Emergency Management Healthcare

Transcript: Family Reunification: Reconnecting Loved Ones After an Incident

The Weill Cornell Medical Center, part of New York Presbyterian.

This is a transcription from a Veoci webinar, Family Reunification: Reconnecting Loved Ones After an Incident, hosted on April 12th, 2023. If you would like to watch the webinar recording, click here.

Lance Lynch  00:00

We appreciate everyone logging in and sharing some of their valuable time with us today. Family reunification is one of those nerves that we unfortunately just have to touch. You know, given the current times that we’re living in, and as much as I don’t advocate doing it, every time we turn on the news, we kind of run into a scenario in which family reunification plans are being activated almost constantly. Figured it’s a really good time for us to get together as a group of EM practitioners in the space, regardless of what industry we’re serving, just to talk a little bit about how we reconnect families with their loved ones, during and immediately after an event.

My name is Lance Lynch, I’m with Veoci’s healthcare team came over about three years ago after after being a client for for a couple of years, the Dallas and Fort Worth area. Former hospital EM and Business Continuity Director, paramedic by trade kind of circled back to this role shortly after COVID.

With that, I do want to open by letting the group and all the attendees know that this is a commercial free webinar, right? We’re happy to talk to you anytime about what Veoci does, as a matter of fact, it’s our job. But what we’re focusing on here is how we, you know, can borrow and share best practices for reconnecting, reuniting patients with family members after a “thing” occurs. So with that, I’d like to go ahead and step back out of the way to introduce the rest of our panel. I’d like to kick it off to my partner, Anthony, to introduce himself.

Anthony DeGeorge  01:36

Absolutely, thanks, Lance. My name is Anthony DeGeorge. Also on the Veoci team on the Solutions side building some of the stuff that our clients use every day to respond to incidents as well as manage their programs. I come from a similar background as Lance, paramedic by trade, spent four years in corporate emergency management in the New York metro area for the largest private health system there. And like I said, I’ve been with Veoci for about three and a half years now and happy to be a part of this conversation. Art, I will throw it over to you.

Art Ditzel  02:16

Thanks, Anthony. Good afternoon, everybody. My name is Art Ditzel. I am the Corporate Program Manager for New York Presbyterian’s healthcare enterprise. I’ve been with the hospital about 19 years. Started here in the EMS department as a paramedic and for the last nine have been working in emergency management.

Greg Wayrich  02:31

Hi, good afternoon. This is Greg Wayrich, I am the Emergency Preparedness Coordinator for the Queens campus of The New York Presbyterian Hospital System. Again, paramedic by background and Art and I go way back. Probably my 30th year overall in EMS or EM, and I’m happy to be here. Thanks.

Lance Lynch  02:58

And let’s go ahead and kick it over to our New York City counterparts. Rob, do you want to say hello?

Robert Bristol  03:03

Sure. Good afternoon, everyone Rob Bristol, Director of the Health and Medical Unit here at New York City Emergency Management. I’ve been with the agency for about five years in parts that have had experience in sports medicine, emergency medicine and mountain rescue.

Lance Lynch  03:17

Thank you, sir. And last but certainly not least, Andy.

Andrew Perlman  03:22

Good afternoon, everybody. Andy Perlman from New York City Emergency Management, where I am Program Manager in the Human Services Unit. I’ve been here for about six and a half years coming from the fire service near Philadelphia, Pennsylvania. And I have oversight of the agency’s Family Assistance Center Plan, which includes family reunification.

Lance Lynch  03:45

Beautiful, thanks so much. I want to thank you guys for carving out time to join us and kind of share lessons learned over your careers as well with the folks that have logged in with us today.

Before we get going, super important for us just to kind of, you know, highlight at the 30,000 foot view, what we hope folks are going to take away from this sort of a talk. First, it’s essentially what you know, robust family reunification processes should look like, right. And perhaps we’re not there yet, even as panelists on this side of the conversation we know enough to know that there’s stuff that we don’t know, right, but it’s just about sharing those pearls in terms of where we should be.

One of the things we also hope to highlight would be you know, what stakeholders we need to be including in our plans and exercises, particularly those we tend to forget. Third, we want to be able to anticipate and explore potential gaps and plans and processes and we’ll get that from the conversation here. And then lastly, of course, you’re not going to get this sort of a group online without pulling from this team some best practices from shared experiences here.

So as we kind of get started, right, we all understand we’ve got that sort of perfect world picture, right, of what processes should look like, who should be involved in terms of family reunification. So, starting with the end in mind, let’s begin there. Art, Greg, I’ll go ahead and kick it over to you. But from a 30,000 foot view, in a perfect world, what would an ideal state or process flow look like, within and around the hospital after an incident in the community?

