ECON Emergency Contact Registry

1. Proposed Profile: Nat'l Emergency Contact Registry (ECON) of Motor Vehicle Crash Victims for Emergency Responders

• Proposal Editor: Larry Williams, HITSP Care Delivery Technical Committee / Emergency Responder – Electronic Health Record (ER-EHR) Use Case
• Profile Editor: TBD
• Date: N/A (Wiki keeps history)
• Version: N/A (Wiki keeps history)
• Domain: IT Infrastructure

2. The Problem

Annually, motor vehicle crashes injure five million people, resulting in 250,000 life-threatening injuries and 40,000 deaths.

Motor vehicle crashes represent the leading cause of unintentional injury and admittance to an emergency room in an unconscious state, and the third leading cause of death in the United States, surpassed only by heart disease and cancer, according to the U.S. Transportation Department's National Highway Traffic Safety Administration (NHTSA).

Due to the lack of a standards-driven query mechanism, emergency responders, specifically law enforcement, cannot rapidly facilitate the acquisition and exchange of next-of-kin data from a National Emergency Contact Registry (ECON) of motor vehicle owners. As a result, the national average for next-of-kin notification and family member reunification to occur following a traffic crash involving unconscious or deceased persons is six hours. Too often, the process takes much, much longer.

HITSP’s Care Delivery Technical Committee working on the Emergency Responder – Electronic Health Record (ER-EHR) Use Case has identified the ECON query as a ‘standards’ capability gap. In addition, it is important to note that legislation has been passed in California and Illinois requiring reasonable efforts be made to contact next-of-kin of motor vehicle crash victims within 24 hours. Similar legislation in Minnesota, Texas, Utah and Hawaii has been passed regarding a timetable for notification. Federal legislation is pending.

3. Key Use Case

Contrary to popular belief, emergency responders cannot quickly gain access to a motor vehicle crash victim emergency contact and/or next-of-kin data following a traffic crash, especially in immediacy-type situations. A query can be run by law enforcement based upon the vehicle identification number (VIN) or vehicle registration plate, however, neither query will return vehicle owner emergency contact and/or next-of-kin data. Typically, emergency responders resort to searching personal belongings (e.g. wallet, glove compartment, cell phone, etc.) for leads to the identity of an emergency contact and/or next-of-kin. Still many instances involve obstacles, such as unlisted phone numbers which might require a warrant for release in certain jurisdictions. Meanwhile, hours elapse as family members are not notified and crash victims enter the emergency healthcare system without the benefit of family members to advocate on their behalf and/or provide added-value information (medical history, medications, allergies) to enhance medical care of crash victims.

4. Standards & Systems

An operationally logical resolution to this problem is possible today because of the existence of a North America-wide secure multi-directional communications network for public safety called the National Law Enforcement Telecommunications System (Nlets). Specifically, the resolution could work as follows: On-site law enforcement would be able to run a Nlets query of the ECON based upon the Vehicle Identification Number (VIN) and/or Registration Plate as a unique identifier. Nlets will return within seconds (provided the vehicle owner pre-registered their emergency contact / next-of-kin data with the ECON) vital data (i.e., emergency contact phone numbers) to help accomplish unidentified crash victim identification, next-of-kin notification and family member reunification. A standards-based query would need to be established between emergency responders and the ECON. This would facilitate rapid acquisition and exchange of data from the ECON and give possibility for emergency responders to accomplish family member notifications in a timelier manner.

"Potential candidate standards that have been discussed by HITSP’s Care Delivery Technical Committee working on the ER-EHR Use Case include the following:

• HL7 Messaging
• LDAP – Lightweight Directory Access Protocol for querying data
• SAML – Security Assertion Markup Language for exchanging data
• XForms
• HTML over HTTP via Get/Post
• GJXDM
• Secure DNS (or normal DNS with encrypted results)

All options would go over an encrypted channel with authentication and confidentially.

5. Discussion

It is important to note that IHE’s creation of a standards-based query for the ECON of motor vehicle crash victims could eventually be expanded to provide an authorization and authentication framework for on-site care providers, specifically EMS, to query for a crash victim’s Personal Health Record (PHR) and/or Electronic Health Record (EHR) as defined in the Interoperability Specification of the Emergency Responder – Electronic Health Record (ER-EHR) Use Case. (See IHE PCC Profile Proposal - Pre-Hospital Care Report / Integration of Motor Vehicle Crash Victim ECON / PHR Data).