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Central Texas Council of Governments • Regional Mass Fatality Plan • Version 1.0 Page i January 2017 • For Official Use Only

Central Texas Council of Governments

Regional Mass Fatality Management Plan January 2017

Central Texas Council of Governments • Regional Mass Fatality Plan • Version 1.0 Page ii January 2017 • For Official Use Only

Approval and Implementation

The Central Texas Council of Governments (CTCOG) Regional Mass Fatality Management Plan (MFMP) is hereby approved. This plan is effective December 1, 2016 and supersedes all previous existing and additions to CTCOG regional mass fatality planning documents.

County Judge, Bell County March 1, 2017 County Judge, Coryell County March 1, 2017

County Judge, Hamilton County March 1, 2017

County Judge, Lampasas County March 1, 2017

County Judge, Milam County March 1, 2017

County Judge, Mills County March 1, 2017

County Judge, San Saba County March 1, 2017

CTCOG, Executive Director March 1, 2017

CTHCC, HPP Contractor March 1, 2017

Central Texas Council of Governments • Regional Mass Fatality Plan • Version 1.0 Page iii January 2017 • For Official Use Only

Record of Changes Regional Mass Fatality Management Plan

Table 1: Regional mass fatality management plan change documentation table

Change Number

Date of Change Name and Title of Person Who Made

Change

Description of Change

1 11.01.2016 Joy Worsdale HOTRAC EP

Converted previous plan format to TDEM standardized plan format

2 11.01.2016 Joy Worsdale HOTRAC EP

Updated county contact information, judge’s, emergency management, funeral homes

Central Texas Council of Governments • Regional Mass Fatality Plan • Version 1.0 Page iv January 2017 • For Official Use Only

Table of Contents

I. AUTHORITY ............................................................................................................. 1

A. FEDERAL ............................................................................................................... 1 B. STATE ................................................................................................................... 1 C. LOCAL ................................................................................................................... 1 D. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT ................................... 2

II. PURPOSE, OBJECTIVES, AND SCOPE ................................................................ 4

A. PURPOSE .............................................................................................................. 4 B. OBJECTIVES ........................................................................................................... 4 C. SCOPE................................................................................................................... 4

III. EXPLANATION OF TERMS ................................................................................... 5

A. ACRONYMS AND ABBREVIATIONS ............................................................................ 5 B. DEFINITIONS .......................................................................................................... 8

IV. SITUATIONS AND ASSUMPTIONS ..................................................................... 12

A. SITUATIONS ......................................................................................................... 12 B. ASSUMPTIONS ...................................................................................................... 15

V. CONCEPT OF OPERATIONS ............................................................................... 17

A. GENERAL ............................................................................................................. 17 B. PLAN ACTIVATION: PROCESS ................................................................................ 17 C. PLAN ACTIVATION: POTENTIAL ACTIVITIES TO UNDERTAKE...................................... 18 D. PLAN ACTIVATION: CRITERIA ................................................................................. 21 E. PLAN ACTIVATION: DECISION-MAKING ................................................................... 21

VI. ORGANIZATIONAL AND ASSIGNMENT OF RESPONSIBILITIES ..................... 24

A. GENERAL ............................................................................................................. 24 B. ORGANIZATIONAL STRUCTURE .............................................................................. 24 C. ROLES AND RESPONSIBILITIES .............................................................................. 26

VII. DIRECTION AND CONTROL .............................................................................. 41

A. GENERAL ............................................................................................................. 41 B. INCIDENT SITE ASSESSMENT ................................................................................. 42 C. INCIDENT SITE SAFETY ......................................................................................... 43

1. Health and Safety ........................................................................................... 43 2. Hazardous Materials ...................................................................................... 43 3. Fire Control Measures .................................................................................... 44 4. Site Clean-Up and Remediation ..................................................................... 44 5. CBRNE Considerations .................................................................................. 44 6. Traffic Control Measures ................................................................................ 44 7. Personal Protective Equipment ...................................................................... 45 8. Responder Medical Support ........................................................................... 45 9. Law Enforcement and Security ....................................................................... 45 10. National Transportation Safety Board ........................................................... 46

Central Texas Council of Governments • Regional Mass Fatality Plan • Version 1.0 Page v January 2017 • For Official Use Only

D. TEAMS................................................................................................................. 47

1. Search and Rescue ........................................................................................ 47 2. Evidence Response Team and Scene Investigation ....................................... 47 3. Human Remains Recovery Team ................................................................... 48 4. Personal Effects Team ................................................................................... 48 5. Human Remains Transportation Team ........................................................... 48

E. BI-NATIONAL CONSIDERATIONS ............................................................................. 49

VIII. READINESS LEVELS ........................................................................................ 50

IX. ADMINISTRATION AND SUPPORT .................................................................... 51

A. SUPPORT ............................................................................................................ 51 B. REPORTING ......................................................................................................... 51 C. RECORD MAINTENANCE AND PRESERVATION ......................................................... 51 F. DEMOBILIZATION ................................................................................................... 53 G. POST-INCIDENT REVIEW ....................................................................................... 53 H. EXERCISES .......................................................................................................... 54 I. STATE AND FEDERAL ASSISTANCE ......................................................................... 54 J. PLAN MAINTENANCE .............................................................................................. 54

X. REFERENCES ....................................................................................................... 55

XI. TABS .................................................................................................................... 57

A. ANTE-MORTEM DATA COLLECTION ........................................................................ 58 1. Ante-Mortem Data Collection Guidelines ........................................................ 58

B. BIOLOGICAL CONTAMINATION SAFETY AND HANDLING RECOMMENDATIONS ............. 63 C. BURIAL PREFERENCES BY CULTURAL AND RELIGIOUS AFFILIATION .......................... 65 D. COMMUNICATIONS ............................................................................................... 67

1. Working with the Media .................................................................................. 67 2. Public Information and Messaging .................................................................. 68 3. Interoperable Communications ....................................................................... 69 4. Hardware and Technology ............................................................................. 69 5. Roles and Responsibilities ............................................................................. 70

E. DEATH NOTIFICATION ........................................................................................... 71 F. DISASTER BEHAVIORAL HEALTH SERVICES ............................................................ 73 G. FAMILY ASSISTANCE CENTER ............................................................................... 75

1. Organizational Structure ................................................................................. 76 2. Site Selection ................................................................................................. 78 3. Security .......................................................................................................... 79 4. Patron Intake .................................................................................................. 79 5. Patron Briefings .............................................................................................. 80 6. Forensic Unit .................................................................................................. 80 7. Family Management Unit ................................................................................ 82 8. Health and Human Services Unit .................................................................... 88

H. FAITH-BASED SERVICES AND OUTREACH ............................................................... 91

Central Texas Council of Governments • Regional Mass Fatality Plan • Version 1.0 Page vi January 2017 • For Official Use Only

I. HANDLING HUMAN REMAINS .................................................................................. 92 1. General .......................................................................................................... 92 2. Personal Protective Equipment ...................................................................... 94

J. HUMAN REMAINS STORAGE ................................................................................... 96 K. INCIDENT COMMAND SYSTEM ............................................................................... 98

1. Incident Command System – Overall ............................................................. 99 2. Incident Command System – Fatality Management Branch: Incident Site Group .................................................................................. 100 3. Incident Command System – Fatality Management Branch: Victim Identification Group ....................................................................... 101 4. Incident Command System – Fatality Management Branch: Morgue Group . 102 5. Incident Command System – Fatality Management Branch: Family Assistance Group ........................................................................ 103

L. INCIDENT SITE MANAGEMENT .............................................................................. 104 M. MORGUE MANAGEMENT ..................................................................................... 105

1. Introduction .................................................................................................. 105 2. Organization ................................................................................................. 105 3. General Considerations ................................................................................ 107 4. Personnel ..................................................................................................... 107 5. Documentation ............................................................................................. 107 6. Safety ........................................................................................................... 107 7. Security ........................................................................................................ 108 8. Temporary Morgue ....................................................................................... 108 9. Morgue Protocols ......................................................................................... 108 10. Common Tissue.......................................................................................... 108 11. Known Decedents ....................................................................................... 109 12. Work Flow................................................................................................... 109 13. Repatriation ................................................................................................ 110 14. Admitting / Processing Unit ......................................................................... 110 15. Forensic Unit .............................................................................................. 115

N. ORGANIZATIONAL CHARTS .................................................................................. 120 O. VICTIM IDENTIFICATION ....................................................................................... 121

1. Scientific Vs. Presumptive Identification ....................................................... 121 2. Identification Process ................................................................................... 121 3. Open versus Closed Victim Populations ....................................................... 121 4. Victim Identification Team ............................................................................ 122 5. Postmortem Data Management Team .......................................................... 124 6. Postmortem Records Collection Team ......................................................... 124 7. Data Analysis Team ..................................................................................... 124 8. Quality Assurance Team .............................................................................. 124

P. SAMPLE FORMS .................................................................................................. 125 1. Family Assistance Center Family and Friend Registration Form ................... 126 2. Missing Persons Call Intake Form ................................................................ 131 3. Personal Effects Release Form .................................................................... 133 4. Records Requested Log Form...................................................................... 134 5. Remains Release Authorization Form .......................................................... 135 6. Secondary Services Referral Form ............................................................... 136

Central Texas Council of Governments • Regional Mass Fatality Plan • Version 1.0 Page vii January 2017 • For Official Use Only

List of Figures

FIGURE 1: STANDARD PROCESS FOR MANAGING HUMAN REMAINS DURING A MASS FATALITY

INCIDENT ................................................................................................................ 17 FIGURE 2: PROCESS FOR ACTIVATING THE CENTRAL TEXAS COUNCIL OF GOVERNMENTS

REGIONAL MASS FATALITY MANAGEMENT PLAN .......................................................... 23 FIGURE 3: SAMPLE INCIDENT COMMAND STRUCTURE TO SUPPORT MASS FATALITY

MANAGEMENT OPERATIONS ...................................................................................... 25 FIGURE 4: SAMPLE INCIDENT COMMAND STRUCTURE TO SUPPORT MASS FATALITY

MANAGEMENT OPERATIONS ...................................................................................... 77 FIGURE 5: EXAMPLE SITE SET-UP FOR THE FAMILY ASSISTANCE CENTER ............................ 78 FIGURE 6: SAMPLE PATRON INTAKE FLOW CHART TO MANAGE ADMITTANCE TO THE FAMILY

ASSISTANCE CENTER ............................................................................................... 79 FIGURE 7: SAMPLE CALL INTAKE PROCESS FLOWCHART .................................................... 85 FIGURE 8: SAMPLE INCIDENT COMMAND STRUCTURE DEPICTING OPERATIONS TO SUPPORT A

MASS FATALITY INCIDENT ......................................................................................... 99 FIGURE 9: SAMPLE INCIDENT COMMAND STRUCTURE DEPICTING OPERATIONS TO SUPPORT

THE MASS FATALITY BRANCH, INCIDENT SITE GROUP ................................................ 100 FIGURE 10: SAMPLE INCIDENT COMMAND STRUCTURE DEPICTING OPERATIONS TO SUPPORT

THE MASS FATALITY BRANCH, VICTIM IDENTIFICATION GROUP ................................... 101 FIGURE 11: SAMPLE INCIDENT COMMAND STRUCTURE DEPICTING OPERATIONS TO SUPPORT

THE MASS FATALITY BRANCH, MORGUE SERVICES GROUP ........................................ 102 FIGURE 12: SAMPLE INCIDENT COMMAND STRUCTURE DEPICTING OPERATIONS TO SUPPORT

THE MASS FATALITY BRANCH, FAMILY ASSISTANCE GROUP ....................................... 103 FIGURE 13: SAMPLE INCIDENT COMMAND SYSTEM STRUCTURE TO SUPPORT MORGUE

MANAGEMENT ACTIVITIES DURING A MASS FATALITY EVENT ...................................... 106 FIGURE 14: MORGUE OPERATIONS FLOWCHART ............................................................. 110 FIGURE 15: SAMPLE INCIDENT COMMAND STRUCTURE FOR THE VICTIM IDENTIFICATION

GROUP ................................................................................................................. 123

Central Texas Council of Governments • Regional Mass Fatality Plan • Version 1.0 Page viii January 2017 • For Official Use Only

List of Tables

TABLE 1: REGIONAL MASS FATALITY MANAGEMENT PLAN CHANGE DOCUMENTATION TABLE ... III TABLE 2: WORDS AND DEFINITIONS AS APPLIED IN THIS CENTRAL TEXAS COUNCIL OF

GOVERNMENTS REGIONAL MASS FATALITY PLAN .......................................................... 8 TABLE 3: ROLES AND RESPONSIBILITIES OF AGENCIES, ORGANIZATIONS, AND INDIVIDUALS

DURING THE FOUR PHASES OF MANAGING A MASS FATALITY INCIDENT ......................... 26 TABLE 4: MASS FATALITY INCIDENT MANAGEMENT ACTIVITIES BY READINESS LEVEL ............ 50 TABLE 5: EXAMPLES OF DOCUMENTS TO BE PRESERVED DURING A MASS FATALITY INCIDENT

.............................................................................................................................. 52 TABLE 6: SAFETY AND HANDLING RECOMMENDATIONS FOR SELECT BIOLOGICAL

CONTAMINANTS ....................................................................................................... 63 TABLE 7: BURIAL PREFERENCES BASED ON CULTURAL AND RELIGIOUS AFFILIATION ............. 65 TABLE 8: INFORMATION TO HELP GAUGE CAPACITY ESTIMATES FOR SITE SELECTION AND

DEVELOPING A FAMILY ASSISTANCE CENTER .............................................................. 76 TABLE 9: CATEGORIES OF POTENTIAL CALLS AND EXAMPLE RESPONSES AND NEXT STEPS ... 82 TABLE 10: MENTAL HEALTH AND SPIRITUAL CARE SERVICES TYPICALLY PROVIDED AT A FAMILY

ASSISTANCE CENTER ............................................................................................... 89

List of Appendices

APPENDIX 1: AGENCY COORDINATION………………………………………………….139

APPENDIX 2: FAMILY ASSISTANCE CENTER STAFFING NEEDS………………………….144

APPENDIX 3: JUSTICE OF PEACE PRECINCTS…………………………………………….145

APPENDIX 4: BEHAVIORAL HEALTH…………………………………………………….152

APPENDIX 5: LOCAL RESOURCES…………………………………………………….….153

APPENDIX 6: FUNERAL HOME CAPABILITIES AND CONTACT INFORMATION…………….154

APPENDIX 7: MEDICAL EXAMINER CONTACT INFORMATION……………………………159

APPENDIX 8: TEXAS DISASTER MORTALITY STRIKE TEAM……………………………...160

APPENDIX 9: MOBILE MORGUE REQUEST PROCESS……………………………………..162

Central Texas Council of Governments • Regional Mass Fatality Plan • Version 1.0 Page 1 January 2017 • For Official Use Only

I. Authority

A. Federal

1. Aviation Disaster Family Assistance Act of 1996 2. Foreign Air Carrier Family Support Act of 1997 3. Health Insurance Portability and Accountability Act of 1996 4. National Response Framework (NRF), Emergency Support Function 8

(ESF-8) 5. Rail Passenger Disaster Family Assistance Act of 2008

B. State

1. Code of Criminal Procedure. Chapter 49. Inquests upon Dead Bodies. Subchapter B, 49.25 Duties performed by Medical Examiners.

2. Emergency Management Plan, Basic Plan, Section 1, and Annex H. 3. Family Code, Chapter 264 4. Health and Safety Code, Chapter 121. Local Public Health

Reorganization Act, Subchapter B. Health Authorities. 5. Health and Safety Code, Chapter 161. Public Health Provisions,

Subchapter A. Immunizations. Section 161.00705 Recording Administration of Immunization and Medication for Disasters and Emergencies.

6. Health and Safety Code, Chapter 81. Communicable Diseases. 7. Health and Safety Code, Chapter 193. Death Records: Section 193.010

Certificate of Death by Catastrophe. 8. Health and Safety Code, Chapter 671. Determination of Death and

Autopsy Reports. 9. Health and Safety Code, Chapter 694. Burial. 10. Health and Safety Code, Chapter 695. In-Casket Identification. 11. Health and Safety Code, Chapter 711. General Provisions Relating to

Cemeteries. 12. Health and Safety Code, Chapter 713. Local Regulation of Cemeteries. 13. Health and Safety Code, Chapter 714. Miscellaneous Provisions

Relating to Cemeteries. 14. Health and Safety Code, Chapter 716. Crematories. 15. Occupations Code. Subtitle L, Chapter 651. Cemetery and Crematory

Services, Funeral Direction and Embalming.

C. Local

Applicable local rules as authorized by state and local regulations


D. Health Insurance Portability and Accountability Act

The Health Insurance Portability and Accountability Act (HIPAA) privacy rule establishes national standards to protect individuals’ medical records and other personal health information. The privacy act applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically. The rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. The rule also gives patients’ rights over their health information, including rights to examine and obtain a copy of their health records, and to request corrections.” This rule is not suspended during an emergency response. HIPAA rules only apply to covered entities and business associates of covered entities. A covered entity is one of the following:

1. A health care provider includes but is not limited to physicians, clinics, psychologists, dentists, chiropractors, nursing home, and pharmacies if they transmit any information in an electronic form in connection with a transaction for which the US Health and Human Services has adopted a standard.

2. A health plan, including health insurance companies, health maintenance organizations, company health plans, and government programs that pay for health care as Medicare, Medicaid, Veterans health care, and the military.

3. A health care clearinghouse entity that processes nonstandard health

information they receive from another entity into a standard or vice versa. The following should be noted about the privacy rule:

1. Once an individual is deceased, HIPAA no longer applies and medical information may be released as part of the medico-legal inquest as soon as possible.

2. Providers can share information during emergencies in order to identify, locate, and notify family members, guardians, or anyone else responsible for the individual’s care, including the individual’s location, general condition or notification of death.

3. Providers are permitted to share information to disaster relief organizations without obtaining the patient’s permission if obtaining such


permission would interfere with the organization’s ability to respond to the emergency.

4. Disaster relief organizations are not covered by the HIPAA privacy rule and can therefore share patient information if necessary.

5. A covered entity may disclose protected health information to a coroner or medical examiner for purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law. A covered entity that also performs the duties of a coroner or medical examiner may use protected health information for these purposes.

6. A covered entity may disclose protected health information to funeral directors consistent with applicable law as necessary to carry out their duties. If necessary for funeral directors to carry out their duties, disclosure may occur prior to and in reasonable anticipation of the individual’s death.

7. A covered entity may use or disclose protected health information without the written authorization of the individual for public health activities and for uses and disclosers for health oversight activities

For additional information on “Uses and Disclosures for which an authorization or opportunity to agree or object is not required” please see 45 CFR, Chapter §164.512. Additional information can also be obtained from www.hhs.gov/ocr/privacy/hipaa.

http://www.hhs.gov/ocr/privacy/hipaa


II. Purpose, Objectives, and Scope

A. Purpose

This plan was developed to coordinate the response between and among jurisdictions in the seven county CTCOG area to support emergency response operations for a mass fatality incident requiring a regional response. This plan does not supersede existing local, city, or county mass fatality management plans. This document is not intended to be a standard operating procedure; rather it is intended to provide operational guidance to entities involved in the response.

B. Objectives

The primary objectives of this plan are to:

1. Provide a uniform, comprehensive response to a mass fatality incident 2. Recover and identify victims in a safe, timely, and dignified manner 3. Respect religious and cultural traditions of victims 4. Treat family members with respect and dignity 5. Provide assistance to family members to cope with the tragedy 6. Support law enforcement activities related to the incident

C. Scope

An incident resulting in fatalities that exceeds the capacity of responding entities will be designated as a mass fatality incident and will serve as grounds to request the activation of this plan.

1. Plan activation is not based solely on the number of fatalities. Other considerations include:

i. Condition of remains ii. Accessibility of the scene iii. Complexity of recovery iv. Resources available to support the response

2. Plan activiation is dependent on the above referenced considerations and

the immediacy of need as identified by the mass fatality incident.

3. The primary audience for this plan is governmental, private sector, and non-governmental organizations in the seven county CTCOG region


III. Explanation of Terms

A. Acronyms and Abbreviations

The following acronyms and abbreviations may be used in this document.

Acronym or

Abbreviation

Defined Term

AAR After Action Review

ABMDI American Board of Medico-legal Death Investigators

ADA Americans with Disabilities Act of 1990

AED Automated External Defibrillator

AM Ante-mortem

ANSI American National Standards Institute

ARC American Red Cross

ATF Bureau of Alcohol, Tobacco, Firearms, and Explosives

BCP Body Collection Point

BNE Board of Nurse Examiners

BSL Bio-Safety Level

CAR Commissioner’s Authorized Representatives

CBRNE Chemical, Biological, Radiological, Nuclear and High-Yield Explosives

CEMP Comprehensive Emergency Management Plan

CERT Community Emergency Response Teams

CISM Critical Incident Stress Management

COOP Continuity of Operations

CSI Crime Scene Investigator

CTCOG Central Texas Council of Governments

DECON Decontamination

DEXIS Digital X-ray Imaging System

DFPS Department of Family & Protective Services

DHS Department of Homeland Security

DMAT Disaster Medical Assistance Team (National Disaster Medical System Team)

DMORT Disaster Mortuary Operational Response Team

DNA Deoxyribonucleic Acid

DoD Department of Defense

DPMU Disaster Portable Mortuary Unit

DPS Department of Public Safety

DSHS Department of State Health Services, Texas

DVR Deceased Victim Record

EMC Emergency Management Coordinator

EMS Emergency Medical Service

EMT Emergency Medical Technician


Acronym or

Abbreviation

Defined Term

EOC Emergency Operations Center

EOP Emergency Operations Plan

ERT Evidence Response Team

ESF-8 Emergency Support Function-8

FAC Family Assistance Center

FBI Federal Bureau of Investigation

FEMA Federal Emergency Management Agency

FM Fatalities Management

FOG Field Operating Guides

FOUO For Official Use Only

FSRT Fatality Search and Recovery Team

GPS Global Positioning System

HAZMAT Hazardous Materials

HHS Health and Human Services, U.S.

