EIIP Virtual Forum Presentation — April, 14, 2010

Mass Fatalities Incident Response Planning

Dennis McGowan
Fatalities Management Program Manager
University of Tennessee

Amy Sebring
EIIP Moderator

The following has been prepared from a transcription of the recording. The complete slide set (Adobe PDF) may be downloaded from http://www.emforum.org/vforum/massfatality/100414presentation.pdf for ease of printing.

[Welcome / Introduction]

Amy Sebring: Good morning/afternoon everyone. Welcome to EMforum.org. I am Amy Sebring and will serve as Moderator today. We are very glad you could join us.

We would also like to extend a special welcome to a new partner today. Nathan J. Eberle is Director of Business Operations for Fireside Partners, LLC who offer a broad range of services across several areas of expertise such as Crisis Mitigation, and the development of Emergency Response Plans.

For further information about becoming a Partner, please click on the link to Our Partners on our home page.

Our topic today is Mass Fatalities Incident Response Planning. Of course we hope that you will never have to actually deal with mass fatalities, but just like every other aspect of emergency management, the time to start thinking about the challenges is before they actually occur. If you have not already done so, please see today’s Background Page for some related resources.

We are making a recording, which should be available later this afternoon. The text transcript will be posted later on. If you are not on our mailing list, you can subscribe from our home page, and then you will get a notice when the recording is ready to view.

Now it is a pleasure to introduce today’s guest:

[Slide 1]

Dennis McGowan is currently vice president of SAC International, a Fatalities Management program manager with the University of Tennessee and an international trainer on the topic of Mass Fatalities events as related to acts of terrorism, natural disasters and pandemic outbreaks.

Intimately involved with the World Trade Center identification efforts at the New York City Office of the Chief Medical Examiner, McGowan was named a section manager for documenting human remains recovered at the site. He is the former Chief Investigator with the Fulton County Medical Examiner's Office and has 30 years of experience as a fatalities management planner and responder.

Welcome Dennis, and thank you very much for being with us today. I now turn the floor over to you to start us off please.


Dennis McGowan: Good morning, or afternoon. Let’s get started. We’re going to talk today about fatality management issues at a fairly fundamental level. We’re not going to get into too much detail, but rather give you an idea of where we come from in this country in terms of developing our approaches to mass fatality management, and some of the planning concepts that need to be considered across the board by all agencies who might be involved in such a response.

[Slide 2]

The first thing we want to do is define it. We’re going to define a mass fatality incident. There’s a lot of confusion. I’ve been to mass casualty seminars that were really talking about fatality management. We’re going to strictly deal with incidents that involve a large number of deaths.

Those incidents have to overwhelm whatever locally available resources exist in order to be a mass fatalities incident. Some communities can handle 20-30 fatalities and it’s not a mass fatalities event because they can deal with it in their day-to-day operations. Others, as few as 6 or 8, and it may be in over their heads.

The things that are going to help determine what is a mass fatalities incident are—how many many deaths are there? How many people have been killed, or do we think have been killed? You probably remember at the World Trade Center, the numbers were 30,000-50,000 estimated, and then that dwindled down over time.

The second thing is the scope of destruction. Are these bodies intact? Every single fragment , every single body part is going to have to be documented. An intact body is treated as a single item, but so would a hand or foot. Obviously, if the scope of destruction is minor, the process is going to go more quickly.

Also involved in this is contamination. We have to think of terms of whether remains are contaminated or not, because that is going to make the process more complex and slow it down.

Finally the rate of recovery—if an incident occurs in the open and bodies can be moved readily, obviously, removing them from the scene to whatever forensic facility they are going to is going to be fairly rapid and tend to overwhelm the system more than if, let’s say we’re talking about a collapsed building, and only 5 or 6 or 10 a day can be removed.

Rate of recovery is going to play a role also in our determining for any particular jurisdiction what a mass fatality is.