Andrew Perlman  05:35

Sure, I’ll, I’ll kick it off from the corporate side let Greg talk a little bit about the local level. So from a corporate perspective, when we’re thinking about family unification, in a perfect world, you know, we’re looking for obviously, partnership with our community partners, whether it be in New York City or in the suburbs, for a process where notifications and questions from families that are looking for their loved ones to flow through in an ideal fashion, whether that’s 800 numbers or three digit non emergency numbers where that information can flow directly to us. You know, that’s, that’s the ideal state and then on the local level I’ll let Greg take that over.

Greg Wayrich  06:17

Yeah, you know, that’s a good, that’s a great point Art and having expectations amongst your partners is always something we do on a blue sky day and through training and exercises. But I think when the wheels finally hit the ground, you really have to put yourself in the position, the empathetic position of the families on the other side, right? Because they all want answers, they want information, some of which they can’t get either of. And sometimes it’s confusing, especially if there’s lots of news and lots of social media taking, you know, taking information and distributing it in ways that maybe aren’t really reliable, or certainly not specific. So the kind of flipping the script and understanding where you need to connect with those people that are calling, or arriving or whatever, that’s when you really need to lean into the right people. I mean, we’re all into doing, you know, the right thing for people and saving lives and all that sort of stuff. But there are people in our organization that we worked with that we can retask and they’re really, really good at front end kind of interactions, right? The, you know, whether it’s patient experience staff, whether it’s Chaplain staff, or you or any of those kinds of people, you really want to lean into them, because they are the ones who are going to have the best interactions with people. They have the highest levels of empathy, the highest source of sympathy, they’re there, they’re going to spend the time with people and they’re going to get to their needs quicker than then others might do. So I think it’s important to be able to have a stable of people ready to do that. And that really, I think, adds a lot of credibility to your process and gives the people in the field, the families and friends what they really want to hear.

Lance Lynch  08:00

That is absolutely perfect. And I’m so glad to hear you’re kind of keying in on that empathetic tone, right? We know nerves are high, people are stressed. Fantastic. So we’ve got some key stakeholders to kind of lean into there. Thank you so much for offering that to us. We’re kind of working backwards here, right? We’re looking at the hospital. And we’re going to step out here to kind of the health and medical coordination aspect of it. And then we’ll get to the Family Assistance Center. So, next, Rob, when we talk about kind of that human service and ESF eight, right, that medical coordination bit, what does perfect looks like to you?

Robert Bristol  08:39

Well, I don’t know if I can get to perfect, but I’ll try and get as close as possible. But you know, I think as Art and Greg mentioned, right, having the right lines of communication open. Our role as the SFA Coordinators in the city, is to be that touch point to the larger operation specifically for healthcare partners. We know that there are many different lines of effort or verticals happening. You know, as Greg mentioned, there’s there’s still that medical component of taking care of the individuals impacted by the incident. But then you still have to look at the human component, the Health and Human Services component. In our job, in health and medical, is to make sure that we are not only bringing situational awareness up to our partners at offices of Chief Medical Examiner’s Office, the fire department, which is doing EMS and then across the border over to our ESF six colleagues working with Andy and his team to make sure that we are raising the issues from our healthcare sector up to his team and the FAC operations and then vice versa. We also have an obligation to push that information out from the city from emergency management, from our back operations team to get that information to the hospital so that we’re all speaking hospitals in the city with one voice of where to get information for those that are impacted.

Lance Lynch  09:50

So I’m hearing single common operating picture, clear communication between multiple stakeholders. Absolutely. So we’ve got a lot of folks on the call a lot are EM SMEs. Some are not. Can you help us to unpack a little bit? I think we’ve mentioned health and human services being ESF Six. Can you explain ESF Eight for the folks that aren’t immediately aware?

Robert Bristol  10:14

Yes, and I’m sorry for that. So, ESF Eight tower brings these functioning public health and medical in New York City that encompasses all of our federal, state and local stakeholders that are involved, providing medical services or the betterment of the communities public health. So for example, at the federal level, CDC, the state level New York State Department of Health Office of Mental Health, Bureau of EMS at the city level fire department, our city Health Department or Office of Chief Medical Examiner, all the way down to our facility levels or hospitals our nursing homes and our adult care facilities.

Lance Lynch  10:51

Beautiful, thank you so much. Appreciate that. Andy, moving on to kind of your perspective, right, we’re walking backwards. So we did hospital and then we did the ESF Six and Eight coordination. But let’s talk immediately post incident and kind of what that Family Assistance Center should look like. What’s perfect look like to you?