HHSC Health and Human Services Commission, Texas

HIPAA Health Insurance Portability and Accountability Act

HIV Human Immunodeficiency Virus

HR Human Remains

HVA Hazard Vulnerability Assessment

HVAC Heating, Ventilation, and Air Conditioning

IAP Incident Action Plan

IC Incident Command or Incident Commander

ICE Immigration and Customs Enforcement

ICP Incident Command Post

ICS Incident Command System

IP Infection Preventionist

IRCT Incident Response Coordination Team (NDMS management team)

IT Information Technology

JFO Joint Field Office

JIC Joint Information Center

JIS Joint Information System

JP Justice of the Peace

LE Law Enforcement

MA Mortuary Affairs

MACC Multi-Agency Coordination Center

ME/C Medical Examiner / Coroner

MFI Mass Fatality Incident

MFMP Mass Fatality Management Plan

MLI Medico-Legal Investigator

MOU Memorandum of Understanding

NDMS National Disaster Medical System


Acronym or

Abbreviation

Defined Term

NGB National Guard Bureau

NGO Non-Governmental Organization

NIMS National Incident Management System

NOK Next of Kin

NPO Non-Profit Organization

NRF National Response Framework

NTSB National Transportation Safety Board

OCME Office of the Chief Medical Examiner

OEM Office of Emergency Management

OME Office of the Medical Examiner

OSHA Occupational Safety and Health Administration, U.S.

PD Police Department

PE Personal Effects

PHIN Public Health Information Network

PIO Public Information Officer

PM Postmortem

PPE Personal Protection Equipment

RRT Regional Response Team

SAR Search and Rescue

SME Subject Matter Experts

SNS Strategic National Stockpile

SOG Standard Operating Guideline

SOP Standard Operating Procedure

STAR State of Texas Assistance Request

TAHC Texas Animal Health Commissioner

TCEQ Texas Commission on Environmental Quality

TDCJ Texas Department of Criminal Justice

TDEM Texas Department of Emergency Management

TER Texas Electronic Registrar

TFDA Texas Funeral Directors Association

TMF Texas Military Forces

TSA Texas Salvation Army

TX Texas

TxDOT Texas Department of Transportation

TXVOAD Texas Voluntary Organizations Active in Disaster

UVIS Unified Victim Identification System

VIP Victim Identification Program

VMRT Veterinary Medical Response Team (National Disaster Medical System

team)

WMD Weapons of Mass Destruction


B. Definitions

A mass fatality incident is any situation where more deaths occur than can be handled by local medico-legal resources. There is no minimum number of deaths for an incident to be considered a mass fatality incident because communities vary in size and resources. Table 2 identifies words and definitions as applied in this document.

Table 2: Words and definitions as applied in this Central Texas Council of Governments regional mass fatality plan

Word(s) Definition Ante-mortem Prior to death

Casualty A person who is injured but does not die in a mass fatality incident

Cause of Death A formal medical opinion by an attending physician or the medico-legal authority (jurisdictional Justice of the Peace) of the internal medical condition and/or external incident or chain of incidents that resulted in death

Direct Reference A DNA sample obtained from the deceased or their personal effects used for comparison with other DNA samples in laboratory identification procedures

Disaster Medical Assistance Team (DMAT)

A program of the National Disaster Medical System (see below), a team of volunteer medical professionals and support personnel equipped with deployable equipment and supplies that can move quickly to a disaster area and provide emergent or definitive medical care

Disaster Mortuary Operational Response Team (DMORT)

A program of the National Disaster Medical System (see below). A team of mortuary service and medico-legal and forensic personnel to include Forensic Pathologists, Medico-legal Investigators (MLI) and funeral directors/embalmers who provide mortuary and victim identification services following major disasters

Emergency/Disaster Declarations

Official emergency declarations made by specified elected officials at the local, state, or federal level authorizing the use of equipment, supplies, personnel, and resources as may be necessary to cope with a disaster or emergency. Formal declarations are made when the incident requires more assets and resources than exist within the jurisdiction

Family Assistance Center (FAC)

The designated location/facility established to exchange accurate, timely information render support services for victim family members of mass fatalities and friends who travel to the incident location

Family Reference A DNA sample taken from a biological relative (only one generation removed) or a spouse of the deceased used for comparison with other DNA samples in laboratory identification procedures. Also referred to as indirect references

Fatality A person who dies as a direct or indirect result of a mass fatality incident (interchangeable with victim, decedent)

Fatality Management The process of locating, recovering, processing, identifying, and releasing for final disposition deceased victims of a mass fatality incident


Word(s) Definition Final Disposition of Human Remains

The concluding arrangement for the remains of the decedent, a decision of the next of kin. Options include burial, entombment, cremation, or donation

Functional Needs Individuals/Groups

Includes the elderly, medically fragile, mentally and/or physically challenged or handicapped, individuals with mental illness, and the developmentally delayed. These groups may need specially trained health care providers to care for them, special facilities equipped to meet their needs, and require specialized vehicles and equipment for transport. This population requires specialized assistance in meeting daily needs and may need special assistance during emergency situations

Human Remains (HR) A deceased body, whole or fragmented parts

Incident Command System (ICS)

A prescribed method of command, control, and coordination within the National Incident Management System (NIMS) to provide a common organizational structure designed to aid in the management of facilities, equipment, personnel, supplies, and information

Justice of the Peace (JP) An elected county official whose duties include serving as the medico-legal authority in counties that do not maintain an Office of the Medical Examiner

Just-in-Time Training (JIT)

Instruction provided to capable individuals with general skills enabling them to perform task-specific functions immediately following the instruction

Manner of Death A classification of the fashion or circumstances that resulted in death (homicide, suicide, accidental, natural, or undetermined)

Mass Burial A large plot of land used for burying multiple victims in partitioned, marked graves

Mass Fatality Incident (MFI)

Any incident that results in more fatalities than a local jurisdiction can adequately manage, whether natural or man-made, accidental or intentional

Mass Grave A common grave containing multiple, usually unidentified human corpses

Mass Interment Burial of large numbers of identified or unidentified bodies

Medical Countermeasures (MCM)

Medications including vaccines, antiviral drugs, antibiotics, antitoxin, etc., used in support of treatment or prophylaxis (oral or vaccination) to the identified population in accordance with public health guidelines and/or recommendations

Medico-legal Of or pertaining to law as affected by medical facts

Medico-legal Authority The local authority assigned to conduct medico-legal death investigations. This responsibility is usually assigned to the Justice of the Peace in the jurisdiction where the death occurred. If the cause of death is unknown, then the County Contracted Pathologist will be tasked to conduct the medico-legal death investigations

Missing Person Those persons whose whereabouts are unknown to family or friends following an incident

Morgue The facility location where decedents undergo external and internal physical examinations. Also may refer to where human remains are


Word(s) Definition kept prior to release to a funeral home or family

Mortuary Affairs A term synonymous with fatality management, generally referring to the provision of necessary care and disposition of missing and decedent persons, including their personal effects. Commonly refers to Department of Defense assets

National Disaster Medical System (NDMS)

A nation-wide mutual aid network consisting of federal agencies, businesses, and other organizations that coordinates disaster medical response, patient evacuation, and definitive medical care. At the federal level, it is a partnership between Department of Health and Human Services, the Department of Defense, the Department of Veterans Affairs, and FEMA. Non-federal participants include major pharmaceutical companies and hospital suppliers, the national Foundation for Mortuary Care, and certain international disaster response and health organizations

National Transportation Safety Board (NTSB)

An independent Federal agency charged by Congress with the authority for investigating all public transportation fatalities including civil aviation, railroad, highway, marine, and pipeline accidents in the United State. In the absence of suspected criminal activity, NTSB is the lead investigative agency for transportation incidents. The Aviation Disaster Family Assistance Act of 1996 mandates transportation carriers meet the needs of aviation disaster victims and their families. These needs include victim identification, providing a Family Assistance Center, and crisis counseling

Next-of-Kin (NOK) Immediate family members including: parents, spouses, siblings, and children. In order, per Texas Health and Safety Code 711.002: Person previously designated in writing by the decedent

Spouse

Children

Parent (if minor child, or adult with no children)

Siblings

Any adult person who in the next degree of kinship in the order named by law to inherit the estate of the decedent

Non-Governmental Organization (NGO)

Independent organizations free from government control

Non-Profit Organization A business or enterprise that does not distribute its surplus funds to owners or shareholders, but instead uses them to help pursue its goals

Patrons Family members and close friends that visit and have access to the Family Assistance Center

Personal Effects (PE) Belongings of an individual including clothing, clothing accessories, jewelry, and other property on their person or otherwise in their possession

Public Health Information Network (PHIN)

Online portal containing a collection of applications, such as the Health Alert Network and Document Sharing, which provide users with a range of functions to carry out public health preparedness goals and duties. Examples of these functions include call down


Word(s) Definition

and alerting, bio‐surveillance tools and communication systems designed to enhance collaboration between public health preparedness stakeholders

Postmortem (PM) After death

Situational Orphan

A child, due to circumstances of a MFI, that has been involuntarily separated or otherwise detached or displaced from their immediate family, relatives, or designated caregivers. The child may, or may not, have actually been orphaned as a result of the MFI.

Spontaneous Unaffiliated Volunteers

An individual, not associated with any recognized disaster response agency, who may or may not have special skills, knowledge, or experience, but who appears, unsolicited, at an incident to render assistance

Strategic National Stockpile (SNS)

The SNS is a national repository of antibiotics, chemical antidotes, antitoxins, life-support medications, IV administration, airway maintenance supplies, and medical/surgical items. The SNS is designed to supplement and re-supply state and local public health agencies in the event of a national emergency anywhere and at any time within the U.S. or its territories

Survivor Anyone who is exposed to or otherwise encounters a mass fatality incident that does not perish as a result of the incident

Temporary Interment A location where decedents are interred underground in individually marked spaces that may or may not become the final disposition location for some decedents

Temporary Morgue Ad hoc morgue operations established specifically to process, identify and store human remains resulting from a mass fatality incident

Victim A person who dies as a result of a mass fatality incident (interchangeable with fatality, decedent)

Victim Identification Program

A disaster management computer software program designed to collect personal information of known and unknown individuals, and then conduct comparative analysis to suggest best probable matches or exclusions of ante- and postmortem information to aid in identification processes of unidentified individuals. Designed by DMORT, this program is free


IV. Situations and Assumptions

A. Situations

1. Mass fatality incidents may occur anywhere within the seven county CTCOG region as the result of a catastrophic disaster or public health emergency, and may be natural, accidental, or intentional in origin. Examples of a mass fatality incident may include:

a. Mass fatality incidents as a result of an infectious disease outbreak fall under the jurisdiction of the local health authority and are to be investigated by the local health authority. In such cases, the attending physician and / or medico legal authority signs the death certificate. Such deaths are reportable conditions under state law and should be reported to the appropriate local or state health agency.

b. Intentionally-caused disease outbreaks resulting in death (mass or otherwise) will be a joint investigation of local, state, and federal health and law enforcement officials, as appropriate to the incident. Results of such an investigation will be used to certify death by the appropriate medico-legal authority for the county in which the death(s) occurred.

2. In certain instances, (e.g., a prolonged hospital stay) the medical provider

may elect not to contact the Medico-legal Authority instead using medical records of the deceased to certify the death as to cause and manner.

3. During an emergency, the governor, county judge, or other appropriate

authority may suspend procedural laws and rules related to the pronouncement, certification, and registration of deaths. The data and biometric identifiers necessary for accomplishing such procedures should still be methodically and appropriately collected and stored to fulfill the intent and requirements of said laws and rules.

4. Texas law requires that every human death be officially pronounced, certified, and registered by appropriately licensed professionals prior to the final disposition of remains. Death certification involves determining the cause and manner of death.

a. Natural deaths may be certified by licensed treating or primary

care physicians


b. Deaths of unidentified individuals, children under the age of six

years, and unnatural deaths fall under the jurisdiction of the local medico-legal authority. Such deaths must be reported to the local medico-legal authority as soon as possible and prior to movement of the body, notwithstanding rescue and resuscitative efforts.

5. The scope of a medico-legal death investigation, although somewhat

variable, generally includes investigation of the scene of the death, collection of evidence, external examination of the body, an autopsy, tests of body tissues or fluids, and death certificate completion. The local medico-legal authority in the jurisdiction where the death(s) occurred determines the scope of the investigation.

6. The State of Texas has a mixed medico-legal system for the investigation of deaths from trauma, suspicious nature or unknown cause and/or manner.

7. Each county within the CTCOG area will have identified the medico-legal authority responsible for death investigations.

a. Bell County: Justice of the Peace b. Coryell County: Justice of the Peace c. Hamilton County: Justice of the Peace d. Lampasas County: Justice of the Peace e. Milam County: Justice of the Peace f. Mills County: Justice of the Peace g. San Saba County: Justice of the Peace

8. Medical determination of cause of death can take months to complete

depending on the steps needed to achieve identification of the decedent and/or the laboratory tests needed for completion of an autopsy, which can be either case-dependent or capacity-driven.

9. Deaths are investigated for both law enforcement and public health purposes.

10. While death registration requires the determination of cause and manner of death, it is possible to secure an interim death certificate that states the cause of death is pending. Interim death certificates allow progress towards the final disposition of human remains of identified decedents.


11. Persons handling human remains will be at risk of blood borne or body fluid exposure requiring universal precautions, personal protective equipment (PPE), and proper training for handling the dead.

12. Media interest will be high in an event involving mass fatalities. Plans and procedures covering media access and management should be developed to support communication needs and privacy concerns.

13. Each of the participating jurisdictions in this plan has a local emergency management plan and annex to support mass fatality planning, response, and recovery.


B. Assumptions

This plan includes the following assumptions.

1. Disasters or events that result in mass fatalities have the potential to quickly exceed local jurisdictional resources. Local jurisdictions that are overwhelmed will likely seek assistance at the regional and/or state level.

2. Family members and close friends of victims will require a secure location to give and receive accurate, timely and credible information.

3. Families will seek quick identification and release of family members;

expectations for identification must be managed early in the response.

4. Family member and friends will make large number of inquiries to authorities regarding their loved ones. The volume of inquiries will be exponential to the number of victims (approximately 100 times).

5. Family Assistance Center operations for disasters involving aviation accidents (but not military or intelligence agency-related), selected rail, highway, marine, pipeline or hazardous material accidents will be the responsibility of the National Transportation Safety Board (NTSB) to coordinate. Local jurisdictional resources will still be needed to assist with family assistance center staffing and operation.

6. It may take a considerable length of time to recover, identify and determine the cause and manner of death of the decedents depending on incident type and complexity.

7. The process for victim identification is a lengthy scientific process that

requires great accuracy and attention to detail in order to correctly identify the victim.

8. An infectious disease pandemic may take longer to resolve and may

require extensive interim in-the-ground interment of human remains.

9. A mass fatality event may be the result of exposure to chemical, biological, radiological, nuclear, or explosive agents (CBRNE).

10. Specialized assets to assist with decontamination of victims of exposure to chemicals, radiological or biological agents may be required.


11. Incidents resulting from an act of terrorism will involve the Federal Bureau of Investigation (FBI) as the lead investigative agency and will require close cooperation and coordination with local authorities.

12. Special precautions may need to be taken during episodes of civil unrest.

13. Cultural and spiritual concerns should be considered by all entities

involved in a mass fatality incident.

14. During the incident, county medico-legal authorities and mortuary service providers will continue to experience normal caseloads, in addition to demands due to the mass fatality incident.

15. Public education during and after a mass fatality event will prove beneficial

in calming the fear and anxiety of relatives and the community.

16. An information management system will be an important component of mass fatality management. The system should have the capacity to track the movement and storage of the deceased (including individual body parts), and manage data needed to support identification and cause of death. The system should link to other systems used to collect information from the public on missing persons.

17. Response to the incident may be hindered by incidents secondary to the

original incident, unrelated incidents or the failure of critical infrastructure.

18. A mass fatality incident response will require coordination with local civil agencies and non-governmental organizations.

19. The local jurisdiction medico-legal authority retains control and authority over fatality management, even when regional, state, or federal assets support the response.

20. Mass fatality incidents will draw attention from media and curious bystanders.

21. Catastrophic incidents will likely implement alternate standards of death

care (e.g., temporary internment) regarding the processing and identification of victims.

22. Public evaluation of the government’s ability to effectively manage the

disaster is often based on a few key factors, including the appropriate management of victims and their families.


V. Concept of Operations

A. General

This section provides an overview of how mass fatality management operations will occur.

B. Plan Activation: Process

The overall goals of mass fatality management are to (1) recover, identify, and effect final disposition of human remains in a dignified and respectful manner; (2) preserve the scene and collect evidence, as appropriate; and (3) provide family assistance to victims’ relatives and loved ones. A standard process for managing human remains will be used during a mass fatality incident operation. Figure 1 presents this standard process. Figure 1: Standard process for managing human remains during a mass fatality incident

© 2014 • The Litaker Group LLC • All Rights Reserved Draft Document • Not for Release or Distribution

5

LRGVDC Mass Fatality Plan Standard Process for Managing Human Remains

1. Incident Notification

2. Scene Evaluation and Organization

3. Recovery of Remains

4. Holding Morgue 5. Transportation of

Remains 6. Morgue Operations

7. Transportation to Final Resting Place

8. Final Disposition of Remains


C. Plan Activation: Potential Activities to Undertake

In response to a mass fatality incident the following potential activities may occur as part of the response, however, specific activities will be based on the needs relevant to that event.

I. Receipt of mass fatality event notification II. Informational and material coordination to include

a. Situational briefing i. Cause of event ii. Evolution of event iii. Nature of scene (known risks and PPE requirements,

contamination, terrain, local conditions, buildings) iv. Number of suspected dead v. Parallel scene activity (injured at scene, search and

rescue, weather impacts on response) vi. Responders on scene and local authorities vii. Local contact information, especially for local response

coordinators b. Preliminary assessment of communication needs for field work

support (e.g., specific community equipment needs, communications kits, communications trailer) and equipment to take on-scene

c. Acquisition of additional death management materials and equipment (possibly including hand held scanners for use of patient tracking system)

III. Arrival on scene a. Report to local officials in charge of the scene obtaining briefing

information and access to the response area b. Establish communication link with responding agencies and

organizations IV. Situation briefing from local coroner and law enforcement and

assessment of field response resources required V. Identify partners

a. Local (e.g., coroner, law enforcement, fire and rescue services, EMS, local incident command, hospitals, hospital preparedness programs)

b. State (e.g., human service agencies, law enforcement) c. Federal and international (e.g., FBI, Bureau of Indian Affairs,

State Department) d. Other partners (e.g., American Red Cross) e. See local plans for county specific contact information

VI. Staffing


a. Identify staffing needs beyond that available in the field b. Staff acquisition c. Implement command structure d. Team assignment and staff schedule e. Setting of daily operational periods (usually 8-12 hours) f. Setting objectives

VII. Initial assessment of scene a. Scene access and security b. Risk assessment and safety (chemical, radiological, biological,

site stability) and nature of scene (natural, man-made, intentional)

c. Number, condition and accessibility of dead VIII. Resource need assessment;

a. Additional involvement and jurisdictional control (e.g., FBI, search and rescue)

b. Material and personnel resource needs i. Storage for remains at temporary and incident morgue

sites ii. Room or body cooling systems iii. Additional quantities of body bags, tags iv. PPE, office equipment, additional communications

equipment, stretchers, vehicles v. Resource material storage and security

c. Assess need for incident morgue distinct from state morgue d. Training needs for mobilized personnel e. Adequate rehydration for staff f. Mental health resource needs for personnel

IX. Consider early establishment of family assistance center and delegation of task

X. Scene coordination a. Task identification and assignments b. Timeline assessment c. Evidence collection procedures d. Records management system e. Office site setup/IT

XI. Assessment of longer term storage needs a. Bodies b. Personal effects c. Documentation

XII. Setup of temporary and/or permanent morgue location a. Site identification b. Assignment of personnel c. Loading-unloading area


d. Check-in and documentation area e. Body storage f. Personal effects storage g. Setup and use of cooling system if indicated h. Security

XIII. Establish morgue procedures to account for: a. Separate process for completion of routine cases b. Routine procedures (small number of remains) versus multi-

station setup (large number of remains) c. Mass fatality processing

i. Triage ii. Personal effects iii. Identification and forensic evidence collection

(photography, radiography, fingerprint, odontology, autopsy/pathology)

iv. Embalming v. Documentation

d. Consider need to contact and/or request the Texas Funeral Directors Association DMORT

XIV. Death scene task completion a. Initial death scene investigation and documentation, including

scene layout b. Coordination of remains recovery (e.g., documentation,

evidence preservation) c. Preliminary examination of the remains and collection of

forensic evidence (e.g., labeling body with date, time, location, identifiers, means of identification, investigator, presence of known contamination)

d. Identification tagging of remains including fragments e. Placement of remains in body bags and labeling of body bags f. Bagging and labeling of personal effects unassociated with a

body g. Transport of remains to temporary morgue

XV. Establish or modify incident morgue procedures XVI. Interaction with families

XVII. Disposition of remains


D. Plan Activation: Criteria

Activation of this plan is dependent on multiple criteria. As such, activation will be based on indicators1, triggers2, and circumstances related to the mass fatality incident itself. It should be noted that any decision to activate the plan would have considered the availability and use of local jurisdictional resources in the first instance. A mass fatality event consistent when one or more of the following measures may indicate activation of this plan.

