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You are Here: Home Page > Pediatric and Obstetric Emergency Preparedness Toolkit > Section 15 - Family Information & Support Center (FISC)  

Section 15 - Family Information & Support Center (FISC)

Purpose: It is recommended that hospitals establish a Family Information and Support Center (FISC) as part of their Disaster Preparedness Plan to assist victims and their families during a mass casualty event.

Section Contents

• Introduction
  • The Role of Information during Disasters
• FISC Objectives and Functions
• Structure of the FISC
  • The Main FISC Unit
  • Peripheral Hospital Units
• FISC Information Flow
  • FISC Staffing
• FISC Equipment, Materials and Supplies
• Training Staff in the FISC
• FISC Activation
• Interactions with Families
• Identification of Identified or Unidentified Victims/Family Members
• Day Care for Dependents of Hospital Staff Members
• FISC Educational Tools for Staff
  • Psychological First Aid for Disaster Survivors
  • Normal Reactions to Disaster for Adults and Children
  • Mental Health Consequences of Disaster
  • Helping Children Deal with Disasters
• References

Introduction

Disasters, whether natural or man-made, produce effects that have psychological repercussions beyond individuals and families, extending to broader sections of the affected community.¹ Healthcare facilities should be prepared to handle these disasters from a family-centered, psychosocial perspective, in addition to the crisis and acute medical management of victims.

During 9/11 many family members and friends went from one hospital to another looking for their loved ones. Every time families arrived at a different hospital to find out that their loved ones were not there, their confusion, fears and anxiety levels increased. During the Katrina disaster, many families were evacuated outside their own state of Louisiana, making family reunification tedious and lengthy, and adding emotional distress to an already bewildering situation.

Children injured or involved in a disaster bring additional emotional distress. It has been estimated that for every child arriving at the emergency department, the hospital can expect an average of 4 to 5 arriving family or caregivers. Staff in the emergency department will be faced with the medical management of multiple victims and will not have the time, space and training that this population of concerned family members requires.

For these reasons, it is recommended that hospitals establish a FISC as part of their emergency preparedness plan.

The Role of Information During Disasters

Information has a dual role in enabling effective coping mechanisms. First, active seeing of information can help the people regain a sense of control.² Second, the availability of information reduces a sense of certainty inherent in traumatic events³ and hastens the interpretation of a situation. When people turn to an informed center, they are inevitably distraught and provision of essential information on a missing person is the first step in enabling the process of coping.⁴

Together with emotional support, families are informed of the following in the FISC:

• The circumstances of the event (where, when, how and what happened);
• The evacuation of casualties (whether more are injured or still arriving to the hospital);
• Other hospitals where victims are being taken to and when the evacuation is complete; and
• The victim identification stages and psychological reactions to trauma and related symptoms.^5,6

FISC Objectives and Functions⁷

The FISC has three main objectives:

1. Provide the necessary reliable information via the systematic organizational framework and provide assistance in the identification process;
2. Assist relatives coping with uncertainty, stress and stages of adaptation; and
3. Enable the medical staff to concentrate freely on their treatment of the casualties, especially in the acute stage of the proceedings, while providing a formal support system for bewildered and anxious relatives and friends.

The FISC also serves these functions:

• Provides accurate information;
• Provides psychological first aid to distraught families;
• Offers crisis counseling or refers individuals and families for immediate mental health services;
• Escorts and provides comforting services to families;
• Offers temporary childcare for well children of either the injured or of family members who need to assist the injured;
• Helps to locate patients and reunite families within the hospital;
• Contacts family members to arrange care of children present at hospital;
• Makes or helps to make in-place shelter arrangements or community placement of children who do not have a safe place to be or a family member who can care for them;
• Provides for the communications needs of families (phone, e-mail); and
• Protects families from intrusion by media or curious bystanders.

Structure of the FISC⁷

The FISC structure should be divided into 2 main areas:

1. The Main FISC Unit is the physical location of the FISC; and
2. The Hospital Peripheral Units that are the hospital units with which staff will need to be in constant communication during the immediate phase following a disaster.

The Main FISC Unit

This unit should be able to have contact with the public, via phone or in person. It deals with the widest range of activities and has the largest number of professional personnel allocated to it. It is recommended that facilities identify physical space for FISC, wired with telephone and Internet connections.

The structure of the Main FISC Unit is as follows:

• Reception Area: At any given time, there may be hundreds of families and friends in contact with FISC at varying stages of the disaster. The simultaneous presence of all these people, especially in the earlier stages, requires expertise in crowd management.