[Slide 3]

Among the things that we need to consider in terms of a response is integrated incident management. "Integrated" here is the key. For many years, these incidents were treated in sort of an ad hoc fashion. Departments would stick up their hands and say, "I can give you some help." But the planning tended to be done in a very isolated level, mostly at the coroner or medical examiner’s level, without a lot of interplay from other agencies.

Today, given the nature of response, which we’ll talk about, the integration of all the potential players really is an important factor. Human remains recovery—this is sort of the beginning of the process, if you want. People who are engaged in this should be trained, or at least have some experience. It’s not a place to put people where maybe the fire chief sticks up his hand and says, "My guys can do that."

They may well be capable, but it would be better if they had had training and some notice. Forensic services—this is fundamentally the identification process. This is conducted by scientists—forensic pathologists, odontologists, or dentists, anthropologists, and a host of other people whose goal is to identify the decedents so they can be returned to their families.

We tend to work in a rather large group, so someone is going to have to deal with staff issues and managing volunteers. We had a fellow who came to New York City from one of the western states. His town took up a collection. They raised about $2,500. They pointed the nose of his pickup truck east and said, "Go to New York and help."

When he showed up, it took a day or two to vet him to make sure he really was who he said he was, and qualified. That role should be managed. That entire process has to managed by a group of people who, again, who planned for it and trained for it.

Family assistance—as complex as fatality management can be, family assistance is where we’re going to get our report card at the end of the day. Back in the mid nineties, we had some air crashes—ValuJet and TWA. The families felt their needs weren’t met as well as they should be. They complained to Congress, and what resulted was a law that deals with how families should be taken care of in commercial air crashes. It is rigidly enforced by the National Transportation Safety Board.

Family assistance is going to be how we get our grade. Taking care of those family members, making sure their needs are met, whether they are physical, emotional, psychological, spiritual, it goes far beyond just finding them a place to sleep and some things to eat. It is the critical fulcrum for determining whether a mass fatalities response is going to work properly.

Finally, personnel support—our people are our greatest asset. We really do have to make sure that their needs are met, that we don’t wear them down, whether decisions are made to work them an 8 hour shift or a 12 hour shift, at the end of a shift, people need to go back to where they either live or are staying, get rest, and get a break from the process. Any injuries need to be taken care of.

Our people are not engaged in fatality management full time. They have other jobs. They need to go back to those other jobs healthy.

[Slide 4]

Let’s take a look back historically as an example of the way things were done 100 years ago. In New York City, there was a factory, the Triangle Shirtwaist Factory that was a blouse factory, essentially. There was a fire on a Saturday at 5:00. One hundred forty-six women and girls died. Many of them died by jumping out the windows.

Essentially, the bodies were lined up on a sidewalk. They were eventually moved to a temporary morgue on a pier on the east side. The bodies were literally side by side in open wooden coffins. Family members, or people who claimed to be family members could walk through and try to visually identify their family member.

The morgue was also open the press and people who were just interested. The identification process was a little sketchy. It wasn’t exactly conducted with the level of dignity that we would expect today. This was not uncommon going back to the early 1900’s.

[Slide 5]

Over the course of the 20th century, sensitivities to the needs of the families grew tremendously as well as the sense of dignity and respect for the decedents. We also started to think far more about the fact that we were doing this work for the living. We are identifying the dead for the living, so they can get their loved ones back.

Scientific processes became much more sophisticated. Testing today for identification, dental process, etc. are sophisticated and a lot quicker. We’ve added DNA identification to our suite of tools. That’s not to say that these things don’t come with a cost. Some things, like DNA matching, can be very expensive, but they are also very effective.

We are also dependent on the family’s cooperation for DNA. Egypt Air, for example, back in 1999—some of the families from the Middle East said they would not donate a DNA sample for matching because they felt it was Allah’s will that their loved ones should truly be left at the bottom of the ocean and not recovered to try to make an identification. We’re dependent on families once we get into DNA matching.

[Slide 6]

In terms of contemporary fatality management concepts, back in 1990 there was an Avianca flight that was coming into New York and it literally ran out of fuel. It crashed on Long Island. Seventy-three people were killed. At the time, the New York State Funeral Directors had a well-organized group that was put together to respond to these sorts of event.