Andrew Perlman  11:13

Well, hopefully the graphic that we’re going to pull up here is going to show you exactly what perfect looks like.

Ideal state for a family reunification event.

At the top in the middle, we’ve got the mass casualty incident. And then again, this is the perfect world, a couple of things that are happening simultaneously. We have uninjured survivors going to a Survivor Center, that Emergency Management is coordinating with our partners. At the same time family and friends of impacted individuals are going to be going to a Friends and Family Center. Again, being coordinated by Emergency Management. These are two separate facilities, two separate locations. And what you’re seeing here is really the beginning of the Family Assistance Center or FAC operation, as well as the reunification operation. So you have uninjured survivors in one place, family and friends in another. And those people are going to be reunified either at the FAC or at some other kind of reunification location. This is a perfect world scenario. As we’ll talk about each mass casualty incident with numerous fatalities is very, very different. Different in partners, different in response, different in approach. But this is just a perfect world snapshot of what it would look like.

What we see here is the timeline for that, again, in a perfect world, the first operation that starts is the reunification. You want to start not necessarily reunification of the families, but we want to get that operation going so we can do that effectively. And we want to stand that up almost immediately up until the first day. And that’s when we set up the Survivors Center and the Family and Friends Center. That’s the first thing that gets set up. It’s very little technology, it’s just a place for people to go. And then there’s the FAC, the Family Assistance Center, okay, in the first 24 hours, we’re just setting it up. It’s not open yet. But it’s going to be open in 24/36 hours, maybe. And that is where all the work, all of the service provision is going to take place. And I’ll talk a little bit about what those services are and what that looks like.

Lance Lynch  13:50

Beautiful, thank you. And when we start, you know, you kind of step back and look at these three different operations, the hospital component, the ESF  six and eight coordination and the Family Assistance Center, right the FAC coordination, it seems to be all predicated on information and effective communication. Right. And we all know, that’s item number one and every After Action Review that we’ve ever done. And I can kind of see quickly, right when we start talking about what this reunification bit looks like, how the latter part of this could get overrun really quickly with how many people would be looking for a particular person, right involved in any one of these particular things. That’s great. I’d like to kick it over to Anthony now to talk a little bit about the right stakeholders and some of the other points we have discussed.

Anthony DeGeorge  14:39

Absolutely, thanks, Lance. So you know, coming from the backgrounds we all come from we know that getting that perfect picture that we just talked about, that ideal state takes a lot of practice and exercising. Based on your experience, which stakeholders have you seen or do you see left out of plans, exercises, maybe even a real world event that could have been helpful if they were involved earlier on in the process? Art I think I’ll toss it over to you first for the kind of corporate hospital view there.

Art Ditzel  15:19

Sure, you know, and we put a lot of thought into this when we were discussing this ahead of time. And I think on the corporate side, we forget a lot about, I don’t think forget is the right word,  we don’t think while we’re in the moment in an emergency, about the people. We think about the hospital, we think about what we need to do, we think about our staff, but we don’t think about the people, the families who are looking and you know, that falls down to the local level a lot. Thankfully, those local guys pick up where corporate guys leave off. But we don’t think a lot of other people, and in some conversations we’ve had with what I’ve really thought about the right stakeholders, we need to engage our Social Work teams and our Clerical teams. You know, the folks that provide spiritual help, you know, a lot of people need that in an emergency. And that’s not something that we think a lot about at the corporate end of things.

Anthony DeGeorge  16:20

Absolutely, a lot of those services are going to be provided at the local level. Right. So how do you kind of coordinate that at a corporate level? Absolutely. Greg, your thoughts from a more of a single facility or location based perspective?

Greg Wayrich  16:35

Yeah, no, I agree with Art The idea of bringing people to these kinds of drills, and trying to walk them through a scenario where they might have to be put into service. And we’re talking about, as I’ve said, the non medical people, the community in the community is where you kind of can mine the best people. They’re the ones who have the community groups, the civic associations, it depends on where you are in the country, or in the state or the city, you know, in New York City has through the federal guidelines and federal Asper plans. We have borough coalition’s that are sort of community based, and the more you work with the community, and the grassroots people in the community, the more connections you make, when these things happen, especially they take a long time. You know, the standard MCI, you know, that happens in a metro area, whether it’s a, you know, transit accident or something like that, there’s a bit of a, you know, short arc on that one. You know, the incident happens, it takes a few hours to kind of get through it, and it’s kind of buttoned up in it, you know, and a half a day, but you’re talking about long term like, you know, we’ve talked a little bit about how COVID manage that, and in a very long term operation where you had people in the hospital, couldn’t make contact, you had a lot of, you know, fatalities. The whole community bubbles up on this one. And so the best chance you have to having successful long term issues, and those connections you need to make are with the people who actually live in the community and you can always find them. And they’re a very important part of that and I think that’s something that we often leave out.

