Mass fatality planning Daniel Jordan, PhD

Daniel Jordan, PhD, ABPP

drdanj@roadrunner.com

Mass Fatality CatastropheResponse

Objectives: Develop and Organize

Establish MFC Response Policy &

Procedures

Understand Handling Deceased

Assist Families and Loved Ones

Familiarity with Death Certification Process

Establish Role of Mass Fatality Response

Coordinator in an Operations Center

Mass Fatality Planning Objectives: (FEMA)

Don’t become overwhelmed

Overcome denial and “disbelief”

Mass Fatality Planning Objectives: (Jordan)

FEMA Definition:Catastrophes vs Disasters

Mass vs Multi casualty and fatality

Community activity breaks down

Infrastructure (buildings, roads, water, power)

Daily life: Work, leisure, education

Social order

Local governance into recovery and beyond

Help from outside is not available FEMA and Enrico Quarantelli. “Emergencies, Disasters and Catastrophes

are Different Phenomena.”

Catastrophes: High Probability, Low Frequency

Health (Worst case, large scale, infrequent)

Pandemic: 5,000 to 80,000+ Ventura County

deaths, nation/world-wide, no/little mutual aid

Natural (Likely, not as large scale)

7.9 or larger earthquakes, dam failure, tsunamis,

likely some mutual aid from outside CA

Human-made (Less likely, smaller scale)

Biological or dirty bomb attack, larger than 9/11

Mass Fatality Incident Guidance

Planning tool,

not a plan

Start with worst case

scenario

Reality Check

It "may not be ethical, it may

not be nice, it may not even

be legal, but it might be the

only thing you can do.” Michael Leavitt, Secretary of

Health and Human Services

Reality Check: It Could Get Bad --Really, Really Bad

“The corpses had backed up at the undertakers’,

filling every available area of these establishments

and pressing into living quarters; in hospital

morgues overflowing into corridors; in the

[Philadelphia] city morgue overflowing into the

street. And they backed up in homes. They lay on

porches, in closets, in corners of the floor, on

beds.”

Barry, JM. (2004). The Great Influenza: The Epic Story of

the Deadliest Plague in History.

Reality Check: AHRQ* Plan (See Any Problems with This?)

Establish a Regional Home Death Management Process Set up regional hubs for body retrieval and processing

with a review by the Medical Examiner, a registration process, and a temporary holding place awaiting definite management.

Deploy refrigerated trucks from the hospital for body management, exchanged daily to regional processing sites.

Arrange for Web-based death certificate processing and secure tracking to the Department of Health.” *Agency for Healthcare Research and Quality

http://www.ahrq.gov/research/mce/mce8b.htm

Reality Check: A State Pan Flu Plan (See Any Problems with This?)

Handling of Deceased Bodies by the General Public, Such as At-Home-Death: If . . . the death of a family member occurs in your home . . . isolate the body in an area where it will not be touched or disturbed. If the body must be moved or otherwise touched . . . wear gloves and avoid contacting oral and respiratory secretions (from mouth, eyes, nose). Wash hands thoroughly after touching the body or surfaces contaminated by secretions. Thoroughly disinfect surfaces and launder clothing that may have been contaminated by secretions. Call appropriate authorities to report the death. State of ------------, Dep’t. of Health. Public Health Pandemic

Influenza Response Plan, Ver. 5. (emphasis added)

Reality Check: Mass Fatality Plan Weaknesses

Consider:

15-20% of the population has died

35-40% of the population is very sick

Nationwide pandemic, mutual aid is not

coming

Reality Check: Yes, It Could Get Bad -- Really, Really Bad

Epidemiological Modeling: Ventura County

could have between 5,000 and 125,000

deaths in a 6 to 8 week period (with a

second, smaller wave following the first)

Our society is not prepared

No society can be truly prepared

But we must do our best

Nationwide Pandemic: What’s Different from 1918?

Travel: Speed

Numbers

Frequency

of trips Plane landing at Maho Bay, St Maarten

Nationwide Pandemic: 1918 and Now

More people have impaired immune systems

due to medical advances allowing them to

live longer . . . overall our population has

lower immunity levels*

Elderly, transplant recipients, cancer survivors

getting chemotherapy or radiation, and viral

infections including HIV

We’re actually in worse shape than in 1918*http://www.evans.amedd.army.mil/PandemicFlu/1918.htm

Why Establish an MFC Plan?