Tom Shepherdson was the leader of this operation and showed up to work the Avianca crash. Some federal government personnel were there, and they wondered who these people are who were responding to fatalities. Eventually the group became the spearhead for what was to be recognized by the federal government as a necessary asset.

Shortly thereafter, and there have been a couple of iterations, what resulted is a group called the Disaster Mortuary Operational Response Team (DMORT). That’s what we call it today. They’ve been in operation almost all of that time. There have been numerous deployments. DMORT has been everywhere—the Gulf, they’ve actually been to Haiti recently, certainly the World Trade Center, Shanksville, Pennsylvania, and many, many deployments. Successful deployments, too—they really know what they’re doing.

[Slide 7]

Once DMORT became known as a response group, and a very effective response group, it was planned into many, many local response plans that communities would almost automatically defer to the federal government. This is good and bad. On one hand, you do have a qualified group of people, an experienced group of people showing up to help. On the other hand, it meant that there was really no local, or very little local response planning done because of their reliance on the federal teams.

That’s not everywhere. That’s not a generalization, but rather in some localities. It wasn’t a really critical issue because we have experienced about one mass fatality event every 3 years. The incidence is not terribly high. However, in the mid 1990’s, that jumped nine-fold. It became 3 a year.

You remember some of those crashes and events in the course of the mid-90’s where it seemed there was a constant need for fatality responses. I remember at the floods in North Carolina, some of the DMORT members had to break down what they were doing and respond to the Egypt air crash. Before the Egypt air crash was completely processed, some people had to break down and go to the west coast for an Alaska air crash. The 90’s were a busy, busy time.

Then, comes September 11. For the first time, the federal resources were deployed in several places for a long period of time. While they handled everything there was to handle, it became clear to some people that situations could develop where the federal government may not have enough people, and those assets may not be available for long enough to be able to process multiple mass fatality events simultaneously. There was a level of awareness that popped up there.

In 2005, the hurricanes in the Gulf, Katrina and Rita, again put new strains on the people who are responsible for fatality management—another sort of awakening, if you want. About the same time, the public health community started to focus on the fatality consequences of planning for a pandemic and what the potentials could be if we did have an influenza pandemic like we had in the early 1900’s. Would we have enough people to be able to manage processing fatalities?

What had been sort of a slam-dunk theory in the past, now started to drive down to the local levels more of a sense of urgency for planning locally at the county level or the state level.

[Slide 8]

We have a broad experience in this country. What we know about managing mass fatalities, we know because we’ve been there. Commercial air crashes are a fairly significant contributor to our knowledge base, and in fact, as a country, we do a very, very fine job of managing the fatalities from commercial air crashes. The National Transportation Safety Board is a magnificent organization with an awful lot of guidance and wisdom.

We also deal with natural disasters—floods, tornados, hurricanes, earthquakes, etc. Again, in different parts of the country, different natural disasters have priority. In those areas, those people tend to be better prepared for that type of disaster.

We are also experience in what I call "focused violence". If you think about the Murrah Building in Oklahoma City, it was a building that was blown up, not a city. You can put yellow tape around it. Even the World Trade City, as large as that is, 16 or 18 acres, you could still string yellow tape around it. For those kinds of events, we are pretty good at dealing with the management of fatalities.

[Slide 9]

There are a couple of things that lead us to being good at this. Number one is, they tend to occur in a single place. They tend to also be in a single geo-political jurisdiction. Think again about the World Trade Center—it was all within New York City’s boundaries. The space tends to be defined.

We don’t have a large long-term risk to the people that are in the area once the initial energy from that is dispersed. A plane crashes, it hits the ground. When the fire is out, the risk is largely returned to zero. Once an earthquake stops shaking, the risk returns to zero.

We also have had the opportunity to pretty quickly know how many people have died, how bad the damage is, and how many deaths there are—not exactly, but at least within a reasonable number.

As part of the American process, we are used to instant gratification. Our response to these things peaks very quickly. In a few hours, we’ve got people out the door, and in a couple of days, we’re up and running. They tend not to last more than a few weeks, with some exceptions, like the World Trade Center.