  Here, social workers or assigned staff may be allocated to the families and friends as they arrive. This social worker or assigned staff member takes in information from arriving family members and assigns them a social worker. Coordination among staff members prevents unnecessary doubling up and allows optimal use of staffing resources.

  A central waiting area should be large enough to accommodate family members seeking information. This area should be away from the Emergency Department area but ideally in close proximity or easily accessible to facilitate communication. There should be conveniently located bathroom facilities.

• Information Desk: The information provided by the social worker or assigned staff member who is operating the information desk in person and via telephone is based on constantly updated data retrieved from the computer, social workers in the field and the Incident Command Center.
• Photograph/Identification Room: This room is utilized for those people without confirmatory information on a missing relative. It is assumed that the missing relative is among the casualties. At this stage of the proceedings, the need for support is at its greatest and requires sensitive and careful intervention. Only the closest relatives are brought to this room. This will also serve as the center for family reunification through photograph identification.
• Consultation Areas: Side rooms are used for those members of the public that express extreme stress reactions (i.e., shock or pain). When the social worker or assigned staff member identifies a family reacting in an extremely volatile and agitated manner and feels that they would benefit from personal, supportive attention in a quiet atmosphere, they are encouraged to withdraw to a side room provided for this purpose. This area separates the family from the rest of the public in order to prevent a panic chain reaction. These areas should at least minimally be furnished with chairs, desk or table, tissues, trashcan and a telephone.
• Pediatric Safe Area:As discussed in Section 5-Security, the Pediatric Safe Area may be located within the FISC. The Pediatric Safe Area is a designated place for unaccompanied children who have been discharged from the Emergency Department or who have been separated from their caregivers. These children are awaiting reunification with appropriate family members or others.

  If the Pediatric Safe Area is located within the FISC, set aside a portion of the large room to accommodate child-sized furniture with a selection of toys, games, art materials and books. This area should have a regularly assigned adult, Pediatric Safe Area Coordinator and appropriate security staff (either staff or volunteer) to attend to the children. If your organization has a Child Life Program, they may be the most experienced to setup and monitor the Pediatric Safe Area.

Peripheral Hospital Units

In addition to the Main FISC Unit, the hospital will need to be in close contact with other areas. Consider planning FISC linkage with the following:

• Emergency Department: The emergency department (ED) is the first venue for the injured. ED care is extremely intensive and short term. All identity/location information obtained by social workers during the interviews with patients will be communicated to the main information center.
• Incident Command Center: Most of the information related to the disaster will come to the Incident Command Center. Any information related to patients' families is passed on to the Director of Human Services, who will in turn contact the Main FISC Unit head appointee to relay the information and brief the staff on changes relevant to the incident.
• Intensive Care Unit: Social workers or designated staff assigned to this area will collect information about the physical characteristics of patients (such as tattoos, scars or other outstanding distinguishing features) that can be used to further identify individuals and communicate this information to the FISC.

FISC Information Flow:

• Information on patient status and identification will come to the FISC from the ED, ICU, other hospitals, EMS, the morgue, the Medical Examiner's Office and the Incident Command Center. Information may come to the FISC via fax or telephone, electronically or by runners.
• The FISC will act as a liaison between the families and the peripheral units.
• The FISC is in constant communication with the Incident Command Center.
• Any media seeking information about patients, families or the nature/status of the event should be directed to the hospital's Public Information Officer.
• It is recommended that hospitals continue to develop communication systems and protocols to facilitate the flow of information within the facility, within the community, and with other city, county and state agencies.

FISC Staffing

It is recommended that the facility plan for staffing as stated below:

• Director/Coordinator: The unit should be directed by the Human Services or Social Work administrator or manager.
• Assigned Professional Staff: Assigned staff may include social workers, caseworkers, mental health practitioners, child life specialists, chaplains, human resources personnel, and pre-screened volunteers.
• Volunteers: Volunteers should be pre-screened and already trained as hospital volunteers. Volunteers might also include fieldwork students assigned to the ancillary services, clergy from nearby religious institutions and personnel from community-based human services organizations.
• Red Cross Liaison: : A liaison from the American Red Cross could be very useful in providing communication and on-site support.
• Patient Information Officer: A Patient Information Officer should be assigned to the Information Desk. This person could be very helpful in reuniting families who become separated and sharing communication about family members currently admitted to other units.
• Security: Hospital security personnel must be assigned to the area. Security personnel should be trained in normal human reactions to disasters and how to handle psychologically fragile individuals.
• Translators/Interpreters: In the event of a disaster, translators/interpreters may be needed. When individuals are stressed by a disaster, they may have more difficulty understanding directions, whether or not English is their first language.
• Runners: Runners should be assigned to deliver or pick up information/hard data to and from the FISC and all other areas of the hospital.