Anthony DeGeorge  18:16

Absolutely, no, thank you for that. You know, I’ve been through plenty of hospital drills, and you know, they were isolated to our staff, right? So including those people in drills, those community stakeholders, those spiritual leaders, to your point, is definitely valuable. For sure. Rob, from the ESF coordination, who do you see that potentially doesn’t get included all the time?

Robert Bristol  18:42

I kind of want to double down on what Greg just said, is the community. I think that, you know, we as a city, and as a jurisdiction, we get very hyper focused on city agencies and city response partners. You know, we don’t necessarily get down to the frontline facility level, we rely heavily on some of our larger healthcare associations to bear the brunt. But I think that we’ve seen in some past events, that, you know, we need to start including our hospitals and our frontline health care facilities into, you know, city wide planning and exercises. It’s something that we’re trying to do. It’s hard to turn that that tugboat a little bit. But I really think that, that that’s a piece that we’re missing, I think that we focus so much on kind of the larger picture. And don’t get down into this, you know, just what we got to talk about today about that kind of hospital interaction during a reunification event.

And then secondly, I would say regional partners. You know, we’re very, very siloed, very jurisdictional centric to protect your city residents, but any event inside of New York City is going to touch Nassau and New Jersey and Westchester and I think that we really need to go out and make sure that we’re working with our regional partners, to make sure that we’re you know, going back to communication. What are our lines of communication? What may we expect if there’s an incident just outside of the borders of our jurisdiction? You know, I think that that’s something that we can do better on and, you know, as a best practice to make sure that we’re including those partners in our planning exercises.

Anthony DeGeorge  20:14

Perfect. No, absolutely. You know, I’m hearing that it’s kind of a level up and a level down, right. So looking more to the local community, and then also up to the region, and you don’t have to own that all yourself. Your lives are going to be a lot easier if you include those two groups. Andy the from the Family Assistance Center Operations point of view?

Andrew Perlman  20:34

Yeah, sure. I mean, you know, looking at it immediately after the incident, being out in the field, who the stakeholders are largely depends on the incident itself. You know, after the obvious immediate police and EMS response, once it’s confirmed to be an MCI, you know, at least with New York City Emergency Management, we would send at least one of our responders there typically. And this is where it really starts from the bottom, they’re typically detailed to us from NYPD, FDNY and through their communication with us, if the incident meets a trigger, to activate the Family Assistance Center plan, which is the possibility or confirmed of at least 10 fatalities, the response of the stakeholders really starts to build out from there. Whether it’s an accident or a criminal act, that would dictate who the partners will be. The core partners, as mentioned before, are typically Office of the Chief Medical Examiner, because they’re providing forensic operations. NYPD missing persons detectives, who are obviously helping with the missing persons accountability. Our 311 system, which is the initial point of contact for family members in the reunification process. Of course, the Red Cross and other social service organizations providing crisis counseling.

It tends to start to build out from there, if it’s a transportation incident, again, I said it’s all situational. With the transportation incident, this will add the air carrier or the rail carrier and the NTSB into the operation. And it can build out even more if it’s a criminal act, like the Joint Terrorism Task Force, which of course includes local, state and federal law enforcement. All of these agencies mentioned provide primary critical services. But there are other stakeholders providing secondary services. And these secondary services are really for individuals who may not have had loved ones involved in the incident, but who are impacted in some way. For example, if there’s a natural gas explosion in a residential neighborhood, there are going to be a lot of homes destroyed. So people are going to need housing, they’re going to need financial support. They may have medical issues like not being able to get into their home, to retrieve their medications, but they don’t have family members possibly directly involved in terms of injuries, missing or deceased. And these secondary services are provided by city agencies, and nonprofit organizations that often partner with Emergency Management, such as I mentioned, the Red Cross, and other social service organizations.

Anthony DeGeorge  23:32

Absolutely, thank you for that. Lance I’m not sure if you had any follow up questions there related to this?

Lance Lynch  23:40

No, no immediate follow up questions, right, but when we start talking about, you know, stakeholders that we tend to forget and tend to leave out, I do like to reflect back on my hospital experience understanding that, you know, a lot of the folks that we have on the call are working in the hospital, right, and they’re bolstering their reunification plans due to some accreditation guidance that changed the middle of last year. Some of my experiences, always, they always surrounded communications, right, whether it was at the corporate level, or even, you know, more so at the individual hospital level it was how do I get my PBX or my call center staff, right on the same page as the hospital command center? How do we make sure that the connection is seamless over where it needs to be for information coming into the community? So I hate to sound like a broken record, but it’s all about communication and, you know, exercising people and testing plans. No, I think these are fantastic contributions. Thanks, Anthony.

