Amanda Sozer, Ph.D. Arbie Goings November 2, 2013 Be Prepared for the Worst Emergencies: Mass...

Amanda Sozer, Ph.D.

Arbie Goings

November 2, 2013

Be Prepared for the Worst Emergencies:

Mass Fatality Family Assistance Center Operations for the Public Health Community

Overview

• Introductions• Lecture:

– Mass Fatality (MF) Response Overview– Mass Fatality Family Assistance Center (MF FAC)

Overview– Purpose of MF FAC– Determining the Reported Missing– Size and Location of the MF FAC– MF FAC Operations and Staffing– Stages of MF FAC Operations

• Discussion Exercise

SNA Team’s MF Response Experience Includes:

• Joplin, Missouri • Haiti Earthquake• Continental #3407 • Comair #5191 • Hurricane Katrina• American Airlines #587• 9/11 World Trade Center• 9/11 Pentagon• 9/11 Pennsylvania• Egypt Air #990 plane crash• Alaska Air #261 plane crash• West Texas Fertilizer Plant

Explosion

• Georgia Tri-State Crematorium• Columbia Shuttle Crash• Hurricane Rita (cemetery

disruption)• Corporate Air #5966 plane crash• Colgan Air #3407• Hurricane Ike• Hurricane Floyd• US Air Express #5481• International Mass Fatalities

(Humanitarian)o Cypruso Lebanono Iraqo Colombiao Guatemalao Afghanistan

Disaster (Destruction)

Casualty (Injured)

Fatality (Death)

Mass Fatality

5

Mass Fatality

A situation with deaths that exceed local available resources.

Will differ with each locality depending on the available resources.

Main goal: Returning the bodies of the deceased to their families.

MF Operational Components

1. Field Operations - recovery of human remains

2. Family Assistance Center - collection of antemortem data

3. Morgue - collection of postmortem data

4. Identifications - comparison of antemortem and postmortem information for identification

Response Components

Identification and Reunification

Recovery

FACMorgue

The OCME is Responsible for:

• Situational assessment & requesting support• Establishing operations:

– Search and recovery– Morgue– Temporary storage of remains– Family assistance center

• Identifying the deceased, issuing death certificates & notifying next of kin

MA MF Management Plan

The purpose of the Commonwealth of Massachusetts Fatality Management Plan is to provide a general guidance in managing the recovery, identification and repatriation of human remains in an efficient and effective manner while maintaining the dignity and respect of the deceased.

Objectives of the MF Management Plan

• Identifying the relevant administrative rules and regulations• Defining the situational assumptions• Specifying the incident command system and activation process• Documenting management agency roles and responsibilities• Providing a mass fatality operational response overview• Identifying resource support • Outlining incident scene considerations and evaluation criteria• Describing the general operations of and resource requirements.

o body recoveryo mortuary operationso storage and trackingo family assistance

• Providing general guidance on transiting from the response back to normal operations.

o identificationo issuance of death certificateso repatriation to family

Objectives of a “Typical” MF Response

• Investigate and recover human remains• Determine cause and manner of death• Provide families with accurate and timely

information• Perform accurate and timely identification

of victims• Rapidly return the victims to their legal

next of kin

Operations Flow – Sudden MF

Operations Flow – Pandemic Death Surge

Making the Identification

Information collected from the human remains in the morgue (post-mortem)

• Dental• Fingerprints• Medical Devices• Surgeries• Body art• Physical characteristics• DNA

Information collected from the victims’ families or other agencies(ante-mortem)

• Dental• Fingerprints• Medical Devices• Surgeries• Body art• Physical characteristics• DNA

Forensic Pathologist: Death Certificate and Release of Body

IT

Mass Fatality Family Assistance Center (MF FAC) Operations

MF FAC is is an integral part of the identification process

MF FAC Operations

• Purpose is often confused/misunderstood• Especially when pre planning• ESF 8 • Leads to communities being ill prepared

• Complicates MF response• The MF FAC is the interface with families and public

• FAC vs VIC

• Purpose may vary depending on cause of incident• Traditional mass fatality (hurricane, terrorist attack)• Natural Causes (pandemic flu)

Purpose of MF FAC Operations

• Primary purpose is the collection of antemortem data for comparison to postmortem data collected at the morgue

ID

Collection of Ante Mortem Data

But First………

Who is TRULY missing?

