Handling the Dead in a Mass Fatality Incident

1
Handling the Dead in a Mass Fatality Incident

• Kathy Taylor, Ph.D.
• Forensic Anthropologist
• King County Medical Examiners Office

2
Medico-legal Investigation System

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

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RCW 68.050

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

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Cause Manner of Death

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

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Duties in MFI

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

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Special Concerns in MFI

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

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Body Recovery

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

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Identifying the Dead

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

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Methods of Positive Identification

• Scientific Identification
• Fingerprints
• Comparative Dental/medical radiography
• DNA
• Visual (unlikely in MFI)
• Photo ID comparison (MFI dependent)

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Communication with NOK

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

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Family Assistance Center (FAC)

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

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Location of FAC

• Hotel, church, convention center, school
• 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)
• The location must be secured so that media and
  others cannot infiltrate

13
Staffing of FAC

• Medical Examiner or DMORT personnel to obtain
  identification information on decedents
• Translators
• Counselors
• Chaplains
• Medical personnel
• Security personnel
• Others (depends on disaster specific needs)

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Determining Cause and Manner

• Forensic Autopsies
• Facility
• Staff
• Storage of bodies???
• Death certificates
• Filing and processing

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DMORT

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

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Disposition

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

17
Frustrations

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

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ME frustrations cont.

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

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ME Frustrations

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

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TAKE HOME MESSAGES

• The public must have trust in the system
• A community must care for and respect the dead
• No agency acts independently in a disaster.
• 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