Two fairly recent natural disasters have produced clarion calls for greater emphasis on planning, training, exercising, and funding for the management of mass-fatality incidents and events. The 24 December 2005 Indian Ocean tsunami – which resulted in over 250,000 dead – and the earlier Hurricane Katrina catastrophe along the U.S. Gulf Coast, which killed over 1,500, proved once again the need to incorporate mass-fatality planning in the nation’s local, state, and federal emergency-management efforts. In addition, the United States is: (1) still applying the lessons learned from the mass fatalities caused by the terrorist attacks of 11 September 2001; and (2) now preparing for the potential worst-case scenario of a virulent pandemic influenza caused by the H1N1 virus.
The federal government has primary responsibility for national preparedness, but all 50 states and hundreds of cities are preparing to meet their own response and recovery responsibilities. The State of California, for example, has taken several measures to strengthen its mass-fatality management system while at the same time establishing a new organization to increase mass-fatality management awareness and readiness at the state and local levels.
Unlike other states, California does not have an elected (or appointed) state coroner or medical examiner. Primary responsibility for the investigation, recovery, and management of the dead resides within the authority of local coroners or medical examiners. Most counties in California have assigned the county sheriff with coroner responsibilities, which would be carried out concurrently with their law-enforcement duties.
A Master Plan for a Diverse Mix of Jurisdictions
California has 58 counties. In 47 of them, the coroner function is assigned to the county sheriff. Eight counties have separate coroners’ offices; the remaining three counties employ medical examiners. Because there is no state coroner or state medical examiner per se, the counties must rely on what is called the Coroners’ Mutual Aid System to meet their resource needs in incidents that overwhelm their individual capacities to respond.
The California Master Mutual Aid System, which was established in 1950, has been used on a number of occasions to meet the extraordinary demands caused by major catastrophes (many of which caused a large number of casualties). Surprisingly, perhaps, although the state’s fire-service and law-enforcement agencies have often used their respective mutual-aid systems over the years, the Coroners’ Mutual Aid System has been in place but has been rarely used. The Law Enforcement Branch of the California Emergency Management Agency, formerly the State Office of Emergency Services, administers the Coroners’ Mutual Aid program and its official plan, while maintaining an active association with all coroners’ and medical examiners’ offices throughout the state.
Despite the thus-far limited need for actual mutual-aid responses, the coroners and medical examiners remain resolute in preparing for catastrophic mass-fatality events. The “State of California Coroners’ Mutual Aid Plan,” formally established in 1981, has provided the standard framework for how the state’s local coroners and medical examiners should request (and/or provide) mutual aid. (The Mutual Aid graphic accompanying this article shows both the mutual-aid organization and the channels available for requesting coroner resources.)
Notwithstanding the state’s establishment of its own mutual-aid system, any catastrophe in California that produces an overwhelming number of fatalities will undoubtedly require the participation and coordination of several state agencies – as well as the federal government, usually, and even private-sector organizations – to support the local coroners or medical examiners directly affected.
The specific assistance provided to local jurisdictions in the aftermath of a catastrophic mass-fatality incident may well encompass any or all of the following material resources and/or operational activities: coroners’ mutual-aid personnel and equipment; the recovery, transportation, and temporary storage of human remains; the availability and operation of a portable morgue facility; victim-identification assistance; personal-effects management; the establishment and staffing of a family assistance/information center; family/responder/community grief and stress counseling; the burial and final disposition of human remains; the implementation of legal remedies governing coroners, funeral directors, and cemeteries; the repatriation to their home countries of deceased foreigners; and the planning of certain types of “memorial” events.
Dignity, Respect, and a Much-Needed Planning Guide
Recognizing the need, at the state level, to identify the important and necessary roles that would be played by state agencies in supporting local coroners and medical examiners performing their essential duties, the Cal EMA Law Enforcement Branch prepared The Mass Fatality Management Planning Guide: A Supplement to the California Coroners’ Mutual Aid Plan. The guide essentially describes mass-fatality roles, issues, and how the state is organized to assist local governments in their fatality-management operations following a catastrophic mass-fatality event. The guide represents the collaboration of a representative number of state, local, federal, private, and volunteer organizations that recognized the compelling need to distinguish the State of California’s role in fatality management.
In October 2006, the Cal EMA Law Enforcement Branch also established, in its role as the State Coroners’ Mutual Aid Coordinator, a State Mass Fatality Management Planning Committee. A primary task assigned to the committee was to improve and further refine the mass-fatality guide while at the same time ensuring that it conforms not only to California’s own Standardized Emergency Management System (SEMS) but also to the U.S. government’s National Incident Management System (NIMS).
Although primarily focusing on the task of producing the fatality-management guide, the committee also provides a state forum to deliberate on fatality-management issues and activities that, for too long, had been absent in emergency-management discussions and planning. In that context the committee also serves as a multi-discipline organization the tasks of which are guided by the coroners’ and death-care industry’s principle that the recovery, identification, and final disposition of the dead be carried out at all times “with dignity and respect.”
In 2009, the Cal EMA Law Enforcement Branch launched an ambitious training campaign to introduce and orient public-safety, emergency-management, EMS, and death-care departments and agencies – and other organizations throughout the state that are involved in fatality management – to: (a) the roles played by coroners and medical examiners; (b) the Coroner’s Mutual Aid System; and (c) the often complex planning guidelines required for management of a catastrophic mass-fatality event. The timing of this campaign probably could not be more critical, especially when one considers the potentially catastrophic nature of the current influenza pandemic.
To briefly summarize: The State of California is determined to establish and maintain an effective mass-fatality management plan as an essential element of the state’s overall emergency-management and planning responsibilities. Louisiana’s fatality-management experience in the aftermath of Hurricane Katrina serves as a clear and sober reminder that the deceased victims of disaster deserve proficient, organized, and caring attention. Government organizations should now be on notice that a fundamental and critical component of the overall response and recovery of a disaster includes proper fatality management. California intends to meet that challenge.
Robert Gerber is a deputy chief in the Law Enforcement Branch of the California Emergency Management Agency. In addition to his responsibility as the State Coroner’s Mutual-Aid Coordinator, he is the chairman of the State Mass Fatality Management Committee. In 2005, Chief Gerber served two tours (as a private contractor) in Thailand, supporting victim identification in the aftermath of the Indian Ocean tsunami. He also deployed to Louisiana that same year in support of law-enforcement mutual-aid operations in the wake of Hurricane Katrina. Chief Gerber holds B.S. and M.A. degrees, and is a graduate of the FBI National Academy.