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Family Reunification and Support
Topic Collection
December 8, 2022

Topic Collection: Family Reunification and Support

Disasters and mass casualty incidents can strike at any time, separating families and friends from their loved ones or displacing them for long periods of time. Some patients will not survive, and family notification and support must be provided. Patient tracking and family reunification and support services are key aspects of disaster response and recovery, but also some of the most challenging. Hospital-based family support actions and centers must also integrate activities and referrals with community-based resources and Family Assistance Centers.

The documents, case studies, templates, and systems outlined in this Topic Collection will help stakeholders better understand and fulfill their roles. Healthcare preparedness planners can utilize existing systems and concepts traditionally used by other response agencies and reunification agencies. This Topic Collection was refreshed in November 2022.

Please note: Pediatric and family resources are considered integrated, therefore, there is no separate sub-category in this Topic Collection specific to pediatrics.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Must Reads

American Academy of Pediatrics, in collaboration with Massachusetts General Hospital, Center for Disaster Medicine. (2018). Family Reunification Following Disasters: A Planning Tool for Health Care Facilities.
This planning tool was created to assist hospitals with their plans to provide information, support services, and safe reunification assistance to family members of patients who have experienced disasters. It provides potential solutions to reunification-related challenges, including: planning for the secure reception, tracking, and care of large numbers of children who may present to a hospital following a mass-casualty event; identifying injured and unaccompanied children in a disaster; tracking unaccompanied children during their hospital stay; and what legal authority a hospital has to administer care to minors when the parent/guardian is unavailable to participate in the informed consent process.
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ASPR TRACIE. (2018). Tips for Healthcare Facilities: Assisting Families and Loved Ones after a Mass Casualty Incident.
This ASPR TRACIE tip sheet highlights best practices and issues related to planning for, activating, and operating hospital or healthcare facility family information centers (FIC)/family support centers (FSC), in collaboration with family reception centers (FRC) and family assistance centers (FAC).
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Federal Emergency Management Agency (FEMA), U.S. Department of Health and Human Services (HHS), American Red Cross (ARC), and National Center for Missing and Exploited Children (NCMEC). (2013). Post-Disaster Reunification of Children: A Nationwide Approach.
This guidance document provides a comprehensive overview of the coordination processes necessary to reunify children separated from their parents/legal guardians in the event of a large-scale disaster and reflects how the whole community - to include educational, child care, medical, and juvenile justice facilities, nongovernmental organizations, state, local and federal partners, voluntary and faith based organizations, disability and pediatric experts, and private sector partners can work together to achieve one wide ranging mission. This document can assist in developing new, or apply to existing, emergency preparedness plans and/or reunification procedures.
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Shields, S., Wilson, M., Amara, R., et al. (2013). Family Information Center Planning Guide for Healthcare Entities. Los Angeles County Emergency Medical Services Agency (EMS).
This guide for healthcare providers describes the elements to develop a family information center (FIC) plan, which includes providing information, support services, and reunification assistance to families of disaster patients. This guide includes activation, management, and demobilization of a FIC, in addition to example forms, diagrams, and needed resources.
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Family Assistance Centers (FAC)

* ASPR TRACIE. (2018). Tips for Healthcare Facilities: Assisting Families and Loved Ones after a Mass Casualty Incident.
This ASPR TRACIE tip sheet highlights best practices and issues related to planning for, activating, and operating hospital or healthcare facility family information centers (FIC)/family support centers (FSC), in collaboration with family reception centers (FRC) and family assistance centers (FAC).
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Chatham Emergency Management Agency. (2013). Chatham County Emergency Operations Plan: ESF-08 Annex Appendix 8-3: Family Assistance Center.
This plan includes the county family assistance center concept of operations and protocols for Chatham Emergency Management Agency (Georgia). It addresses roles and responsibilities of the multiple response agencies.
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Commonwealth of Massachusetts. (2017). Survivor and Family Assistance Plan.
This document provides information on setting up a location for survivors and families to reunite after a disaster. It gives guidance on planning assumptions, operations, agency responsibilities, family assistance, administration, and authorities.
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County of Monterey Operational Area. (2020). Emergency Operations Plan Annex: Family Assistance Center Plan.
This annex describes the purpose and scope of a family assistance center, and includes information on operations, the incident command system and coordination, communications with elected officials, media, and the public, demobilization, and plan maintenance.
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EMSC Innovation and Improvement Center. (2019). Patient Tracking & Family Reunification.
This webpage includes links to resources on setting up a family reception center, coordinating tracking and reunification of children during disasters, and a nationwide approach to reunification.
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Government of the District of Columbia. (n.d.). District of Columbia Family Assistance Center (FAC) Plan. (Accessed 11/23/2022.)
This plan--though specific to the District of Columbia--can serve as a mode for others interested in planning to establish a Family Assistance Center after a mass fatality event to provide services to those seeking assistance regarding the status of their loved ones.
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* Los Angeles County Office of Emergency Management and Los Angeles County Department of Mental Health. (2014). Los Angeles County Operational Area Family Assistance Center Plan (Contact ASPR TRACIE to access this file.).
This plan provides a framework for the activation, operation, management, and demobilization of a County Operational Area (government-led) family assistance center (FAC) during large scale mass casualty incidents (e.g., earthquakes) and local incidents such as shootings and explosions. The establishment of a FAC can: ensure a place for loved ones to gather information; serve as a coordination spot for first responders; and be a location where emotional support and other types of health support can be provided. (The Los Angeles County Operational Area covers all 88 cities and the unincorporated areas in the county.)
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Maine Disaster Behavioral Health. (2014). Family Assistance Center SOP.
This plan includes the family assistance center protocols for Maine Disaster Behavioral Health. It addresses roles and responsibilities of the multiple response agencies, and core and support services.
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Ohio Emergency Management Agency. (n.d.). Family Assistance and Victim Identification Centers Planning Guidance. (Accessed 11/22/2022.)
This website provides a framework for regional and county coordination to help determine when a family assistance center is needed, provides guidance for victim identification and family reunification, and provides tools for the assistance center implementation. It contains a toolkit and action sheets for these operations.
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Texas Children’s Hospital. (2019). Texas Children’s Hospital Family Reception Center Plan.
This family reception center plan contains information on the scope and assumptions of a reception center, organizational structures, roles and responsibilities, communications, patient tracking, plan development and maintenance, and demobilization after reunification is complete.
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U.S. Department of Justice, Federal Bureau of Investigation; and National Transportation Safety Board. (n.d.). Mass Fatality Incident: Family Assistance Operations. Recommended Strategies for Local and State Agencies. (Accessed 11/23/2022.)
This guide was developed for local and state agencies involved in the response to mass fatality events. It provides an overview of the family assistance process and the family assistance center operations as they relate to transportation and criminal incidents.
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Washington Military Department. (2012). Puget Sound Region. Victim Information and Family Assistance Annex: Regional Catastrophic Disaster Coordination Plan.
This plan provides a framework to facilitate multi-county, regional coordination of situational awareness and response related information for the purpose of determining when a family assistance center (FAC) is needed after a catastrophic incident. It includes several tools (e.g., checklists, templates, and job action sheets) that may be used for planning or response to implement a FAC.
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General Resources

National Center for Missing and Exploited Children (NCMEC). (2020). Team Adam.
Team Adam is a program of specially-trained retired law enforcement professionals from the federal, state and local levels. In addition providing technical assistance to law enforcement agencies and families in serious cases of missing children, they also provide support to emergency management agencies, hospitals, and public health agencies in the event that children become separated from their families due to disaster.
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Rebmann, T., Gupta, N., and Charney, R. (2021). US Hospital Preparedness to Manage Unidentified Individuals and Reunite Unaccompanied Minors with Family Members During Disasters: Results from a Nationwide Survey. (Abstract only.) Health Security. 19(2):183-194.
The authors surveyed Association of Healthcare Emergency Preparedness Professionals to better understand hospital preparedness for reuniting unaccompanied minors with family members after a disaster. Respondents agreed preparedness for family reunification was important, but the survey suggested that just 65.9% of hospitals are prepared to reunite minors with family, while 63.6% had some form of reunification plan. The authors suggest hospitals prioritize development of plans for a scenario where reunification is required.
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Guidance Documents