FISC Equipment, Materials and Supplies:

Listed below are some of the equipment, materials and supplies likely to be needed:

Area:	Supplies Needed:
Information Desk	Computer with Internet connection Fax machine Digital camera with related software Multiple phone lines to facilitate in-house communication Pen and paper Quarters for pay-phone calls Tissues Staplers Message board with scotch tape or tacks Dry erase boards with markers and erasers
Reception Area	Refreshments Cups, napkins, paper goods
Pediatric Safe Area	Diapers and extra children's underwear Clothing or tee-shirts in small sizes Formula Age-appropriate toys Infant seats/play pens Areas for sleeping Age-appropriate books and other diversions See Section 5 - Security for more information.
Throughout	Clearly defined signage Comfort

Training Staff in the FISC

• Just In Time training can be given to staff that would be potentially assigned to the FISC Center, along with a job action sheet, if needed.
• Training should review protocols and check lists on how to screen, support and triage families who need psychological first aid.
• Refer to Section 14-Psychosocial Needs for pertinent information on interactions with families, typical reactions to disaster and signs of trauma. Also, see FISC Educational Tools #2 and #3.
• Off- or on-site training or briefing sessions with pre-screened volunteers from the community should include how to facilitate communication for mobilization.
• There should be a plan for staffing each shift and for on-call response for each discipline or service assigned to the Center.
• There should be periodic mass casualty event in-service training for mental health providers.

FISC Activation

• After notification of disaster and at the direction of the Incident Command Center, the designated coordinator of the Family Information and Support Center mobilizes with other directors of service or managers in the human service/human resources, MIS, telecommunications and housekeeping departments to set up physical space for the Center.
• Previously identified hospital personnel who are in-house are scheduled for shifts as needed.
• Coordinator or other assigned supervisory staff assesses the need to call in additional staff and outside volunteers or agencies (i.e., Red Cross).
• Information systems are tested and ready to go.
• Supervisors of participating departments provide shift coverage within their own discipline or, in a smaller facility, the Center coordinator deals with shift coverage directly from the pool of assigned hospital personnel.

Interactions with Families

• Families need to be provided with the most up-to-date information available in a supportive and safe environment.
• Upon arrival to the FISC, families either are logged in via an electronic database or sign-in book. Registered families are reviewed periodically for information coming into the FISC.
• Assign a social worker or other support staff member to families that are identified as exhibiting overt psychological upset or need to be given bad news.⁸
• Professional staff or trained volunteers should be assigned to circulate throughout the Center to answer general questions, offer comfort and support, provide directions and supply information about the facility. For age-specific communications guidelines, see FISC Educational Tools for Staff #4.
• If possible, there should be a dedicated social support person in the children's area.

Identification of Identified or Unidentified Victims/Family Members

• Information is gathered from various sources, including Emergency Medical Services, the ICU, and the Emergency Department and from families themselves. Data on unidentified injured victims (i.e., gender, approximate age, physical characteristics) are gathered on admission to the Emergency Department. All personal details and pictures are transferred to the FISC via fax, electronically or by runners.
• Under intense stress, family members often fail to remember essential identifying details. To minimize critical errors, the intake process must be conducted with great caution. To achieve a higher level of accuracy, use structured forms for data collection. (See Section 5 - Security for sample Child Identification Survey Form.)
• Unaccompanied children may either be brought to the facility unharmed, treated medically but with no adult readily available to care for them, or may have come to the facility with an adult who is being treated urgently. These children should also be photographed and given an ID bracelet with their personal information and that of their family member, if appropriate. (See Section 5-Security.) This information should then be forwarded to the FISC.
• Adults coming to the hospital to claim children will have to show ID. We recommend that the adult (to the best of their ability) bring a picture that shows the person pictured together with the child before a child is released to them. Before releasing the child, driver's license numbers or other ways to identify the claiming adult should be recorded. Photographing the claiming adult should be considered.
• Individuals who must identify a deceased family member may be brought to the Photo Identification Room to view photos with an assigned social worker that can also accompany them to the morgue area. Pictures of victims that are beyond recognition should not be shown to family members. The Medical Examiners Office may have a primary role here.

