Handling the Dead in a Mass Fatality Incident

Handling the Dead in a Mass Fatality Incident Kathy Taylor, Ph. D. Forensic Anthropologist King County Medical Examiner’s Office

Medico-legal Investigation System Medical Examiner: Appointed position held by a board certified forensic pathologist. n Coroner: Elected position held by the election winner (no forensic background required) n Coroner/Prosecutor: Usually an elected position in which the county prosecutor also serves as coroner. n

RCW 68. 050 n ME has jurisdiction over deaths: Of individuals in apparent good health without medical attendance for 36 hours preceding death. n Caused by unlawful or unnatural means. n Involving suspicious circumstances. n Caused by any violence whatsoever. n Caused by contagious disease. n Resulting in unclaimed bodies n

Cause & Manner of Death Cause the injury or disease process responsible for a death Manner Natural Accidental Suicide Homicide Undetermined

Duties in MFI Document, tag, map, and recover bodies from scene. n Perform postmortem examinations, certify cause and manner of death. n Establish positive identification on all remains (whole or fragmentary). n Identifying and communicating with NOK n Release bodies to funeral homes for disposition. n

Special Concerns in MFI Processing large number of fatalities (postmortems, data entry, tracking of bodies, identification of whole or fragmentary remains, generating death certificates) n Obtaining antemortem data necessary to establish positive identification n Communication n Continuing normal service to county n

Body Recovery Must consider if scene is a CRIME SCENE n Bodies may be fragmentary or decomposed n Body recovery may not be immediate in a large scale MFI n n Handle the public’s concern over “bodies sitting around” n Coordinate efficient method of body recovery so that bodies are not “lost in the system” n Maintain the public’s trust in the system

Identifying the Dead Coordinating with law enforcement or other agencies an effective system of reporting missing (unaccounted for) persons. n Collecting antemortem records on the missing. n Collecting DNA samples if necessary. n Matching body parts and positively identifying each individual. n Decision whether to identify each body part. n

Methods of Positive Identification n Scientific Identification Fingerprints n Comparative Dental/medical radiography n DNA n Visual (unlikely in MFI) n Photo ID comparison (MFI dependent) n

Communication with NOK Who are the dead? n Who are the NOK and LNOK? n Communication is long term – from the recovery through the examination process and beyond the disposition n MUST ESTABLISH AND MAINTAIN A TRUST IN THE SYSTEM!!! n

Family Assistance Center (FAC) A reception center for family and friends of disaster victims n It provides a safe and protected (from media) environment for family. n It assures family access to information (provided to family before its provided to the media) n Provides KCMEO access to family members to obtain information necessary for identification. n

Location of FAC Hotel, church, convention center, school n The location must be accessible, away from the disaster, and have adequate resources (space, private rooms, telephone lines, restrooms, FAX and copy machine, televisions and radios, medical personnel) n The location must be secured so that media and others cannot infiltrate n

Staffing of FAC Medical Examiner or DMORT personnel to obtain identification information on decedents n Translators n Counselors n Chaplains n Medical personnel n Security personnel n Others (depends on “disaster specific needs) n

Determining Cause and Manner n Forensic Autopsies: Facility n Staff n Storage of bodies? ? ? n n Death certificates n Filing and processing

DMORT Disaster Mortuary Operational Response Team n Requires a Presidential Disaster Declaration n Resources and personnel to establish mobile morgue and handle processing of large numbers of fatalities. n WMD team for decontaminating victims. n NOTE: DMORT operates under the umbrella of the local jurisdiction. n

Disposition Releasing bodies to funeral homes at request of NOK n Finding NOK n Unclaimed bodies n Indigent status n n How do you handle a large number of bodies that may be unclaimed? ? ?

Frustrations The ME will NOT have confirmed numbers available until after positive identification. n The ME will NOT call someone deceased until positive identification is established. n The NOK will be frustrated that answers are not immediate. The FAC is designed to help them through the process. n

ME frustrations cont. Families being incorrectly informed of MEO procedures and time frames. n Other agencies or media insisting on answers we cannot provide immediately (i. e. who is dead and how many are dead). n

ME Frustrations Movement of bodies prior to ME notification or without ME consent (IN VIOLATION OF RCW!!!) n Loss of information because of mishandling of bodies (i. e. location) n Removal of property or other identifiers n Other agencies reporting fatality numbers or names of deceased individuals. n

TAKE HOME MESSAGES The public must have trust in the system n A community must care for and respect the dead n No agency acts independently in a disaster. n Even if the coroner/ME is not part of public health, the public health system will face challenges related to the dead in an MFI n