Notify and assist families

Protect families, property, estates --the future

Identify the deceased, repatriate as possible

Maintain evidence trail

Determine and certify causes of death

Track patterns for prevention and mitigation

Properly dispose of remains

Need a Multi-Agency Plan

Health Department

Hospitals

Community health entities

Mortuaries

County/City planning agencies, parks

departments

and more

Community-Wide Scene(s)

The Scene: Contained Event to Nationwide Disease Outbreak

Single Contained Incident

County-wide event

Regional to nation-wide

catastrophe

TransportPlans

Transport of Deceased

Assume: System is overwhelmed

From scenes to funeral homes and/or

morgues

Funeral homes and morgues to burial sites

Access to appropriate vehicles, ambulances,

hearses, trucks,

Body bags, boards, coffins, equipment

Disaster MorguePlans

Morgue Standards

Out of sight from bystanders and victims.

Access control: Only authorized staff.

Attempt to identify all human remains.

Photographs and descriptive information for each

Collect and store, find refrigerated containers or

temporary burial to allow for subsequent

investigation and/or identification.

Family Assistance CenterPlans

Psychological

First Aid

Community

Intervention

Family and Community Assistance Centers

Removed from the press, the morgue

Mental Health staff trained in psychological first aid

Emotional support and practical information

Gathering place for families to get information and provide support to each other

Establish community response plans

Be able to address whether dead bodies cause epidemics

Dead bodies from natural disasters do not have epidemic causing diseases (e.g., cholera, typhoid, malaria, or plague).

Victims of disease need some precautions

Follow precautions, use Personal Protective Equipment (PPE) use

Partially Derived from: Morgan, O., Tidball-Binz, M. & Van Alphen, D. Eds. (2006).

Management of dead bodies after disasters: a field manual for first

responders. Washington, D.C: PAHO.

Avian Flu Virus

How Urgent is Collection of Dead Bodies?

Body collection is not the most urgent task

after a natural disaster.

The living are our priority.

No significant public health risk is related to

simple presence of dead bodies.

Collect bodies as soon as possible and

maintain identification.

Health Risks to the Public and Workers Handling Dead Bodies

Rescue workers, morgue workers, etc. have small risk from tuberculosis, hepatitis B and C, HIV, and diarrheal diseases.

Infectious agents causing these diseases last no more than two days in a dead body (HIV may survive up to six days).

Reduce risk with rubber boots and gloves.

Little risk to general public

Handling the Deceased:Examples of Advice

Follow DOC/EOC

instructions

Universal precautions

Volunteers only (even

staff should be

volunteers)!

Use shovels not hands

Masks help emotionally

Cover the body or

head before moving

Use backboards

Double glove and tape

wrists

Human & Social Welfare

Survivors: Special Considerations

Orphans (especially if 1918 pattern held)

Elderly

People with special needs

Language barriers

Mental Health Issues

The primary desire of relatives (from all religions and cultures) is to identify their loved ones.

Help with decision-making.

Grieving and traditional burial are important for the personal and community recovery and healing. [See Cultural Competencies in MFCs plan.]

Examples of Dealing with Victims, Loved Ones, Bystanders

Act with respect and dignity for all involved.

Reduce pain witnesses may feel (they will

watch handling of the deceased).

Handle deceased as if they were still alive.

Avoid “M.A.S.H. humor.”

Watch for signs of stress among responders

and help them get time.

Communications and Media

PIOs, Journalists

Challenge comments or statements

regarding the need for mass burial or

incineration of bodies to avoid epidemics.

Consult PAHO/WHO, ICRC, the IFRC or

local Red Cross sources.

Don’t join alarmists by spreading bad

information.

Disposition and Collective Burial

It Can [Will] Happen Again

Coffins on loading dock 1918

Mass coffins 1918

1918 pandemic viewing area

Mass grave digging 1918

Modern Collective Burial image

Cremation vs Burial (PAHO* Guidelines)

Cremation is not universally accepted destroys evidence.

Large amounts of fuel are needed.

Achieving complete incineration is difficult, often resulting in partially incinerated remains that have to be buried.