1. A mass fatality incident that exceeds or is likely to exceed the resources available within the original jurisdiction including situations in which there are more fatalities and remains than can be recovered and / or examined by the local jurisdiction

2. A mass fatality incident involving a protracted and / or complex recovery

operation

3. A mass fatality incident involving remains contaminated by chemical, biological, radiological, nuclear, or explosive agents or materials.

4. A mass fatality incident requiring multi-agency or regional response efforts

to support a mass fatality management operation

E. Plan Activation: Decision-Making

This plan can be activated pending discussion and approval by any of the following:

Chief Elected Official

Emergency Management Coordinator

Public health administrator

Medico-legal Authority for the jurisdiction incurring the mass fatality incident

1 As defined by the Institute of Medicine, indicators are measures or predictors of a change in health care demand across the disaster continuum of care (e.g., from conventional care to contingency care or from contingency care to crisis care). Indicators may include data, measurement, events, or actions that indicate demand is changing or is likely to change. 2 As defined by the Institute of Medicine, triggers are specific decision points that guide operational decisions based on changes in the availability of resources.


The process for activation includes the following steps in accordance with already established procedures and is summarized in Figure 2.

1. The local jurisdiction (e.g., city or town) responds to a potential mass fatality event

2. Should additional resources be needed, the local jurisdiction would activate mutual aid agreements or contact the county office of emergency management, as dictated by local plans

3. If additional resources are still required, the local jurisdiction would notify

the county office of emergency management

4. The county office of emergency management would determine if additional resources are available within the county, and if so, request such resources, based on the county specific mass fatality plan

5. At such time that the county where the incident occurred is believed to be

or likely to be overwhelmed by resource requests, this plan can be activated

6. Once county level resources have been exhausted, the regional mass

fatality plan will be activated

7. Further assistance may be requested using the State of Texas request process

Central Texas Council of Governments • Regional Mass Fatality Plan • Version 1.0 Page 23 October 10, 2016 • For Official Use Only

Figure 2: Process for activating the Central Texas Council of Governments regional mass fatality management plan


7

Activation and Flow of Information and Resources Process for Requesting Resources

1. Incident Command

Post

2. Affected City EOC asked to fulfill request

3. Affected County

EOC asked to fulfill request

4. MACC asked to fulfill

request locally

5. Disaster District Committee asked to

fulfill request

6. State Operations

Center asked to fulfill request

Request unable to be fulfilled by affected city EOC

Request unable to be fulfilled by affected county EOC

Request unable to be fulfilled by multi-agency

coordinating center

4a. Unaffected County EOC

Request unable to be fulfilled by the

disaster district committee

4b. Unaffected City EOC

4c. Other Local Resources

EOC: Emergency Operations Center

MACC: Multi-Agency Coordination Center

The regional

mass fatality

plan can be

implemented

in box 3, 4,

4a, 4b, or 4c


VI. Organizational and Assignment of Responsibilities

A. General

Responding to a mass fatality incident will involve multiple response partners; no single entity is able to manage the complexity of such an event by itself. Within the response framework, each entity will have specific roles and responsibilities. This section outlines roles and responsibilities for different entities and provides and overview of the Incident Command System (ICS) for mass fatality management operations. More details of the ICS structure for mass fatality management operations are located in Tab K: Incident Command System.

B. Organizational Structure

Tasks associated with incident site management fall within the responsibilities of the Operations Section chief within the Incident Command System. Branch directors with site responsibilities include Fire, Search and Rescue, Law Enforcement, and Fatality Management. Activation of this plan in the seven county CTCOG region will utilize the National Incident Management System (NIMS) guidelines, including activation of the regional incident management team. The following five functional sections will support activation activities:

1. Command 2. Operations 3. Logistics 4. Planning 5. Finance and Administration

Figure 3 provides an ICS structure to support mass fatality management operations. Tab K: Incident Command System provides additional ICS diagrams to further delineate additional branch and team structures.


Figure 3: Sample incident command structure to support mass fatality management operations


6

Sample Incident Command Structure Mass Fatality Management Operations

Incident / Unified

Command

Operations*

Section Chief

Logistics*

Section Chief

Planning

Section Chief

Finance / Admin

Section Chief

Temporary Morgue

Unit

Fatality Management

Representative

Fatality Management

Representative

Fatality Management

Representative

Fire Branch

Director

Search and

Rescue Branch

Director

Law Enforcement

Branch Director

Fatality

Management

Branch Director

Hazmat Team

Search and Rescue Team

Incident Site Group

Supervisor

Morgue Group Supervisor

Family Assistance

Center Group Supervisor

Fatality Management

Deputy Director

Assistant Safety Officer

Incident Site Group

Supervisor

Morgue Group

Supervisor

Victim ID Group Supervisor

Family Assistance Center Group

Supervisor

Security Team

Evidence Recovery

Team

Security Team

Fingerprint Team

Security Team

Missing Persons

Team

Public Information Officer

Safety Officer

Liaison Officer

Boxes with a dotted line indicate

potential operational components

depending on the needs of the

mass fatality incident

* Not all operational and logistical

branches are reflected


C. Roles and Responsibilities

Table 3 highlights roles and responsibilities of agencies, organizations, and individuals who are likely to have a role in managing a mass fatality incident. Roles and responsibilities are identified for the following categories: (1) preparedness; (2) activation; (3) operations; and (4) demobilization. Please note that participation by an entity or agency will be based on incident severity. Table 3: Roles and responsibilities of agencies, organizations, and individuals during the four phases of managing a mass fatality incident

Phases and Activities

Entity / Agency 1. Preparedness 2. Activation 3. Operations 4. Demobilization

American Red Cross

Coordinate Family Assistance Center operations to include sharing information with, providing physical, psychological, emotional and spiritual support services for, and obtaining before-death information about the deceased from family members to aid in identification effort.

(Note: If the accident involves a

response by the National Transportation Safety Board

(NTSB), the NTSB will be responsible for the family

assistance center.)

Work with Assessment Team to determine Family Assistance Center (FAC) location and needs

Communicate asset requests to EOC

Begin set-up of FAC

Serve as the FAC Group Supervisor

Manage and provide oversight to FAC operations

Update Incident Command/Planning Section Chief daily with a situational report

Coordinate all non-governmental agencies involved in FAC response

Serve as the Family Management Unit Leader

Serve as the Data Entry Team Leader with CERT support, if available

Greet and register FAC patrons

Coordinate family briefings

Staff call center, if needed

Serve as the Case

Monitor change in FAC operational requirements

Identify declining operational tasks

Assess operations that can be accomplished with routine procedures in house

Create and implement demobilization timeline

Coordinate long-term FAC operations, if needed

Organize staff debriefings with mental health provider

Participate in after action assessment

Participate in demobilization meeting

Participate in post-event mental health debriefing sessions




Assessment Team Leader

Staff help desk for FAC patrons

Coordinate appropriate outside services for FAC patrons

Secure temporary childcare services to FAC patrons

Secure translation/interpreter services

Coordinate other volunteer services as needed

Elected Leadership (County Judge or Mayor)

Be aware of roles and responsibilities during activation and operational phases

Approve the mass fatality plan

Direct partial or full activation of the emergency operations center

Approve plan activities

Retain incident oversight.

Coordinate with other local elected officials for consistency in messaging

Attend and speak at briefings (e.g., media, family, etc.)

Terminate EOC operations, when appropriate




EMS Participate in planning activities


Personnel notified of event and possibility for recall to work as needed to support operational activities

Provide medical support for responders

Develop and implement demobilization plan, as appropriate to address long-term needs and responsible parties


Participate in demobilization




meeting


Faith Based Organizations

Participate in planning activities


Notified of mass fatality incident and potential need for services and support

Provide spiritual services to FAC patrons and staff




Fire Services Participate in planning activities


Personnel notified of event and possibility for recall to work as needed to support operational activities

Serve as Incident Commander, if applicable

Serve on Assessment Team.

Identify HAZMAT issues, if any

Implement HAZMAT procedures, if applicable under the direction of the medico-legal authority

Activate Search and Rescue operations

Transition to Search and Recovery after Search and

Serve as Incident Commander or in Unified Command

Manage search and rescue operations

Manage DECON/HAZMAT operations, if applicable.


Participate in family briefings when requested

Perform search and rescue/recovery efforts

Assist with disposal of HAZMAT waste

Organize staff debriefings with mental health provider








Rescue mission is complete

Identify and report discovery of remains as established by recovery procedures identified at start of recovery efforts

Foreign Consulates

Not applicable Notified of mass fatality incident potentially involving foreign nationals

Aid in notification of human remains

Aid in identifying relatives and next of kin

Assist with transportation of next of kin to the United States

Assist with transportation of human remains to country of origin for burial

Assist with cultural or faith-based issues related to foreign nationals

Finalize activities with Foreign Consulates

Forensic Services



Serve on Assessment Team (after authorization by the Justice of the Peace)

Serve as Morgue Group Supervisor

Develop messaging for Public Information Officer (PIO) regarding MFM


Provide oversight of body removal from the site

Provide oversight of temporary storage







operations

Identify MFM response needs along with the Justice of the Peace and EMC to include transportation for HR

Communicate asset requests to the county OEM using STAR requests

Activate MFM response on site along with the Justice of the Peace

Begin formulating investigative approach in concert with the County Sheriff’s Office, Justice of the Peace, and/or other agencies involved in the incident

Assist in MFM incident objectives and hand off to Incident Commander (IC) and Justice of the Peace

Coordinate victim recovery process in concert with the county Law department, Justice of the Peace, other agencies (if applicable), Search and Rescue Team, and the mass fatality management team

Request Subject Matter Experts (SME) for morgue

Monitor and provide oversight to fatality management operations

Manage and perform post mortem activities for victim identification

Approve victim identification protocols

Monitor asset needs and communicate changes to emergency operations center


Manage personal effects recovery and refurbishing process

Perform autopsies as needed

Present certified identifications

meeting





operations

Request/Approve volunteers working for morgue operations

Funeral Services




Transport human remains from site to body collection point/temporary morgue

Develop final interment plans for each victim with family members and friends




Hospital Preparedness Program

Coordinate the provision of behavior support services to first responders in a mass fatality event.

Assure participating hospitals have developed facility plans that provide for an increase of 5% in morgue capacity

Represent participating hospitals in the development of local and regional mass fatality plans.


Be prepared to coordinate morgue resources consistent with planning activities





Hospitals Participate in planning activities

Be aware of roles and

Be prepared to provide services during the operational phase

If a patient dies in the hospital:

Hold, identify, and track deceased and deceased

Develop and implement demobilization plan, as appropriate to address long-




responsibilities during activation and operational phases

personal property until disposition

Expedite medical certification of death certificates

Apply procedures to protect hospital workers, and others if requested, handling decedents

Report information on decedents to local authorities and local health department

term needs and responsible parties




Incident Commander

Not applicable Identify incident command or unified command

Notify assigned incident commander

Manage the incident on site.

Relay all information to the emergency operations center

Develop operations plan





Cease operations




Law Enforcement (Local)

Establish security protocols and perimeters for site, morgue, and Family Assistance Center.



Serve as Incident Commander, if applicable

Serve on Assessment Team

Ensure security of mass fatality scenes and sites for morgue operations

Begin formulating investigative approach in concert with medico-legal authorities’ office

Communicate asset requests to emergency operations center

Notify the medico-legal authority (e.g., Justice of the Peace) to respond

When requested by the medico-legal authority, work with the Texas Department of Public Safety to support DNA testing in the identification of unidentified human remains

Assist in collecting and analyzing specimens from potential relatives of unidentified descendants

Serve as the central repository for information on missing persons through the Missing Persons

Serve as Incident Commander or in Unified Command


Preserve site and control access

Secure morgue from media, bystanders, general public, families, etc.

Secure FAC from media, bystanders, general public, etc.

Collect evidence from site and morgue triage station

Preserve evidence and establish chain of custody

Conduct incident investigation in concert with jurisdictional medico-legal authority, forensic services, other local law enforcement, and state and federal law enforcement, as appropriate

Staff fingerprint station and assist in fingerprint identifications as needed, along with other agencies

Release incident site, morgue, and family assistance from security requirements








Clearinghouse (FBI and/or Department of Homeland Security)

Manage FAC Victim Identification Unit


Local Health Department

Coordinate with local and state public health officials to develop consensus recommendations on case definitions

Provide ongoing education and updates about potential epidemic diseases and disease outbreaks to local community leadership, health practitioners, and medico-legal authorities to increase awareness and facilitate relationships for prompt response.

Coordinate with state and federal public health agencies.

Maintain and promote compliance with the Texas Electronic Death Registration system wherein licensed death care providers, physicians, justices of the

Develop and adopt a standard case definition for infectious disease fatalities in a public health emergency or disaster

Assist in implementing disaster-related mortality surveillance when a mass-fatality event crosses jurisdictional lines

Provide incident-specific guidance on appropriate preventive protections for responders engaged in mass fatality response operations

Coordinate with local medico-legal authorities to implement alternative disaster-related mortality surveillance system if necessary

Utilize the Public Health Information Network (PHIN) and redundant communication systems to

Serve as Incident Commander or in a Unified Command (if incident is disease outbreak, biological terrorism related)

Coordinate with hospitals to manage fatalities, if applicable

Maintain the record of deaths utilizing the mortality surveillance system

Assist, if requested, gathering and disseminating ante-mortem data through the FAC and the ARC

Manage responder safety according to plans

Supply equipment and technology, as additional resources are needed

Activate the Medical Reserve Corps, as appropriate








peace, and local registrars may report, electronically sign, certify, or verify the Certificate of Death.

Coordinate ESF-8 functions with the Hospital Preparedness Program, hospitals, public health, and other appropriate entities

Identify the surge capacity of the various agencies and local death care providers to strengthen and sustain local mass fatality response.

Work with local authorities to pre-identify multiple sites for the interim storage of human remains.

Strongly encourage and provide guidance to death care providers to develop business contingency plans for all hazards and continuity of operations plans (COOP) for pandemic disease.

rapidly disseminate and receive health alerts

Work with the American Red Cross to establish the Family Assistance Center

Local Mental Health Authority


Be aware of roles and responsibilities during


Provide mental health services / counseling to first responders

Provide mental health

Develop and implement demobilization plan, as appropriate to address long-term needs and responsible




activation and operational phases

services / counseling to family assistance center patrons

Attend family briefings and site visits

Identify trained mental health professionals to accompany law enforcement during death notifications, if requested

parties




Provide on-going mental health support post-event

Medical Reserve Corps




Obtain victim medical records to aid in identification process

Collect buccal swabs from victim next-of-kin, if directed to do so

Manage personal effects process

Provide basic first aid for family assistance center patrons and staff





Medico-Legal Authorities


Serve on Assessment Team. Retain medico-legal investigation control

Develop and implement demobilization plan, as




Office Be aware of roles and responsibilities during activation and operational phases

Begin formulating investigative approach in concert with law enforcement

Designate lead medical legal authority, as applicable

Attend and speak at community forums


Certify victim identifications.

Sign death certifications

Provide oversight of body release

appropriate to address long-term needs and responsible parties




Office of Attorney General




Assist in resolving issues of authority in a disaster involving mass fatalities




Office of Emergency Management

Coordinate planning



Exercise the plan

Activate emergency operations center when requested

Staff emergency operations center as appropriate

Request personnel and/or equipment assets as needed to support local requests for assistance

Collect information and provide situation reports to all interested parties as required

Provide staff for the emergency operations center

Coordinate resource and information support for mass fatality management operations

Develop daily situational reports for use by responder personnel, local officials, and during family briefings

Manage asset requests

Continue coordination with city, county, state, federal agencies

Notify PIO/JIC of demobilization timeline as soon as possible

Notify all response agencies of demobilization timeline and strategy via meeting

Conduct transmission meeting with federal support agencies

Coordinate After Action




by operations procedures and directives

Communicate operational activities to local officials

Respond to requests from local/state/federal officials to attend community forums

Initiate and coordinate press releases

Establish a Joint Information Center in coordination with the public information officer

Review (AAR) process with all necessary participants

Arrange facility and asset demobilization





Create press releases in coordination with the emergency operations center, incident commander, and others, as appropriate

Address media enquiries

Address public enquiries

Coordinate media encounters, briefings, and community forums as necessary

Establish a Joint Information Center based on Incident Command System guidelines





Public Services (Local)


Be aware of roles and


Manage traffic flow on County roads, if applicable






responsibilities during activation and operational phases

meeting


Salvation Army Participate in planning activities



Serve as the Mass Care Team leader, as needed

Feed family assistance center patrons and staff

Coordinate lodging for family assistance center patrons, if applicable




Texas Commission on Environmental Quality




Provide technical expertise on environmental and ground and surface water protection issues in local or state consideration of potential sites for interim in-the-ground storage of human remains




Texas Department of Public Safety




Manage traffic flow, if applicable.

Conduct investigations relating to traffic incidents

Manages disaster response on a state wide-level and aids in the appropriation of federal and state resources during disasters




Texas Department of

Participate in planning Notified of mass fatality Manage traffic flow on state Participate in after action




Transportation activities


incident and potential need for services and support

roads, as applicable. assessment




VII. Direction and Control

A. General

Command and control activities rest within the established framework of the jurisdiction where the incident has occurred, but will typically encompass the following:

1. The overall direction and control for a mass fatality incident will be

managed at the local jurisdictional level. The Incident Commander or Unified Command will establish incident objectives, manage incident operations, oversee the request, use, and disposition of resources, and will be responsible for personnel involved in the response.

2. The Incident Commander or Unified Command will direct the activities of the deployed emergency response elements.

3. In accordance with a mission assignment and mutual aid agreements, support organizations assisting will retain administrative control over their resources, but will remain under operational control of the Incident Commander or Unified Command.

4. The incident command post will support activities at the incident site, including providing perimeter control, traffic control, providing personnel and equipment deployment, implementing personal protective measures, submitting resource requests, obtaining situational awareness, managing the search and recovery of human remains, and engaging the media with the assistance and support of the public information officer.

5. The emergency operations center will support the needs of the incident

command post, including the handling of resource requests, securing the scene, providing incident situation awareness, addressing media inquiries, and issuing press releases.

6. The emergency management coordinator will direct the activities of the

emergency operations center.

7. The medico-legal authority has the primary responsibility for mass fatality management

8. The Incident Command System is the organizational structure used during

the incident


B. Incident Site Assessment

The incident site will be assessed upon notification of a mass fatality incident. This assessment will typically occur by the jurisdictional authorities where the accident occurred. However, additional assessment may be needed should the seven county CTCOG mass fatality management plan be implemented. Should this occur, key considerations for assessment are noted below.

1. An assessment team will be formed to determine the operational requirements at the incident site, for the morgue, and for a family assistance center (if applicable). The assessment team will include a representative from the following agencies for the jurisdiction(s) involved:

a. Emergency Management Coordinator b. Sheriff or other designated law enforcement official c. County medico-legal authority d. Fire services official e. Local Health Department director

2. The assessment team will evaluate the incident based on the following

criteria: a. Number of fatalities, both actual and potential (if the incident is

ongoing) b. Condition of human remains c. Size of incident site d. Accessibility of incident site e. Potential difficulty in recovery activities f. Possible criminal site g. Possible CBRNE hazards

3. The assessment team will issue findings based on the evaluation of the

incident site to support the following decision-making activities: a. The type and number of personnel and equipment need for search

and rescue, recovery, transportation, and security of the incident site b. Location of a temporary morgue c. Type and number of personnel and equipment to process and

identify human remains d. Location for a family assistance center and an estimate of the

number of persons who will need access to the center e. Determination of whether deviations from general standards of

death care are needed for internment, autopsy procedures, release of remains, timing and location of burial, and memorial services


C. Incident Site Safety

Mass fatality incidents have the potential for presenting safety and security issues. This section highlights areas of consideration for responders. A safety officer, who will be designated at the onset of the incident, will manage incident site safety.

1. Health and Safety

Every mass fatality incident site has the potential of presenting hazardous environmental issues for responders and the general population affected by the incident. Health and safety must be a common theme during the entire response process and is the responsibility of all leaders and responders. Responders should never be placed at risk and operations should not commence without properly addressing all potential safety risks. Responder health and safety should be monitored throughout the progression of site management.

