Family Reunification—Concepts and Challenges

Acute response to the October 7th hostage release: rapid development and evaluation of the novel ReSPOND protocol implementation within a children's hospital

BACKGROUND

The decision to allocate hospitals for the initial reception of hostages abducted on the October 7th Hamas attack introduced an array of unprecedented challenges. These challenges stemmed from a paucity of existing literature and protocols, lack of information regarding captivity conditions, and variability in hostage characteristics and circumstances.

OBJECTIVE

To describe the rapid development, implementation and evaluation of the Hostage-ReSPOND protocol, a comprehensive trauma-informed procedure for the care of hostages, including young children, their caregivers and families, immediately following their release from prolonged captivity.

METHODS

A multidisciplinary expert focus group conducted a comprehensive literature review to develop the ReSPOND protocol, consisting of: Readiness of teams via multifaceted trainings, utilizing live simulations and video debriefings; Specialized professional teams experienced in providing holistic trauma-informed care; Personalized care tailored to individualized and developmentally-informed needs; Optimal safety rooted in creating a secure environment and trauma-informed response to young children, adolescents, caregivers and families; and Navigating Discharge, through coordination with community-based care systems.

RESULTS

A designated facility at the Children's hospital was carefully prepared for receiving 29 hostages, aged 3.9-80 years, 28% under the age of 18. Implementation of the ReSPOND protocol, which prioritized holistic psychosocial interventions above urgent medical care, proved feasible and effective in managing the diverse and complex needs of returnees as per provider report. Finally, systemic assessment of returnee's immediate and long-term mental health needs proved highly challenging.

CONCLUSIONS

There is currently no literature addressing the response to released hostages, especially those involving infants, young children and families within a children's hospital facility. This study has the potential to fill a crucial gap in knowledge by introducing a novel protocol which could offer valuable insights for public health organizations tasked with providing acute care to diverse individuals and families experiencing extreme, multi-layered mass traumatization.

The Potential of Networks for Families in the Child Protection System: A Systematic Review

There has recently been increased interest in the potential for formal and informal networks to aid interventions with biologic families in helping them achieve reunification in the context of the child protection system. When group support is provided to families, the creation of a network of social support seems to be a consequence. The article analyzes the conceptualization of social support in order to create social support networks and the benefits on the intervention with families in the framework of the child protection system through a systematic review. From a wide search 4348 documents, finally 14 articles were included in the reviews. Results show that social support is considered a process by which social resources are provided from formal (professional services and programs associated with those services in any off the protection, health of educational systems) and informal (extended family, friends, neighbors and acquaintances) networks, allowing the families to confront daily moments as well as in crisis situations. This social support is related to emotional, psychological, physical, instrumental, material and information support that allow families to face their difficulties. Formal and informal networks of child protection systems contribute to social support, resilience, consolidation of learning and the assistance of families to social intervention programs.

An Integrated Scenario Ensemble-Based Framework for Hurricane Evacuation Modeling: Part 1-Decision Support System

This article introduces a new integrated scenario-based evacuation (ISE) framework to support hurricane evacuation decision making. It explicitly captures the dynamics, uncertainty, and human-natural system interactions that are fundamental to the challenge of hurricane evacuation, but have not been fully captured in previous formal evacuation models. The hazard is represented with an ensemble of probabilistic scenarios, population behavior with a dynamic decision model, and traffic with a dynamic user equilibrium model. The components are integrated in a multistage stochastic programming model that minimizes risk and travel times to provide a tree of evacuation order recommendations and an evaluation of the risk and travel time performance for that solution. The ISE framework recommendations offer an advance in the state of the art because they: (1) are based on an integrated hazard assessment (designed to ultimately include inland flooding), (2) explicitly balance the sometimes competing objectives of minimizing risk and minimizing travel time, (3) offer a well-hedged solution that is robust under the range of ways the hurricane might evolve, and (4) leverage the substantial value of increasing information (or decreasing degree of uncertainty) over the course of a hurricane event. A case study for Hurricane Isabel (2003) in eastern North Carolina is presented to demonstrate how the framework is applied, the type of results it can provide, and how it compares to available methods of a single scenario deterministic analysis and a two-stage stochastic program.

Separated After a Disaster: Trust and Privacy Issues in Sharing Children's Personal Information

BACKGROUND

After disasters, unaccompanied children may present to an emergency department requiring reunification. An effective reunification system depends on the willingness of guardians to utilize it.

OBJECTIVE

Assess guardian willingness to share children's personal information for reunification purposes after a disaster, perceived concerns and beliefs, and trust in reunification agencies.

