Dead or Alive:

Managing Both in
Mass Fatality
Incidents
Martin A. Luna, D-ABMDI
Laramie County Coroner
Cheyenne, Wyoming
Poll Question
In my career, the largest mass fatality
incident that I have worked on involved
A. 6–20 fatalities
B. 20–100 fatalities
C. Over 100 fatalities
D. I have never worked
on a mass fatality
Definition
What is mass fatality?
 Number of victims
 Capacity of affected jurisdiction
to respond
 The type of disaster
 A Descriptive Framework
Natural Accidents/ Pandemic
disasters incidents events
• Sudden • Sudden • Expected
Onset
• Unexpected • Unexpected • Preplanning
• Hundreds or • Hundreds or
Deaths • Tens or hundreds
thousands thousands

Infectious • Potentially very

• Same • Same
disease issues high
• “Nobody • Medicolegal • Public health legal
Legal context
responsible” framework issues
Forensic • Identification • Identification • Actual cause of
investigation • Cause of death • Cause of death death
Commonalities
• All victims must be identified
• The need to preserve evidence
• Treat remains and relatives with
dignity and respect
• Political pressure
• Public health concerns
Public Health
Why take a public health approach to
management of the dead following mass fatalities
incident?
 Not just about identification
 Physical health of survivors and relief
workers
 Impact on other healthcare providers
 Mental health
 Legal issues
 Assessing the impact of the disaster
Assessing Disease Risk
Presence of
Exposure to Susceptible
infectious
the agent host
agent

Natural disasters
• Victims of natural • Public usually not • Susceptible to
disasters die from exposed common chronic
trauma/drowning/fire • Body handlers most infections
• Unlikely to have acute likely to be exposed • TB
(epidemic) infections • HBV & HCV
• HIV/AIDS
• Possible chronic
infections • Enteric pathogens

O Morgan. Rev Panam Salud Publica. 2004: 15(5);307-12

Assessing Disease Risk
Presence of
Exposure to Susceptible
infectious
the agent host
agent

Gloves Vaccination
Basic hygiene TB, HBV

Natural disasters
• Victims of natural • Public usually not • Susceptible to
disasters die from exposed common chronic
trauma/drowning/fire • Body handlers most infections
• Unlikely to have acute likely to be exposed • TB
(epidemic) infections • HBV & HCV
• HIV/AIDS
• Possible chronic
infections • Enteric pathogens

O Morgan. Rev Panam Salud Publica. 2004: 15(5);307-12

Risk to the Public
• Assessment suggests low risk
• Public may be isolated from incident
• Mortuary personnel may be the only
“general public” at risk of exposure
Workers
• Potentially a “high risk group”
• No “occupational” infections
• Physical injuries
• Hazardous working environment
 Injury
 Tetanus
 Hepatitis
Body Recovery
• Feel the need to begin immediately
• Confusion
• Lack of prepared recovery personnel
• Those that die in medical care facilities
Equipment: Basic

Local
equipment
usually
available
Equipment: Technical
More sophisticated equipment
 Not available
 Necessary?
 Time to respond
Managing Body Recovery
• Difficult to set up systems for body recovery
“after” the disaster
• Should be considered as part of preparedness
at local level
• Expectation that it will begin soon after the
incident
Challenges
• Public/media want rapid disposal of bodies
• Demand proper identification of victims
• Short time before decomposition
• Identifying suitable storage
• Limited resources
• Preserve as much evidence as possible
• Families wanting closure now!
Methods for Identification
• Viewing and visual identification
• Individual identifying features (scars,
marks, tattoos)
• Collection of photographs
• Advance forensic techniques
 Fingerprints
 Dental
 DNA
• Other
Viewing
• Decomposition may be too advanced
after 24–48 hours
• Logistically very difficult to arrange
• Distressing for relatives
• Error potentially quite high
Photographs
• Photographs: face and body
• As soon after as possible
• Possibly the best postmortem information
available in mass fatality incident
• Not as simple to do as it sounds
 Quality of photographs
 Availability of photographic equipment
 Cost
Advanced Forensic Methods
• Standard methods
 Lack of antemortum data
 Availability of resources

• DNA techniques
 Collection of sample material
 Facilities and expertise
unavailable
 Cost and practicability
Other Methods
• Personal effects
 Identity cards
 Distinctive jewellery
 Clothing

• Location of body
• Posters and flyers of missing
• Internet sites
Suggestions for Identification
• Photographs and
Viewing and visual
documentation
• Personal effects data
+ identification if possible

Storage
+ Forensic investigation
when needed
Data Management
What do we do with the data?
 Lots of photos, information.
 Difficult to use for identification.
 Who owns the data?
 Who verifies the identification
process?
 Provided for “lessons learned.”
 Legal aspects.
Poll Question
In your jurisdiction, how many bodies can be
stored at once?
A. 1-10
B. 10-20
C. More than 20
D. I don’t know
Storage
• Not possible to keep bodies for long
without storage
• Limited options if numerous bodies
 Refrigeration
 Ice
 Dry ice
 Temporary burial
Refrigeration
• Existing facilities too
small
• Funeral homes do
not have capacity to
hold too long
• Refrigerated trucks
can be used
• Up to 45-50 bodies in
each container
Burial
• Preserve evidence
• Location of suitable grave sites difficult
 Local communities
 Environmental health concerns
• Operational difficulties
 Lack of suitable documentation
 Single graves or trench graves?
 Clearly marked, not a “hole in the ground”
 Minimum burial depth, distance from water
sources, etc.
 Coordination and Support

Communities, volunteers, police, military,

Body Recovery
non-governmental organizations (NGOs)

Doctors, medical staff, forensic specialists,

Identification
FBI, DMORT, NGOs

Death certification Coroners, physicians

Disposal Coroner, ME, funeral directors

Technical Support
• Planning assistance for technical support
• Potential sources of support
 American Red Cross
 Mutual aid
 DMORT
Disaster Preparedness
• Develop fatalities management plans
• Build local capabilities
 Police/Fire
 Military
 Red Cross
 Hospitals
 Mental health organizations
 Clergy
 State partners
 Public health
Review
1. Consider whether recommendations are
suitable to all “mass fatality events.”
2. Time for action is short.
 Decomposition 24–72 hours
 Body recovery begins immediately
3. Specialized equipment or teams may arrive
too late.
4. Simple methods of identification and data
management need to be developed
5. Temporary burial may be best storage option
where refrigeration is unavailable
Review (cont.)
6. Management of dead needs to be included
in disaster preparedness.
7. Coordination by single person/agency with
clear mandate and legal authority.
8. Technical support is needed for
governments/local organizations.
9. Active engagement with the media.
10. Ongoing program of systematic learning from
future natural disasters.
Above All…
• Planning
• Training
• Exercising
 Exercise beyond “The Hero”
 Include multi-disciplinary
approach to exercises

• After Action Reports—Implement

And More…
• Yearly training in fatalities
management issues
• Additional time spent exercising
recovery and processing
• Develop capabilities now
Sources
A Working Group Consensus Statement on
Mass Fatality Planning for Pandemics and
Disasters: July 2007
 Joint Task Force Civil Support Mass Fatality
Working Group

www.homelandsecurity.org/newjournal/Articles/displayArticle2.asp?
article=160
Questions

Martin A. Luna, D-ABMDI

Laramie County Coroner
310 West 19th Street, #410
Cheyenne, WY 82001
307.633.4513
mluna@laramiecounty.com