2. Hazardous Materials

Mass fatality incidents may involve sites that are impacted by hazardous materials. Such materials may range from mild irritants to highly toxic and lethal substances. Prior to any mass fatality incident site processing, the area must be examined by locally trained HAZMAT teams, usually affiliated with the fire services to determine if hazardous materials are present and, if so, act to prevent responder exposure or mitigate the threat with appropriate countermeasures. Concerns for evidence, personal effects, and human remains handled at the site or subsequently removed from the site must be addressed to prevent hazardous materials from leaving the incident site. In addition, exposure monitoring of hazardous materials should occur:

When required by a specific standard (e.g., as specified by OSHA standards for benzene, lead, asbestos, noise).

When exposure is reasonably anticipated to be greater than the “action level,” as required by an individual OSHA substance-specific standard. This is recommended for assessing exposure to other chemicals that response and recovery workers may be exposed to. Screening data, previous sampling results, and anecdotal information may be evaluated to assess an employee’s anticipated exposure.

When necessary to assess and evaluate specific employee exposure or to investigate and resolve employee complaints and concerns.

To verify the adequacy of implemented hazard control methods.


3. Fire Control Measures

The scene of a mass fatality incident may require fire control measures, either to extinguish an ongoing fire or to prevent new fires from igniting. Fire services should be on-site to assist with fire control measures, particularly related to fuels, oils, etc., that have the potential to ignite and cause injury and damage to the incident scene and incident personnel. Fire services and HAZMAT personnel are responsible for fire suppression and addressing hazardous materials at the incident site. Such activities will occur before mass fatality response operations will occur. As such, the time to initiate mass fatality response operations is dependent on the time it takes to suppress a fire or mitigate hazardous material exposure.

4. Site Clean-Up and Remediation

Contractors are responsible for site cleanup and remediation post fire-suppression and / or hazardous material mitigation. Contractors will be contacted using already established procedures of the jurisdiction in which the incident takes place.

5. CBRNE Considerations

When human remains and/or personal effects are contaminated with CBRNE agents, subject matter experts on the CBRNE agents and materials are needed to identify how these agents / materials influence safe handling, recovery, transport, processing, storing, and release of human remains and personal property. Management of contaminated human remains and personal property requires extensive planning. Fatality management activities must not commence before CBRNE hazards are addressed. This may include decontamination and dealing with hazardous materials.

6. Traffic Control Measures

Traffic control issues are likely to arise during a mass fatality incident. This may occur for a vehicular or non-vehicular accident. Preparation efforts should include a process for engaging transportation officials – either local or state – to support traffic control, should such assistance be requested. In cases of a vehicular accident, this may include closing roads and re-routing traffic. Other reasons for traffic control include the need to close roads and re-routing traffic to account for emergency activities, to reduce bystander access to the incident site,


and to promote a safe distance from potential hazardous materials and / or investigatory activities.

7. Personal Protective Equipment

Appropriate personal protective equipment requirements must be identified and responders must be outfitted accordingly before accessing the mass fatality incident site. Anyone allowed access to the incident site should first be provided a safety briefing, and identified personal protective equipment requirements should be strictly adhered to and enforced, as needed.

8. Responder Medical Support

The Regional Medical Strike Team, or local EMS should dispatch a minimum of one EMS unit to the incident site specifically to attend to the medical needs of the responders. The EMS unit should be on site to monitor the safety environment and working conditions of responders and to provide medical attention to any responder who sustains injury from response efforts or becomes ill for any reason. The dispatched EMS unit on site should also assess their ability to adequately support the response force and request additional EMS resources as necessary.

9. Law Enforcement and Security

The law enforcement agency taking charge of the site will establish a security perimeter, create access point(s), and control entry and exit to and from the site. The entire site area should be designated as off limits to non-authorized persons, equipment, or activities until site processing and human remains removal has been completed. In the event the site processing efforts continue beyond one or two days, a badging system should be implemented to control access to the site, morgue, and family assistance center. The local jurisdictional law enforcement authority will be responsible for security unless designated to a state or federal agency. Photography and videography are restricted at the incident site scent. Only persons who have a legitimate reason are legally authorized take photographs or record video at a mass fatality incident scene. Such reasons may include for scene documentation, investigatory processes, human remains collection, etc. Photos or videos may also be taken by emergency medical service personnel solely to provide documentation of injuries for those being transported for emergent care in order to aid treatment decisions by the treating physician.


All recordings or photographs (of non-EMS injuries) shall be provided to the case officer. No other recordings are allowed, particularly of the scene or of dead bodies, by the public or first responders. Individuals who take unauthorized recordings are at risk for arrest and prosecution.

10. National Transportation Safety Board

Federal authorities will have mission specific activities to investigate accidents involving airplanes, but local authorities will be responsible for human remains recovery, morgue operations, the family assistance center, and other mass fatality incident operations. Specifically, federal authorities are responsible for investigatory activities in the event of an airplane accident. These activities will seek to determine the cause of the crash and will be the responsibility of federal authorities. However, mass fatality incident response operations remain the responsibility of local, regional, and state officials as codified in planning documents. Mass fatality incident response activities will be secondary to the investigatory process and they will not commence until such time that federal officials have released control of the site to local officials.


D. Teams

Mass fatality management will likely involve specialized teams to support response, recovery, identification, and transport of human remains and personnel effects. Information about these teams is noted below.

1. Search and Rescue

Resources Search and Rescue units from the local fire departments and law enforcement agencies will be activated to conduct rescue operations to locate casualties and fatalities. The Regional Medical Strike Team or local provider will provide EMS resources to address medical needs of survivors located by search and rescue teams. All rescue assets must be knowledgeable of crime scene preservation techniques and exercise caution to protect potential evidence as they conduct operations. Investigation efforts take precedence over human remains recovery when those tasks are assigned to separate teams. Discovery of Human Remains As rescue units locate human remains, the location should be marked and GPS coordinates noted. The Human Remains Recovery team, under the direction of the medico-legal authority or designee, will transport human remains from the site to a designated site. Human remains cannot be removed from the designated site without approval from the Justice of the Peace or his/her designated representative. The County Office of Emergency Management or other designated authority shall contact the Justice of the Peace.

2. Evidence Response Team and Scene Investigation

Inquest resources are likely to be overwhelmed during a mass fatality incident and local law enforcement will likely assume responsibility for conducting a preliminary investigation into the circumstances surrounding the mass fatality incident. Law enforcement investigators will process death scenes to properly document the site and record, collect, and safeguard evidence. A designated facility will assume responsibility for the victims and associated personal effects that remain on the body. Law enforcement will collect personal effects remaining on bodies, should they be deemed necessary for criminal investigation or other purposes. Proper control and tracking of these items will be provided.


3. Human Remains Recovery Team

Human remain management must be respectful and efficient. It must also be done with precision in order to properly denote, tag, and register body parts to support identification and investigation purposes. As the response effort and identification process continues it is important to know specific details of where human remains were first located and by whom. An accurate account of the body recovery process cannot be overemphasized. Numbering Technique: Human remains and personnel effects will be assigned a unique identifier using a numbering technique to be established in advance of an incident. The numbering technique should be based on best practice and should seek to reduce errors and confusion. The numbering system should provide a competent means for tracking across a continuum that includes:

A. Initial site location (by GPS coordinate if possible) B. Identification C. Storage D. Final disposition

Multiple Sites: A mass fatality event may include multiple locations in which fatalities are present. If this is the case, the incident commander may wish to consider establishing more than one designated body collection points and more than one human remains transportation team.

4. Personal Effects Team

Personal effects items not considered investigative evidence will remain at the site for collection by a team designated by the medico-legal authority for the jurisdiction in which the incident occurred. Clothing found on or near the victims and personal effects in clothing will be kept with the victim and transported to the morgue with the body. Disassociated personal effects from the site will be transported to a designated forensic center, work site, or another location designated by the medico-legal authority.

5. Human Remains Transportation Team

Transport services will be called to transport human remains from the incident site to the designated “morgue” site. A manifest is required to document the identification (by numbering technique) for all human remains and personal effects transported. A transportation log will be created to document the following information:


A. Transportation operator information (e.g., organization, driver name, driver

license details, contact phone number, etc.) B. Body parts and personal effects transported (identified by description and

by numbering technique) C. Vehicle identification D. Initial mileage at time of removal E. Time of removal F. Designated entity in which remains are to be transported G. Review and count of body parts and personal effects on delivery to

designated entity H. Final mileage at time of delivery I. Time at time of delivery J. Name, title, and signature of person accepting delivery

E. Bi-National Considerations

The following bi-national considerations have been identified The CTCOG regional mass fatality plan must include planning for multiple bi-national and multi-national considerations including:

A. Clear understanding of legal issues with regard to holding, storing, and transporting bodies across international borders

B. Role and responsibilities of local health authorities to release bodies of foreign nationals

C. Clear delineation of roles and responsibility between federal, state, and local governments with regard to mass fatalities involving foreign nationals

D. Consultation and planning with foreign consulates should be considered particularly with regard to identification of remains and awareness of planned response activities

E. Multi-national planning may vary with the type of mass fatality event, (e.g. for a biological event plans are in place for epidemiology, communications, and transport of remains across international borders)

F. Review and consideration of enhancing existing sister city plans for fire and HAZMAT response.


VIII. Readiness Levels

Table 4 identifies activities by readiness level.

Table 4: Mass fatality incident management activities by readiness level

Level IV Normal Conditions

Level III Increased Readiness

Level II High Readiness

Level I Maximum Readiness

Review and update plan

Review roles and responsibilities and update as necessary

Update contact lists with organization, entities, and individuals listed in the plan

Review plan

Revise plan as needed

Alert the following about potential plan activation in the non-impacted CTCOG counties

Emergency management coordinator

Sheriff

County medico-legal authority

Fire services official

Local health department director

Implement plan

Document potential revisions to plan based on activation


IX. Administration and Support

A. Support

When a mass fatality incident exceeds resources locally, based on criteria identified in Section V.D., local authorities may activate this Seven county CTCOG regional mass fatality plan. Resource requests will be processed using already established policies and procedures.

B. Reporting

All participating entities and organizations should be knowledgeable about and comply with their individual entity or organizational reporting requirements. The incident command team will create on a daily basis, or more frequently if needed, situation reports. Relevant information from all sources will be included into the initial emergency report and the daily situation reports prepared and disseminated to local officials, state-level entities, and other relevant organizations. A copy of these documents should also be provided to the CTCOG.

C. Record Maintenance and Preservation

Documents will be produced throughout a mass fatality incident that should be collected, filed, and archived for historical purposes. Document types may include but are not limited to those that may support recovery activities, expense reimbursement, response costs, claim settlements, response operation review, and revision of plans and procedures. Specific examples are noted in Table 5.


Table 5: Examples of documents to be preserved during a mass fatality incident

Document Type Description Responsible Entity Preservation Activity

Death certificate An official statement or document, signed by a physician or medico-legal authority of the cause, date, and place of a person’s death

In the case of a mass fatality event, the death certificate will normally be signed by the medico-legal authority

Death certificates are to be filed electronically pursuant to Texas Health and Safety Code Section 193.002

Medical records A chronicle providing activities of a person’s medical history and care

Medico-legal authority

Local health department

Preserve using normal retention procedures of the responsible entity

Human remains numbering log

Catalog of human remains and personal effects using the numbering technique established in Section IV.D.3



Transportation log

Catalog of information related to the transport of human remains and personal effects as established in Section IV.D.5



Cost documentation

Information and receipts on costs incurred in carrying out mass fatality management activities, including, but not limited to, response, recovery, identification, transport, final disposition of human remains, and criminal investigation activities (if applicable)

All entities that incur costs Development of a cost center to document expenses

Usual and customary accounting guidelines and procedures

Other documents of importance

Other documents that may need to be preserved including but not limited to: emails, record of discussions, and other documentation to record activities

All entities that may have such documentation



F. Demobilization

The decision to demobilize operations will be made by the incident commander in consultation with elected officials, the medico-legal authority, and other entities involved in the response. Upon determining demobilization is appropriate, incident command may assign demobilization activities to one or more entities. Considerations for demobilization may include.

A. Notifying staff, the media, and the public that demobilization is going to take place

B. Identifying the time frame to demobilize all response operations, including incident site, morgue group, victim identification, and family assistance center activities

C. Developing a transition plan to address outstanding issues / activities i. Identify outstanding issues / activities ii. Identify entity to undertake outstanding issues / activities iii. Assign responsibility for undertaking outstanding issues / activities iv. Establish schedule to provide updates on outstanding issues /

activities v. Identify an individual who will oversee transition activities

D. Finalizing all documents, log books, and other electronic and written documentation to ensure accuracy and completeness before closing files

E. Coordinating the cleaning and return to steady state of all equipment and supplies for future incident response activities

F. Debriefing staff on lessons learned and opportunities to review and update the regional mass fatality plan including review and revision of:

i. Position descriptions ii. Operational checklists iii. Procedural changes

G. Participating in stress management and psychological counseling, as needed H. Participating in agency after action assessments and other improvement

meetings

Responding entities and agencies will undertake their own demobilization process.

G. Post-Incident Review

For instances when this plan is activated, the CTCOG shall organize and conduct a post-incident review of operational activities tasked in this plan no later than 30 days’ post major activities. The CTCOG may decide to conduct a post-incident review in conjunction with other responding organization or on its own. The purpose of the post-incident review is to:


1. Identify activities that worked well in the response 2. Identify areas for improvement in terms of procedures, processes, and

other operational components of this plan An after action report shall be produced incorporating the findings of the post-incident review. This report shall comply with U.S. Department of Homeland Security requirements on after action reports and shall be Homeland Security Exercise and Evaluation Program compliant. Other reporting requirements may also be needed.

H. Exercises

When appropriate, exercises involving plan components shall be conducted. Such exercises may include local drills, tabletop exercises, functional exercises, and full-scale exercises. Information learned during these exercises should be used to revise this plan, as appropriate.

I. State and Federal Assistance

If state and / or federal assistance is required, such assistance shall be routed through the incident commander through already established resource request procedures.

J. Plan Maintenance

The CTCOG is responsible for developing and maintaining this plan. Suggested revisions should be provided in writing to:

Central Texas Council of Governments Department of Homeland Security 2180 N Main Street Belton, Texas 76513 Phone: +1 (254) 770-2200


X. References

1. Texas Division of Emergency Management

State of Texas Emergency Management Plan Annex H (Health and Medical Services)

Available at:

2. Texas Department of State Health Services

Mass Fatality Planning Toolkit: https://www.dshs.state.tx.us/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=8589956852

DSHS website: www.dshs.state.tx.us

Health Service Region 11 website: https://www.dshs.state.tx.us/region11/default.shtm

3. U.S. National Transportation Safety Board

Mass Fatality Incident Family Assistance Operations

Website:

Guidance: http://www.ntsb.gov/tda/TDADocuments/Mass%20Fatality%20Incident%20Family%20Assistance%20Operations.pdf

Training: Managing Transportation Mass Fatality Incidents: A course for emergency managers, law enforcement, and the medico-legal community: http://www.ntsb.gov/Training_Center/Pages/TDA406_2015.aspx

4. National Association of Medical Examiners

Website: http://www.thename.org

Standard Operating Procedures for Mass Fatality Management (2010): https://netforum.avectra.com/temp/ClientImages/NAME/31434c24-8be0-4d2c-942a-8afde79ec1e7.pdf

5. Public Health

US Centers for Disease Control and Prevention Resource Library on Mass Fatalities: http://emergency.cdc.gov/radiation/resourcelibrary/massfatalities.asp

https://www.dshs.state.tx.us/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=8589956852

https://www.dshs.state.tx.us/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=8589956852

http://www.dshs.state.tx.us/

https://www.dshs.state.tx.us/region11/default.shtm

http://www.ntsb.gov/tda/TDADocuments/Mass%20Fatality%20Incident%20Family%20Assistance%20Operations.pdf

http://www.ntsb.gov/tda/TDADocuments/Mass%20Fatality%20Incident%20Family%20Assistance%20Operations.pdf

http://www.ntsb.gov/Training_Center/Pages/TDA406_2015.aspx

http://www.thename.org/

https://netforum.avectra.com/temp/ClientImages/NAME/31434c24-8be0-4d2c-942a-8afde79ec1e7.pdf

https://netforum.avectra.com/temp/ClientImages/NAME/31434c24-8be0-4d2c-942a-8afde79ec1e7.pdf

http://emergency.cdc.gov/radiation/resourcelibrary/massfatalities.asp

http://emergency.cdc.gov/radiation/resourcelibrary/massfatalities.asp


World Health Organization Fact Sheet: http://www.who.int/hac/events/drm_fact_sheet_mass_fatalities.pdf

World Health Organization Regional Office for the Americas Mass Fatality Plan Checklist: http://www.paho.org/disasters/index.php?option=com_content&view=article&id=820:mass-fatality-plan-checklist&Itemid=931&lang=en

National Association of City and County Health Officials Mass Fatality Planning Toolkit: http://apc.naccho.org/Products/APC20091595/Pages/Overview.aspx

6. International Committee of the Red Cross Management of bodies after disaster – A filed manual for first responders: https://www.icrc.org/eng/assets/files/other/icrc-002-0880.pdf

7. State of Florida Mass Fatality Plan: https://www.fdle.state.fl.us/Content/getdoc/ff5b917d-0101-4727-85c7-60213cb0d01b/MEC-Florida-Mass-Fatality-Plan-pdf.aspx

8. US Department of Defense

Joint Publication 4-06 Mortuary Affairs: http://www.dtic.mil/doctrine/new_pubs/jp4_06.pdf

http://www.who.int/hac/events/drm_fact_sheet_mass_fatalities.pdf

http://www.paho.org/disasters/index.php?option=com_content&view=article&id=820:mass-fatality-plan-checklist&Itemid=931&lang=en

http://www.paho.org/disasters/index.php?option=com_content&view=article&id=820:mass-fatality-plan-checklist&Itemid=931&lang=en

http://apc.naccho.org/Products/APC20091595/Pages/Overview.aspx

http://apc.naccho.org/Products/APC20091595/Pages/Overview.aspx

https://www.icrc.org/eng/assets/files/other/icrc-002-0880.pdf

https://www.fdle.state.fl.us/Content/getdoc/ff5b917d-0101-4727-85c7-60213cb0d01b/MEC-Florida-Mass-Fatality-Plan-pdf.aspx

https://www.fdle.state.fl.us/Content/getdoc/ff5b917d-0101-4727-85c7-60213cb0d01b/MEC-Florida-Mass-Fatality-Plan-pdf.aspx

http://www.dtic.mil/doctrine/new_pubs/jp4_06.pdf


XI. Tabs

The following tabs for reference are included in this document (in alphabetical order by topic name): Tab A. Ante-Mortem Data Collection Tab B. Biological Contamination Safety and Handling Recommendations Tab C. Burial Preferences by Cultural and Religious Affiliation Tab D. Communications Tab E. Death Notification Tab F. Disaster Behavioral Health Services Tab G. Family Assistance Center Tab H. Faith-Based Services Tab I. Handling Human Remains Tab J. Human Remains Storage Tab K. Incident Command System Tab L. Incident Site Management Tab M. Morgue Management Tab N. Organization Charts Tab O. Victim Identification


A. Ante-Mortem Data Collection

The purpose of collecting ante-mortem data is to obtain information about victims to assist with identification. Ante-mortem data may include the following information or details:

Dental information and dental records

DNA reference samples from victim personnel effects or from family reference samples

Fingerprint records

Jewelry description at the time of incident

Medical records

Physical clothing at the time of incident

Unique characteristics (e.g., tattoos, scars, birthmarks) Ante-mortem data collection process is usually included as part of activities within the family assistance center. The medico-legal authority designated personnel will collect ante-mortem data. Designated personnel will meet with family members within private areas of the family assistance center or contact them by telephone to collect relevant information and data. Family members may also contact the family assistance call center and be referred to a member of the ante-mortem data collection team for further assistance and interview. Individuals trained in dealing with grieving individuals will conduct interviews. In instances where DNA references are required, such specimens will be collected under the supervision of experienced professionals to support validity and reliability of the data collection process and to avoid contamination, mislabeling, or inappropriate storage of collected samples.

1. Ante-Mortem Data Collection Guidelines

I. Establish ante-mortem data collection procedures for the following

activities. a. Develop a process for conducting family member interviews. b. Develop an ante-mortem data acquisition and entry plan.

i. Determine if interviewers will enter the ante-mortem data into a database of if data entry clerks will transcribe the data from an interview form into a database that will be used for comparisons with postmortem data.

ii. Information should be transcribed and entered into a database as soon as possible, but no later than six hours after the interview took place.


iii. Original copies of the interview notes and questionnaire should be scanned to PDF document with original documents kept for the permanent file

iv. Consider using the DMORT questionnaire, the VIP Personal Information Questionnaire. It is a universal questionnaire designed to expedite ante-mortem data collection.

1. Add local jurisdiction death certificate information to the questionnaire so that families do not have to provide this in another interview at the funeral home.

2. Note: Directions for filling-in the VIP Personal Information Questionnaire are available at: http://www.dmort.org/forms/Forms%20Manual-VI-DMORT.doc.

v. For multicultural populations: 1. Ensure proper formatting of first and last names

and correct spelling of similar sounding names. For example, consider putting last names in all capital letters.

