Keeping track of patients in a disaster... like dandelions in the wind.

Tracking patients in a disaster is, well, complicated. Many patients--all at once--different facilities--technological disruptions--ad hoc organizations, et cetera. The potential problems are limitless. The less planned the event, the bigger the disaster, the more agencies and communication systems involved, and the more infrastructure damaged; the more complicated it gets. Without a system to track patients’ identities, injuries and illnesses, location, and progress... the medical care of patients may seem like dandelion seeds blown into the breeze.

Patient tracking impacts both at the time of a crisis event as well as in recovery. When the earthquake/fire/explosion/bus crash/shooting/building collapse/etc. occurs, many organizations respond, both formal and informal (ie volunteers, concerned bystanders, family members). Communication on scene is thus complicated by organizations and individuals using different, or no, systems and not necessarily along frequently-practiced channels. Relaying this information, when there is an overwhelming amount of information, to receiving facilities is notoriously unsuccessful [1]. Families of patients, too, will be seeking information on the status of their loved one, further adding to the communication burden for health care facilities [1].


Much of the preparation for crises comes from lessons learned in previous incidents. If we haven’t been able to document the paths of patients, both geographically and in the course of their medical care, we are limited in our learning from those events. The lesson learned may be that a more reliable patient tracking system is necessary [2]. That way we can focus on learning lessons of patient transport and care.


This is not to ignore the problems inherent in a true disaster when infrastructure is disrupted. Many studies in this area explore and describe different systems involving more or less technology. Systems using GPS [3], near-field communication [4], coloured vests to identify high-needs patients [5], barcodes [6], and a myriad of others may all fail if the systems they rely on (power, cellular service, sunlight, carrier pigeons) fail. Of course this shouldn’t imply that creating, studying, and practicing patient tracking systems is without benefit. It is better to improvise from a place of preparation than starting from scratch.


“You do what you can with what you have.”

-Eddy Afram, EMS division chief, city of Côte Saint-Luc

…and CEEP webinar guest panelist

References

1. Tavakoli N, Yarmohammadian MH, Safdari R, Keyvanara M. Health sector readiness for patient tracking in disaster: A literature review on concepts and patterns. International Journal of Health System and Disaster Management. 2016 Jul 1;4(3):75.

2. Frangos SG, Bukur M, Berry C, Tandon M, Krowsoski L, Bernstein M, DiMaggio C, Gulati R, Klein MJ. A multiple casualty incident clinical tracking form for civilian hospitals. American Journal of Disaster Medicine. 2020 Jan 1;15(1):43-8.

3. Gross IT, Coughlin RF, Cone DC, Bogucki S, Auerbach M, Cicero MX. GPS devices in a simulated mass casualty event. Prehospital emergency care. 2019 Mar 4;23(2):290-5.

4. Cheng PL, Su YC, Hou CH, Chang PL. Management of in-field patient tracking and triage by using near-field communication in mass casualty incidents. InMEDINFO 2017: Precision Healthcare through Informatics 2017 (pp. 1214-1214). IOS Press.

5. Prot EY, Clements B. Preparedness in long-term care: a novel approach to address gaps in evacuation tracking. Disaster medicine and public health preparedness. 2017 Feb;11(1):28-30.

6. Haverkort JM, Bouman JH, Wind JD, Leenen LP. Continuous development of a major incident in-hospital victim tracking and tracing system, withstanding the challenges of time. Disaster medicine and public health preparedness. 2017 Apr;11(2):244-50.

7. Photo by Bayram Er from Pexels



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