But the definition is changing, particularly on the heels of 9/11 and the hurricanes.

[Slide 10]

In the future, we probably need to be thinking in terms of very large numbers of fatalities. They could be caused by diseases, in which case we are going to have to depend on the public health community very heavily. The response can last a long time. I have a buddy in New York who worked on the 9/11 identifications for over 2 years. Some future responses could turn out to be very, very long.

Contaminated victims, a result of a WMD incident have to be factored in as a reality. Potential for the imposition of quarantine—we’ve done it in this country in the past. It has tended not to end well. There have been a couple of incidents where public health personnel have literally been shot trying to impose quarantine.

Then there’s the potential for forced disposition. What if the CDC turns around and says, "All these smallpox victims should be cremated, or the anthrax victims shouldn’t be embalmed." It can produce a different model than what we’re used to.

[Slide 11]

These things may occur at multiple sites. Think about 9/11, but think if those 3 sites took place in your state. It can span jurisdictions, cross state lines. If it’s something like a chemical or radiological issue, it can be uncontained and continue to spread. Many of these events are going to have to be managed as a crime scene or environmental scene, particularly as a crime scene up front.

Risks will continue, unlike a plane crash, until we’re finished with the process. The scope, if we go back to national diseases, may actually be a function of people at the CDC, for example, who do epidemiological modeling. The response may take a very long time, and this is not something that necessarily sits well with the American psyche.

[Slide 12]

In terms of fatality management, a couple of simple things—number one, EMS shouldn’t be in the business of moving dead bodies, especially in a large scale event. Ambulances need to be maintained as available to take care of people who are injured. Deaths need to be reported to the appropriate authority, whether it’s medical examiner or a coroner. In Texas, it’s a Justice of the Peace.

Talk to those people now. If you’re part of a plan, talk to the medical examiner or coroner. Find out what the statutes require. Refrigerated storage can be an issue. We’ll take a look at this in some of the next slides.

No one can function in isolation anymore. The partnerships that are necessary across public safety, public health, emergency management, even including people like public works, need to be crafted now. Ownerships of problems that aren’t yours rightly belong to someone else—don’t take them on just because you feel generous.

If you’re not in the business of providing food and shelter for families on a day to day basis now, then it’s not your problem. Emergency management may need to figure out which agency will be responsible.

[Slide 13]

We talked about refrigerated storage. Quickly, we’ll go through some of the options here.

[Slide 14]

There are trailers. Let’s just right off the bat agree that in most places, hospitals don’t have a lot of morgue space. Even medical examiners and coroners’ offices may not have the space necessary. The first step up is to use refrigerated trailers. They have to be serviced. You need to get in the back of these things so that you need ramps and steps.

They have to have a power source. They either need to be hooked up to a tractor or they need to be plugged in somewhere. They have a limited capacity. There are only a few dozen bodies that can be put into one of these trailers. So, they have some inherent limitations.

[Slide 15]

The next step is refrigerated structures. The one of the top was actually used in North Georgia during what was referred to Crematory Incident. The one on the bottom was from the Gulf. These are buildings that are set up and then artificially cooled or heated.

[Slide 16]

This is actually a federal facility that was built toward the end of Hurricane Katrina and Rita. It’s more or less a permanent facility that the federal government can use in the South for mass fatality events.

[Slide 17]

These are the power units that would control the environment.

[Slide 18]

You see that they pump in cool or warm air, depending on what’s needed.

[Slide 19]

This is New York City—same idea, but they decided to put up an enclosed structure over the back of the trailers. That worked out very, very well. That was called Memorial Park.

[Slide 20]

This is the British version. The British bought this. It cost them about $1,200,000 in American dollars, and they own it. They keep it in a palletized form. They rolled it out for the London bombings a few years ago. Keep in mind that all of England is not as big as the state of Georgia, so they have one of these packed up and they can pretty much roll anywhere in the country in short order.

