An Introduction to the NTSB and Hospital Engagement

An Introduction to the NTSB and Hospital Engagement

Executive Summary

September 13th, 2018

The MESH Coalition recently hosted another successful Grand Rounds event in conjunction with Franciscan Health Indianapolis at their Professional Education facility. The featured speaker was Dr. Elias Kontanis, Chief of Transportation Disaster Assistance Division for The National Transportation Safety Board (NTSB). This Grand Rounds event provided various professionals with an insight and background into what the NTSB responsibilities are and how they interact with a diverse group of organizations and agencies. Dr. Kontanis discussed various topics such as:

·      An overview of NTSB governance, agency mission, and scope of investigative responsibilities

·      Interfacing with healthcare facilities regarding investigative matters

·      Interfacing with healthcare facilities regarding family assistance services

·      Challenges associated with the victim accounting process following mass casualty incidents and the role of healthcare facilities

Background

 There is a misperception that the NTSB is just in charge of determining the probable cause of transportation accidents and making safety recommendations to prevent reoccurrences. However, the mission of the NTSB reaches further to include conducting special studies and investigations, certification appeals for airmen and mariners, and coordinating resources to assist victims and their families after an accident. The NTSB is a relatively misunderstood Federal agency in regard to their responsibilities and duty to the public. Unbeknownst to many, the NTSB is an independent Federal agency that has only 420 full-time staff and no regulatory authority, meaning they have no authority to enforce laws or regulations. Additionally, they are compromised of five Board Members who report directly to Congress.  

Investigative Interface 

All U.S. civil aviation and commercial space Railways, Highways, Marine, Pipeline, and Hazmat accident investigations are conducted by the NTSB (accredited representative for foreign aviation accidents). For suspected criminal actions that affected any of the above possible accident scenarios, the Federal Bureau of Investigations takes the lead as investigator and the NTSB serves as a subject matter expert in support of their efforts. In non-criminal cases, the NTSB will have its staff conduct interviews with surviving passengers and crew, obtain medical records, secure and coordinate shipment of blood and urine samples for toxicological analysis, and gather remaining crew personal effects. An area where the NTSB runs into some hurdles is obtaining medical records of the crew and passengers, which often relates to the Health Insurance Portability and Accountability Act (HIPAA). However, in order to complete a thorough investigation passenger and crew medical records will be obtained by the NTSB with or without the consent of the individual because their agency acts as a Public Health Authority (PHA). Per the Department of Health and Human Services, the NTSB being a PHA authorizes a healthcare provider to disclose protected health information to a Public Health Authority without the patient’s written authorization or opportunity to agree or object for purposes of controlling disease, injury, or disability. The NTSB will provide letters to hospitals explaining their authority and request for information. In extreme cases, the NTSB will obtain subpoena records and lab draws, but ultimately would like to avoid that process.

Family Assistance Interface

 The NTSB recognizes three different Federal Family Assistance Legislations after a transportation accident, the Aviation Disaster Family Assistance Act of 1996, Foreign Air Carrier Family Support Act of 1997, and the Rail Passenger Disaster Family Assistance Act of 2008. The criteria for the NTSB involvement is that it occurred in the United States or its territories (Puerto Rico, Guam, Virgin Islands, etc.), a major loss of life, Department of Transportation Certificate of Public Convenience and Necessity or Economic Authority (Aviation), and Amtrak and future high-speed rail operators. The NTSB has separated family assistance into four primary concerns: notification of involvement, access to resources and information, victim accounting, and personal effects. These four categories entail further actions and duties interconnected to those primary concerns that the NTSB plays a pivotal role in completing the entire process. The victim accounting and patient tracking task is a process that can become confusing with various healthcare and responding agencies. However, if this process is done effectively, it can reduce the panic, and bring closure to family and friends. The NTSB does their best to work with local authorities since the locals are responsible for the Mass Casualty Incident (MCI) that happens within their jurisdiction. Ultimately, the NTSB uses patient tracking and information from several different sources to come together and provide the most accurate and up-to-date data.

Some major challenges that are faced with Victim Accounting are as follows:

·      Open population MCI’s

·      Unidentified victims

·      Proximity of family members to accident location

·      Rapid dispersion of victims

·      Social and traditional media

·      Lack of coordinated data collection processes

·      Errors in data

·      Misconceptions regarding sharing of data

Who and How Healthcare might be Engaged:

·      Hospital linkage with Emergency Management and the local response community/agencies

o   Integration with patient tracking for the jurisdiction

o   Awareness of broader family assistance response

·      Healthcare Coalitions (Multidisciplinary)

·      Hospital Systems

·      Hospital Associations

·      ESF 8- Public Health and Medical

Source:

Kontanis, E., PhD, D-ABMDI. (2018, September 13). An Introduction to the NTSB and Hospital Engagement. Lecture presented at MESH Coalition Grand Rounds in Francisan Health Indianapolis, Indianapolis.