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During times of crisis, you’re forced to learn a lot about yourself — and quickly. That was certainly the case for our team at Orlando Health when faced with the aftermath of the Pulse nightclub shooting on June 12, 2016.

The Pulse assault was, at the time, the single deadliest mass shooting in the history of the United States, with 49 dead and 58 wounded — the majority of whom were treated by our teams at Orlando Health. The horrifying tragedy rocked our community, and our hospitals and emergency response teams were confronted with challenges they had not faced before.


Immediately after the shooting, multiple consulates contacted Orlando Health in an effort to determine if any of their citizens were killed or injured in the shooting.

At the time, connecting foreign patients with representatives from their home countries wasn’t something we could do easily. That realization prompted us to develop a program that provides patients, as well as embassies or consulates, with this important support.

Central Florida, home to major attractions such as Walt Disney World and Universal Orlando, is one of the top tourist destinations in the world, attracting an estimated 10 million international visitors each year. In the event of a health care emergency, foreign patients are at a distinct disadvantage. They often face communication barriers, resource limitations, unfamiliarity with our health care system and payment processes, and transportation challenges.


These additional anxieties can make receiving treatment that much more challenging. Connecting foreign patients with the appropriate consulate — especially during tragedies such as a mass shooting or fire — can help them understand the process, ease anxieties, and reduce the rigors of navigating an unfamiliar health care system alone. Consulates are ordinarily staffed by people from the home country who understand their culture, language, and the issues affecting the patient. Additionally, and perhaps, most importantly, they understand the health care systems in both countries. This enables them to explain the situation to the patient in a language they understand, using familiar phrasing.

Beginning in September 2017, we implemented a successful pilot program — the first of its kind in the nation — that provides foreign national patients with the information they need to reach out to their consulate or closest embassy. If the patient is unable to reach out on their own, Orlando Health will help make the connection for them.

In the first four months of this program, Orlando Health asked more than 5,363 of its foreign national patients about consular support. Of these, 954 declined to provide information on their nationalities, while 4,409 made use of the initiative. Although not every patient may need or request the support of their home government, providing them with contact information shows consideration to their needs and furthers their ability to make informed decisions about their own health care.

How does our program work? It is specifically geared to hospital admissions. We’ve modified our electronic hospital intake form to let patients voluntarily answer questions about their home address, nationality, and citizenship. For patients who voluntarily identify themselves as foreign nationals, we give them customized consular or embassy information. In cases where a patient is unconscious or can’t respond, a representative from our patient-care team speaks with his or her proxy and asks this individual to make an informed decision on whether it is in the patient’s best interest to initiate contact with a consulate.

Patients are never required to answer questions about their nationality. And the level of care provided is the same regardless of whether or not patients share information about their home countries.

The U.S. Department of State, Office of Foreign Missions, and several consulates have told us that this program opens up vital lines of communication. During 17 years as a consular officer, one of us (J.C.) made numerous hospital visits to British citizens throughout Florida and saw through the relief and gratitude expressed by patients and their families how that contact helped.

Through this process, Orlando Health learned that it treats more foreign nationals and international visitors than we had previously estimated. Between the start of the program on Sept. 1, 2017 and June 1, 2018, Orlando Health treated 34,442 such patients.

Implementing the program was surprisingly cost-effective. We did not use outside staff or consultants and there were minimal training costs associated with modifying our systems.

Orlando Health’s reunification program may have been born from a devastating tragedy, but its implementation will help numerous international patients from this point forward. It’s our hope that hospitals across the nation and beyond will rise to the challenge and provide foreign patients with the level of support they deserve. You never know when tragedy may strike — and this kind of extra care for foreign nationals could make a big difference in their recovery.

Eric Alberts is the corporate manager of emergency preparedness at Orlando Health. John Corfield is the corporate emergency preparedness specialist at Orlando Health and was the Pro-Consul at the British Consulate-General in Miami at the time of the Pulse tragedy.