[Slide 21]

The next opportunity, or choice, might be temporary interment. If we start to look at number at about 1,000 dead, it may be that the choice would be to take the top 3 or 4 feet of dirt off an acre of land, and use that as a temporary underground storage. Those bodies would then have to be removed and returned to families as they are identified, etc.

This is traumatic. This is one of those things where we would have to talk to the community and make sure they buy into the process. It’s not an easy choice to make.

While we’re on that topic, there was a lot of mass burial going on in Haiti. That is probably not a high priority in the U.S. and I doubt seriously that we would be involved in it. It would have to be something overwhelming to consider that.

[Slide 22]

Let’s take a look at our providers, the people who are going to respond. Some incidents, and we’ve seen this in the past, may produce fatalities among our staff, particularly if it’s something like a WMD incident. Some of the victims of this can be the very people that we would be looking at to help out to manage large numbers of fatalities. A pandemic would have much the same effect.

Staff members may become secondary victims, particularly if they have someone close to them who is a primary victim, and then they get whatever is causing these illnesses and deaths. Some people are going to decide that they don’t want to come to work. They are tired of potentially being exposed to hazardous materials.

Some of are going say, "No, I don’t want to come in because I don’t want to bring things back to my family." Again, these are realities we need to consider when we start to plan.

[Slide 23]

If we lose employees, it tends to de-motivate other folks who are working. It also means that the people who are left to do the job, and I think people who work in emergency departments in hospitals can see this sort of being overtaxed physically and psychologically during periods of high stress. This is not a unique event.

Sometimes acute, atypical incidents will cause a shut-down. You’ll see someone, maybe there’s a 7-year-old child. You’re taking care of that child, and it reminds you of your own, and it may not be the best day to be at work.

Grief, stress, all these traumas are going to start to reduce efficiencies and effectiveness. After awhile, people are going to become too tired to work. They have to be rotated out. These are long-term events. This is not a 3-alarm fire up the street.

[Slide 24]

Plan to have fewer people part of your staff. Understand the local laws. Talk to the coroner or medical examiner and find out exactly what their expectations are. Look at some of those refrigerated storage alternatives—those open structures that can be used for storage are actually leasable.

Staffs that may be involved should be trained ahead of time. Once folks have had some kind of training, they are at least aware of what some of the implications are and are much better prepared to deal with it.

We have to deal with some detailed guidelines for infrastructure management and security. In this group is information infrastructure. I can’t overemphasize the complexity of data management in these sorts of events. There may be needs for people with strong backs, gloves and masks, but there’s just as much a need for people with pocket protectors and a serious devotion to the management of data.

[Slide 25]

What do we need to do now? We can’t wait until something happens. We have the start the planning process now. We need to work as a group. If you go back 20-25 years ago, you would see a disaster plan that had a sheet in there for fatality management, and it was a single sentence. It said, "See coroner." Or, "See medical examiner."

It is no good. We can’t work that way. We’ve got to do this across the jurisdiction, and across jurisdictions. Let people know. If you are, for example, a funeral director, and you belong to a funeral director’s association and you want to participate in fatality management should it occur, let the people who run that jurisdiction know that you want to be a part of it. Establish the interagency connections that are necessary to make this thing move smoothly.

Once the plan is written, exercise it and train to it. If we don’t train to a plan, we’ll never know where it might break.

[Slide 26]

Now it’s time for questions. There is also contact information there if anyone wants to get in touch with me afterwards or offline, an e-mail address is there for your use. I’d be more than happy to answer questions.

Amy Sebring: Thanks very much Dennis for an excellent overview. Now, to proceed to our Q&A.

[Audience Questions & Answers]

Nate Eberle: Mr. McGowen, First, thank you for giving this presentation today. I believe the president of my company Fireside Partners, Donald Chupp, and you are acquainted. With the global community becoming more and more intertwined, how can American companies stay connected with global and cultural needs / requirements?

Dennis McGowan: The cultural issue is one that in America, we are just starting to get our hands around. We have always tended to look at these things from an American perspective as an American event. But the cultural issues are very strong as you move around different parts of the country, let alone when you go overseas.

