The Management of Mass-Fatality Incidents

Most if not quite all U.S. public-safety agencies, at all levels of government, can effectively manage one or two fatalities, and they do so on a regular basis in communities large and small throughout the country. A mass-fatality incident, however – which can arguably be defined as one “in which more deaths occur than can be handled by local resources” – is a much more daunting challenge.

A mass-fatality event can occur from several types of situations, including transportation incidents, industrial accidents, severe weather – including earthquakes, tornadoes, and other natural disasters – and acts of violence, specifically including terrorism. When any of these ravage a community it is important to remember, throughout the event and long after: (a) reverence for the dead and compassion for the living; and (b) the inescapable fact that these types of incidents will generate considerable media attention, and that in turn will in most if not all cases cause family members to respond by rushing directly to the scene.

The first indication that a mass-fatality event has occurred may come with the initial 911 calls. The event could be a high-impact plane crash with 45 “souls on board,” a mass shooting, a severe bus accident with numerous injuries, or a tornado sweeping through a heavily populated area. Whatever the situation, the principal rule to be followed by first responders is the same – namely, that the bodies of the deceased must be left in place until released by the medical examiner’s (or coroner’s) office. One reason for this rule is that the “event” may also be a crime scene and/or part of a major investigation and must be treated as such at all times.

Blocks of Evidence, and a Mountainous Workload

In some situations, bodies and/or body parts might be scattered over a wide area. Or there could be numerous burn victims. There could be women or men, the elderly, or children among the fatalities. And, as previously mentioned, the incident “area” could be a crime scene that covers several square blocks. In the latter situation, all bodies, body parts, personal effects, and other potential evidence not only will have to be gathered and examined, but also very carefully documented.

That is only the start. After all of the deceased have been found and examined, and their bodies presumptively identified, a longer and more detailed examination, identification, and investigative process will begin. It is preferable, of course, that a fully equipped morgue be used during this stage of the process. However, if the overall workload – caused by the number of bodies recovered, for example, the difficulty of the terrain, and/or other circumstances – overwhelms the local morgue capabilities immediately available, a secured temporary morgue area can be established.

With very few exceptions, a major law-enforcement response will always be required in the aftermath of a mass-fatality event. There will be scene issues, investigative procedures, area security, family notifications, and numerous other factors to consider in managing the aftermath both effectively and as expeditiously as possible. Security is likely to be a major issue not only at the incident scene but also at family assistance centers and/or other facilities that may be established to address the needs of the friends and family members of the victims who have been identified. The correct handling of many mass-casualty events also may require the participation of public information officers, and sometimes the establishment of a joint information center (JIC) to handle requests for media interviews and other questions.

Safety and Planning Issues Take Priority

The personal safety of the responders themselves must always be a paramount concern. Many mass-casualty events will initially be designated as biohazard areas, which means that first responders and others working at the scene must wear the appropriate personal protective equipment needed. They also must scrupulously follow all safety guidelines. Emergency managers must also take into consideration the weather, the surrounding terrain, and a number of other variables – including, for example, the possibility that the incident scene might be further contaminated by spilled fuel and/or that some buildings in the area might be in danger of collapsing. The handling of these and other issues might require that additional safety precautions be followed – e.g., the wearing of safety helmets and/or respiratory-protection masks, and the establishment of decontamination stations (for both the living and the dead). Obviously, the handling of mass-fatality events can be very stressful both for the responders and for the surrounding community.

It is important to identify, as early as possible, the local and/or state medical examiners’ offices that probably will be the lead agencies in the recovery operations; most of these agencies have extensive quantities of information available, and considerable operational experience as well; both of these invaluable assets can help immensely in the planning and response efforts.

A major federal resource that also is available for assistance, through the Department of Homeland Security (DHS), is the Disaster Mortuary Assistance Team (DMORT), a component of the National Disaster Medical System (NDMS). The DMORT is a federal-level response unit that was created specifically to provide mortuary assistance during and in the aftermath of mass-fatality incidents and similar events.

It is equally important that state and local public-safety agencies and their emergency-management offices discuss and plan, as far in advance as possible, how to handle the types of events discussed above. In doing so, they should be sure to follow previously established local guidelines and procedures as closely as possible. They will find that advance planning, combined with as much individual and group training as can be scheduled, will be the keys to the successful management of any mass-fatality incident that does occur.