Plane crash highlights gaps in data gathering
Database set up after TWA 800 tragedy
Officials in Suffolk County, Long Island, NY, thought they had their bases covered after forming a mass disaster committee. But when TWA flight 800 crashed into the Atlantic Ocean off the coast of Long Island on July 17, 1996, the officials weren’t sure how to set up and organize the medical records that would be used to identify the victims.
"That was the one component of the mass disaster planning they hadn’t considered," says Beth Friedman, RHIT, director of marketing for eWebCoding in Atlanta. Friedman and her husband were visiting her in-laws when the accident occurred. Her father-in-law was the forensic dentist for Suffolk County and was the coordinator of the mass disaster committee. "When the plane crashed, he gathered the committee and was primarily the lead dentist in the [victim identification] process."
As soon as the accident occurred, officials gathered family members of the victims and asked them to contact physicians and hospitals to request that the victims’ medical records be sent to Long Island. The county, however, was not prepared to handle these records and had to create a database and filing system "on the fly," Friedman explains. Realizing the county could use her medical records expertise; Friedman and her husband decided to stay in town for about five days and volunteer to help. She recounted her experience on a storyboard at the September conference of the American Health Information Management Association in Chicago.
The Federal Express packages started arriving in two or three days from around the country and other parts of the world. The incoming information was in disparate media, Friedman says. "The dentists sent dental X-rays. Hospitals sent paper records." The families also provided photographs as well as victim identification sheets that detailed victims’ identifying marks. "We had all types of information that we had to pull together."
This proved to be a challenge. At first, clerks receiving the information were filing each piece in a different filing cabinet. Photographs, therefore, were filed in one place, dental records in another.
Friedman knew from her experience in database management that this filing method would not help officials identify victims quickly. "I said, We need to have all the patient information in one place so the dentists can open the folders and have all the information in front of them.’" The office made that switch the first day, revamping the filing system so that everything was filed by passenger name.
The medical records workers then collaborated with the dental team to figure out the logical way to set up the data. "We created a checklist," Friedman says. "We said, Here are the pieces of information that we are trying to capture.’" As the information came in, clerks checked off what they received for each passenger. The second step was deciding how to file this information to make it most useful for the dentists to do the confirmation identification.
Then the medical records workers created an electronic database in Access to start logging in what information they had and what they still needed. "At that point, we had huge manila file folders with each of the passengers’ names and had those filed alphabetically in the war room,’ the place where we dealt with the records," Friedman says.
What if?’ scenarios now possible
Since these initial stages of information gathering, the Suffolk County Medical Examiner’s Office has created extensive databases from the accident. The databases include all of the post-mortem information for each victim, including the person’s injuries. Special software links this information to the actual seat the person was using on the plane. "That enables them to do a lot of what if?’ scenarios,’" Friedman says.
County officials have since included data collection in its disaster plan. One part of the plan involves using a scanner in the "family area" to scan the paper documents, making the media of the records more uniform.
County forensic professionals have spoken nationally about the lessons they learned from the disaster, Friedman says. They have also worked with medical professionals from other disaster sites to encourage communities to form a disaster committee and have a plan in place.
"If communities could think about some of these issues ahead of time and be prepared," she says, "the [victim identification] process would be much more efficient."
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