The other piece of this is, there are only a few places in the world where the models that we use here are actually used—England, parts of Canada, there’s a bit in New Zealand and Australia. Once you start to get outside of those areas, they deal with things in their own way, completely differently.

I would say that companies that are interested in seeing and staying in touch with what is going on, are probably best served by literally being vendors at some of the conferences that take place around the country—emergency management conferences, medical examiner and coroner conferences, even public health conferences.

The feedback you can receive generally is good because it tends to come from the street. It tends to have been garnered through mistakes that were made and lessons that were learned the hard way. It tends to be a bit more incisive than reading things out of a book. I would say, as in many things, the best way to be an informed individual is to be part of a group.

Amy Sebring: You talked about the funeral directors—let it be known that you want to participate. Let’s say that the planning assignment has been assigned to emergency management. You would recommend that they go out and reach out in their communities to those types of folk, and perhaps the religious leaders as well, wouldn’t you think so?

Dennis McGowan: You bring in the religious leaders, and I think that’s a very important piece of this. The funeral industry is not of a single mind nationally. I’ll give you an example. In the state of Maryland, for example, the funeral directors are so connected to the medical examiner’s office, the mass fatality planning done by the state of Maryland actually involves the Funeral Director’s Association on a formal level and literally turns over some aspects of the responsibilities to them.

In other states, the funeral directors are not nearly as interested or vocal about being interested, and they tend to be left out. In Ohio, actually, the funeral directors have a mobile morgue. Everywhere you go it’s just a little bit different.

The clergy—I think the religious community needs to be involved. I did some work two years ago in Washington, D.C. just to explore what the desires of the clergy were. It was impressive to see how many people turned up from religious organizations to say, "Yes, we want to be a part of any formal effort."

A lot of this has to do with advertising. Get the word out that this is taking place. If an organization pops up on your radar and you think, "I wonder if they should be…" Go ahead and do it. The worst that can happen is they say no. I think those organizations are a very, very important part of this.

Isabel McCurdy: Dennis, if not EMS for body recovery, who is best suited?

Dennis McGowan: This is one of those things where what we do on a day-to-day basis can change in a disaster. On a day-to-day basis, if you had an accident on a highway, and there are two fatalities, the local medical examiner or coroner probably has a service of some kind—a removal service that can recover those bodies.

In some cases, it’s an internal operation where the medical examiner or coroner has their own personnel with a van to move those bodies into the facility. If it’s 2, 3, or 4 bodies, those kinds of things can be handles the regular way, whatever the day-to-day process is.

When it gets to be 30, 40 and 100, now you have to have a secondary mechanism for making this happen. It’s one of the places where the funeral industry can be a huge contributor, but it has to go into a plan.

The answer to the question is—anybody that is willing and capable can do this, but is has to be part of the formal plan. They have to know about it, they have to have volunteered to do this, and then they have to be included in exercises and training.

If you have an event that truly has no secondary effects, where you don’t have injured to be taken care of, then using ambulances is not a terrible idea, but it would always be smarter to try to keep them available to take care of the living and make the normal runs. When we have a mass fatality event, all the rest of the things we deal with on a day-to-day basis are still going to occur and they need to be responded to.

Brian Onieal: Is there a Homeland Security Information Network (HSIN) - Community of Interest for Mass Fatality?

Dennis McGowan: I can’t answer his question directly, but let me give you a real quick overview. The DMORT teams are a wonderful resource, and they do have a website. It is good for information. They also provide guidance if you need it. For years they were under Health and Human Services, and then they were moved under FEMA after 9/11, and then they were moved back again.

The Homeland Security is at the very top of the pyramid, but the actual information is probably a little further down, either through HSS, the National Disaster Medical System or DMORT itself. Somewhere in that matrix, you’re going to find information.

Amy Sebring: You mentioned NDMS. I believe they have a big annual exercise. Do you know if NDMS also exercises the DMORT functions?