* Coyote Crisis Collaborative. (2019). Documents (Reunification and Hospital Reception Site).
This webpage includes links to the following documents designed to help staff draft plans related to emergency call management and reunification after a disaster/ mass casualty incident: Emergency Call Center Planning (2016); Family Reunification Center Planning Guide (2017); and Hospital Reception Site Planning Guide (2019).
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Division for At-Risk Individuals, Behavioral Health, and Community Resilience (ABC). (2017). The Role of Healthcare Providers in Combating Human Trafficking during Disasters. U.S. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response.
The materials on this webpage can be used by disaster responders and health professionals: understand the relationship between human trafficking and disasters; recognize signs of human trafficking; identify the resources that exist for further training on this topic; and determine next steps if human trafficking is suspected.
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Federal Emergency Management Agency (FEMA), U.S. Department of Health and Human Services (HHS), American Red Cross (ARC), and National Center for Missing and Exploited Children (NCMEC). (2013). Post-Disaster Reunification of Children: A Nationwide Approach.
This guidance document provides a comprehensive overview of the coordination processes necessary to reunify children separated from their parents/legal guardians in the event of a large-scale disaster and reflects how the whole community - to include educational, child care, medical, and juvenile justice facilities, nongovernmental organizations, state, local and federal partners, voluntary and faith based organizations, disability and pediatric experts, and private sector partners can work together to achieve one wide ranging mission. This document can assist in developing new, or apply to existing, emergency preparedness plans and/or reunification procedures.
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Gubbins, N. and Kaziny, B. (2018). The Importance of Family Reunification in Pediatric Disaster Planning. Clinical Pediatric Emergency Medicine. 19 (3): 252-259.
This article briefly reviews the status of pediatric disaster planning; resources to support pediatric disaster planning; and essential components of a family reunification plan, with a focus on children’s needs.
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Mace, S., Sharieff, G., Bern, A., et al. (2010). Pediatric Issues in Disaster Management, Part 2: Evacuation Centers and Family Separation/Reunification. (Abstract only.) American Journal of Disaster Medicine. 5(3):149-161.
This section of a three-part series on pediatric issues in disaster management covers setting up and maintaining family reunification centers. The authors also cover emergency medical services, healthcare facility considerations, children with special healthcare needs, children’s mental and behavioral health, and hospital or evacuation center surges.
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Maine Department of Health and Human Services. (2018). Disaster Behavioral Health Family Reunification Plan.
This section of the state’s ESF #8 Fatality Management Annex describes how to provide short-term behavioral healthcare (e.g., emotional support, spiritual care, assessments, and referrals) at both a family and friend reunification center and family assistance center after a disaster.
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Reidenberg, J., Gellman, R., Debelak, J., et al. (2013). Privacy and Missing Persons after Natural Disasters. Center on Law and Information Policy, Fordham University School of Law and the Woodrow Wilson International Center for Scholars.
The authors identify key legal and policy issues surrounding privacy and missing persons following a disaster and highlights current missing persons information sharing activities during disasters. The authors recommend a set of options and strategies that organizations and policy makers can pursue to address some of the privacy concerns.
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* Shields, S., Wilson, M., Amara, R., et al. (2013). Family Information Center Planning Guide for Healthcare Entities. Los Angeles County Emergency Medical Services Agency (EMS).
This guide for healthcare providers describes the elements to develop a family information center (FIC) plan, which includes providing information, support services, and reunification assistance to families of disaster patients. This guide includes activation, management, and demobilization of a FIC, in addition to example forms, diagrams, and needed resources.
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Lessons Learned /Case Studies