Logistically difficult to arrange cremation of a large number of dead bodies. Pan-American Health Organization

Collective Burial Not Mass Graves

2.5 acres can hold about 2,000 bodies.

Gridding system, each body identified or identifying characteristics recorded.

Special training for heavy equipment operators.

Dilemma: Repatriation vs. permanence.

Avoid trauma, even international consequences of mass graves

Collective Burial Site Criteria

Accessible yet able to be protected.

Not linked to water tables.

Relatively flat expanses of open ground.

Dirt, low proportions of rock to be cleared.

Convertible to permanent cemeteries.

Neighborhood burials, local parks

Example Collective Burial Site Location:This is not an actual planned site, but an example of thinking through the process

Parcel ARN 234005014

One Hundred Year Flood Plain

Scary dairy close up with 100 year floodplainParcel ARN

234005014

MemorializingPlans

Collective burial sites planned as

temporary have become permanent

Winfield Township’s 1918 Influenza Mass Grave SiteHistory Of the 1918 Mass Graves in Winfield Township, Butler County PA

1918_Program_Service_b_Ukranian_Catholic.jpgwww.saxonburglocalhistory.com/Winfield.html

Alaska Inuit mass grave marker

site of a mass grave in

Brevig Mission, Alaska,

where 72 people were

buried following their

deaths during the

Spanish flu breakout of

1918. Ned Rozell

photo.

Photo by Ned Rozell

Castlebar, Ireland Memorial to the Flu Victims of 1918

Maori memorial

Carved wooden Maori

cenotaph erected at

Te Koura marae.

Cenotaph designed

and carved by Tene

Waitere of Ngati

Tarawhai.

Photograph 1920 by

Albert Percy Godber.

1928 Hurricane, Florida

September 16, 1928, a hurricane hit near the Jupiter Lighthouse (FL) heading west across Palm Beach County to Lake Okeechobee. It destroyed hundreds of buildings and damaged millions of dollars in property. Lake Okeechobee dike collapsed -- 1,800 to 3,000 fatalities. 1,600 buried in a mass grave in Port Mayaca in Martin County. In West Palm Beach, 69 white victims were placed in a mass grave in Woodlawn cemetery and approximately 674 black victims were buried in this mass grave in the City's pauper's burial field. Many others were never found. On Sep. 30, 1928, the City proclaimed an hour of mourning for the victims with rites conducted at each burial site. 2,000 persons attended at the pauper's cemetery, black educator and activist Mary McLeod Bethune (1876-1955) read the Mayor's proclamation. This burial site was not again recognized until 1991, when a Yoruba (Nigerian religious) ceremony was held here.National Register #02001012 (2002)

Hurricane memorial statue

International Dimensions

Planning

Managing bodies of foreign nationals

Families or countries may demand identification and repatriation of bodies.

Problems could have serious economic and diplomatic implications.

Bodies must be kept for identification.

Department of Foreign Affairs or Governor’s Office, foreign consulates, embassies, INTERPOL, etc.

Debriefing & Demobilization Plans

Give Every Consideration to Participants

Operational Debrief

Psychological First Aid, referral and

follow-up interventions

Information capture, tactical changes,

organizational learning and practice

Staff welfare, staff recovery

Overall follow-up planning

Demobilization

Body Recovery Demobilization

Personal Effects Recovery Demobilization

Family Assistance Center Demobilization

Morgue Demobilization

Collective Interment Operations

Demobilization

Breakout Session: Suggested (Initial) Mass Fatality Annex Work Groups

Scene(s) Management (may be entire County) including Transportation

Hospital Mass Fatality Plans Funeral Home/Mortuary Roles Disaster Morgue Family Assistance, Identification &

Viewing (cultural & religious issues) Health and Safety (universal precautions) Social Welfare (e.g., orphans, displaced

people) Communications and Media Disposition, Collective Burial, Memorials Demobilization

For each domain we

need at least:

Objectives

Policies

Management &

Organization Plan

Procedures

Contact

Research Psychologist

2240 E. Gonzales Road, Suite 220-M

Oxnard, CA 93036

Phone: 805-981-5258

Email: drdanj@roadrunner.com or

dan.jordan@ventura.org

Mass fatality planning Daniel Jordan, PhD

Health & Medicine

Transcript of Mass fatality planning Daniel Jordan, PhD

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