Pediatric Mass Casualty Processes for Handling a Surge of Unaccompanied Minors

Purpose: To educate the ED staff on the proper management of unaccompanied minors in the ED during a MCI Objectives Know where to find your MCI tools and cart Know where to find and how to use the MCI Polaroid Know where to tear off and place the triage tag squares Understand the proper use of the Unaccompanied Minor Form Understand the proper use of the purple ID bands Understand the purpose of the pediatric safe area

EMS Calls to inform us that a 3rd grade school bus has crashed with patient’s inbound what are your first steps? 1)Tell the HC and your team 2)Gather your tools: The cart and the polaroid camera are located in the EMS Room off the de-contamination room. Unplug it from the charger, take the camera tips card along with film The camera is under the shelf Roll the cart under the triage board by the double doors

Make sure the camera is charged and has film… Open the back of the camera to access film compartment Insert the entire package of film shiny side up with the blue sheet at the bottom Close the back, push the power button then point and shoot. Please refer to laminated tips card for questions regarding operation

Check your supplies…The top three drawers of the cart will get you started. Drawer three has the purple bracelets used specifically for pediatric patients and their parents along with other supplies such as scissors, OPA’s, tape and goggles… Drawers 1 and 2 have the MCI management tool along with other admin supplies The drawers are labeled.

Let’s see what else is in the cart… Splints, gloves, batteries BP Cuffs and tourniquets Kerlix Everything needed to quickly triage, bandage, splint and protect ourselves… Ace Wraps Masks and 4x4’s

EMS has called; they are inbound with the first patient an unconscious 8 year old boy. One of the white top portions of his tag is ripped off and placed on the board and then colored over with his appropriate triage color (red, yellow, green) using a marker. Upon arrival he is banded with the purple bracelet and his stat pack bracelet; “disaster 1” (not pictured). The purple bracelet indicates that he is unaccompanied by an adult or his adult is injured and incapable of supervising his care. He is triaged in the doorway, he is a “red” and needs immediate care. His triage tag number will be handwritten on his unaccompanied minor form. We have no identifying information and no parents are present. The triage tag will remain a part of his chart.

As he is being triaged this is occurring simultaneously… A staff member from the labor pool who is comfortable with children and being around medical procedures; is assigned to him. This staff escort will stay with only him through discharge from the ED or reunification with his parents. In addition to making sure this patient remains where they need to be; this staff member will offer emotional support and be responsible for filling out the Unaccompanied Minor Form.

The Unaccompanied Minor Form… Stat Pack sticker goes here Triage number is written here He will be photographed by his staff escort. They will take two pictures one of his face and one of his clothes and stick them to the form. The escort will glean as much information as possible from EMS or other patients and try to fill out the unaccompanied minor form to the best of their ability. This form will be used to help identify the patient. This form can be found in drawer 1 of the disaster cart

Patient care will not be delayed and the nursing staff is unencumbered with the task of identifying the patient… At the same time The patient’s escort hands off the completed form for a runner to give to admissions. They will begin the process of reunifying injured children and parents. EMS turns over the patient

The child is stabilized and his mother has been located…In the OR. The mother’s identifying information is added to the unaccompanied minor form. Mom is given a purple bracelet to indicate she had a child with her. The child's StatPak ID sticker is placed on Mom’s purple bracelet.

The child is stable, but needs admission or transfer . Admission to NVH Transfer to another facility The staff escorts remain with the child until a relative with appropriate identification arrives to relieve them, (similar to a 1:1 patient) The child’s destination will be communicated to the staff caring for the child’s parent in surgery The child’s location will be continuously updated on the backside of the unaccompanied minor form flow sheet. Both sides of the unaccompanied minor form will be photocopied in color after the destination is added to the flow sheet and the copies sent with the patient along with all other required records and forms (COBRA etc…) The child’s destination will be communicated to the staff caring for the child’s parent who is in surgery The receiving staff will be told in report that the child has an injured parent at the departing facility and is unaccompanied.

Notes On The Stat Pack Process… When a patients name is unknown they are assigned an alias name and number; “StatPack 1” or “Disaster 3” for example This will come with a visit ID number and bracelet that will be placed on them and function as their patient identifier. They will be gender specific with as closely matching age as possible. When the patient is ID’d continue to use the statpack account until discharge from the ED. Do not change the name this will cause confusion with lab, imaging and blood bank. Do not remove the stat pack ID’s if the patient is admitted. Both sets of identification will remain on the patient through their stay so that lab and blood bank can be properly matched to the patient. Once the patient is discharged the accounts will be merged.

The child is to be discharged and there is no one to take them… Once the child is ready for discharge. The child is taken to the pediatric safe area to await reunification with the child’s family. The child’s location is communicated to the admissions staff and the flow sheet is updated on the back of the unaccompanied form. The patient escort hands off the child to the leader of the pediatric safe area and says goodbye. The child will remain in this secure area staffed with NVH employees until a guardian arrives with proper credentials to take him home.

Further questions regarding the Pediatric Safe Area and the reunification process can be answered in the policy: Pediatric Emergency Operations Plan on the intranet