2. Note information about the family’s religious or spiritual beliefs, including practices and rituals, daily prayer times, important dates, beliefs about autopsy, and other information that may be relevant to the rescue, recovery and disposition of their loved ones. Leaders of religious or spiritual communities can also provide guidance.

a. Demonstrate sensitivity to cultural beliefs and practices of the victims’ families in a mass fatality – even when needs cannot be met – is important to effective response.

vi. Provide an address for receipt of all ante-mortem records (e.g., the ME/C Office).

c. Be prepared to add changing and new information to each person’s file as it is collected from family members, friends, dentists and doctors after the initial interview.

i. Do not discard previous information collected; simply draw a line through information that has been revised

d. Maintain logs of the files, of all incoming data/samples, and of all forwarding data/samples.

i. Accountability for forwarding and receiving records is essential.

http://www.dmort.org/forms/Forms%20Manual-VI-DMORT.doc

http://www.dmort.org/forms/Forms%20Manual-VI-DMORT.doc


e. Be prepared that some family members may not want to provide ante-mortem information or supply DNA for kinship matches because they view doing so as a sign that they have given up hope for finding their family member alive.

II. Orient/brief ante-mortem data collection team on the information they need to collect from families (forms, procedures, etc.) and their role as a representative of the ME/C Office.

III. Coordinate operations with the Morgue Information Resource Center and the Morgue Records Supervisor.

IV. Schedule interviews with families. Allow 2 hours for each interview with a 30-minute period between interviews.

V. Conduct interviews in rooms that are private and quiet. Make sure rooms are comfortable, have tissues and other amenities to support grieving family members

VI. Reassure families that all information will remain confidential. VII. Collect ante-mortem data using approved form. Once form is

completed, ante-mortem information is given to the medico-legal authority or designee, the Morgue Information Resource Center, and any other appropriate agencies approved by the ME/C.

a. Dissuade families from acquiring or carrying the victim’s medical or dental records to the family assistance center.

i. Ask family members to sign release forms to allow for the release of the missing person’s dental and medical records.

ii. The medico-legal authority will request these records iii. Note HIPAA privacy issues, as appropriate

b. Call dentist and physician offices to request original dental records, x-rays, and medical records.

i. Follow-up call by sending an authorization fax that includes the HIPAA Exemption for Medical Examiners and Coroners, CFR 164.512(g), to verify and confirm the request for the victim’s medical/dental record and request timely delivery of records.

c. Develop a detailed plan to collect, store, and monitor use of incoming dental records, x-rays, and medical records so that all records are original and have been received.

i. Inform families when ante-mortem data and samples have been received.

ii. Have victim records in foreign languages translated as needed.

d. Follow-up on requests that have not been received. VIII. Arrange for collection of DNA samples.

a. Establish DNA collection procedures to ensure proper


collection procedures, prevent cross contamination, and ensure the best possible specimens are collected for subsequent laboratory testing.

b. Provide families with a copy of Appendix G, Identifying Victims Using DNA: A Guide for Families, in the National Institute of Justice’s Lessons Learned From 9/11: DNA Identification in Mass Fatality Incidents, September 2006. The family guide is available in English and Spanish and how to access it is included later in this section under Associated Tools and Resources.

c. Answer family members’ questions regarding collection of DNA samples. Explain the differences between Forensic DNA and Kinship DNA analysis.

d. Maintain an open, honest and sensitive approach to questions surrounding lineage when requesting samples for Kinship DNA analysis.

e. If buccal swabs are used, assist family members in collecting the samples.

f. If blood samples are used, arrange for family members to meet with staff who will be collecting blood samples. Allow families to go to their family physician to collect their blood sample, if they prefer to do so.

IX. If family members do not visit the family assistance center, interviews can be conducted over the telephone following the same procedures.

X. For families that do not come to the family assistance center, DNA samples can be arranged through the medico-legal authority and local law enforcement agencies. Send letters and consent forms to families that do not visit the family assistance center. If necessary, make arrangements to collect samples from anywhere in the world. When families are sending DNA samples, it is important that they are aware of complex mailing procedures for specimens and that not all companies provide this service.

XI. If telephone contact is made before a family arrives at the family assistance center, follow a scripted checklist to request contact details (e.g., name, address and phone number) of the following providers as well as any names that the victim may have used with these providers:

a. Physician b. Dentist c. Hospital d. Fingerprints e. Photographs f. Military service records g. Essential vital statistics.


XII. Arrange for collection samples to be sent to the DNA laboratory that the medico-legal authority office has approved at the end of each day.

XIII. Get daily status reports from the DNA lab. XIV. Once the form for ante-mortem data collection has been completed

and copied/printed at the family assistance center, direct it to the Information Resource Center at the Morgue for review and analysis. This may also be done electronically.

XV. Maintain chain of custody of records via sign-in and sign-out logs. XVI. Keep copies of forms at the family assistance center for reference.

When the family assistance center is closed, the forms will be maintained by the medico-legal authority or destroyed in compliance with record retention rules.

Source: University of Georgia Mass Fatality Plan Template


B. Biological Contamination Safety and Handling

Recommendations

Table 6 provides biological contamination safety and handling information for select contaminants.

Table 6: Safety and handling recommendations for select biological contaminants

Agent General Handling Autopsy Handling Burial Handling Cremation Handling Anthrax Standard precautions

Additional respiratory personal protective equipment (PPE) when performing activities that generate aerosois

Wear additional respiratory PPE

Bio-Safety Level (BSL) 3 practices when performing activities with high potential for aerosois

Regulated by 42 Code of Federal Regulations (CFR)

Contact with corpses should be limited to personnel wearing PPE

Package in leak-proof containers

Avoid embalming

Buy without reopening

Recommended

Botulinum Toxin

Standard precautions

Additional respiratory PPE when performing activities that generate aerosois


BSL 3 practices when performing activities with high potential for aerosois

Regulated by 42 CFR

Recommend no embalming

No restrictions

Plague Standard precautions



BSL 3 practices required when performing activities with high potential for droplet or aerosois or working with antibiotic resistant strains

Regulated by 42 CFR



No restrictions

Tularemia Standard precautions



BSL 3 practices when performing activities with high potential for aerosois

Regulated by 42 CFR



No restrictions

Viral Hemorrhagic Fever

Standard precautions

Additional respiratory PPE


BSL 4

Negative pressure rooms

Autopsies should be

Minimize handling by all personnel, even in PPE


Avoid embalming

Recommended


Agent General Handling Autopsy Handling Burial Handling Cremation Handling performed only if absolutely indicated

Regulated by 42 CFR

Bury without reopening

Smallpox Standard precautions

Additional respiratory PPE

Personnel should be under a fever watch or vaccinated


BSL 3

Autopsies should be performed only if absolutely indicated

Regulated by 42 CFR

Personnel should be vaccinated

Minimize handling by all personnel, even in PPE


Avoid embalming

Bury without reopening

Recommended



C. Burial Preferences by Cultural and Religious Affiliation

The cultural and religious preferences regarding care of the deceased should be considered during mass fatality management procedures activities. Table 7 identifies general burial preference information by select cultures and religions. However, the specific religious affiliation and burial preference should be confirmed during the ante-mortem process with family members.

Table 7: Burial preferences based on cultural and religious affiliation

Cultural / Typical Religious Affiliation

Burial Preference Additional Information

Afghanistan / Islam Rapid Burial Embalming allowed; Cremation forbidden

Amish / Mennonites No Restrictions

Arab Cultures / Islam Rapid Burial Embalming allowed; Cremation forbidden

Buddhist No Restrictions Autopsy only if necessary

Chinese / Hindu Cremation Burial as an option

Christian Scientist No Restrictions Cremation as an option

Cuban / Roman Catholic Burial

Eastern Orthodox Burial Cremation forbidden

Filipino / Roman Catholic Burial

Guatemalan / Roman Catholic Burial

Hispanic / Latino / Roman Catholic

Burial (Generally)

Indian / Hindu Cremation Autopsy only if required by law

Japanese / Buddhist No Restrictions Autopsy only if necessary

Jewish Rapid Burial Cremation forbidden; Embalming forbidden unless required by state

Korean Burial

Latter-Day Saints / Mormon Burial

Mexican / Roman Catholic Burial

Native American Burial

Jehovah’s Witness Burial or cremation Funerals conducted according to spiritual guidelines and “unclean practices” are forbidden

Pakistani Rapid Burial No coffin

Polynesian Burial

Protestant Burial


Cultural / Typical Religious Affiliation

Burial Preference Additional Information

Puerto Rican / Roman Catholic Burial

Rastafarian Don’t believe in burial Request preference

Sri Lanka / Buddhist No Restrictions

Note: This table should be used as a general guide for cultural and religious affiliation. However, the religious affiliation and preferred burial preference must be confirmed during the ante-mortem process. Source: University of Georgia Mass Fatality Plan Template


D. Communications

1. Working with the Media

Effective and accurate communication with the media is critical to informing the public of activities related to the mass fatality incident. Media play a key role in providing facts and information to the public. It is important for the incident commander and others involved with the mass fatality incident to be prepared to provide factual, timely, and accurate information to the media in a coordinated fashion in order to eliminate misinformation and rumor and to effectively support media requirements related to timelines, etc. for broadcast or print. The following guidelines are suggested for working with the media during a mass fatality incident:

a. Establish a joint information center as soon as practically possible and appoint a single public information officer from among the coordinating agencies to be the sole contact for media briefings, inquiries, and news releases

b. The initial media briefing should include the chief elected official for the jurisdiction in which the incident occurs, as well as supporting officials from the agencies and entities involved in response and recovery operations

c. Determine media timelines for broadcast and print deadlines and to

the extent possible, schedule media briefings to support such deadlines

d. Establish a media schedule so family members, the public,

responders, and the media will know when to expect additional information to be released

e. Monitor social media for misinformation and rumor and respond

with factual information

f. Use social media as an additional outlet of information to the media and the public


2. Public Information and Messaging

In a mass fatality incident, it is imperative that public information and messaging be timely, accurate, and regularly updated. Doing so will aid response and recovery efforts and bring a sense of security and understanding to the public. Failure to provide timely, accurate, and updated information can result in mixed and inaccurate messages, unreasonable expectations, and an angry constituency. Public messaging should involve Texas 2-1-1. I. Public Messaging

Information will be reported to the general public that will not only give verified details as to what has taken place at an incident, but will also manage expectations as to how long the search and recovery effort will take and why. These messages should not undermine the response efforts of the county. Separate telephone numbers and website addresses will be disseminated for:

a. A call center to report missing persons

b. Family members and friends outside the area who wish to obtain information on recovery and identification effort, incident investigation, and other concerns

c. Volunteer opportunities

d. Donations management

II. Family Briefings Private briefings for families and friends will be held on a regularly scheduled basis to report on the progress of recovery efforts, identification of victims, the investigation, site visits and memorial services (if appropriate), return of personal effects, and a description of services available at the family assistance center. These briefings should commence within 24 hours of family assistance center operations activation. Briefings should be held even if there is no new information to report. Greater detail regarding family briefing procedures can be found in Tab G: Family Assistance Center.


III. Messaging Sequence It is imperative that critical information (i.e. details of the investigation, progress of recovery efforts, identification of victims, etc.) is shared in this order:

a. Fatality management responders

b. Victim family members and friends (i.e. family assistance center patrons or on conference telephone line) at briefings

c. General public and media

Families must receive information from responsible officials (e.g., search and rescue, medico-legal authorities, etc.) prior to the media. This is essential to the success of the response.

3. Interoperable Communications

Following any mass disaster, including a mass fatality incident, responding agencies will follow their normal communications protocols. Given the complexity and number of agencies involved in a mass fatality response, there are likely to be agencies that cannot communicate directly with each other. Any time this plan is activated, the jurisdictional emergency operations center will be activated and a communications plan will be created. The communications unit leader will assist in resolving any communications issues and relay information between agencies if necessary. The emergency operations center activation is particularly critical if the mass fatality incident response is ongoing and requires coordination of recovery of remains with other efforts, such as in the aftermath of a hurricane. If this is not possible, the responsible agency will utilize alternate communication methods (i.e. fax, email, WebEOC, ham radio) to provide updates to the emergency operations center.

4. Hardware and Technology

The Logistics Section is tasked with providing the necessary communications hardware and technology needed to effectively manage a mass fatality incident. These items include:

a. Telephonic and computer connectivity to support mass fatality management operations


b. Technical component operators of mass fatality incident related call centers

c. Computer servers support at mass fatality incident locations

d. IT infrastructure to support ante mortem and postmortem data collection systems

e. Interoperability between mass fatality incident branches and law enforcement, search and rescue, etc.

5. Roles and Responsibilities

Communication typically causes the most challenges during incident response. It is essential for cohesive and efficient mass fatality management to appropriately control communication inflow and outflow.

a. The Public Information Officer (PIO): The PIO represents the incident

commander and serves as the single point of contact for the incident, conducts press briefings, and presides over family briefings. PIO messages directed to the media will include written statements summarizing details.

b. Joint Information System (JIS): The JIS establishes parameters of how

the public information function will operate at an incident. c. Joint Information Center (JIC): The JIC serves as a single point of

dissemination for incident-related information. d. Branch Directors: These are liaisons from the fire services, search and

rescue units, law enforcement, and fatality management branches. They will provide timely, accurate, and verified information about respective branch operations to the PIO for dissemination.


E. Death Notification

The purpose of death notification is to notify next of kin and family members when their loved one has been positively identified. Once notified, the release of the remains between the family, the morgue and the selected funeral home is coordinated, pending release by the medico-legal authority. The death notification process assists in the return of remains and allows families to grieve, memorialize their loved ones, settle estates, and resolve legal issues. Death notification is the responsibility of the local medico-legal authority. A death notification team is preferred for notifications and may include a representative of the medico-legal authority, a crisis counselor, and/or clergy. The individuals who provide notification should have specific training related to death notification activities. It should not be presumed that a person who works in mental or behavioral health has this specific training or qualification. Death Notification Guidelines

I. Establish death notification procedures. a. Notify family members of a loved one’s death in person, if at all

possible. i. Notification can take place at the family assistance

center or at a location of the family’s choice, such as their home. Request assistance from local law enforcement for notifications at a person’s home if outside the jurisdiction of the medico-legal authority.

b. A team rather than an individual is preferred for notification. This will allow having support persons present in case they are needed.

II. Brief death notification team members on death notification procedures and their role as a representative of the medico-legal authority.

III. Identify the death notification team that will notify the family of a loved one’s death. In cases where local law enforcement in another area is making the notification, encourage them to bring a local mental health professional or member of the clergy. Such professionals should be trained in death notification and grief counseling.

IV. When assistance is needed to find next of kin, notify appropriate authorities.

a. If the victim(s) lived out-of-state or out of the country, seek assistance from state officials on notification protocols.

b. If the victim is from another country, the Agency for International Development, Office of Foreign Disaster Assistance may assist in contacting a deceased foreigner’s


family through the appropriate embassy. V. Prepare a fact sheet for each family with relevant information:

a. Explain how identification was determined. b. Explain process for release of remains. c. Include:

i. Family assistance telephone number and contact details for further information or to call for services and/or referrals.

ii. Medico-legal authority contact person and phone number for further questions and information on how and when the medico-legal authority report will become available.

VI. Assemble the death notification team and thoroughly brief members on the information that will be provided to the family.

VII. Notify next of kin when identification has been made and the death notification team is ready to meet with them.

VIII. In cases of fragmentation or commingling of remains, counsel families on the available options for disposition of subsequently identified remains:

a. Notification each time additional remains are identified. b. Notification at the end of the identification process. c. Return of the currently identified remains to the family now for

final disposition. d. Return of all remains at the end of the identification process.

i. Note: If DNA analysis is the method used to conduct identifications of fragmented/commingled remains, the physical re-association of all remains may take place several weeks or months after the incident.

e. Consider other requirements the family may have if they do not impact overall identification efforts.

i. Counsel families on the likelihood of common tissue. Note: Due to the length of time required to complete the scientific identification of the tissue and/or the time required to investigate and complete legal proceedings if the incident is the result of a crime, inform families that internment of common tissue will not occur soon.

f. Document the family’s decision. Complete a release authorization and place it in the victim’s file.

IX. Ask family members and loved ones if they desire crisis assistance or someone to talk to. If family members are undecided or say no, provide the family assistance call center number for use in the future.

X. Provide the following information to families: copies of the fact sheet on notification procedures, contact details for the family assistance and


medico-legal authority, release authorization, and documentation of the family decision disposition on subsequently identified remains.

XI. Coordinate the release of remains between the family, the morgue, and the selected funeral home.

XII. Provide the family assistance center Officer in Charge and JIC with names of victims and their next of kin, relationship to victim, and next of kin addresses and telephone numbers after the death notification. The ante-mortem questionnaire is a good source for this information.


F. Disaster Behavioral Health Services

Disaster behavioral health services are critical to the needs of both victim families and to first responders. Disaster behavioral health is defined as the provision of mental health, substance abuse, and stress management to disaster survivors and responders3

The primary goal is to decrease the stress of an event and mitigate future problems

Modalities may include Psychological First Aid, Spiritual Care, Substance Abuse services, Critical Incident Stress Management (CISM), Crisis Counseling, or other crisis intervention and disaster specific support services

It is community based

It is focused on strengths and coping skills

It restores functioning

It confirms reactions are common/normal

It has an education focus Possible disaster behavioral health outreach locations include

Disaster District Committee

Disaster Recovery Center

Family Assistance Center

Incident Command Post

Joint Field Office

Mass Care Shelter

Points of Distribution

Re-entry Points

Regional Health and Medical Operations Center

3 Source: U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response http://www.phe.gov/Preparedness/planning/abc/Documents/DisasterBehavioralHealth.pdf

http://www.phe.gov/Preparedness/planning/abc/Documents/DisasterBehavioralHealth.pdf


Disaster behavioral health services are available from Central Counties Services; the Texas Department of State Health Services, Disaster Behavioral Health Services branch; and Texas Department of Public Safety Victim Services Counselors.


G. Family Assistance Center

A Family Assistance Center (FAC) is the designated location / facility established to provide support to family members and friends who contact or travel to the incident site seeking assistance. Services include providing accurate and timely information about the incident, recovery process, and victim identification / release process. In the aftermath of a mass fatality incident, family members and close friends (hereafter referred to as patrons) will struggle to cope with the tragic, unexpected loss of family, friends, and co-workers. Attending to those needs and providing assistance is fundamental to an adequate response to any mass fatality incident. It is important that all responders understand the significant and critical role of the family assistance center in this process. A key component of the family assistance center is to provide a safe place for family members to express concerns, anger, sadness, grief, and other emotions brought about due to the tragedy. Functions that may be included in a family assistance center include (in alphabetical order):

Ante-mortem data collection (see Tab A: Ante-Mortem Data Collection)

Call center services

Child care

Death notification (see Tab E: Death Notification)

Family briefings

Family management

Food services

Health and human services

Information desk

Language translation services

Medical and first-aid services

Mental health services

Spiritual care services

Training to set up a family assistance center


1. Organizational Structure

The family assistance center is organized under human services structure of the jurisdiction in which the incident occurs. Staffing is typically provided by volunteers and includes the following three main units: forensic, family management, and health and human services. See Figure 4 for a sample organizational chart consistent with the Incident Command System practice of scalability and flexibility, thus allowing for incident specific design. The family assistance center will operate under the auspices of the fatality management branch director. The site and structure for the family assistance center should be expected to accommodate and / or assist approximately 10 persons per victim. Table 8 provides information on potential scale of a family assistance center. Table 8: Information to help gauge capacity estimates for site selection and developing a family assistance center

Mass Fatality Incident Scale

Small Medium Large Catastrophic Fatality Estimate (N)

< 50 persons 50 – 300 persons 300 – 1,000 persons

> 1,000 persons

Daily Capacity

8 Stations 12 hours per day 96 interviews per

day

25 Stations 12 hours per day

300 interviews per day

50 Stations 12 hours per day

600 interviews per day

50 - 75 Stations 12 hours per day 600+ interviews

per day

Patrons (N)

< 400 400 – 2,400 2,400 – 8,000 > 8,000

FAC Site Stand Alone Stand Alone Stand Alone Remote and / or Multiple Facilities


Figure 4: Sample incident command structure to support mass fatality management operations


8

Sample Incident Command Structure Mass Fatality Management Operations

Incident / Unified

Command

Operations*

Section Chief

Logistics*

Section Chief

Planning

Section Chief

Finance / Admin

Section Chief

Temporary Morgue

Unit

Fatality Management

Representative

Fatality Management

Representative

Fatality Management

Representative

Fire Branch

Director

Search and

Rescue Branch

Director

Law Enforcement

Branch Director

Fatality

Management

Branch Director

Hazmat Team

Search and Rescue Team

Incident Site Group

Supervisor

Morgue Group Supervisor

Family Assistance

Center Group Supervisor

Fatality Management

Deputy Director

Assistant Safety Officer

Incident Site Group

Supervisor

Morgue Group

Supervisor

Victim ID Group Supervisor


Supervisor

Security Team

Evidence Recovery

Team

Security Team

Fingerprint Team

Security Team

Missing Persons

Team


Safety Officer

Liaison Officer

Boxes with a dotted line indicate

potential operational components

depending on the needs of the

mass fatality incident

* Not all operational and logistical

branches are reflected


2. Site Selection

The assessment team (see Section VII.B: Incident Site Assessment) will select a site for the family assistance center. Considerations for selection include: incident type, scope, and location; ease of access to the site; ability to provide adequate security; and ability to support appropriate information technology needs. The family assistance center must be compliant with the American with Disabilities Act (ADA compliant). The emergency management coordinator in the jurisdiction in which the site is located will provide final approval for the site. Personnel, supplies, equipment, and technical support will be obtained from the logistics branch upon request by the family assistance supervisor. Figure 5 provides an example site set-up for the family assistance center. Figure 5: Example site set-up for the family assistance center

PUBLIC ENTRANCE

SECURE ENTRANCE

CHILDCARE

HELP DESK

&

CASE

ASSESSMENT

CALL CENTERFIRST AID

COMMAND

CENTER

&

CONFERENCE

ROOM

MENTAL

HEALTH

&

SPIRITUAL

SERVICES

QUIET ROOM

RECEPTION

&

REGISTRATION

FAMILY INTERVIEW AREA CASE MANAGEMENTDATA

MANAGEMENT

FAMILY WAITING AREA

(Dining, Briefings, etc.)