Day Care for Dependents of Hospital Staff Members

In addition to caring for families of victims, it is suggested that consideration be given to establishing an extension of the FISC as a safe space for the dependents of hospital staff who are working during a disaster and do not have a safe place for their children. This decision will need to be made in the context of the emergency, as it may be counter to recommendations that would be made for infection control and social distancing.

FISC Educational Tools for Staff #2

Normal Reactions to Disaster for Adults and Children

Age	Parameter	Normal Reactions May Include:
All Ages	Emotional	Shock Fear Grief Anger Guilt Shame Helplessness Hopelessness Numbness Emptiness Decreased ability to feel interest, pleasure, love
	Cognitive	Confusion Disorientation Indecisiveness Worry Shortened attention span Poor concentration Memory difficulties Unwanted memories Self-blame
	Physical	Tension Fatigue Edginess Insomnia Generalized aches & pains Startles easily Rapid heartbeat Nausea Decreased appetite Decreased sex drive
	Interpersonal	Difficulties being intimate Being over-controlling Feeling rejected or abandoned
Children's age-specific disaster response:
Pre-school	Emotional	Separation fears Temper tantrums
	Cognitive	See All Ages
	Physical	Regression Fussiness Somatic complaints Sleep disturbances including nightmares, somnambulism and night terrors
	Interpersonal	Likely to seek comfort
School-age	Emotional	All of above, plus: Excessive guilt and worries about others' safety
	Cognitive	Poor concentration and loss of school performance
	Interpersonal	Repetitious re-telling or play related to trauma
Adolescent	Emotional	Depression Wish for revenge
	Cognitive	Altered view of the future
	Physical	Sleeping disturbances Eating disturbances
	Interpersonal	Acting out

FISC Educational Tools for Staff #3

Mental Health Consequences of Disaster - An Overview for Emergency Department Staff

Developmental Considerations in the Comprehension of Death in Children and Adolescents
	Infants	Preschool	School-Aged	Adolescents
Developmental considerations	Object permanence Establishing trust Dependency for basic needs	Magical thinking No concept of time Egocentric	Logical thinking Concept of time Differentiation of self from others	Abstract thinking Establishing independence Identity formation Feelings of omnipotence
Effect of disaster	Destroyed routine Loss of loved ones
Behavioral changes seen as result of disaster	Regression Detachment	Posttraumatic play Withdrawal Apathy	School problems Anxiety Anger Somatic complaints Post-traumatic play	Risk-taking Somatic experiences Depression Anger Hostility to others Self-doubt Shame Guilt
View of disaster	No comprehension	Reversible	Understands loss as a consequence of injury and illness	Full understanding
Modified from: American Academy of Pediatric Workgroup on Disasters, Psychological issues for children and families in disasters: a guide for the primary care physician. US Department of Health and Human Services, 1995 [DHHS Publication (SMA) 95-3022].

References:

1. Hartsough DM. Planning for disaster: a new community outreach program for mental health centers. J Community Psychol. 1982;10(3):255-264.

2. Cohen F, Lazarus RS. Coping with the stresses of illness. In: Stone GC, Cohen F, Adler NE, assoc eds. Health Psychology-A Handbook: Theories, Applications, and Challenges of a Psychological Approach to the Health Care System. San Francisco, CA: Jossey-Bass; 1979.

3. Lazarus R, Folkman S. Stress, appraisal, and coping. New York, NY: Springer Publishing Company, Inc; 1984.

4. Drory M, Posen J, Vilner D, Ginzburg K. Mass casualties: an organizational model of a hospital information center in Tel Aviv. Soc Work Health Care. 1998;27(4):83-96.

5. Curtis JM. Elements of critical incident debriefing. Psychol Rep. 1995;77(1):91-96.

6. Everly GS Jr. The role of the Critical Incident Stress Debriefing (CISD) process in disaster counseling. J Ment Health Counsel. 1995;17(3):278-290.

7. Gagin R, Cohen M, Peled-Avram M. Family support and victim identification in mass casualty terrorist attacks: an integrative approach. Int J Emerg Ment Health. 2005;7(2):125-131.

8. Bell JL. Traumatic event debriefing: service delivery designs and the role of social work. Soc Work. 1995;40(1):36-43.