METHODS

Guardians of children presenting to 2 pediatric emergency departments were approached to participate in a survey-based study. Willingness to share their children's personal information was scored on a scale of 1 to 19 (1 point per item). Perceived concerns about and importance of sharing information, level of trust in reunification agencies, and guardian demographics were collected. Chi-square was used to compare trust and attitudes/beliefs. Multivariate linear regression was used to determine factors associated with willingness to share information.

RESULTS

A total of 363 surveys were completed (response rate, 80%). Most guardians (95.6%) were willing to share at least some information (mean, 16 items; range, 1-19). Half were concerned about protection (55.4%) or abuse (52.3%) of their child's information. Hospitals were trusted more than other reunification agencies (P < .001). Perception of reunification importance was associated with willingness to share (P < .001).

CONCLUSIONS

Guardians are willing to share their children's information to facilitate reunification after disasters, but have privacy concerns.

Pediatric Disaster Preparedness

Children can be victims of mass casualty or illness, but their needs, with respect to their care and recovery are substantially different from adults. Emergency or urgent care physicians must be prepared to evaluate and manage child victims presenting to their facility in numbers or acuity that could significantly overwhelm normal operations. This article presents the general approach to pediatric disaster preparation in the United States, the expectations of emergency department providers, and different methods of disaster triage, and introduces the most likely types of mass illness (some of which are bioweapons or chemical agents) and their management.

Use of Facial Recognition Software to Identify Disaster Victims With Facial Injuries

OBJECTIVE

After large-scale disasters, victim identification frequently presents a challenge and a priority for responders attempting to reunite families and ensure proper identification of deceased persons. The purpose of this investigation was to determine whether currently commercially available facial recognition software can successfully identify disaster victims with facial injuries.

METHODS

Photos of 106 people were taken before and after application of moulage designed to simulate traumatic facial injuries. These photos as well as photos from volunteers' personal photo collections were analyzed by using facial recognition software to determine whether this technology could accurately identify a person with facial injuries.

RESULTS

The study results suggest that a responder could expect to get a correct match between submitted photos and photos of injured patients between 39% and 45% of the time and a much higher percentage of correct returns if submitted photos were of optimal quality with percentages correct exceeding 90% in most situations.

CONCLUSIONS

The present results suggest that the use of this software would provide significant benefit to responders. Although a correct result was returned only 40% of the time, this would still likely represent a benefit for a responder trying to identify hundreds or thousands of victims. (Disaster Med Public Health Preparedness. 2017;11:568-572).

Planning for disasters involving children in Australia: A practical guide

Children comprise 19% of the Australian population. Children are at risk of higher morbidity and mortality in disaster events than adults; however, there is a paucity of paediatric-specific disaster preparedness in Australia. Paediatric disaster plans should be developed, tested and renewed regularly. Plans need to address unaccompanied and unidentified children, medical and psychosocial needs and family reunification. Specific management is required for chemical, biological and radiological events.

Life recovery after disasters: a qualitative study in the Iranian context

INTRODUCTION

Planned and organized long-term rehabilitation services should be provided to victims of a disaster for social integration, economic self-sufficiency, and psychological health. There are few studies on recovery and rehabilitation issues in disaster situations. This study explores the disaster-related rehabilitation process.

METHOD

This study was based on qualitative analysis. Participants included 18 individuals (eight male and ten female) with experience providing or receiving disaster health care or services. Participants were selected using purposeful sampling. Data were collected through in-depth and semi-structured interviews. All interviews were transcribed and content analysis was performed based on qualitative content analysis.

RESULTS

The study explored three main concepts of recovery and rehabilitation after a disaster: 1) needs for health recovery; 2) intent to delegate responsibility; and 3) desire for a wide scope of social support. The participants of this study indicated that to provide comprehensive recovery services, important basic needs should be considered, including the need for physical rehabilitation, social rehabilitation, and livelihood health; the need for continuity of mental health care; and the need for family re-unification services. Providing social activation can help reintegrate affected people into the community.

CONCLUSION

Effective rehabilitation care for disaster victims requires a clear definition of the rehabilitation process at different levels of the community. Involving a wide set of those most likely to be affected by the process provides a comprehensive, continuous, culturally sensitive, and family-centered plan.

Delayed family reunification of pediatric disaster survivors increases mortality and inpatient hospital costs: a simulation study

BACKGROUND

Disasters occur randomly and can severely tax the health care delivery system of affected and surrounding regions. A significant proportion of disaster survivors are children, who have unique medical, psychosocial, and logistical needs after a mass casualty event. Children are often transported to specialty centers after disasters for a higher level of pediatric care, but this can also lead to separation of these survivors from their families. In a recent theoretical article, we showed that the availability of a pediatric trauma center after a mass casualty event would decrease the time needed to definitively treat the pediatric survivor cohort and decrease pediatric mortality. However, we also found that if the pediatric center was too slow in admitting and discharging patients, these benefits were at risk of being lost as children became "trapped" in the slow center. We hypothesized that this effect could result in further increased mortality and greater costs.