3. Security

The family assistance center is a safe and secure environment. It is designed to protect family member privacy and from unwanted intrusion from the media, curious onlookers, the general public, and unauthorized individuals. Site security is provided by local law enforcement with constant security present on-site for the duration of the event. Access to the family assistance center is monitored at all times and only authorized personnel with a business reason to be on site are allowed access.

4. Patron Intake

Patrons who require access to the family assistance center shall be screened and managed in an orderly fashion. Figure 6 identifies a process that can be used to manage patron intake. Figure 6: Sample patron intake flow chart to manage admittance to the family assistance center

Is the victim

known missing or

possibly missing?

Refer to 2-1-1

TexasNO

Register, give

credentials,

and assign

guide

Does patron have

additional needs?

Refer to:

Translator

Childcare

Clergy

Counselor

Etc.

YES

Assign to

Family

Interview

Team member

Obtain DNA

sample (if

appropriate)

Patron uses

FAC services

or waits for

family briefing

Patron exits FAC

Patron arrives

at FAC

YES

NO


5. Patron Briefings

It is important to provide information to patrons on a regular, somewhat constant basis, so they are aware of activities related to recovery, identification, and overall incident management activities. Patron briefings help to meet this need. Information must be provided to families as soon as possible and at all times before such information is released to the media. This keeps patrons informed before the public at large, particularly if there are sensitive issues to convey. The Family Management Unit leader coordinates the patron briefing process in conjunction with the PIO. The PIO or designated representative leads these briefings and updates patrons on the latest developments. A conference call bridge is set up in the briefing room to connect to family members who are not on site, however care must be taken to make sure that unauthorized individuals are not provided access to the conference bridge. Patrons are informed of the times, locations, and call in numbers for the briefings and are notified of any changes of location and/or time. The Family Management Unit Leader works with the logistics section to make sure facility needs in the briefing room are appropriate and functional (e.g., tables, chairs, refreshments, facial tissue, grief counselors on site, etc.). Family briefings are conducted at least twice daily, ideally at the same time to promote consistency of information release to patrons.

6. Forensic Unit

The Forensic Unit coordinates all victim identification operations among different teams within the family assistance center. a. Family Interview Team

After initial intake by the reception and registration team, patrons are escorted to a family interview room. A team member conducts an in-depth and confidential interview using the ante-mortem interview form (see Tab A: Ante-Mortem Data Collection), which allows for the collection of detailed information about the victim. This interview normally takes two to seven hours to complete. Team members are specifically trained to interview families or friends of mass fatality incident victims.


b. Data Management Team

The data management provides clerical support for all aspects of the family assistance center, enters information from the ante-mortem interview form into the database, and manages all paper and electronic files. In addition, this team scans victim photographs and other pertinent documents into the database. Information is exchanged with the morgue to enable a complete file for each victim. c. Ante-Mortem Team

The ante-mortem records collection team obtains and organizes information from family members to support victim identification activities. The ante-mortem team works closely with morgue operations and the data management team. See Tab A: Ante-Mortem Data Collection for information regarding the ante-mortem data collection process. d. DNA Reference Team

The DNA reference team is responsible for collecting reference samples of DNA to support victim identification. Activities of the DNA reference team must be conducted in such a manner as to have confidence in the process and eliminate potential for contamination, mislabeling, and loss of samples.

Direct Reference DNA Family members are requested to locate and provide personal items of the missing / unidentified loved one that may contain victim DNA (e.g., toothbrush, hairbrush, etc.). These items are surrendered by the families and must be documented on a chain of custody evidence form for subsequent transmittal to the DNA laboratory conducting the DNA testing. All direct reference samples are documented using chain of custody procedures.

Family Reference DNA Family members are requested to provide a sample (e.g., buccal swab or blood sample) as determined by the DNA reference team. Buccal swabs are preferred as they are the least invasive and are easy to collect. All family reference samples are documented on a chain of custody procedures and released to the individual responsible for transferring the samples to the laboratory conducting testing. Consent forms and evidence forms vary by agency and may be obtained from the laboratory that will process the samples.


e. Personal Effects Team

The personal effects team supports personal effects recovery at the incident site and personal effects recovery at the morgue. This team collects, inventories, refurbishes (but does not restore), photographs, and catalogues the deceased’s personal effects for return to family members and for evaluation for criminal investigation, if applicable. In some incidents, families are required to identify the personal effects of loved ones. Personal effects recovered must be made acceptable for viewing prior to photographing or release to family members to prevent further traumatizing the family. Review of personal effects has the ability to assist identification of items that will be returned to a family member and to aid in circumstantial victim identification based on possession type.

7. Family Management Unit

The family management unit supports family members and friends who require assistance during the recovery process.

a. Call Center

The call center receives, triages, and processes calls about the incident from patrons. It may also take calls from volunteers, individuals wishing to donate items, and others seeking information. The call center will be established using local jurisdictional procedures. This may include standing up a pre-designed call center process or using available state assets (e.g., 211 Texas). Scripts covering likely potential calls will be developed and provided to all call center personnel to support a consistent message covering a range of topics. Upon receipt of a call about potential victim information, the call taker will complete an online intake form to distinguish and process calls among the categories noted in Table 9. Figure 7 shows a sample call intake process.

Table 9: Categories of potential calls and example responses and next steps

Category Type of Information

Provided

Response to Caller

Next Steps After Response to Caller

Known missing

My [relation type here] were expected to be at the location where the incident took place and I am unable to reach

Obtain contact details and information on potential victim

Law enforcement or other personnel handling missing

If the relation remains missing after a return phone call from law enforcement or other personnel handling missing persons, the family is encouraged to travel to the family assistance center for a



Provided

Response to Caller


them and it has been three hours since the incident occurred. Can you help me?

persons will be notified

Expect to receive a call from law enforcement or other personnel handing missing persons.

family interview.

If the family cannot travel to the family assistance center, the family interview team will conduct an interview on the phone

If the caller is in crisis, he or she is transferred to disaster behavioral health services

Possible missing

My [relation type here] said they might go the location where the incident took place and I am unable to reach them and it has been three hours since the incident occurred. Can you help me?

Obtain contact details and information on potential victim

Law enforcement or other personnel handling missing persons will be notified

Expect to receive a call from law enforcement or other personnel handing missing persons.

If the relation remains missing after a return phone call from law enforcement or other personnel handling missing persons, the family is encouraged to travel to the family assistance center for a family interview.

If the family cannot travel to the family assistance center, the family interview team will conduct an interview on the phone

If the caller is in crisis, he or she is transferred to disaster behavioral health services

Not known My [relation type here] often attend activities at the location where the incident took place and I am unable to reach them and it has been three hours since the incident occurred. Can you help me?

Obtain contact details and information about the potential victim

Review information obtained to determine if matches human remains or personal effects

Found Person

A person calls to report a person (themselves or others) reported missing has been located

Obtain contact details and information

Refer this information to the call center team lead for follow-up

Follow-up by law enforcement to confirm veracity of the claim

Volunteer Offer

I would like to volunteer to help family members of

The caller is referred to the volunteer

None



Provided

Response to Caller


this disaster and have the following areas of expertise [expertise listed here]

management phone or website

Donation Offer

I would like to donate [item names here] to support families of the disaster.

The caller is referred to the donation management phone or website

None

Other Calls

Varies Transfer the call to the case assessment team help desk

None


Figure 7: Sample call intake process flowchart

Incoming Patron

Call

Dispatcher

completes Call

Center Intake

Form

Is missing person

known missing or

possibly missing?

YES

Refer to Call

Center Specialiist

Dispatcher hands

off intake form to

Law Enforcement

Law Enforcement

calls patron, opens

missing persons

case file

Is missing person

known missing or

possibly missing?

Refer to Call

Center Helpline

Specialist

Instructs family

to come to (or

call) FAC

YES

NO

NO

What is the reason

for the call?

Helpline

Specialist

Helpline

Specialist

Volunteers or

Donations

Missing Person

Report

Other MFI-related

questions


b. Reception and Registration Team

The reception and registration team receives initial intake information from patrons who present themselves at the family assistance center. When patrons arrive, staff warmly greet them and ensure they are treated with respect, kindness, and sensitivity.

Patron Entry Patrons register upon admittance. At the time of first admittance they may complete a detailed registration form. Subsequent entry will require documentation on the daily sign in sheet, including the date and time of entry. Identification will be verified upon entry.

Patron Exit Exit will require documentation on the daily sign in sheet, with notation of date and time of exit. Patrons will be asked to confirm contact information to support contact if needed.

Guides Upon initial entry, a team member guides patrons through the family assistance center and informing them of available services, provided relevant information about activities and processes, provided the daily briefing schedule, and assisted in learning about the family assistance center.

Intake Interview Upon initial entry, and after a review of services (see Guide above), family members meet with the ante-mortem interview team. This interview will take from two to three hours.

c. Notification / Disposition Team

The notification / disposition team informs family members upon confirmed identification of the related victim. This team is also responsible for release of remains in accordance with family member preferences and health and safety concerns. Preferences will be recorded on a remains release authorization form, which will document the family member’s wish regarding notification and disposition. Available options for notification and disposition that a family member may choose include:

1. Do not notify (families are content not knowing specific details of the identification)

2. Notify one time (i.e. when the first remains are identified)


3. Notify each time remains are identified 4. Wait to notify until all known remains are identified 5. Notify through a third party (clergy, funeral director, etc.)


Notification Process (Local) The process of notification is determined by the size of the incident and the proximity of patrons to the incident site. If families live within a close proximity, notification is made either at the Family Assistance Center or by a personal visit by a team of authorized representatives (law enforcement, clergy, funeral directors, mental health professionals, etc.) to the family member’s home.

Notification Process (non-Local) Non-Local families are assigned a contact person from the Notification/Disposition team. Once identification has been made, the family should be notified by local law enforcement of that identification. A family should be notified by telephone only as a last resort. If notification is to be made by telephone, the FAC member assigned to that family should make the notification.

8. Health and Human Services Unit

The health and human services unit provides for the administrative, physical, emotional, and spiritual needs of patrons within the family assistance center. a. Case Assessment Team

The case assessment team provides ongoing support to patrons. Support may include, but is not limited to (in alphabetical order):

Benefits counseling

Financial assistance and planning

General information

Housing and sheltering (based on local jurisdictional direction)

Internet and email access

Language interpreter services for individual meetings, family meetings, and documents

Language translation services for individual meetings, family meetings, and documents

Laundry services

Mental health services

Physical health services

Referral to support services / agencies, including governmental, corporate, and non-profit services

Spiritual services


b. Mental Health Services Team

The mental health services team provides counseling and behavioral health services to patrons and response staff members in response to stress, grief, sadness, and other emotions related to the mass fatality incident. Spiritual care is also available to patrons and response staff through the mental health services team. Table 10 provides additional details of the types of services that can be offered. The mental health services team monitors patron and staff for support throughout the event.

Table 10: Mental health and spiritual care services typically provided at a family assistance center

Support Category

Activities Types of Providers

Me

nta

l H

ea

lth

Se

rvic

es

Patron Family counseling

Marriage counseling

Grief counseling

Support during and after family briefings

Support during the review of personal effects

Support during the ante-mortem interview

Support during death notifications

Management of at risk patrons

Referral to off-site mental health services

Ad hoc support

Social workers

Licensed professional counselors

Psychologists

Psychiatrists

Grief counselors

Response Staff Daily debriefing

Demobilization support

Social workers

Licensed professional counselors

Psychologists

Psychiatrists

Grief counselors

Peer counselors

Sp

irit

ua

l C

are

Se

rvic

es

Patron Provide spiritual support across faith groups

Prevent unwanted forms of spiritual intrusion

Conduct interfaith services

Attend family briefings

Support during the review of personal effects

Support during the ante-mortem interview

Clergy and chaplains from different faiths


Support Category

Activities Types of Providers

Support during death notifications

Monitor family reactions

Response Staff Support spiritual needs of staff, volunteers, and first responders

Conduct interfaith services

Clergy and chaplains from different faiths

c. Childcare Team

The childcare team provides temporary respite care for children while their parents or guardians are at the FAC involved in interviews, briefings, and meetings. The childcare area is prepared to provide support and activities for children representing a range of ages and is structured and staffed to provide appropriate monitoring and support for children’s needs. The childcare facility and staff will be subject to state regulations.

Credentialing Only licensed childcare providers and staff who have passed a criminal background check are to provide childcare services. Credentialing should occur pre-incident.

Accountability Appropriate documentation of children will be maintained through sign-in and sign-out and badging or tagging procedures. Parents or guardians must provide staff with special instructions, such as medical conditions or dietary needs and requirements, when registering their children.

d. Mass Care Team

The mass care team provides feeding for patrons and staff and limited lodging for out-of-town family members. The mass care team arranges for a dining area where three meals per day are served and where snacks and drinks are available during hours of operation. Spiritual care and mental health services teams are present and available during meal times to meet with and bring comfort to patrons and staff.


e. First Aid Team

The first aid team provides basic first aid or medical care for patrons and staff at the family assistance center. The team also serves as a liaison with medical service providers in the event of a medical emergency. If DNA family reference collection is required, the first aid team may also be assigned that responsibility in lieu of a separate DNA reference collection team.

H. Faith-Based Services and Outreach

Faith-based services and outreach may occur either as part of a coordinated response or as part of a spontaneous outreach during a mass fatality incident. Functions of faith-based organizations may include:

Advising on issues of cultural and religious sensitivity

Advising on beliefs and practices related to death and burial

Advising on spiritual beliefs

Providing grief counseling

Recruiting and coordinate clergy activities in the community to best support response activities

Providing housing, sheltering, and support activities to victims’ families

Providing mental health support to first responders and first responder families

The incident commander may consider assigning a liaison to direct faith-based services at the incident site to ensure that such activities are in compliance with ongoing security, safety, and administrative activities.


I. Handling Human Remains

1. General

Victims of natural disasters, accidents, or weapons of mass destruction events usually die from trauma and are unlikely to have acute or infections. In the event of an intentional release of a CBRNE agent or infectious disease agent resulting in mass casualties, there may be potential health risks from dead bodies, dependent on the CBRNE or infectious agent. Staff should consider the following general information handling human remains as part of a mass fatality incident.

1. Seek advice from public health and medical officials before handling dead bodies.

2. When the body dies, the environment in which pathogens live can no longer sustain them. However, this does not happen immediately for all pathogens and transmission of an infectious agent from a dead body or fragmented remains to a living person may occur. The likely three types of exposure are from blood borne viruses (e.g., hepatitis A, B, C, D and HIV), gastrointestinal infections caused by the shigella and salmonella bacteria, and mycobacterium tuberculosis.

3. Be aware of specific CBRNE or infectious agents causing death. Some

CBRNE or infectious agents may require specific control measures to prevent contamination. For example:

a. Persons who have died of Ebola must be handled using strong

protective clothing and gloves and must be buried immediately. The World Health Organization advises that the deceased be handled and buried by trained case management professionals, who are equipped to properly bury the dead).

b. Persons with influenza died during the infectious period may continue to have live virus in the lungs, thus requiring additional respiratory protection during autopsy and embalming

4. Protect your face from splashes of body fluids and fecal material. You can

use a plastic face-shield or a combination of eye protection (indirectly vented safety goggles are a good choice if available; safety glasses will only provide limited protection) and a surgical mask. In extreme situations, a cloth tied over the nose and mouth can be used to block splashes.

5. Protect your hands from direct contact with body fluids, and also from

cuts, puncture wounds, or other injuries that break the skin that might be


caused by sharp environmental debris or bone fragments. A combination of a cut-proof inner layer glove and a latex or similar outer layer is preferable. Footwear should similarly protect against sharp debris.

6. Maintain hand hygiene to prevent transmission of diarrheal and other

diseases from fecal materials on your hands. Wash your hands with soap and water or with an alcohol-based hand cleaner immediately after you remove your gloves.

7. Give prompt care--including immediate cleansing with soap and clean water, and a tetanus booster if indicated--to any wounds sustained during work with human remains.

8. In addition to guarding physical safety, participate in available programs to provide psychological and emotional support for workers handling human remains. Agencies coordinating the management of human remains are encouraged to develop programs providing psychological and emotional support and care for workers during and after recovery activities.

9. Appropriately dispose of used protective equipment such as gloves or other garments

10. Avoid cross-contamination: personal items should not be handled while

wearing soiled gloves.

11. Hand washing is essential.

12. Vehicles used for transportation should be washed carefully with a disinfectant or decontaminated if appropriate.

13. Human remains pouches will further reduce the risk of infection and are

useful for the transport of decedents that have been badly damaged. Wrapping with plastic and a sheet may be an economical and practical containment solution.

14. Make sure to have up to date vaccinations for tetanus and hepatitis B

vaccination Source: University of Georgia Mass Fatality Plan Template


2. Personal Protective Equipment

First responders will be required to wear personal protective equipment (PPE) commensurate with the activity they are undertaking, degree of exposure, and risk of potential infection. When additional hazards are identified, PPE requirements will be adjusted to address those specific hazards. Responders should utilize the most appropriate PPE. a. PPE Recommendations for Incident Site Personnel who Handle Human

Remains

General PPE recommended for everyone includes:

Hardhat for overhead impact or electrical hazards.

Eye protection with side shields.

Gloves chosen for job hazards expected (e.g., heavy-duty leather work gloves for handling debris with sharp edges and/or chemical protective gloves appropriate for chemicals potentially contacted).

ANSI-approved protective footwear.

Respiratory protection as necessary—N, R, or P95, filtering face pieces may be used for nuisance dusts (e.g., dried mud, dirt and silt) and mold (except mold remediation). Filters with a charcoal layer may be used for odors.

Additional PPE recommendations for workers at the incident site that will be handling human remains includes:

Fluid-proof gloves (e.g., latex, nitrile, rubber). Cover with heavy-duty work gloves if potential for cuts and abrasions (e.g., moving debris).

Protective clothing appropriate for preventing blood penetrating to underlying skin/clothing.

b. Recommendations for Morgue Site Personnel

Morgue personnel will wear PPE as directed by the medical examiner. This will include typical morgue PPE and any additional PPE specific to the incident as directed by the health officer. In the event of a pandemic influenza, additional respiratory protection is needed during autopsy procedures performed on the lungs or during procedures that generate small-particle aerosols (e.g., use of power saws and washing intestines) in case the decedent was infectious when he/she died.


Potentially contaminated human remains (e.g., biological such as a category a biological agent, chemical or radiological contamination) must be decontaminated prior to introducing them into the morgue facility. c. Recommendations for Funeral Service Personnel

Funeral service personnel who handle human remains will wear typical PPE associated with their profession unless otherwise directed by the health officer. In the event of a pandemic influenza, additional respiratory protection similar to requirements for autopsy procedures will be needed for personnel who are involved in embalming those who die from the pandemic in preparation for burial or cremation in case the decedent was infectious when he/she died. If funeral service personnel encounter potentially contaminated remains (e.g., a biological agent, chemical or radiological contamination), they must:

Take steps to protect themselves and other mortuary staff.

Immediately stop the removal process.

If removal has already been made to the mortuary, stop all processing efforts.

Notify the medico-legal authority of the circumstances as then known and prepare to release the remains to the medico-legal authority for investigation.

When remains cannot be adequately decontaminated, they will be placed in a sealed container that can be externally decontaminated prior to release to the funeral service by the decontamination team at the incident site. The sealed container must not be reopened prior to final disposition. Source: Santa Clara County Advanced Practice Center – Managing Mass Fatalities, A Toolkit for Planning


J. Human Remains Storage

A mass fatality incident may exhaust local storage capacity for human remains. To prepare for such an eventuality the following should be considered.

