February 2018 to learn about that city’s response to the October 1, 2017, mass shooting in which 58 individuals were killed and more than 500 were injured. The delegation was comprised of emergency managers and emergency medicine physicians from nine New York health systems, representatives from the Fire Department of the City of New York, NYC Emergency Management, the NYC Department of Health and Mental Hygiene, the NYC Office of the Chief Medical Examiner (OCME), the National Transportation Safety Board, and the US Department of State Diplomatic Security Services. A key takeaway was the importance of developing a regional approach to naming unidentified patients. Sunrise Hospital and Medical Center, the Las Vegas–area hospital that received the largest number of patients, treated 92 individuals who arrived with no identification. The volume of unidentified patients quickly overwhelmed their existing naming convention procedures. At a jurisdictional level, it was difficult for the public health authority to compile and track these patients.
Existing Jurisdictional Systems
Acknowledging the importance and complexity of patient tracking, jurisdictions in our region have and continue to develop systems that simultaneously support patient tracking, missing persons investigations, and family reunification. In New York City, the NYC Emergency Patient Search initiative ensures the capture of data from 311 callers looking for loved ones and has a lookup feature that draws on the admission/discharge/transfer data available from hospitals via Regional Health Information Organizations, now known as Qualified Entities. New York Police Department personnel, OCME, and 311 operators use this information to direct concerned family members.
Current Practice
While many hospitals and health systems across the New York region have unidentified patient naming conventions and associated disaster registration protocols, these protocols may not adequately accommodate the high volume of patients that have been seen in recent incidents. Additionally, the lack of a consistent use of these protocols among hospitals impedes the creation of citywide or regional victim manifests.
Guidance
Below is guidance developed through a collaborative workgroup process led by GNYHA, which involved numerous hospital and government agency representatives. The guidance includes a naming convention for first and last names, and a convention for estimated age. There is also information for incorporating identifying features into the patient record and a tag for associating victims of the same incident. Lastly, the guidance offers a target time period for patient registration. The accompanying tool provides suggested first and last name parameters for every GNYHA member hospital.
| Patient Variable | Naming Convention |
|---|---|
| Last Name | Abbreviation of hospital name + digit (beginning with “1”). Example for General Hospital: GenHosp1, GenHosp2, GenHosp3. Please see the accompanying tool for suggested hospital abbreviations for all member hospitals. |
| First Name | Each hospital has been assigned an item; please see the accompanying tool for a list of assigned items, plus 50 suggested names for that item. Hospitals are encouraged to develop additional names within their assigned item type beyond those provided. Example: Assigned Item = Flowers Name list: Begonia, Daffodil, Lily, Rose, Lilac, Dahlia, etc. |
| Estimated Age | 1/1/estimated year of birth (based on hospital staff observation) |
| Gender | Indicate “male,” “female,” or “unknown” |
| Additional Variables | |
| If the Patient is a Minor | Indicate in the medical record whether the patient arrived unaccompanied or was brought in by or with someone. If brought in by someone, capture the individual’s contact information. |
| Identifying Physical Features | Ensure there is a place on registration documentation and within the electronic medical record (EMR) to capture information about tattoos, unusual features or markings, and their location, which could help with identification. |
| Accompanying Items | List any items that the person may have had with them upon arrival that could aid identification; if possible, take a photograph of these items and include it with the medical record. Include “in case of emergency” information obtained from the individual’s cellphone. |
| Photo | Take a picture of each patient and upload it to the EMR as time allows. |
| Disaster Tag | Associate all patients related to the incident, whether identified or unidentified, with an electronic disaster tag. Because the nature of the incident may not be known, a suggested convention for the disaster tag is: MCI_m/d/y_closest hour to the arrival of the first patient.
A government entity may instruct hospitals to retroactively apply a different incident tag such as “Pulse Nightclub Incident.” |
| Reconciled Last Name, First Name | Ensure there is a place within the medical record to indicate the individual’s first and last names once he/she is identified. Also, allow space for commonly used nicknames. Both the medical record and identification bracelet should be updated as soon as the patient is identified, with both names visible. This is necessary to ensure labs, radiography, and other clinical care elements associated either with the assigned name or reconciled name are available under a single patient record. |
| Target Time Period for Electronic Registration | |
| Within 20 Minutes | While patient care takes precedent, hospitals should develop and exercise disaster registration protocols so that patients, including unidentified patients, can be quickly registered. Registering patients within this timeframe directly supports broader patient tracking and family reunification efforts. |
Use of Disaster Medical Record Packets
Many hospitals maintain a supply of disaster medical record packets with basic documentation, an assigned medical record number, and a corresponding bracelet. If a hospital chooses to create such packets, a supply of 150–200 is recommended. The facility can pre-print unidentified patient names (i.e., GenHosp1, Begonia; GenHosp2, Tulip), which can be affixed to the documentation and bracelet for any patients arriving without identification. Kits may also include: labeled blood tubes, an IV start kit and catheters, and blood request forms.
Arrival Mode
Based on recent MCIs, hospitals should expect many patients to arrive by means other than emergency medical services (EMS). Disaster registration protocols should accommodate arrivals by EMS and other means.
Integration with Clinical Care
All departments involved in the care of unidentified patients from a MCI should be familiarized with any changes made to the current registration procedures. Ideally, a representative from each department should take part in a multidisciplinary team tasked with implementation.
Drills and Exercises
Given the importance of rapid patient registration during a MCI response scenario, this aspect should be drilled as part of a broader MCI response exercise plan. Patient registration staff and providers involved in patient triage should practice registering both identified and unidentified patients.