Dennis McGowan: In the past, they have tended to work separately, but the people from DMORT are at the NDMS meeting when it takes place, the big annual meeting. If there is another of the Top Off exercises which started in 2000, and they’ve had several, then both the NDMS, DMAT teams and DMORT teams are all involved in those exercises.

Linda: What guidance does the Federal government have for community training (eg: planning documents)

Dennis McGowan: I would start with things like the National Response Plan with NIMS, with ICS. Those are all highly formalized structures in which this stuff works. The first place that I would look if I were working at a local or county level, I would talk to the people at the state. Many of the states already have pretty robust documents in terms of wisdom regarding mass fatality management.

I would start at the local level and work my way up. If you need to get to the federal level, somewhere in the DHS, HHS, and DMS, DMORT acronym soup, you’re going to find some information.

Chris Rustin: Do you recommend purchasing the packaged "mobile morgues' and pre station them around the state with local EMA's that agree to deploy in their region when necessary?

Dennis McGowan: This is a little like telling someone how to raise their child. I think that depending on each state’s view of how this can and should be done, the purchase of a mobile morgue may make sense. In some places, take the state of Texas which covers a lot of real estate, it may make sense to have several.

This is not something I would want to advise someone about. That answer has to come locally and percolate up. It’s also an interesting time to try to find 5 extra dollars to do anything. It would be a local convention.

Jennifer Lord: Would you elaborate on the leasing of refrigerated trucks? Where would one get contact information for such partners? It would be a good idea to have that information as a part of our hospital mass fatality plan.

Dennis McGowan: This is one of my pet peeves. It goes back years and years. I’ve been doing this about 30 years. Twenty years ago, the medical examiners and coroners all tended to look out and say, "Where can I get a truck? Where can I get 2 trucks or 5 trucks?" Today hospitals are thinking the same way.

The true answer to this is, talk to the people in emergency management. I had a wonderful emergency manager here in Atlanta prior to the Olympics, Ellis Stanley, and we talked about this many, many times. What we essentially came down to was that emergency management would figure out how to secure contracts to make trailers available, and then it would only involve a phone call from the agency that needs them.

There are actually 3 pieces to this. The trailer is one thing. You need to get a tractor to bring it to your site. I remember in New Jersey years ago, we managed to secure a trailer one night, and we actually managed to get a tractor, but we couldn’t get a driver. They wanted double time and a half to come out at 11:00 at night.

This is a 3-part problem, but I would kick it back to emergency management. They are the ones with the resources and the wisdom to be able to secure this in a central fashion instead of everybody, every hospital, every coroner and medical examiner trying to secure their own.

ldhernan: What type of training do we provide to volunteers to assist with retrieving bodies and body parts? Are there chain of custody issues involved?

Dennis McGowan: There are. I probably wouldn’t put volunteers, people who are showing up unsolicited—I wouldn’t put them in the fields to do recovery. I would potentially put local volunteers out in the field, but first I’d have to put them through training and they would have to have a very clear set of goals and responsibilities and accountability, etc.

The unaffiliated volunteers, those that just show up, there are a lot of other things they can do. But I would prefer to know that the squads of people I was sending out to do a recovery were people that I knew, that I would be able to rely on their training, and know that they had been aware of things like evidence management, evidence collection, etc.

J.R. Jones: Are there laws in every state permitting DMORT to take DNA, picture, and fingerprint samples from every victim before releasing to relatives, storage, or temporary interment?

Dennis McGowan: DMORT is an interesting organization. I’m going to rephrase the question a little bit because it’s not really an issue of the law. Any function that DMORT is going to provide, all the participants who are coming along as DMORT workers are federalized and they bring their license with them.

So if you’ve got a forensic pathologist or a funeral director from Omaha who is coming to work in Tennessee, their license transfers with them. They don’t need special permissions. On the other hand, if a physician from Georgia independently was coming to Tennessee, there may have to be (and you’d have to look at the legislation to see what exists) someone who blesses that physician’s license. That’s really where the legal issues are.

The collection of DNA is done on human remains and it is done on the families that volunteer. There’s really not a legal barrier there.