1. Utilize existing surge capacity (i.e., hospitals, medical examiner, funeral homes, and other refrigerated assets, such as trucks)

2. Request Public Health mortuary trailers through mutual aid 3. Construct temporary morgue facilities using tents or trailers

If temporary human remains storage is necessary, the following requirements can assist in the identification and / or construction of a temporary facility. Site Requirements Any facility used as a temporary morgue should meet the following requirements: Size

10,000-12,000 square feet at a minimum

Room for 53’ refrigerated trailers (number needed to be determined by incident) Structure Type

Hard, weather-tight roofed structure

Separate accessible office space for the Information Resource Center

Separate space for administrative needs/personnel

Non-porous floors, preferably concrete

Floors capable of being decontaminated (hardwood and tile floors are porous and not usable) Accessibility The temporary morgue site should have:


Easy access for vehicles, equipment and a tractor trailer

A 10' x 10' door

Loading dock access or site should be at ground level

Convenience to the incident scene

Complete security (away from families) Electrical

Electrical equipment utilizes standard household current (110-120 volts)

Power obtained from accessible on site distribution panel (200-amp service)

Electrical connections to distribution panels made by local licensed electricians

Two Diesel generators (7K) carried in DPMU cache

DPMU may need 125K generator and a separate 70K generator for Administrative and IR Sections Communications Access

Existing telephone lines for telephone/fax capabilities

Expansion of telephone lines may occur as the mission dictates

Broadband Internet connectivity

If additional telephone lines are needed, only authorized personnel will complete any expansion and/or connections Water/Sanitation/Drainage

Single source of cold water with standard hose bib connection

Water hoses, hot water heaters, sinks, and connectors in the DPMU

Existing drainage to dispose of gray water

Pre-existing rest rooms within the facility are preferable

Decontamination

Each jurisdiction to address decontamination of any facilities used during the activation of this plan to usable state during demobilization


Note that biological hazardous waste, liquid or dry, produced as a result of morgue operations, will be disposed in accordance with local/state requirements. In the event that the jurisdiction does not have the capabilities to meet local/state requirements, cleanup and disposal can be contracted out to a private company that specializes in this service. Source: University of Georgia Mass Fatality Plan Template

K. Incident Command System

This section provides an Incident Command System organizational chart for the mass fatality management operations (see Figures 8 – 12).


1. Incident Command System – Overall

Figure 8: Sample incident command structure depicting operations to support a mass fatality incident


Incident / Unified Command

Operations* Section Chief

Logistics* Section Chief

Planning Section Chief

Finance / Admin Section Chief

Temporary Morgue

Unit

Fatality Management

Representative

Fatality Management

Representative

Fatality Management

Representative

Fire Branch Director

Search and Rescue

Branch Director

Law Enforcement

Branch Director

Fatality Management

Branch Director

Hazmat

Team

Search and

Rescue Team

Incident Site

Group

Supervisor

Morgue Group

Supervisor

Family

Assistance

Center Group

Supervisor

Fatality

Management

Deputy Director

Assistant

Safety Officer

Incident Site Group

Supervisor

Morgue

Group

Supervisor

Victim ID Group

Supervisor


Supervisor

Security

Team

Evidence

Recovery Team

Security

Team

Fingerprint Team

Security Team

Missing

Persons

Team


Safety Officer

Liaison Officer

Personal Effects Team

Human Remains

Recovery Team

Human Remains

Transportation Team

Storage Team

Decontamination.

Team

Triage / Evidence

Recovery Team

Admitting

Team

Tracking

Team

Personal

Effects Team

Photography

Team

Radiology

Team

Pathology

Team

Fingerprints Team

Odontology

Team

Anthropology

Team

DNA Team

Admitting Processing Unit

Forensic Unit

Postmortem Data

Management

Team

Postmortem

Records Collection Team

Data Analysis

Team

Quality

Assurance

Team

Family

Interview Team

Antemortem Data Management Team

Antemortem Records

Collection Team

DNA Reference

Collection Team

Personal

Effects Team

Call Center

Team

Reception and

Registration Team

Notification and

Disposition Team

Forensic Unit Family

Management Unit

Case Assessment

Team

Mental Health Services Team

Spiritual Services

Team

Childcare

Team

Mass Care Team

First Aid

Team

Health and Human

Services Unit

Boxes with a dotted line indicate potential operational components depending on the needs of the mass fatality

incident.

* Not all operational and logistical branches are reflected.


2. Incident Command System – Fatality Management Branch: Incident Site Group

Figure 9: Sample incident command structure depicting operations to support the mass fatality branch, incident site group


9

Sample Incident Command Structure Fatality Management Branch – Incident Site Group

Fatality Management

Branch Director

Incident Site

Group Supervisor

Victim

Identification

Group Supervisor

Morgue Group

Supervisor

Family

Assistance Group

Supervisor

Fatality

Management

Deputy Director

Safety

Officer

Personal

Effects Team

Leader

Human

Remains

Recovery

Leader

Human

Remains

Transportation

Team Leader


3. Incident Command System – Fatality Management Branch: Victim Identification Group

Figure 10: Sample incident command structure depicting operations to support the mass fatality branch, victim identification group


10

Sample Incident Command Structure Fatality Management Branch – Victim Identification Group

Fatality Management

Branch Director

Incident Site

Group Supervisor

Victim

Identification

Group Supervisor

Morgue Group

Supervisor

Family

Assistance Group

Supervisor

Fatality

Management

Deputy Director

Safety

Officer

Postmortem

Data

Management

Team Leader

Postmortem

Records

Collection

Team Leader

Data

Analysis

Team Leader

Quality

Assurance

Team Leader


4. Incident Command System – Fatality Management Branch: Morgue Group

Figure 11: Sample incident command structure depicting operations to support the mass fatality branch, morgue services group


11

Sample Incident Command Structure Fatality Management Branch – Morgue Group

Fatality Management

Branch Director

Incident Site

Group Supervisor

Victim

Identification

Group Supervisor

Morgue Group

Supervisor

Family

Assistance Group

Supervisor

Fatality

Management

Deputy Director

Safety

Officer

Storage Team

Decontamination Team

Triage / Evidence Recovery

Team

Admitting Team

Tracking Team


Photography Team

Radiology Team

Pathology Team

Fingerprints Team

Odontology Team

Anthropology Team

DNA Team

Admitting / Processing

Team

Forensic

Unit


5. Incident Command System – Fatality Management Branch: Family Assistance Group

Figure 12: Sample incident command structure depicting operations to support the mass fatality branch, family assistance group


Fatality Management

Branch Director

Incident Site

Group Supervisor

Victim

Identification

Group Supervisor

Morgue Group

Supervisor

Family

Assistance Group

Supervisor

Fatality

Management

Deputy Director

Safety

Officer

Family Interview

Antemortem Data Management

Antemortem Records

Collection

DNA Reference Collection

Personal Effects

Forensic Unit

Leader

Call Center

Reception / Registration

Notification / Disposition

Family Management

Leader

Case Assessment

Mental Health Services

Spiritual Services

Childcare

Mass Care

Health and Human Services

Leader

First Aid


L. Incident Site Management

Mass fatality incident sites will vary depending on the incident type, number of fatalities involved, and general scope of the disaster. However, there are commonalities among different sites. For example, body and body parts will need to be catalogued and collected; human remains will need to be transported; personal effects will need to be collected; and families will be impacted by the disaster. Similarly, activities at a mass fatality incident will involve many of the same day-to-day response requirement from emergency service providers, including establishing the accident site perimeter, controlling access to the site, and bringing in subject matter experts to evaluate and process site activities. Specific incident site management activities can be found under the following tabs:

Section VII.C: Direction and Control: Incident Site Safety (Page 40)

Section VII.D: Direction and Control: Teams (Page 44)

Section XI, Tab K: Incident Command System (Page 87)


M. Morgue Management

1. Introduction

Oversight of morgue operations is the primary responsibility of the fatality management branch director under the operations section of the ICS command structure. The individual tasked with oversight of morgue management must have considerable knowledge of human identification and forensic sciences in general. Human remains must be handled with dignity and respect throughout the entire process of locating, collecting, and processing for identification, and release.

2. Organization

There are a variety of responsibilities within the structure of morgue operations, which require varying degrees of expertise. Many of the subject matter expert positions require highly trained and skilled individuals holding certification and licensure. Morgue components can be built to the extent necessary to meet the identification challenges of the incident being managed. The organizational chart below depicts a possible mass fatality incident morgue operation within ICS guidelines (see Figure 13).


Figure 13: Sample Incident Command System structure to support morgue management activities during a mass fatality event


11

Sample Incident Command Structure Fatality Management Branch – Morgue Group

Fatality Management

Branch Director

Incident Site

Group Supervisor

Victim

Identification

Group Supervisor

Morgue Group

Supervisor

Family

Assistance Group

Supervisor

Fatality

Management

Deputy Director

Safety

Officer

Storage Team

Decontamination Team

Triage / Evidence Recovery

Team

Admitting Team

Tracking Team


Photography Team

Radiology Team

Pathology Team

Fingerprints Team

Odontology Team

Anthropology Team

DNA Team

Admitting / Processing

Team

Forensic

Unit


3. General Considerations

The following discussion about morgue operations encompasses detailed operational aspect relevant to a full-scale incident. However, the concept is designed to be flexible and scalable to meet the demands of each specific incident. Any number of the components discussed below can be included, excluded, or expanded to support the specific needs of the situation. For ease of discussion, the individual sections are referred to as teams although the team may consist of only one person and a single person may serve more than one team function based upon the scale of the operation.

4. Personnel

The local medico-legal authority will preapprove subject matter experts prior to being assigned to these individuals being assigned to morgue duties. This is because of the highly technical work to be conducted by morgue personnel. Spontaneous, unaffiliated volunteers are not permitted to work in a mass fatality incident morgue. However, some of the skill sets necessary to support morgue operations are general in nature. The requirements for pre-approved SMEs have a direct impact on the ability of morgue operations to expand to the needs of the incident and a lack of pre-approved SMEs may hasten a need for regional, state, and/or federal assistance.

5. Documentation

All documents created (including photographs and x-rays), collected, or otherwise generated during morgue operations for a mass fatality incident fall under the control of the jurisdictional medico-legal authority. The jurisdictional medico-legal authority holds authority over the release of information concerning human remains and morgue operations.

6. Safety

A safety officer should be identified and appointed to oversee all aspects of mass fatality incident morgue operations. Personnel working in the morgue must comply with international safety precautions and wear appropriate personal protective equipment. Biohazard waste bags and sharps containers must be available for disposal of all waste generated from human remains processing and disposal of used scalpels, syringes, etc. Personnel assigned to work in morgue operations must have completed blood-borne pathogens training prior to assignment of duties in the morgue. The Department of State Health Services can provide this training.


7. Security

Processing of human remains from a mass fatality incident cannot commence without first establishing security of the facility housing that operation. Security shall be provided by the local law enforcement agency having jurisdiction where the morgue or temporary morgue is located. A form of badging of all personnel assigned to the morgue is required to control morgue access to authorized persons. Media, family members of the deceased, spontaneous, unsolicited volunteers, and curiosity seekers are not authorized to enter the morgue.

8. Temporary Morgue

A temporary facility can be an existing building or a temporary structure. Either option must have running water, electricity, and heating/air conditioning. The structural footprint must be a single floor configuration with a minimum of 10,000 square feet and arranged in such a manner to facilitate efficient morgue flow processing. It should also be located relatively close to the incident site yet sufficiently distanced to be clear of danger from the site and associated aftermath of the incident. The facility must also be conducive to security and controlled access. Avoiding highly trafficked areas, schools, public facilities or hospitals is preferable when possible. Potential facilities include but are not limited to commercial warehouses, National Guard Armories, vacant buildings, and hangars.

9. Morgue Protocols

Written protocols (also referred to as Standing Operating Procedures [SOPs]) should be established to document morgue processing procedures. The protocols are determined prior to any human remains being processed by the morgue. Protocols should address, at a minimum, the following: degree of degradation of the remains, number of bodies, availability of medical equipment and facilities, funding constraints, time constraints, and safety issues. All protocols established must be approved for implementation by the local medico-legal authority. Once a protocol is adopted the processes should remain consistent throughout the project.

10. Common Tissue

In some instances, there are human remain fragments that are not suitable for morgue processing. Common tissue most frequently results from incidents of high-impact airplane crashes where severe fragmentation occurs. Examples include small nondescript pieces of bone and tissue that are unclassifiable and


unsuitable for DNA testing. These human remain fragments are labeled during triage as common tissue, described to the degree possible, photographed, weighed and returned to temporary storage for safekeeping.

11. Known Decedents

If a victim’s demise was a direct result of injury or medical conditions resulting from the mass fatality incident, the remains should be processed as a mass fatality incident victim, even when the identity is known. The remains of these victims should be transported to the mass fatality incident morgue and processed. If a family member’s attempts to deliver a deceased family member to a hospital, the hospital should make arrangements with the human remains transportation team to transport the remains to the morgue or to a designated body collection point. If the death occurs after mass fatality incident operations have been completed and can be attributed to injuries/infection from an accident or willful event, the death is reportable to the local medico-legal authority, regardless of where the death occurred (another city in Texas, or even another state). If the death occurs in another state, the local medico-legal authority is responsible for certifying the cause and manner of death. Again, the death must be reported to the local medico-legal authority for purposes of keeping an accurate record of the event. The local medico-legal authority will assist the contracted medical examiner or coroner with the death investigation. The local medico-legal authority will request a copy of the death certificate for record keeping purposes.

12. Work Flow

All human remains entering the morgue for processing should be handled in a uniform fashion. The remains pass through various operational phases, categorized into three general functions

1. Admitting / processing 2. Forensic examination 3. Victim identification.

Figure 14 depicts the workflow through various stations of the morgue.


Figure 14: Morgue operations flowchart

Human

Remains

Storage

Decon.(incident-specific)

Triage

Documentation

Number

Photography

X-Ray

Forensic Exam

Pathology

Odontology

Anthropology

Fingerprints

DNA

Storage Reassociation Release

Evidence

Personal Effects

Common Tissue

Victim

Identification

Unit

FAC

Ante-Mortem

Data

ME/L-MA

Approval

Next-of-Kin

NotificationDNA Laboratory

DNA Samples

DNA Reference

13. Repatriation

Repatriation efforts are similar in nature to mass fatality responses and therefore must be addressed. Cemetery compromise may be a result of flooding where no fatalities occur or part of a larger scale incident (as was the case with Hurricanes Floyd and Katrina). In either circumstance, casket repatriation will require a non-routine response and should be managed in similar fashion to a MFI response.

14. Admitting / Processing Unit

Morgue admitting and processing functions for human remains include:

Storage

Decontamination

Evidence review and triage

Admitting

Tracking human remains

Management of personal effects These functions are designed to maintain an orderly process, provide for the safety of individuals working in the morgue, to provide a systematic and thorough documentation process, and to provide accountability.


a. Admitting Team

There must be a formal admitting procedure set in place to properly account for each set of human remains submitted to the morgue and to create a record of each step by various forensic disciplines to document procedures, classify, and identify the remains. The admitting team creates a folder of pre-printed forms for use by each morgue station along with a tracking log to verify each set of remains has been examined at each station. The admitting team also assigns an escort, referred to as a “tracker,” for each set of remains to direct the remains from station to station.

Support Function Member

ICS Training: ICS 100

Description: Conducts administrative work to account for human remains

Minimum Requirements: Experience in preparing and maintaining records and ability to use relevant computer software for job duties

b. Decontamination Team

Human remains transported to the morgue may or may not have been contaminated. Radiological-contaminated remains or remains suspected of having been exposed to high levels of radiation are unsafe for transport to the morgue. Biologically contaminated remains that are transported to the morgue will need to be decontaminated prior to morgue intake. In that situation the nearest hazardous materials team (HAZMAT) should be tasked with operating human remains decontamination station at the point of entry into the morgue flow process. A general rule of precaution is to handle all human remains as if they are infectious.



Description: Provides decontamination of human remains and site

Minimum Requirements: Experience and training relevant to decontamination activities

c. Evidence Response Team

In the event a mass fatality incident results from a criminal act or suspected criminal act there may be a need to have evidence collection capability in the morgue operation. The responsibility for evidence processing always rests with law enforcement officials. Evidence technicians may need to examine all human remains and personal effects submitted to the morgue to determine potential for evidentiary value. This procedure should also occur at the front end of morgue


processing and may be conducted in concert with triage. Items identified as having potential evidentiary value may be collected by the evidence response team and removed from the morgue. Other items of evidence discovered during later stages of morgue processing (e.g., a bullet discovered at autopsy) can also be collected as evidence by the evidence response team at the morgue. The evidence response team should annotate any item(s) taken from a numbered human remains body bag on administrative tracking forms. Items that have potential for identification should be processed through the morgue stations prior to release to the evidence removal team and removal from the morgue.



Description: Receives and process evidence including human remains, possessions, etc.

Minimum Requirements: Experience in basic inventory management principles, use of relevant computer software, and skills in developing and maintaining records

d. Personal Effects Team

Belongings associated with or disassociated from human remains at the site must be collected, safeguarded, examined for evidence, documented, cataloged, refurbished (but not restored), associated to the rightful owner, and eventually relinquished to next-of-kin when possible. The personal effects team takes responsibility for these activities. Personal effects collected at the incident site should be transported to the local medico-legal authority’s pre-designated morgue or temporary morgue. If personal effects are evaluated for evidence prior to collection at the site, they should still be evaluated at the morgue following standard procedures. All personal effects should be handled as if they have evidentiary value until determined otherwise. Personal effects identified as evidence should be separated from other personal effects and released to investigators. Personal effects are removed from bodies during forensic examination but are not separated from the human remains for personal effect processing until the human remains have been process through all identification stations. Pending complete examination of the human remains, personal effects are segregated from the human remains and stored for safekeeping or transferred to another location for refurbishment. Personal effects will be returned to next of kin per established protocols.




Description: Conducts administrative work to manage and track belongings associated / disassociated from the incident


e. Storage Team

Temporary body storage will be needed when the ability to process human remains exceeds capacity to process the remains. Refrigerated, mobile units such as trailers and Conex containers work well for this purpose. These units can be powered by either fuel or electricity and the number of units can increase to meet the needs of the incident. Trailers can also be fitted with shelving to increase unit capacity. It is not acceptable to stack bodies on one another. Commercial freezers are not acceptable options for temporary storage. Storage facilities should segregate contaminated and non-contaminated remains in separate storage containers. Common tissue that is not associated to any victim, remains that are not identified, and remains identified that are not claimed, are retained under the control of the local medico-legal authority at the contracted morgue or morgue designated by the next of kin until other disposition decisions are reached. For more information on human remains storage, see Tab J: Human Remains Storage.



Description: Responsible for handling and storage of human remains in accordance with rules, regulations, and direction from the pathology team

Minimum Requirements: None f. Tracking Team

The admitting team also assigns an escort, referred to as a “tracker,” for each set of remains to through each station to make sure each discipline has an opportunity to examine the remains. Trackers use a one-page form listing each morgue station where the human remains are presented for examination. A station representative must check and initial the tracking form to verify each set of remains has been presented for


examination. The tracker also collects the station’s documents generated from the exam or evaluation for that set of remains. In the event remains are presented to a station but are determined to be unsuitable for examination (i.e. a fragmented body with no hands or feet that do not require fingerprinting) the station representative will initial the tracking document as verification that no examination was conducted at that station. After the tracker has completed the entire morgue circuit the remains are returned to storage and the documents generated from station examinations are returned to the admitting team for subsequent release to the victim identification unit.



Description: Conducts administrative work to track human remains throughout the examination process


g. Triage Team

During triage a pathologist, anthropologist, or other qualified individual will examine the contents of each body bag to verify anatomical articulation, search for potentially comingled body parts, and segregate accordingly. Body bags discovered to represent multiple victims must be sorted, re-bagged as separate human remains, and issued a new human remains numbering for processing. Records must reflect this sorting process and annotated with the associated human remains number(s). Any fragmented remains that cannot be classified, as having potential for identification may be declared common tissue, culled from the process, and stored as human remain material unsuitable for identification. The triage team can determine whether or not a specific human remains item needs to be processed through every station. For example, a body bag containing only a flap of skin does not need to be examined by the dental or fingerprint sections, unless that skin shows signs of friction ridges.


ICS Training: 100

Description: See individual descriptions for pathologist, anthropologist, etc.

Minimum Requirements: See individual descriptions for pathologist, anthropologist, etc.


15. Forensic Unit

In the forensics phase, subject matter experts conduct technical examination of human remains using a variety of processes and activities, as noted below. Forensic specialists and evidence specialists will support forensic unit activities.

Forensic Specialist

ICS Training: 100

Description: Assists DNA, pathology, anthropology, odontology, photography, or personal effects teams. They may also serve as section leader for the photography support team or personal effects team

Minimum Requirements: Laboratory level, toxicology, chemistry, and firearm forensic experience

Evidence Specialists

ICS Training: 100

Description: Supports scene search and recovery; assists photography, personal effects, pathology (as scribe), anthropology (as scribe), odontology (as scribe), or DNA support teams; and may serve as section leader for disaster site center, transport, remains holding or storage, photography, or personal effects

Minimum Requirements: Strong attention to detail and experience in basic inventory management principles, use of relevant computer software, and skills in developing and maintaining records

The following teams (in alphabetical order) are described in more detail below:

Anthropology

DNA

Fingerprint

Odontology

Pathology

Photography

Radiology


a. Anthropology Support Team

This team primarily classifies unidentified, decomposed, mummified, skeletal remains, and articulate disarticulated remains. Anthropologists may also be needed on site for human remain recovery efforts and at the triage station to sort comingled remains. An evidence specialist may serve as a scribe for this support team.