Anthony DeGeorge  24:49

All right. So I mean, I know my favorite part of you know, living in the Emergency Management community is the information sharing, right. It’s which one of our partners did an exercise and which one of their best practices can I learn from and to enhance my plans or my processes moving forward? So if you had to isolate some best practices to share, whether that be from an exercise or maybe even a real world event, what would they be? And I’ll start with Art, again, kind of following that same flow?

Art Ditzel  25:24

Sure, I think one of the best practices that we’ve come up with and it’s been through exercising, is we’ve created lists that all of our campuses have all of the available open spaces. Whether they’re conference spaces, or office spaces, drop-in spaces that, you know, we don’t have to scurry to find a room to put, say, the NYPD or the local sheriff’s office is coming, or to set up a Family Assistance Center or other sorts of centers inside of the hospitals.

Anthony DeGeorge  25:57

Perfect. Yeah, I think we all know that space in a health care facility comes at a premium nowadays. So absolutely. That’s a daunting task. Greg, from the local facility level?

Greg Wayrich  26:10

I think I totally agree with that as well, these spaces are tough to find. But I think also, if you’re especially if you’re setting up a phone bank, for example, where, you know, you publicize or through some means to get information out there to say, don’t come here, but call here. You want to make sure that those phones work, you want to make sure that they are going to answer, that they’re not going to go to some voicemail, that somebody leaves a voicemail that nobody’s ever going to hear. And if they you know, if you have hours on them, if you’re only gonna run them for 12 hours a day, you know, somehow that phone needs to be switched to someplace else that will actually get a person to answer. Again, this goes back to, you know, having some significant amount of empathy for the caller. Because if you put yourself in that same position, if when you call somebody now, and you get, you know, press one, press two, this is a recording, nobody ever gets back to you, you’re gonna lose your confidence in their ability to take care for your loved one. So somebody’s answering the phone, you know, initially pretend, you know, maybe work, especially if it’s a long, long, detailed, script, what you should kind of say up front, Hi, my name is, you know, I’m here to help you do this, you know, where can I you know, how can I direct your call, that sort of thing. That kind of stuff, seems like low hanging fruit, but goes a long way to creating a credibility level that you kind of want to maintain for this for this incident, and make sure that the people we’re calling are getting the information they need, and they feel comfortable with it, when they finally hang up the phone.

Anthony DeGeorge  27:40

Yeah, absolutely. And, you know, doing that in combination with your normal hospital operations, right, because people are still going to be calling the hospital the same they do every other day for every other reason. So absolutely. Rob, from the coordination ESF coordination point of view.

Robert Bristol  28:00

In kind of going to what Greg mentioned, you know, the hospitals are in this, these types of events are gonna get overwhelmed. Not just with patients, but with media with, you know, if there’s MLS involved, you know, that there’s going to be a crunch or a rush to get to this facilities. And one of the things that we have been doing is trying to start that communication right away, whether it’s in a large scale incident for family reunification, or if it’s a small scale incident, you know, or localized MCI, if you know a facility is getting a decent amount of patient load, we’re going to reach out to that corporate and facility Emergency Manager to start that line of communication. You know, as Andy mentioned, we do have city wide Interagency Coordinators that can respond to work with fire department and police departments to kind of help the facilities manage that load as much as possible.

And then I would say, secondly, we all have plans. Don’t be afraid to enact them. If you’re getting close to a trigger, pull it. We have a lead team call that kind of kicks everything off, if we’re getting close to a trigger. There’s no harm in getting the partners together, sharing situational awareness. And at the end of the call saying you don’t have to move any further, you know, the incident’s under control. But you don’t want to be a half hour, an hour, three hours later and saying, oh, man, I really wish I had that phone call. You know, now we’re playing catch up. So, you know, be aggressive if you’re getting close to a trigger, have a phone call. It’s much easier to stay out of it than to play catch up later on in the incident.

Anthony DeGeorge  29:34

And that goes back to Lance’s communication, right and let everybody know what’s going on. Keep them on the same page and it’s easier to take a step back right and then play catch up to your point, Rob. Andy, from the Family Assistance Center point of view?

Andrew Perlman  29:51

Yeah, I think you know, when an MCI happens, and they’re confirmed fatalities, obviously all of us are gonna want to get the plans going, coordination going, as quickly as possible. But I think it’s a best practice to know when it’s safe to begin that. When is it safe to begin that initial reunification process? If the incident, again, it’s situational. If the incident is still unfolding, like an active shooter, it may not be safe yet to begin the process. So you need to work with law enforcement on knowing when the proper time is to begin that process.