Determine Who is Deceased

Important to determine the truly missing:• To not invest time gathering

antemortem data on living persons• Reduce costs • Expedite the identification of those

who are deceased

Katrina Statistics

910Human

Remains

13,947ReportedMissing

Antemortem Data Collection

• Reported Missing “RM” Number• Family Contact Information• General information• Physical characteristics• Medical information and records• Dental• Photographs• DNA sample collection

MF FAC Operations

If the primary purpose of the MF FAC is the collection of antemortem data for identification purposes, what about the other services?

MF FAC Support Services

• Psychosocial/Spiritual support• Nutritional support• Child care• Basic medical support• Housing (transportation incidents)• Other incident specific support

MF FAC Operations

FAMILY ASSISTANCE CENTER OPERATIONS

ANTEMORTEM DATA COLLECTION

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MF FAC Operations

Implementation Considerations

MF FAC Location

• Secure• Controlled exits• 24 hour security

• NOT near incident site or morgue to avoid• Sights• Sounds • Odors

• Consider length of stay

Size Considerations

• Individuals present• Family members and other visitors

• Average 10 family members per decedent• Ex-100 decedents X10=1000 family members

• Staff

• Functional areas• General meeting area• Interview rooms• Other components

• Data management• Administration• Storage• Dental/pathology/DNA• Visitor dining area• Staff dining / respite area• Counseling /meditation/notification area• Children’s play area

Infrastructure Considerations

• Utilities• Restrooms• Parking

• Family• Staff

MF FAC Possible Locations

• Hotel• School/college• Civic center• Church• Empty commercial

space• Governmental

building

MF FAC Operations and Staffing

• Staffing considerations:• No single agency typically can staff the FAC• Will require coordination and support from

multiple agencies• Must follow incident command structure• Staffing needs may change over time as needs

change


• Reception• Greets family members/visitors• Credentialing (works with security)• First contact with the FAC visitors• Skill sets required:

• Pleasant demeanor• Ability to interact with family members• Understand ass Fatality Operations


• Security• Controls entrances/exits• Patrols parking lots/building exterior• Credentialing (works with Reception)• Provides a sense of safety• Skill sets required:

• Law enforcement/security experience• Ability to interact with grieving families


• Call Center• Provides info to families/public

• Should be pre scripted for consistency

• Scheduling• Data intake• Relaying phone calls/takes messages• Skill sets required:

• Proper telephone etiquette• Attention to detail


• Data Intake• Collects Ante Mortem data from families• Follows up on cases with missing information• Provides families with response information• Interacts with forensic personnel• Skill sets required:

• Comfort /experience dealing with grieving families • Attention to detail


• Data Management• Enters antemortem data into database• Manages electronic and hard copy files• Monitors changes to files• Monitors completeness of data• Skill sets required:

• Strong data entry skills and attention to detail• Records management experience


• Information Technology/Information Resources• Establishes and maintains network• Establishes and maintains database

• Back-up

• Interacts with morgue operations• Provides statistics/reports• Skill sets required:

• Computer network experience• Database management experience


• Family Affairs/Release Section• Positive identification notifications (as

requested)• Coordinates remains release

• Local funeral providers• Disaster mortuary companies

• Skill sets required:• Experience dealing with families concerning their

deceased loved ones• Detail oriented

• Forensic Sciences (Dental, Pathology, Fingerprints, DNA)• Request antemortem records• Collects DNA reference samples• Provides information to family members• Skill sets required:

• Forensic Dental/Pathology experience• DNA collection and possible data interpretation



• Support Services• Psychosocial/Spiritual support• Nutritional support• Medical support• Child care• Other incident specific support• Skill sets required:

• As needed to supply necessary support

MF FAC Stages of Operations

1. Start up/surge

2. Steady state

3. Transition back to routine operations

Return to pre-fatality operations

TransitionOutside

resources diminish

Steady StateFluid

operations

Start up / Surge

Set-up, set policy and resource

surge

Start-up/Surge

• MF FAC establishment• VERY hectic and at times confusing• Convergence of numerous entities to form

one operation• Fine tune/change as necessary

Steady State

• Daily operations once MF FAC is established• Only slight operational changes as needed• In preparation for transition stage• May be some fluidity of operations during this

stage:• Needs of various components will change as FAC

operations continue• Will affect both staffing and hard assets• Examples from the Louisiana FAC following hurricane

Katrina/Rita

Family Affairs

September 2005 May 2006

DNA

September 2005 May 2006

MF FAC Transition

• From larger MF FAC operations with outside support to local operations

• Relinquishing staffing, equipment, and facility

• Transferring records to local authorities• Must convey to public FAC transition

• MF FAC operations never end

FAC Plans are Critical to a Successful Operation

Focuses on the Interaction with Families

49

Situation: SUDDEN DEATH

• Soccer stadium downtown• International soccer

tournament• Stadium capacity of 51,000• 96o F and high humidity• 6:00pm game goes into

Sudden Death overtime


July 22, 2008 Sozer, Niezgoda, and Associates, LLC


West Side of Stadium

• 13,000 seats

• Players, coaches and support staff of team on West side of field = 50

• Employees of stadium in the area =approximately 30


Total fatalities can be upwards of 13,080

53

Balance of Stadium

• Approx 38,000 spectators• 50 personnel with team on East side • 70 employees • All fled stadium after explosion• Total estimated affected= 51,200 people

What will this mean in terms of total reported missing persons?


Demographics

• Local residents

• U.S. residents from around the country

• Non-U.S. residents from various countries


Time Table - Day 1

6:00pm - Explosion....on-site medical personnel begin to render aid and begin triage to local hospitals

6:15pm - Fire Department arrives and begins extinguishing fires, securing scene for both security and safety purposes

6:17pm - Calls begin to come in concerning incident and information on those at the tournament

6:25pm – Explosion Reported by news stations

6:30pm - Family members begin arriving at scene wanting information on survivors/deceased

7:00pm - First responders still battling fires-survivors continue to be triaged, treated and evacuated


Time Table – Day 2

6:00am - Fires out rescue operations still ongoing…Much confusion among surviving family members…USAR teams inspecting weakened ends of west side of stadium


Time Table – Day 2

• 6:00am - Scene declared safe to begin recovery operations

• 9:00am - Local, state, federal, NGO’s, volunteers, faith based organizations, and various others all in town to begin identification and reunification efforts.


Status at Scene

• West side of stadium completely collapsed with unknown numbers of bodies underneath

• Both ends of collapsed section unstable-not safe for rescue/recovery

• Much fragmentation of remains


59

Identification of Human Remains

• Bodies beginning to decompose• Scene has been secured to keep media,

family members and all others out.• Weather-still hot and humid

Now What????


MF Operational Components

1. Field Operations - recovery of human remains

2. Family Assistance Center - collection of antemortem data

3. Morgue - collection of postmortem data

4. Identifications – comparison of antemortem and postmortem information for identification

61

Family Assistance Center (FAC)

• When will FAC operations begin & end?

• Where will the FAC be located?

• What services will be offered?

• Who will staff and manage the FAC?

How will the Local Boards of Health Support the Response Efforts?

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Conclusion

This would be a large scale, multi-jurisdictional investigation and recovery process with

many dynamics effecting the reunification process.

Planning for ANY mass fatality is always the First Step in mitigating the

identification/reunification process.


Thank You!

Amanda C. Sozer, Ph.D.Arbie Goings

SNA International4707B Eisenhower Ave.Alexandria, VA 22304P:+1-703-370-1930F:+1-703-370-1931

www.sna-intl.com

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