J. Scot Freeman: Where can an organization find a resource or resources that facilitate getting a designated Mortuary Affairs team of personnel the requisite training necessary to perform Fatality Management duties? In other words, if a large-scale organization such as a major U.S. military installation had a pre-designated MA team or teams, where or what outlets could they take advantage of to be ready if the need ever presented itself?

Dennis McGowan: The military and the civilian world have been talking about cooperative efforts for a very, very long time. There may be people who are listening today who would have a better answer than I would. I have been out of the actual work of fatality management on a regular basis since 2004, I retired. There may have been things that happened in the past 5 years or so.

However, the military assets and civilian assets—there have been some serious explorations about how they could be used to augment one another. I don’t know what the answer is in terms of contemporary levels of agreement. If, on the other hand, you have a jurisdiction—let’s say you’ve got a city—and they want to stand themselves up and figure out how to plan for fatality management—one of the organizations they can talk to is the Emergency Management Institute in Emmitsburg.

There are classes that are put on there, both general classes and jurisdiction specific classes. I would try to get in touch with someone like John Hoyle at EMI and ask the question there, because they may be able to do something very specific for your jurisdiction.

Michael Luke: Not a HSIN link, but we at USNORTHCOM and HHS have a fatality interagency work group. HHS has the FM CONOPS, we train with DOD and civilian agencies. We used DOD in Haiti along with HHS, DOS.

Brian Onieal: The US Air Force has Fatality Search & Recovery Teams in place (FSRT's). There are 22 teams throughout the US

Dennis McGowan: I knew about that. As far as the NORTHCOM and HHS thing, congratulations. I mean that sincerely. There are people who have been working at this. A buddy of mine named John Nesler with Joint Task Force Civil Support spent most of his life trying to make this kind of thing happen. So, my congratulations—I’m so glad to see you’ve gotten past some of the old barriers. That’s great.

Amy Sebring: What about dealing with the media? Do you have any do’s and don’t’s?

Dennis McGowan: Anyone who deals with the media should be a trained PIO. I would never put anyone out to talk to the media who hadn’t been through PIO training and then coordinate specifically through the incident command system back to the bosses to make sure all the information is right. I think rule one is—go to school.

Amy Sebring: You talked about contamination during your presentation. I’m wondering, in an actual event (I don’t know how much history we have) that involved radiological materials—would that be especially challenging?

Dennis McGowan: There are two kinds of radiological events. One is what we think of as a dirty bomb. People who die in a dirty bomb explosion, die from the explosion, not from radiation, not from any materials that have been deposited on them or in them. That poses a challenge because it is a safety issue for the responders.

How to deal with that is fairly clear cut. We don’t have a lot of time to get into the details, but it’s not really a mystery.

The other kind of event is the detonation of a nuclear weapon. There we have a completely different set of problems. Most of the time, the solution there is just to wait. The half life of those materials is relatively short. We’re talking a couple of weeks, 2 or 3 weeks, and the radiation levels would be low enough to be able to proceed fairly comfortably.

There are two entirely different methods for dealing with these 2 different radiological incidents, but neither one is a mystery. They’ve both been well-studied.

A dirty bomb is designed to scare people. It may kill a few, but it is going to scare a whole lot more. Being able to manage public perceptions—now we’re talking about a skilled politician, to be able to deal with the anxieties of people and get them to settle and not be as panicked for as long.

Gary J. Kleinman: Website for US DHHS info on DMORTs and mass fatality management: http://www.hhs.gov/aspr/opeo/ndms/teams/dmort.html. HHS is responsible for integrating all federal public health and medical emergency preparedness and response with local and state government agencies, and leads ESF #8 when operations are coordinated under the NRF. Regional Emergency Coordinators, located in each of the 10 federal regions, are sources of information on federal programs: http://www.hhs.gov/aspr/opeo/regions/index.html.


Amy Sebring: Time to wrap for today. Thank you very much Dennis. It is very clear you know what you are talking about. We appreciate your taking the time to be with us today. It is good to know there are professionals like yourself helping to educate others on this important facet of emergency management.

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We stand adjourned. Have a great day everyone!