Objective: A reunification tool that captures images of children at the time of the disaster would enable parents to locate their missing children, particularly if the children are unable to communicate their identity. This study assessed the ideal features and parameters of a photographic-based reunification tool.

Methods: A convenience sample of federal, state, and hospital-based emergency management professionals were surveyed to elicit their preferences regarding an image-based reunification algorithm, to assess the parents' level of difficulty in viewing images with facial trauma, and to determine the minimum percentage of successful reunifications needed to justify adoption of a reunification tool.

Results: Of 322 emergency management professionals surveyed, 129 (40%) responded. Only 18% favored a photographic-based tool that would display images in which only the categories of age, gender, and facial features (eye, hair, and skin color) would exactly match the parent's description of the child. However, 72% preferred a broader, less-rigid system in which the images displayed would match all or most features in the parents’ description of the missing child, allowing parents to view more of the image database. Most (85%) preferred a tool showing unedited images of living children, allowing parents to view facial trauma. However, more respondents reported that parents would find viewing unedited images with facial trauma somewhat or very difficult emotionally compared with edited images for both living (77% vs 20%, P <. 001) and deceased children (91% vs 70%, P <. 001.) In a disaster involving 1000 children, a tool that reunites a minimum of 10% of families would be adopted by over 50% of the participants. Participants were willing to accept a lower percentage of reunifications in a disaster involving 1000 children compared with disasters involving 10 (P <. 001) or 100 children. (P <. 001).

Conclusions: Emergency management professionals identified desirable characteristics of a photographic-based reunification tool, including an algorithm displaying unedited photographs of missing children that loosely matches the parents' description, acknowledging the parents' emotional difficulty in viewing photographs with facial trauma. Participants were also willing to accept a lower percentage of successful reunifications as the scale of the disaster size increased.

(Disaster Med Public Health Preparedness. 2012;6:156–162)

We report a case of a very unusual penetrating injury of the middle third of the face. The patient was involved in a road traffic accident, and the indicator control lever became impaled in his right cheek. There was contralateral orbital damage resulting in loss of sight. The cribriform plate was breached and a pneumoencephalocele ensued.

We discuss the modern management of such injuries including injury assessment. We emphasize the importance of crash scene information gathering and analysis of injury mechanisms. Facial injury zonal classification and imaging are reviewed in the context of the case. We discuss the reasons that led us to treat this patient via the subcranial approach.