Mass Fatality Management

The Medical Examiner/Coroner is responsible for the recovery, identification, and disposition of mass fatality incident victims.

One of the sad realities of disasters is that they can result in the loss of human life. Many emergency responders have learned this from their own experience, and they will remember the incident for a long time. Mass fatality disasters are often long remembered by the responders, the community, the state and the nation. Disaster management is important, and every plan should have a section on fatality management.

By definition, a mass fatality incident is any situation where there are more bodies than can be handled using local resources. There is no minimum number of fatalities to become a mass fatality incident because communities vary in size and resources. When a passenger aircraft crashes carrying 100 to 300 passengers or a building structure with hundreds of people inside collapses, the incident would probably be deemed a mass fatality incident, even in the largest of cities. Likewise, an incident like a mad gunman killing five people can be called a multiple fatality incident, but it may not be a mass fatality incident if it occurs in a major city. In any case the recovery, identification, and disposition of the victims are the responsibilities of the medical examiner/coroner of the jurisdiction where the incident occurs.

There are three major operational areas in a mass fatalities incident response:

• Search and Recovery
• Morgue Operation
• Family Assistance

Trained personnel should oversee the tasks associated with each of the three areas.

Search and Recovery (S&R)
Simply stated, search and recovery normally involves locating and removing at least: bodies, body parts, and personal effects. A good S&R team will document everything found at the disaster site, as it may help in the investigation and in the morgue operations. A good policy is to treat every site as a crime scene, until the medical examiner/ coroner says differently. As a rule of thumb search teams systematically search and mark where bodies, body parts, and personal effects are located with either pin flags, stakes, etc. A team member will assign a number to that particular finding. They log each finding on a grid chart, photograph it and move on until the search is completed.

Recovery starts after the search of an area is complete. Bodies and body parts must be treated with dignity and respect at all times. Each finding should be tagged with the number assigned by the search team. Bodies and body parts should be placed into a body bag or acceptable substitute. A tag with the same number as the finding inside the bag will be placed on the outside of bag. The body bag should be removed from the scene and taken to a location designated by the medical examiner/ coroner. Personal effects found on the body should not be removed from the victims at the scene. If weathering may be a problem, the personal effects can be wrapped in plastic and affixed to the body or body part. Victim identification is a function within the morgue operations, not the search and recovery team.

Morgue Operations
Depending on the size and nature of the incident, the medical examiner/coroner will determine where to establish an incident morgue site. The site may be in the existing morgue for that geographical area or it may be a temporary incident morgue site in another location such as a warehouse, airplane hangar or fair ground building. School gymnasiums should not be used, particularly when school is in session.

The medical examiner/coroner should lay out the morgue operation site considering the physical condition of the victims, the number of victims, and the number of personnel needed to perform such morgue functions as administration, logistics, refrigeration, and operations. The operational areas can include areas for receiving, photography, X-ray, personal effects, anthropology, dental, fingerprinting, pathology, storage, and shipping. In some cases an area for embalming may be desirable.

The main purposes for the morgue are to determine the cause of death and identify victims. The use of highly skilled professionals for each of the morgue operational areas is important. Post mortem records will be completed for every body and body part as they are processed through each of the operational stations. Post mortem records include personal effects, photography, radiographs, anthropology, fingerprints, dental and pathology reports. The post mortem records will be compared to the ante mortem (pre-death) records obtained from the victim’s family and other sources such as fingerprint repositories and hospitals. Personal effects, such as driver licenses found on the victim or statements of recognition, should not be used as positive identification, but rather tentative identification. Positive identification is a responsibility of the medical examiner/coroner. After identification is established, the medical examiner can release the body and/or body parts based on the desires of the "next of kin".

Family Assistance Center (FAC)
The family assistance center is one of the most sensitive operations in a mass fatalities event. Its purposes are:

• To provide relatives of victims with information and access to services they may need in the days following the incident

• To protect families from the media and curiosity seekers

• To allow investigators and the medical examiner/coroner access to families so they can obtain information more easily

An FAC should be established quickly, in an area such as a hotel, conference center, school, or church. The area selected should be secured, in order to give privacy to the families. Regular briefing by the medical examiner/coroner or staff twice daily will help keep the families informed. Meeting with the families on an individual basis early on makes it possible to start the process of collecting ante mortem records for use in the morgue operations. The FAC has become so important that federal law recommends one to be established whenever a major aviation disaster occurs. Staffing for the FAC is important. Grief counselors should be available. Personnel from the American Red Cross possessing trained counseling skills and funeral service personnel are good at working with grieving families. Translators may be necessary when working with families from foreign countries.

There are many volunteer organizations and community businesses able to assist the medical examiner/coroner during a mass fatality incident response. If you have or are contemplating forming a response team, be sure they receive quality training on the basic mass fatality incident response principles and procedures. Contact your local emergency management office for training information or contact your state emergency management training officer to obtain information on scheduling a mass fatality incident response course in your area. The course is available from FEMA’s Emergency Management Institute and is entitled Mass Fatalities Incident Response Course. Your response program should include policies and procedures that meet the approval of the medical examiner/coroner. They should also be consistent with the overall disaster response plan managed by the emergency management office.

The subject of fatality management must be taken seriously in this day of natural and man-made disasters.

About the Author
Tom Ralph is Secretary-Treasurer of the National Foundation for Mortuary Care, a non-profit charitable mass fatality incident education and response organization. He is also co-chair of the Florida Funeral Directors Association’s emergency response team, the USPHS, National Disaster Medical System’s Disaster Mortuary Team (DMORT) Region IV which has responded in support of numerous mass fatality disasters. Telephone/Fax: (757)258-4504. E-mail: