Managing Mass Fatalities Cynthia S. Gavin, MS, CCEMT-P Principal - - PDF document

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Managing Mass Fatalities Cynthia S. Gavin, MS, CCEMT-P Principal - - PDF document

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Complexity of the Issue Managing Mass Fatalities Cynthia S. Gavin, MS, CCEMT-P Principal Research Scientist July 2007 2 1 Acknow ledgements City of New York Office of Chief Medical Examiner Clark County Nevada Office of the

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Managing Mass Fatalities

Cynthia S. Gavin, MS, CCEMT-P Principal Research Scientist July 2007

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Complexity of the Issue

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Acknow ledgements

  • City of New York Office of Chief Medical Examiner
  • Clark County Nevada Office of the Coroner
  • Fairfax County, VA Police Department
  • Orange County, CA Sheriff-Coroner Office
  • Commonwealth of Virginia Office of the Chief Medical Examiner
  • District of Columbia Office of the Chief Medical Examiner
  • Disaster Mortuary Operational Response Team and DMORT WMD
  • Department of Health and Human Services
  • Medical Examiner/Coroner Info Sharing Program, CDC
  • Central Joint Mortuary Affairs Office, Department of Defense
  • Office of the Armed Forces Medical Examiner, AFIP
  • US Army North
  • US Army Mortuary Affairs European Command
  • Joint Task Force-Civil Support, US Northern Command
  • National Funeral Directors Association, Maryland State Chapter
  • United States Red Cross
  • BioDefense- ANSER

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Purpose & Objectives

To identify the predominant aspects associated with managing mass fatalities and to provide public health professionals and ME/Cs actionable recommendations for managing this most daunting task

  • Identify key characteristics regarding

management of human remains

  • Discuss legal jurisdiction- which agency has

the legal responsibility to manage decedents

  • Discuss what successful MFM operations

entail for both centralized and decentralized

  • perations

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MFM Characteristics

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MFM Characteristics

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MFM Characteristics

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MFM Characteristics

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MFM Characteristics

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Jurisdiction

Typical Jurisdiction of ME/C-

  • ME/C investigate cases of persons who die within their local jurisdiction for

criminal violence; by casualty or by suicide; suddenly, when in apparent good health; when unattended by a physician; in a correctional facility; or in any suspicious or unusual manner. The Office also investigates when an application is made pursuant to law for a permit to cremate the body of a person

  • 10 USC, 1471- to conduct scientific forensic investigations for determining the

cause and manner of death of members of the Armed Forces on active duty or

  • n active duty for training and, under specific circumstances, civilians who die in

areas of exclusive federal jurisdiction

Atypical Jurisdiction of ME/C- Emergency Health Powers Act-

  • To assist State authorities with developing an appropriate response to a public

health emergency in light of a possible bioterrorist attack and naturally occurring

  • epidemic. A public health emergency is an occurrence or imminent threat of an

illness or health condition or an incident that results in a large number of deaths in an affected population

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Jurisdiction

Death investigation systems vary depending on State and/or county

  • 22 Medical Examiner

Systems

  • 18 mixed Medical

Examiner/Coroner Systems

  • 11 Coroner Systems.

Death investigation systems vary depending on State and/or county

  • 22 Medical Examiner

Systems

  • 18 mixed Medical

Examiner/Coroner Systems

  • 11 Coroner Systems.

CDC’s Medical Examiner & Coroner Information Sharing Program (2003)

14 Figure #

Jurisdiction

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Centralized Management Approach

Incident Characterization Incident Characterization Incident Specific Planning Incident Specific Planning

Family Assistance Center Family Assistance Center Recovery

  • f

Remains Incident Morgue Incident Morgue Transport/ Storage Transport/ Storage Morgue Ops Morgue Ops Final Disposition Final Disposition Personal Effects Depot Personal Effects Depot Transport/ Storage Transport/ Storage Daily Case load Daily Case load Staff Management Staff Management Staff Safety Staff Safety

16 The Medical Examiner Special Operations Response Team Approach to Managing Chemically Contaminated Remains Figure # 17

Decentralized Management Approach

LCP LCP LCP LCP LCP LCP LCP

REMAINS HOLDING REEFER REMAINS HOLDING REMAINS HOLDING REEFER REEFER REMAINS HOLDING REEFER REMAINS HOLDING REMAINS HOLDING REEFER REEFER REMAINS HOLDING REEFER REMAINS HOLDING REMAINS HOLDING REEFER REEFER REMAINS HOLDING REEFER REMAINS HOLDING REMAINS HOLDING REEFER REEFER REMAINS HOLDING REEFER REMAINS HOLDING REMAINS HOLDING REEFER REEFER REMAINS HOLDING REEFER REMAINS HOLDING REMAINS HOLDING REEFER REEFER REMAINS HOLDING REEFER REMAINS HOLDING REMAINS HOLDING REEFER REEFER 18

Decentralized Management Approach

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Actionable Recommendations

Initial Response

  • Local ME/C must have jurisdiction and take ownership to

manage naturally occurring outbreaks

  • Characterize the incident
  • Determine management approach
  • Shift all existing resources towards performing only the

most vital fatality processing functions

– Recovery – Abbreviated processing to secure decedent’s identification – Temporary storage – Tracking

  • Establish the Family Assistance Center (FAC)

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Actionable Recommendations

Response

  • Identify required targeted capabilities
  • Establish operational infrastructure

– Protect staff & provide guidance – Requires ME/C staff change in roles and responsibilities – Requires managing outside resources

  • Work with mayor, public health, religious community, funeral

directors, and other public and private agencies to modify public expectation regarding fatality management operations and final disposition On-going Response

  • Incorporate efforts that hasten final disposition without ever

sacrificing accuracy in deriving victim identification

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Provide Guidance

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Final Thoughts

Before Designing the Incident Specific plan

  • Are we truly streamlining the process or are we trying to do the

same thing we always do more quickly?

  • Do we have the resources to safely process remains? Small or

larger numbers?

  • What level of risk are we willing to accept as a collective body?
  • Political
  • Religious
  • Public perception/media
  • Public health
  • Legal
  • To what extent do families get to influence the process?

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Final Thoughts- Processing

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Final Thoughts- Processing

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Final Thoughts- Temporary Storage

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Final Thoughts- Temporary Storage

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Final Thoughts- Final Disposition

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Final Thoughts- Temporary Interment

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Final Thoughts- External Agencies

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Final Thoughts- Family Members

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Final Thoughts- Service Members

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Cynthia S. Gavin

410-306-8667 gavinc@battelle.org To obtain a copy of

  • The Capstone Document- Mass Fatality Management for

Incidents Involving Weapons of Mass Destruction, by US Army RDECOM Military Improved Response Program

http://www.edgewood.army.mil/hld/dl/MFM_Capstone_August_2005.pdf

  • White Paper- Morgue Operations, Identification, and Command

and Control of Mass Fatalities resulting from a PI event in the US

http://www.icfa.org/pdf/white_paperMFM.pdf