* ASPR TRACIE. (2018). Tips for Healthcare Facilities: Assisting Families and Loved Ones after a Mass Casualty Incident.
This ASPR TRACIE tip sheet highlights best practices and issues related to planning for, activating, and operating hospital or healthcare facility family information centers (FIC)/family support centers (FSC), in collaboration with family reception centers (FRC) and family assistance centers (FAC).
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Barthel, ER., Pierce, JR., Speer, AL., et al. (2013). Delayed Family Reunification of Pediatric Disaster Survivors Increases Mortality and Inpatient Hospital Costs: A Simulation Study. (Abstract Only.) Journal of Surgical Research, 184(1), 430-437.
The authors used a mathematical simulation to examine how a delay in admitting and discharging pediatric cohort affects mortality and the cost of inpatient care. The authors note that children are often transported to specialty centers after disasters which leads to separation from the families. The results of the simulation argue for improvement in identification technology and logistics for rapid reunification of pediatric survivors with their families.
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Broughton, D., Allen, E., Hannemann, R., and Petrikin, J. (2006). Getting 5000 Families Back Together: Reuniting Fractured Families After a Disaster: The Role of the National Center for Missing & Exploited Children. Pediatrics, 117(4): 442-445.
This article highlights the efforts made by NCMEC post-Katrina to reunify children and their families. Both Project ALERT and Team Adam were utilized along with the help of private organizations.
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Richardson, J., Baker, E., Gallagher, H., et al. (2016). Separation and Reunification in Disasters. Planning for Community-Based Disaster Resilience Worldwide.
The authors of this chapter describe the psychosocial considerations related to separation and reunification in disasters, using Australian bushfires as an example. They discuss disaster planning, mental health, patterns of separation, medium- and long-term consequences, methods of reunification, and limitations.
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Stark, L., MacFarlane, M., Rubenstein, B., et al. (2018). Using a Population-Based Survey Approach to Estimate Child Separation After a Natural Disaster: Findings from Post-Hurricane Haiti. BMJ Global Health. 3(3):e000784.
The authors of this article surveyed households in Haiti after Hurricane Matthew in 2016, with the primary outcome being the prevalence of unaccompanied and separated children in the aftermath. The survey found that 3.03% of the 2,046 children living in the surveyed households were separated from their caregivers, and that the prevalence was similar in respondents' neighbors’ households compared with respondents’ households. Despite child separation being relatively low, the authors emphasize the utility of this survey method during future disasters.
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Plans, Tools, and Templates

American Academy of Pediatrics, in collaboration with Massachusetts General Hospital, Center for Disaster Medicine. (2018). Family Reunification Following Disasters: A Planning Tool for Health Care Facilities.
This planning tool was created to assist hospitals with their plans to provide information, support services, and safe reunification assistance to family members of patients who have experienced disasters. It provides potential solutions to reunification-related challenges, including: planning for the secure reception, tracking, and care of large numbers of children who may present to a hospital following a mass-casualty event; identifying injured and unaccompanied children in a disaster; tracking unaccompanied children during their hospital stay; and what legal authority a hospital has to administer care to minors when the parent/guardian is unavailable to participate in the informed consent process.
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American Red Cross. (2017). Reunification Standards and Procedures.
This document contains information on systematic reunification of minors with their caregivers after a disaster. It includes definitions relevant to reunification, roles and authorities, operations structure, standards, procedures, and managing special situations when reunifying families.
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* ASPR TRACIE. (2018). Tips for Healthcare Facilities: Assisting Families and Loved Ones after a Mass Casualty Incident.
This ASPR TRACIE tip sheet highlights best practices and issues related to planning for, activating, and operating hospital or healthcare facility family information centers (FIC)/family support centers (FSC), in collaboration with family reception centers (FRC) and family assistance centers (FAC).
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Chung, S., Christoudias, C.M., Darrell, T., et al. (2012). A Novel Image-based Tool to Reunite Children With Their Families After Disasters. Academic Emergency Medicine, 19(11): 1227-1234.
This article reports the findings of tests completed to determine the accuracy of various child identification tools. One tool, “Feature-Attribute-Matching,” extracts facial features from photographs to be matched with a parent's description of their child. The other tool, "User-Feedback," allows parents to choose photographs resembling their child which then reprioritizes the images in the database.
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Corfield, J. and the Central Florida Regional Medical Coalition (CFDMC). (2023). Family Reunification and Assistance Center Plan.
Hospital emergency planners can use this downloadable Word template to develop/update their own plans to create/activate a family reunification and assistance center.
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* Coyote Crisis Collaborative. (2019). Documents (Reunification and Hospital Reception Site).
This webpage includes links to the following documents designed to help staff draft plans related to emergency call management and reunification after a disaster/ mass casualty incident: Emergency Call Center Planning (2016); Family Reunification Center Planning Guide (2017); and Hospital Reception Site Planning Guide (2019).
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Hadi, T., Paquet, C., Ullah, N., and Maldin Morgenthau, B. (2018). Using Health Information Exchange to Improve Family Reunification After a Mass Casualty Incident. Health Security. 16(6):416-421.
This presentation, given at the 2015 Annual Public Health Preparedness Summit, gives an overview of existing family reunification systems, why the New York City Emergency Patient Search (NYCEPS) workgroup recommended to leverage Health Information Exchanges (HIE), and how NYCEPS was developed. Also includes legal and privacy considerations for hospitals and healthcare facilities.
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Los Angeles County. (2022). Emergency Medical Services Agency Exercises and Drills.
These exercises can prepare healthcare facilities and emergency medical services to set up a family reunification center while also handling the medical response to a surge in patients. It contains documents and resources for the exercises.
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* Los Angeles County Office of Emergency Management and Los Angeles County Department of Mental Health. (2014). Los Angeles County Operational Area Family Assistance Center Plan (Contact ASPR TRACIE to access this file.).
This plan provides a framework for the activation, operation, management, and demobilization of a County Operational Area (government-led) family assistance center (FAC) during large scale mass casualty incidents (e.g., earthquakes) and local incidents such as shootings and explosions. The establishment of a FAC can: ensure a place for loved ones to gather information; serve as a coordination spot for first responders; and be a location where emotional support and other types of health support can be provided. (The Los Angeles County Operational Area covers all 88 cities and the unincorporated areas in the county.)
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Orlando Health. (2018). Questions Every Hospital Must Ask About Whether They’re Supporting Their Non-resident/Foreign Citizen Patients.
This white paper is based on the significant experience Orlando Regional Medical Center had after the Pulse Nightclub shooting and can help health care facility emergency planners plan for and better support non-resident/foreign patients in general and after a mass casualty/mass fatality incident.
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* Shields, S., Wilson, M., Amara, R., et al. (2013). Family Information Center Planning Guide for Healthcare Entities. Los Angeles County Emergency Medical Services Agency (EMS).
This guide for healthcare providers describes the elements to develop a family information center (FIC) plan, which includes providing information, support services, and reunification assistance to families of disaster patients. This guide includes activation, management, and demobilization of a FIC, in addition to example forms, diagrams, and needed resources.
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Texas Department of State Health Services. (2016). Family Assistance Center Toolkit.
This toolkit contains documents that can be used by community organizations tasked with setting up a family assistance center. It includes resources on selecting an appropriate site, management team roles, staffing and volunteers, family assistance center components, and steps for demobilization.
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Twin Cities Metro Area Operation Curtain Call After Action Work Group. (2014). Template Field Operations Guide for Reunification and Family Assistance.
Local emergency planners can use this guide to organize field operations for a family assistance center to reunite loved ones after a disaster. It contains a family resource packet, forms for organizing the family assistance center, a reunification organizational chart, and other resources.
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Western Region Homeland Security Advisory Council. (2017). Children in Disasters Emergency Preparedness: Family Reunification Plan Template.
This template can be used by any organization (e.g., hospitals, educational institutions, and day care centers) to develop a family reunification plan. It addresses information on topics including reunification protocols, legal authorities, terminology, methods of reunification, and coordination of efforts with key stakeholders.
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Reunification Systems