And I think a good way to really tie in a bunch of best practices is don’t forget the fundamental concerns of the family members. One of them is, is my loved one involved? We’re going to want to provide immediate but factual information to them and the best place for that is the Family Assistance Center. Another fundamental concern is, where is my loved one? In New York City, we’re very fortunate to have a system called UVIS, Unified Victim Identification System, which is what NYPD missing persons, the medical examiner’s office and 311 work together to begin the accountability process for those who are missing. Another concern to think about is, how will I get information or resources? The family members, they’re going to want to know about the investigation. They’re probably going to need some crisis counseling, and possibly financial and logistic support. And again, the best place for this is also in the FAC. And of course, they’re going to want to know where are my loved ones’ belongings? This is an incredibly important component. We’ve seen after every MCI where there were a large number of fatalities, the concern of the family members, if they’ve lost a loved one, and they have not yet been reunited with their remains, they want their personal belongings. Because that’s all that’s left, at least up until that point. So please don’t forget the reunification of personal belongings.

As Emergency Managers, you know, we’re obviously dealing with information, information sharing. And if a FAC facility is stood up for an incident, I think it’s important that all of the stakeholders that we’ve kind of talked about before, have a system where they are not asking the family members the same information over and over and over again. There are reasons why those questions are asked. But if in your jurisdiction, if you can come up with a process or a system where you can make that a bit more streamlined, it’s going to be a lot less stressful for the family members.

Another best practice that we’ve seen work really well is an effective credentialing system. A Family Assistance Center is obviously a highly charged, highly sensitive place to be. And we don’t want anybody that is not directly involved in the incident, we don’t want them in the building. Credentialing not only for the public for family members, but credentialing for staff as well.

Another thing to keep in mind when we talk about reunification, specifically, is individual reunification. We tend to think as Emergency Planners, large spaces are better spaces. Avoid large spaces. Look for smaller, private spaces. It’s a lot more private, it’s a lot more sensitive, and do that reunification individually, not in groups. And don’t co-mingle family members of those deceased with other family members who are still looking for loved ones, or whose loved ones are injured.

Another thing that that really, really works is don’t be afraid to ask for help. We’re very fortunate in New York City because we’re resource rich, but smaller jurisdictions don’t have that luxury. Activate those mutual aid agreements and neighboring jurisdictions that may not be directly involved in the incident. Share your resources, don’t covet them. And I’m basically reinforcing what Rob said, Rob really nailed it. Don’t be afraid to activate your plan. It didn’t happen, but we considered that in 2017 where we had a terrorist who used a vehicle as a weapon on the West Side Highway. We knew very quickly that there were, I believe, Rob correct me if I’m wrong, there were seven fatalities which obviously does not meet that trigger of 10. But that number is, is squishy, as Rob mentioned, and we got on a call with our stakeholders and we decided very quickly, based on the medical examiner’s office, that the FAC plan really didn’t need to be turned on, because the medical examiner’s office is able to provide those kinds of services in their offices. But don’t be shy about activating that plan.

And lastly, is really understanding whose plan will be activated. If something happens in New York City, it’s a city plan. But if it’s a transportation incident, let’s say it’s involving Amtrak. It’s their plan. Your roles and responsibilities in somebody else’s plan might be different. And really, lastly, and this is an important point too: develop a relationship with an organization that provides therapy dogs. It’s for families, it’s for friends of those impacted, and it’s important for the staff as well. These operations typically are longer in duration. And as I’m sure you’ve heard, maybe you’ve experienced firsthand, therapy dogs do a lot.

Anthony DeGeorge  36:19

That’s an amazing point. And actually, Lance and I, somewhat recently at a disaster preparedness conference, there were people there with therapy dogs actually starting to advertise those services of being able to partner with I believe it was healthcare coalition’s that specific conference. But you know, that’s a great point. Absolutely, to bring up. Lance, I will throw it back over to you, I do want to mention that Art had to drop. I’m not sure I saw that message he’s dealing with a real world incident right now. But we will continue to move forward.

Lance Lynch  36:52

You know, we have been, we’ve been lucky to this point, right, we got a bunch of, you know, Emergency Managers from New York City kind of online with us. And we’ve only had one drop in the past 40 minutes. I’m also thankful for the folks that are currently online right now. I know, you guys are all dealing with stuff as well. I think we’ve had some fantastic conversation around, you know, best practices, things of that sort. You know, from the hospital perspective, one of the things that I would add, that our communications teams found to be tremendously helpful were introductions to our local emergency management agency’s operations, right? What is the JIC? The Joint Information Center? Where is it? How can I collaborate with my local em partners to not only get info but to vet info, make sure it’s worthy of distribution, things of that sort. So from the hospital perspective, it’s just building those communication bridges to the local EM community is going to be another strong place to be as well.