METHODS

Here, we expand on these ideas to test this hypothesis via mathematical simulation. We examine how a delay in discharge of part of the pediatric cohort is predicted to affect mortality and the cost of inpatient care in the setting of our model.

RESULTS

We find that mortality would increase slightly (from 14.2%-16.1%), and the cost of inpatient care increases dramatically (by a factor of 21) if children are discharged at rates consistent with reported delays to reunification after a disaster from the literature.

CONCLUSIONS

Our results argue for the ongoing improvement of identification technology and logistics for rapid reunification of pediatric survivors with their families after mass casualty events.

A novel image-based tool to reunite children with their families after disasters

OBJECTIVES

Reuniting children with their families after a disaster poses unique challenges. The objective was to pilot test the ability of a novel image-based tool to assist a parent in identifying a picture of his or her children.

METHODS

A previously developed image-based indexing and retrieval tool that employs two advanced vision search algorithms was used. One algorithm, Feature-Attribute-Matching, extracts facial features (skin color, eye color, and age) of a photograph and then matches according to parental input. The other algorithm, User-Feedback, allows parents to choose children on the screen that appear similar to theirs and then reprioritizes the images in the database. This was piloted in a convenience sample of parent-child pairs in a pediatric tertiary care hospital. A photograph of each participating child was added to a preexisting image database. A double-blind randomized crossover trial was performed to measure the percentage of database reviewed and time using the Feature-Attribute-Matching-plus-User-Feedback strategy or User-Feedback strategy only. Search results were compared to a theoretical random search. Afterward, parents completed a survey evaluating satisfaction.

RESULTS

Fifty-one parent-child pairs completed the study. The Feature-Attribute-Matching-plus-User-Feedback strategy was superior to the User-Feedback strategy in decreasing the percentage of database reviewed (mean ± SD = 24.1 ± 20.1% vs. 35.6 ± 27.2%; mean difference = -11.5%; 95% confidence interval [CI] = -21.5% to -1.4%; p = 0.03). Both were superior to the random search (p < 0.001). Time for both searches was similar despite fewer images reviewed in the Feature-Attribute-Matching-plus-User-Feedback strategy. Sixty-eight percent of parents were satisfied with the search and 87% felt that this tool would be very or extremely helpful in a disaster.

CONCLUSIONS

This novel image-based reunification system reduced the number of images reviewed before parents identified their children. This technology could be further developed to assist future family reunifications in a disaster.

Survey of emergency management professionals to assess ideal characteristics of a photographic-based family reunification tool

OBJECTIVE

A reunification tool that captures images of children at the time of the disaster would enable parents to locate their missing children, particularly if the children are unable to communicate their identity. This study assessed the ideal features and parameters of a photographic-based reunification tool.

METHODS

A convenience sample of federal, state, and hospital-based emergency management professionals were surveyed to elicit their preferences regarding an image-based reunification algorithm, to assess the parents' level of difficulty in viewing images with facial trauma, and to determine the minimum percentage of successful reunifications needed to justify adoption of a reunification tool.

RESULTS

Of 322 emergency management professionals surveyed, 129 (40%) responded. Only 18% favored a photographic-based tool that would display images in which only the categories of age, gender, and facial features (eye, hair, and skin color) would exactly match the parent's description of the child. However, 72% preferred a broader, less-rigid system in which the images displayed would match all or most features in the parents' description of the missing child, allowing parents to view more of the image database. Most (85%) preferred a tool showing unedited images of living children, allowing parents to view facial trauma. However, more respondents reported that parents would find viewing unedited images with facial trauma somewhat or very difficult emotionally compared with edited images for both living (77% vs 20%, P < .001) and deceased children (91% vs 70%, P < .001.) In a disaster involving 1000 children, a tool that reunites a minimum of 10% of families would be adopted by over 50% of the participants. Participants were willing to accept a lower percentage of reunifications in a disaster involving 1000 children compared with disasters involving 10 (P < .001) or 100 children. (P < .001).

CONCLUSIONS

Emergency management professionals identified desirable characteristics of a photographic-based reunification tool, including an algorithm displaying unedited photographs of missing children that loosely matches the parents' description, acknowledging the parents' emotional difficulty in viewing photographs with facial trauma. Participants were also willing to accept a lower percentage of successful reunifications as the scale of the disaster size increased.