Mass Fatality Response for Fire/EMS

What is a Mass Fatality event?

Public safety agencies can effectively manage one or two fatalities and do so on a regular basis whether they are from traffic accidents, fires or homicides. But what happens when you are faced with numerous fatalities. A Mass fatality incident can simply be defined as: 'An incident where more deaths occur than can be handled by local resources'. Some jurisdictions could easily handle 5-10 fatalities while others would be quickly overwhelmed. This article is designed to provide an awareness level of understating of Mass Fatality events for Fire and EMS responders.

An event can occur from several types of incidents including transportation incidents, industrial accidents, severe weather/natural disasters, fires or acts of violence. These events can be very complex and intense events that require coordination and communications from multiple agencies. The Incident Management System (IMS) will be crucial to an effective response. A "mass fatality event" needs to be regarded as different from a "Mass Casualty Incident (MCI)". Also, throughout the event it is important to remember reverence for the dead and compassion for the living. "High-impact" incidents will generate a lot of media attention. This in turn will cause many well-meaning people and family members to respond directly to the scene. It must be remembered that this type of event will emotionally charge any jurisdiction and that the public will be following the response and recovery very carefully.

Mass Fatality events can create severe economic, environmental, and emotional impacts on responders and the community. This response will put a tremendous strain on the responders and "the system". In the past, Fire and EMS agencies have received training on Pre-Hospital Triage and have procedures and guidelines to address these issues. What happens when there are more fatalities than victims? Who in your jurisdiction is the lead agency in a mass fatality incident? What is the "benchmark" to declare a Mass Fatality incident? What then becomes the role of local responders? These are just a few items that need to be addressed in your planning.

Pre-Planning

Your benchmark notification should be addressed in your local guidelines and procedures. Another pre-planning step is to decide what types of events in your community could cause a mass fatality incident. Do you have an airport? Is a there major freeway running through your jurisdiction? What past events have occurred in your community: flooding, hurricanes, tornadoes, terrorism, etc.? All these issues should be addressed in a community hazard assessment. The countywide hazard assessment should be completed by all public safety agencies. Some of the key players in this type of event will include: Emergency Management, Law Enforcement, Medical Examiners/Coroners, Funeral Directors, Fire Service, etc. As you can see this type of event will require a tremendous amount of cooperation among many disciplines.

The next step in the pre-planning phase is to identify your resources available in your community to effectively manage the event. How many fatalities can the local morgue handle? What is the daily caseload of the local Medical Examiner? How quickly will the hospital system be overloaded? What resources are available locally and regionally through mutual aid? How can I notify these resources?

Response

Your first indication of an event may come with the initial 911 dispatches. Is there a bus accident with numerous injuries, a high-impact plane crash with 45 "souls on board", or a mass shooting at a public location? These could all be triggers of a Mass Fatality event. During the initial "windshield survey" the Incident Commander must quickly decide if the event meets the "benchmark" criteria of a mass casualty or mass fatality response. Life safety is critical during the response but we also must remember reverence for the dead. At some point during the "response" the proper notifications must begin to prepare a proper mass fatality response. Your local Emergency Management Office is a valuable resource during this point in time. The response phase could be over very quickly and the recovery phase could go on for some time. After all living victims are removed, the fire is out, rescues completed, scene is secured, etc. the scene will switch from the "response" phase to the "recovery" phase. This is the point at which the complex components of a mass fatality incident begin.

Throughout the response we must remember that it is important to remember reverence for the dead and compassion for the living. There are numerous considerations in this type of event that will need to be addressed as soon as possible The deceased must be left in place until released by the Medical Examiner/Coroners office. The event may also be a crime scene or part of a major investigation and must be treated as such at all times. Scenes are usually videotaped and photographed with bodies in place as a minimum. Also many mass fatality incidents will also be involved with criminal and civil proceedings at a later date.

Bodies and body parts can be scattered everywhere. There could be numerous burned victims. Fatalities could be women, men, elderly and children. Could be a crime scene that covers several square blocks. All bodies, body parts and personal effects will need to be documented. Responders must not touch or move these items unless advised. There is an organized process that will be used to effectively manage these types of events. The quicker the process is completed and the deceased identified, the quicker the healing process can begin for the community.

These events are usually always designated as biohazard areas, requiring the proper amount of PPE (personal protective equipment) and safety guidelines. Your planning must also take into consideration the weather/terrain and the fact that there could be spilled fuel, collapsed structures, confined spaces, building debris, glass, aircraft/vehicle parts, crime scene evidence, etc. scattered about. These issue may require additional safety procedures in place including decon for the living and dead, helmets, specialized teams, etc. This is one event that you MUST have an established an experienced Safety Officer designated in your command structure.

Fire and EMS will be tasked to stand by at the event. Also these agencies may be requested to assist with scene security, site surveys, body recovery and other tasks. These individuals must be asked if they can assist, not ordered. Once the deceased are recovered, the identification and processing process will begin. It is preferable for the normal morgue to be used for this process. If the numbers overwhelm local morgue capabilities then a secured temporary morgue area can be established. At this point it is highly recommended that you contact state and federal resources to assist in this event.

During a mass fatality event a large law enforcement response will be required. There will crime scene issues, investigation procedures, scene security, etc. Security will be a major issue at the scene and at the Family Assistance Centers (FAC), which will be opened to address the needs of the deceased friends and family members.

Resources

During a Mass Fatality Response some of the numerous items you may require consist of a large supply of body bags, disposables suits/gowns, gloves, booties, refrigerated trailers, light trucks, generators and professional removal/transport vehicles. Also the needs of an Incident Command Post, feeding services, latrines, temporary housing for responders, etc. You may be on your own for the first 6-12 hours before state and federal assets arrive on scene, except for planned local mutual aid resources.

One example of available resources in my home state is the North Carolina Chief Medical Examiners Office. They are available 24/7 to assist in a Mass Fatality Incidents with personnel and resources. They can notified though our local or state Office of Emergency Management. The NC CMEO has deployed to numerous high profile events across the state in the past twenty years. As part of your planning process it is important to identify these types of local and state resources that are available to assist your jurisdiction.

A federal resource available for assistance through the Department of Homeland Security (DHS) is the National Disaster Medical System (NDMS) Disaster Mortuary Assistance Team (DMORT). This is a Federal Level Response team designed to provide mortuary assistance in the case of a mass fatality incident or cemetery related incidents. Will work under the local jurisdictional authorities such as Coroner/Medical Examiners, Law Enforcement and Emergency Managers.

KEY POINTS TO REMEMBER

• Situations will arise where the need to save lives overrides respect for the dead
• Reverence for the dead
• Treat dead with dignity/respect
• The public is watching you

It is impossible to cover all the issues that will need to be addressed during a Mass Fatality event. An excellent tool for First Responders is the Federal Emergency Management Agency (FEMA) course titled "Mass Fatalities Incident Response Course." These courses can be scheduled with your State Emergency Management Office.

In October of 1996 Congress passed The Family Assistance Act in and required all American based airlines (and later all those operating in the US) to have a plan to assist families in the case of an accident. Each community should also have a plan in place to address these types of catastrophic events. The more our public safety agencies prepare, the better they are prepared to respond to and effectively manage any type of emergency situation that might arise. The community has entrusted us with their safety, so let's prepare now!