This line of work, you know, when we talk about Emergency Management, and any sort of resilience work is full of discovering the things that you didn’t know you didn’t know, until the point in time at which you need them. Right. So the point of this next question is to sort of figure out what sorts of gaps you discovered mid plan, mid activation, that you think others might do well to know now. So with that, Andy, we’ll go ahead and start with you.

Andrew Perlman  38:38

Sure. I mean, we’ve learned so many things, not only from our activations, but activations across the country, internationally. The first thing that I think of in terms of where there were gaps, don’t underestimate the number of family members that will be looking for their loved ones. You’re going to need the appropriate space for these operations and if you scope it too small, you’ll be scrambling around at a time that you really need to be focusing on the families. The planning assumption that we have here in New York City, is there’ll be between eight and 12 family members showing up for every decedent. In some cultures, that number can be even greater. So when you think about the size and the scope of the incident, and how many potential family members could show up, that’s really going to inform the kind and size of facility you’re going to need to choose.

Don’t underestimate the importance of the secondary services that I mentioned. Because they can very quickly become critically important, just as important as missing persons and the work that the ME’s office is doing. And we learned that from an incident outside of our municipality, but we learned a valuable lesson. For example, we don’t think of locksmiths as providing critical services. But if you take a transportation incident, whether it’s rail or air, imagine all of those cars in the parking lot at the station or the airport. And given the number of fatalities, many of those cars are going to remain there, possibly with personal belongings. And getting into those cars and retrieving those belongings will be incredibly important, as I mentioned before, to those family members. And when that happens, all of a sudden locksmiths might have been an afterthought in the past, but they have become critical resources in situations like these.

It’s going to be little details like that, if overlooked, could be the point of failure for the entire operation. Again, I can’t put a finer point on it, but not considering the process for personal effects in your overall operation is going to deem the entire operation and failure. If you’re not considering transportation arrangements for family members from the hospital to the FAC, or from any location to the FAC, that’s a big gap. You could have gotten everything else right under your plan, the right staffing, the right logistics, the right technology in place. But if you didn’t consider what can be perceived as minor details, and how they impacted family members, that’s what people are going to remember.

Also, if it was a criminal act, please remember, don’t over promise when family members will be reunited with their loved ones or their loved ones’ personal effects. Personal effects are treated as evidence and it’ll be handled as such by law enforcement. Expect family members to be anxious about getting those personal items. And you should leverage your resources as the experts to work with the family members and this may take some time.

And finally, we’ve learned that we’ve got to be very, very careful about public messaging. The information you share publicly in an accident can be very, very different than if it were a criminal act because you want to preserve the integrity of the investigation. So please work with law enforcement on talking points and language, and what can be shared during family briefings.

Lance Lynch  42:42

Andy, that’s huge. You know, our practitioners on the line here, if they didn’t take a couple of bullet points away, that could be super thoughtful exercise injections i.e. locksmiths, transport doing from the FACA. You know, I’m not sure what would constitute a thoughtful inject at that point. Thank you so much for sharing that. Flipping it over to Rob. What sorts of gaps did you discover that you really hadn’t thought much about or hadn’t foreseen until you got into the incident?

Robert Bristol  43:16

So looking into what are the incidents that we had recently, in the Bronx, we had a large fire that turned into an inhalation incident, that caused over I think, was 30 to 40 patients. You know, this is when the regionality comes into an inpatient tracking. You know, we had a few patients that went up north, still within a health system that does have facilities in New York City, but it was in another county. And working on getting the services that we were offering in the FAC to those patients and those families that were in another county and another, you know, institution or health care facility was a challenge at first. And I think we worked through that, you know, using the FAC and all the resources available there in that building and some very thoughtful minds, were able to get, you know, to kind of move those services up there for them. And also durable medical equipment and, Andy I know you and I talked about this a bit during the Bronx fire as well, you know, you mentioned locksmiths, but in these large scale incidents, you know, whether they’re patients, whether they’re worried well, or, or even just family members that aren’t impacted, you’re going to be asked for things that you would never have thought of. Whether it’s a walker or a patient mobility device. How to use your resources, use your networks to be able to meet those one off or on the spot demands. That I think was something that we weren’t necessarily ready for, but acted quickly and used our networks to pull some things from our stockpiles to meet the needs of those residents after that fire.