Facebook. (2022). Crisis Response and Safety Check.
This webpage contains information on crisis response tools available through Facebook. It includes links to Facebook’s crisis response page and the safety check feature, as well as frequently asked questions about the tool.
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Federal Emergency Management Agency (FEMA) (n.d.). National Emergency Registry and Locator System (NEFRLS). (Accessed 11/23/2022.)
This secure, online system provides a platform for survivors and loved ones to communicate their location and leave messages. It provides the following options for users: I am Displaced, Search for a Displaced Person, Report/ Search for a Missing Child, and I want to Register/ Search by Telephone.
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Google.org. (2022). Google Person Finder.
This web application from Google can be used by developers, press agencies, non-governmental organizations, and others to allow individuals to post their status after a disaster and to find friends and loved ones.
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National Center for Missing and Exploited Children (NCMEC) (n.d.). Unaccompanied Minors Registry. (Accessed 11/23/2022.)
This data collection tool is focused on collecting basic information of children who have been separated from their families as a result of a disaster. Individuals can provide basic information and photos concerning a located child whose parents are missing. Once registration information is submitted, NCMEC will cross-reference it against any potential phone calls from a child’s parents who may be searching for their child.
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Rebmann, T., Charney, R., and Mazzara, R. (2022). Utility of Child Physical Characteristics and Verbal Descriptors to Aid in Family Reunification During Disasters. (Abstract only.) American Journal of Disaster Medicine. 17(1):5-12.
This article evaluated which physical characteristics were most useful in reuniting parents and children after a disaster. The authors found that gender, eye color, and race were the most useful in identification, while descriptions of hair and skin color were less useful for reunification. Other personal information, such as whether the family had a pet, facilitated rapid reunification. The authors conclude some types of information are more useful than others when reunifying families after a disaster.
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Trainings/Webinars

Barnert, E. (2022). DNA, Family Reunification, and Pediatric Disasters: Lessons and Priority Research Agenda. National Academies Forum on Medical and Public Health Preparedness for Disasters and Emergencies.
The speaker highlights the dearth of research on family reunification, lists the related United Nations’ “Rights of the Child” and family, and highlights recent cases of family separation at various borders. She uses this foundation to explain the DNA Bridge strategy and how it can be used to reunite families after disasters.
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Chung, S. (2020). Family Reunification After Disaster: Have We Made Any Progress? Children’s National.
The speaker discusses lessons learned with reunifying families during disasters and mass violence incidents, from Hurricane Katrina and ice storms in Atlanta to the Boston Marathon Bombing. She also highlights developmental and mental health risks to children separated from their families during disasters, communication with families, considerations for federal officials, reunification using DNA, and the importance of establishing reunification systems before a disaster happens.
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Improving Community Preparedness to Assist Victims of Mass Violence and Domestic Terrorism: Training and Technical Assistance (ICPTTA). (2021). Victim Services Exercise Guide & Scenario Templates. Office for Victims of Crime.
This document contains information on creating emergency management plans and exercises which incorporate victim services. It is complementary to Federal Emergency Management Agency guidance and can be adapted for a variety of jurisdictions.
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Agencies and Organizations

EMSC Innovation and Improvement Center. Patient Tracking & Family Reunification.
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National Mass Care Strategy Reunification.
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Office for Victims of Crime. Improving Community Preparedness to Assist Victims of Mass Violence and Domestic Terrorism.
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Youth.gov Recovery and Reunification.
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This ASPR TRACIE Topic Collection was refreshed in December 2022. It was comprehensively reviewed in June 2015 by the following subject matter experts(alphabetical order): Katherine Galifianakis, Mass Care Division, American Red Cross; Sharon Hawa, National Center for Missing & Exploited Children (NCMEC); John Hick, MD, HHS ASPR and Hennepin County Medical Center; Lauralee Koziol, Federal Emergency Management Agency (FEMA); and Catherine Welker, MEP, Mass Care/Emergency Assistance Section Individual Assistance Division, Federal Emergency Management Agency (FEMA).
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