And then finally, I think kind of looking at some of these incidents that have occurred over the country and the world. And Greg talked about this a little bit before at the hospital level with that number, right? Whatever information line you’re going to publish, make sure it’s ready to go, make sure it’s the line. Not a line that’s going to get changed in a day or the next day. I think we’re fortunate in the city, as Andy mentioned, to have 311. That’s kind of our catchment area, and the entry point to UVIS, but for other jurisdictions that may not have that resource available, really make sure that whatever line or whatever public messaging is being sent out that as soon as that goes live to the public, it’s ready to answer calls because they’re going to come. And switching them we’ve found and we’ve heard is not beneficial to everyone involved.

Lance Lynch  45:44

Absolutely, super helpful, right? You know, understanding that we rarely do things occur within our particular silo, and don’t spill outside of that silo so I hear the regionality aspect of it. That’s tremendously helpful. Greg, how about in and around the hospital? What did you from kind of your personal experiences, what have you run into, that you really didn’t foresee or think about before you got into the thick of things?

Greg Wayrich  46:15

Well, I think just kind of sticking with this community model and the idea of understanding your community and where you live, and where you work. You know, our hospital here, NY-Presbyterian Queens, with the 535 bed tertiary care Trauma Center in, in North Queens. We’re also surrounded by probably one of the largest Chinese populations in the city, outside of Manhattan at least. And, you know, certainly the language and cultural barriers that are there are, you know, they’re hard to ignore. But then, that entire community has numerous civic associations within, within the confines of their communities, and we have some connections with them. And they are very helpful because they become like a single point of contact in the community that you would never be able to get a hold of, you know, without that. So that is something that, you know, we have good connections with, whether it’s via the elected officials office, or via just our own community operations, because we have a pretty robust public affairs division here that does a lot of work with the community. And these are all kinds of latent kinds of areas to tap into when we have an emergency. Because normally you’re dealing with, again, blue sky operations to tabling events and through the community, especially in the fairweather, you know, you have all these things kind of going on, that’s a good time to really make up these relationships. So when the chips are down, you can go to the single, you know, single points of contact and either find out what’s you know, what they need, or they’ll tell you through those relationships, because it’s very tough to get out into the community and is, you know, that we have tremendous amount of language systems, but that only goes so far. So that’s kind of what I will lean into a little bit for a gap that you know, to really monitor and really keep the finger on that pulse as far as when your community is comprised of.

Lance Lynch  48:10

Perfect Greg, thank you so much. Kinda where we’re coming to in the point of the presentation, that’s sort of a webinar, here’s a point to where we’re going to kind of, you know, revisit points and topics that we’ve been chatting about over the past couple of minutes, understanding we got a bunch of EM folks on the line. Something that somebody said triggered a thought that somebody else might have had. Perhaps there are some additions or other areas we want to circle back to before we break into a formal Q&A.

While we’re doing that, I would like to let everyone on the call or everyone listening to us in the future understand that the QR codes in the slide decks are linked to our LinkedIn pages. All of the panelists, just like you would expect from any sort of an EM practitioner, super open to connecting, super open to chatting and sharing information as well. So please utilize these QR codes. Feel free to connect with any one of us. We’re happy to circle back and have some conversation with you anytime.

Andy, I understand we had an addition to kind of tag on to one of the most previous talking points. What was that?

Andrew Perlman  49:18

Yeah, thank you, Lance. And Rob really started it. Thank you, Rob, for bringing up that durable medical equipment issue. Another stakeholder that should be involved would be somebody in your agency or your organization that is considered a subject matter expert regarding individuals with disabilities or access and functional needs. And depending on how large or how small your shop is, it could be an ADA coordinator, as we say, DAFN coordinator and they should be part of the planning process. They shouldn’t be called when the incident happens and say, hey, we need somebody who’s an expert in coordinating and forecasting what possible equipment and communication access and other things that are needed for people with disabilities and access and functional needs, need in a situation like that, to keep them as independent as they typically are, when they have them at home. So if you don’t have somebody in your agency tagged with that responsibility, reach out to your local disability advocacy organization. You know, they feel very strongly about being involved in the planning process. They say nothing about us without us. And they make a really good point. They can be a very good ally, when you want to reach out to the disability community, and you may not know the proper way to do it. These people are really good ambassadors to help you walk through that process. Thank you.

Lance Lynch  50:54

It’s a fantastic point. Thank you so much for circling back on that. You know, local ambassadors are going to be huge and definitely beneficial for each one of our prospective owners here on the call whether we’re talking ESF Six and Eight hospitals or the FAC Center have to have in their back pocket or at least on those fancy ICS-205’s.

To listen to the Q&A that followed the presentation, click here.

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