Anthropologist (Forensic)

ICS Training: 100

Description: Search and / or exam bone or bone fragments. May also serve as the leader for anthropology support team

Minimum Requirements: Doctoral level training (PhD) in anthropology with forensic / postmortem experience

Anthropologist (Non-Forensic)

ICS Training: 100

Description: Search and / or exam bone or bone fragments. May also serve as the leader for anthropology support team

Minimum Requirements: Doctoral level training (PhD) in anthropology without forensic / postmortem experience

b. DNA Support Team

This team collects DNA samples from human remains. It is the last station within the morgue section sequence of activities because DNA sample collection will alter the condition of the human remains. Sample collection consists of buccal swab, whole blood, tissue, bone, or teeth. Records must document what sample was collect, how it was collected, and the human remain origin (e.g., blood, teeth, etc.). The method and timing of transfer of DNA samples from the morgue is coordinated between the DNA team and the laboratory servicing DNA remains. Laboratory results are reported back to the victim identification group.

DNA Specialist

ICS Training: 100

Description: Collect and supervise DNA collection under the medico-legal authority and may serve as the leader for the DNA support team

Minimum Requirements: Laboratory level forensic DNA experience


c. Fingerprint Support Team

Fingerprints present on any remains or personal effects will be obtained and recorded. Digital or inked fingerprint collection methods may be used. Recorded fingerprints are released to law enforcement following document release procedures. Law enforcement will classify, compare, and analyze fingerprints to support identification of victims or to support criminal investigation activities. Fingerprint matches are reported to the jurisdictional medico-legal authority. Fingerprint cards are returned to the medico-legal authority for recording keeping and human remains documentation. Law enforcement assets assigned to support fingerprinting activities will operate under the fatality management branch.

Fingerprint Specialist

ICS Training: 100

Description: Obtains print impressions from remains or ante mortem specimens; compares ante and postmortem prints for identification purposes. May serve as leader for ante or post mortem fingerprint support teams

Minimum Requirements: Postmortem fingerprint experience or latent print analysis

d. Odontology Support Team

Dentists conduct exams of partial or full sets of teeth from each set of human remains. Either the radiology support team or the odontology support team may take radiographs of dental remains. Dentition, or the kind, number, and arrangement of the teeth will be recorded and charted using appropriate computer software. Post mortem, the data analysis team will compare dentition records to victim dental records obtained by the ante-mortem team. Disassociated partial dentition receives separate human remain numbers and are examined and classified. Three members should staff the odontology teams: (1) a dentist; (2) a dental assistance; and (3) a scribe or recorder. An evidence specialist may serve as a scribe for this support team.

Odontologist (Forensic)

ICS Training: 100

Description: Examines dental remains, processes ante-mortem dental records for identification purposes, and may serve as leader for the odontology support team

Minimum Requirements: Licensed dentist (DDS or DMS) with forensic / postmortem experience


Odontologist (Non-Forensic)

ICS Training: 100

Description: Examines dental remains, processes ante-mortem dental records for identification purposes, and may serve as leader for the odontology support team

Minimum Requirements: Licensed dentist (DDS or DMS) without forensic / postmortem experience

Dental Assistant

ICS Training: 100

Description: Assist odontologist at table, provide clerical support, or serve as body escort or scribe

Minimum Requirements: Dental hygienist or other assistance with experience in a dental practice

e. Pathology Support Team

Autopsies will be performed under direction of the jurisdictional medico-legal authority, which will consider the following when determining whether to perform a partial or complete autopsy:

1. The number of remains 2. Condition of remains 3. Complexity of identification

For any partial or complete autopsies conducted a gross description of the remains, must be recorded. Evidence discovered during the autopsy will be recorded, photographed, and released to the evidence response team. Consideration should be given to assigning a person to record notes from the pathologist to expedite the examination process. An evidence specialist may serve as a scribe for this support team.

Pathologist (Forensic)

ICS Training: 100

Description: Examines recovered remains, details anatomic observations and may serves pathology support team leader

Minimum Requirements: Licensed physician (MD or DO) with forensic / postmortem experience


Pathologist (Non-Forensic)

ICS Training: 100

Description: Examines recovered remains, details anatomic observations and may serves pathology support team leader

Minimum Requirements: Licensed physician (MD or DO) without forensic / postmortem experience

Autopsy Technician

ICS Training: 100

Description: Assists pathology, anthropology, odontology, or DNA sections; may serve as team for the radiology support team

Minimum Requirements: Medical examiner morgue autopsy and radiology experience

f. Photography Support Team

Each human remain is photographed, whether it is an intact body part or a small fragment. Photographs serve as a frame of reference for human remains returned to storage and can be examined later without a need to retrieve human remains from storage for visual examination. Specific morgue stations may request photography. The human remains number assigned to that particular remain should appear in each photograph. If additional photography assets are needed to support response activities, local law enforcement should be contacted.

Photographer

ICS Training: 100

Description: Takes photographs at any of the several morgue stations or at the disaster site

Minimum Requirements: Forensic photography experience g. Radiology Support Team

Radiographs expose important biological information (e.g., previous bone fractures, surgical interventions, implants, and trauma related to the incident). Anomaly detection frequently supports positive identification. Radiographs can also aid in the detection of comingled remains. Radiology is also useful in identifying foreign bodies (e.g., unexploded ordinance) that may have penetrated human remains. Dental radiographs may be needed to support activities of the odontology team. All human remains entering the morgue receive and x-ray; intact human remains receive a full body scan to adequately document remains.


Radiologic Technologist

ICS Training: 100

Description: Obtain radiographs using diagnostic or imaging radiology equipment

Minimum Requirements: Licensed radiographic technologist, preferably with forensic experience

h. Organizational Charts

See Figures 8 – 12 in Tab K: Incident Command System for sample organizational charts


O. Victim Identification

The victim identification group is responsible for document housekeeping, collecting victim ante-mortem records, and conducting analysis of ante- and postmortem data to identify human remains. This group analyzes data to reach scientific conclusions upon which to base probable identifications with findings formally documented in an identification report that is presented to the medico-legal authority who either accepts or rejects the findings. Accepted findings become the formal identifications certified by the medico-legal authority.

1. Scientific Vs. Presumptive Identification

Victim identification should be based on scientific findings since legal issues of identification associated with victims of mass fatality incidents, may come under scrutiny by next-of-kin, media, and others. Findings may be contested. In certain circumstances, the ability to provide positive identification may be limited due to factors such as decomposition, poor or limited sample or lack of ante-mortem data. Presumptive evidence may be used in such cases.

2. Identification Process

The identification of mass fatality victims is dependent upon collecting appropriate ante-mortem and postmortem information for comparison and matching details of each in order to reach a conclusion of positive identification. The task of data comparison is aided by the use of computer software designed specifically for that purpose. The Disaster Mortuary Operational Response Team (DMORT) software program used for this purpose is the victim identification program. Another such program is that used by the New York office of the chief medial examiner called the unified victim identification system.

3. Open versus Closed Victim Populations

Identification processes start by creating a closed population of victims. Closing mass fatality incident populations reduces the number of possibilities for identification. Conversely, attempting to close the incident population from a hurricane requires a significant investigative effort and relies on family and friends to report missing persons to proper authorities.


4. Victim Identification Team

Figure 15 depicts a typical victim identification group operating under the fatality management branch director.


Figure 15: Sample incident command structure for the victim identification group


10

Sample Incident Command Structure Fatality Management Branch – Victim Identification Group

Fatality Management

Branch Director

Incident Site

Group Supervisor

Victim

Identification

Group Supervisor

Morgue Group

Supervisor

Family

Assistance Group

Supervisor

Fatality

Management

Deputy Director

Safety

Officer

Postmortem

Data

Management

Team Leader

Postmortem

Records

Collection

Team Leader

Data

Analysis

Team Leader

Quality

Assurance

Team Leader


5. Postmortem Data Management Team

Records management develops a systematic and orderly document system that supports both record keeping and retrieving of records. Management of records also carries the responsibility of tracking files that are released internally to various units and teams for reconciliation. The records management team also maintains a records sign-out log and records the release of any and all documents within the morgue to various units and teams.

6. Postmortem Records Collection Team

The Records collection team receives postmortem information from examinations conducted by morgue teams. This team also seeks to obtain ante-mortem records of potential victims from sources such as family doctors, dentists, and hospitals. The family assistance ante-mortem records collection team relinquishes records they obtain to the postmortem data management team for correlation and safekeeping. These information pieces are used for inclusion and exclusion purposes in the identification process. Note: The subject matter experts working in this team are typically pathologists, odontologists (forensic dentists), and anthropologists.

7. Data Analysis Team

A team of subject matter experts analyzes ante- and postmortem information. Matching pre-existing characteristics of victim information with that of postmortem examinations frequently result in positive identification of victims. It also facilitates re-association of dismembered, unassociated body parts. Software programs aid the comparison process. Laboratory DNA analysis reports generated from human remain samples, direct references of victims, and family references that produce identifications are returned from the laboratory to this unit. When compelling identification information is gathered, a written summary of facts is prepared to explain the details and circumstances of the identification.

8. Quality Assurance Team

Findings leading to matching information and subsequent positive identification of human remains must be verified by a second subject matter expert and the written findings of the analysis endorsed. The identification findings are presented to the medico-legal authority for approval.


P. Sample Forms

This section provides sample forms that can be used or adapted. Additional forms will be

added, as they are made available.


Family/Friend Registration Form (FAC) Use this form if no electronic/database registration system is available

Disaster Victim Information

Last Name First Name MI

For Multiple Disaster Victims of the Same Family, Use Additional Forms

and Cross Reference with Victims Name at Bottom of this Page

Presenting Family Member / Friend Name #1

Last Name First Name MI SS# (optional) Relationship to Victim Permanent Address City County State Zip Home Phone Cell Phone Photo Identification Verification (type/#/State/County) Medications/Medical Needs? Yes No If Yes, Indicate Medication Needs Physician’s Name Physician’s Phone # Next of Kin to Disaster Victim? Yes No If No, Name of Next of Kin


Notes

Presenting Family Member/Friend Name #2

Last Name First Name MI SS# (optional) Relationship to Victim Permanent Address City County State Zip Home Phone Cell Phone Photo Identification Verification (type/#/State/County) Medications/Medical Needs? Yes No If Yes, Indicate Medication Needs Physician’s Name Physician’s Phone # Notes


Last Name First Name MI SS# (optional) Relationship to Victim Permanent Address City County


State Zip Home Phone Cell Phone Photo Identification Verification (type/#/State/County) Medications/Medical Needs? Yes No If Yes, Indicate Medication Needs Physician’s Name Physician’s Phone # Notes


Last Name First Name MI SS# (optional) Relationship to Victim Permanent Address City County State Zip Home Phone Cell Phone Photo Identification Verification (type/#/State/County) Medications/Medical Needs? Yes No It Yes, Indicate Medication Needs Physician’s Name Physician’s Phone #


Notes


Next of Kin Information

Has Next of Kin arrived at the Family Assistance Center? Yes No NOK Last Name First Name SS# (optional) Relationship to Victim Current Address City County State Zip Home Phone Cell Phone Medications/Medical Needs? Yes No If Yes, Indicate Medication Needs Physician’s Name Physician’s Phone # Notes Source Information regarding Next of Kin provided by: Relationship to Next of Kin:


Missing Persons Call Intake Form Use this form if a call center database is not available

Intake Information

Call Taken By

Date of Call Time of Call

Caller Information

Caller’s Name First Middle Last

Home Phone Work Phone

Cell Phone Other Phone

Caller’s Address

City State Zip

Are they the Primary Next of Kin? Yes No

If No, who is the next of Kin?

Missing Person Information

Name First Middle Last

Age Sex Male Female

Relationship of caller to person

Home Address of Missing Person

City State Zip

Home Phone Work Phone

Cell Phone Other Phone

Work Address

City State Zip


Social Security Number

Reason for Call

Missing Person Resource Call Confirmed Death

Other

Last Seen/Heard From/Where (Comments or Concerns)

Call Ranking

Level #1: Person known to have been in the area and is unaccounted for

Level #2: Person may have been in the area and is unaccounted for

Level #3: No correlation to the incident area but may have been involved

Follow-up with the Caller

Best time to reach them

Address for the next 24 hours

City State Zip

Phone Number(s) Cell Phone Number

Follow-up needed/FAC staff responsible

Information Logged Date Time Initials


Personal Effect Release Form

Name of Decedent Date Time Location Name of Person Completing Form (print) Signature Date List all personal effects being released to family; be as specific as possible (e.g. yellow metal ring with clear stone); and add lines as necessary

1.

2.

3.

4.

5.

6.

Name of person receiving personal effects Relationship to decedent Address City State Zip Code Phone Number Alternate Phone Number Signature (of person receiving property) Date Witness (print) Signature Date


Requested Records Log

Case Number

Victim Name

Informant Name

Informant Address

Informant Phone(s)

Location Contact Phone Date

Ordered Data

Received

Dental

Fingerprints

Radiographs

Medical Records

Photo Requests

Notes

Last

Last

First

First

Middle

Middle


Remains Release Authorization

Name of Deceased

Please be advised unidentified human tissue will be buried in an appropriate manner In the event any additional tissue(s) are recovered in the future and are identified as belonging to the above names deceased. I/We request the following:

I/We do not wish to be notified. I/We are authorizing the appropriate officials to dispose of said tissue(s) by methods deemed appropriate by said officials. I/We wish to be notified and will make a decision regarding disposition at that time. I/We the undersigned hereby authorize (Name of ME/Coroner office) to release the remains of (Name of Deceased) to the designated Disaster Mortuary Team or other authorized agent.

I/We further authorize the designated funeral home or another authorized agent to embalm and perform post mortem reconstructive surgery techniques, and otherwise prepare as they deem necessary and upon completion to release said remains to:

I/We certify that I/We have read and understand this document. I/We further state that I/We are all of the next of kin, or represent all of the next of kin and am/are legally authorized and/or charged with the responsibility of burial and/or final disposition of above said deceased. Signed Relationship to Deceased Print Name Date Signed Time Complete Address Telephone Number(s) Signed Relationship to Deceased Print Name Date Signed Time Complete Address Telephone Number(s) Witness

(Name, address & phone of Funeral Home or Agent)


Secondary Services Referral Form

Date:

Person completing form: Referral # 1: Indicate category of referral

Spiritual / Pastoral support

Professional mental health services

Medical care

Housing

Financial

Other disaster services:

Other:

Referral contact information:

Name:

Phone (Business): Phone (Cell):

Phone (Other): Email:

Website:

Address:

Referral # 2: Indicate category of referral



Medical care

Housing

Financial


Other:



Name:



Website:

Address:




Medical care

Housing

Financial


Other:


Name:



Website:

Address:




Medical care

Housing

Financial


Other:



Name:



Website:

Address:


APPENDIX 1: AGENCY COORDINATION

Regional Response Agencies

Central Texas Regional

Advisory Council

The Central Texas Regional Advisory Council (CTRAC or TSA

L) represents and coordinates all health care entities involved in

trauma, acute care, and emergency services within the

designated Region. Trauma Service Area "L" includes: Bell,

Coryell, Hamilton, Lampasas, Milam, and Mills counties.

Heart of Texas American Red Cross

Serving a 17-county area (all seven CTCOG counties), the

Heart of Texas Red Cross Disaster Services provides emergency

food and clothing, temporary shelter, emotional support to

families, home damage assessments, public information, and

emergency communication in the event of a disaster. Disaster

Action Teams, comprised of staff and trained volunteers, are

primarily responsible for providing these services. The Central

Texas Council of Government (CTCOG) has a Chapter of the

American Red Cross in Austin, TX.

Heart of Texas Regional Advisory Council

The Heart of Texas Regional

Advisory Council (HOTRAC [or TSA M])

Emergency healthcare providers to ensure the most efficient,

consistent, and expeditious care of each individual who

experiences an acute injury. HOTRAC represents Trauma

Service Area M, which includes: Bosque, Falls, Hill, Limestone

& McLennan counties. HOTRAC currently serves as the

Hospital Preparedness Program contractor and provides support

to the Central Texas Healthcare Coalition. .

Ministerial Alliance Counties in the CTCOG have organized Ministerial Alliances,

which provide networks of communication between houses of

worship to coordinate faith-based relief and recovery efforts and

provide compassionate care. Ministerial Alliances also

encourage and provide preparedness and training for faith-based

organizations in emergency planning and response.


State Response Agencies

Department of State Health Services (DSHS)

Texas Department of State Health Services (DSHS) manages

emergency disasters and all health aspects of emergency

response. The CTCOG region is located in DSHS Region 7.

Notably, DSHS, in coordination with several other state

agencies, has developed a Mass Fatality Management Plan and

Response Operating Guide for Texas.

Texas Commission on Environmental

Quality (TCEQ)

Texas Commission on Environmental Quality (TCEQ) responds

to natural disasters, spills, and other environmental emergencies

or situations. For incidents with contaminated sites, TCEQ

provides technical and regulatory assistance in the management

of wastes and other residual materials, such as run-off from

decontamination processes.

Texas Division of Emergency Management (TDEM)

Texas Division of Emergency Management within the

Department of Public Safety is responsible for emergency

management programs including training, mitigation,

preparedness, response, and recovery. The State Operations

Center manages disaster response on a statewide level and aids

in the appropriation of federal and state resources during

disasters. The CTCOG Region is contained within District 23,

Sub 2C.

Texas Funeral Directors Association (TFDA)

The State of Texas has equipment resources designed to support

MFI processing. These resources include two portable morgue

units and three temporary cold storage trailers. The TFDA

Disaster Response Team maintains the equipment and trained

personnel for deployment. The resources may be requested

through the State Medical Operations Center in coordination

with local emergency management and public health partners.

Texas Military Forces (TMF)

Texas Voluntary Organizations Active in Disaster (VOAD)

The Texas Voluntary Organizations Active in Disaster is a state

organization that assists in providing volunteers and support

services in emergency response.


Texas Voluntary Organizations Active in Disaster (VOAD)

The Texas Voluntary Organizations Active in Disaster is a state

organization that assists in providing volunteers and support

services in emergency response.

Federal Response Agencies

American Red Cross (ARC)

Supports reunification efforts through its “Safe and Well”

website and in coordination with government entities as

appropriate. Provides supportive counseling for family members

of the dead, for the injured, and for others affected by the

incident. Provides available personnel to assist in temporary

infirmaries, immunization clinics, morgues, hospitals, and

nursing homes. Assistance consists of administrative support,

logistical support, or health services support within clearly

defined boundaries. Acquaints families with available health

resources and services, and makes appropriate referrals

Bureau of Alcohol, Tobacco and Firearms (ATF)

The ATF participates in conducting investigations involving

acts of arson and bombings, illegal use of firearms and

explosives, and acts of terrorism.

The Centers for Disease Control and Prevention (CDC)

The Centers for Disease Control and Prevention (CDC), plays a

key role in natural, biological, chemical, radiological, and

nuclear incidents. When a disaster occurs, the CDC is prepared

to respond and support national, state, and local partners to save

lives and reduce suffering. The CDC also helps these partners

recover and restore public health functions after the initial

response. The Office of Public Health Preparedness and

Response (OPHPR) provides strategic direction, support, and

coordination for CDC’s preparedness and emergency response

activities. Other CDC organizations and programs are also

improving our ability to prepare for and respond to public health

emergencies, including pandemic influenza.

Department of DoD provides assistance, as available, in managing human

remains, including victim identification and mortuary affairs


Defense (DoD)

and temporary internment of the dead. Title 10 Forces refers to

Active Component soldiers, sailors, airmen, and marines. Under

routine circumstances these resources cannot be used for civil

support. However, Title 10 Forces may be called upon as part of

a DoD activation of its Joint Task Force-Civil Support in

response to a CBRNE incident due to weapons of mass

destruction. DoD Directive 1300.22, Mortuary Affairs Policy,

requires a Title 10 mortuary affairs force structure capable of

providing support for search, recovery identification,

evacuation, and, when required, temporary interment,

disinterment, decontamination, and re-interment of (among

others) U.S. noncombatants.

Department of Health and Human Services (HHS)

Department of Health and Human Services, responsible for

Emergency and Human Services Support Function (ESF # 8),

when requested by State, tribal, or local officials, in

coordination with its partner organizations, will assist the

jurisdictional medicolegal authority and law enforcement

agencies in the tracking and documenting of human remains and

associated personal effects; reducing the hazard presented by

chemically, biologically, or radiologically contaminated

human remains (when indicated and possible); establishing

temporary morgue facilities; determining the cause and manner

of death; collecting antemortem data in a compassionate and

culturally competent fashion from authorized individuals;

performing postmortem data collection and documentation;

identifying human remains using scientific means (e.g., dental,

pathology, anthropology, fingerprints, and, as indicated, DNA

samples); and preparing, processing, and returning human

remains and personal effects to the authorized person(s) when

possible; and providing technical assistance and consultation on

fatality management and mortuary affairs. In the event that

caskets are displaced, ESF #8 assists in identifying the human

remains, recasketing, and reburial in public cemeteries. ESF 8

may task HHS components and request assistance from other

ESF #8 partner organizations, as appropriate, to provide support

to families of victims during the victim identification mortuary

process.

Department of Homeland Security (DHS)

Provides logistical support for deploying ESF #8 medical

elements transportation of resources, use of disaster fuel

contracts, emergency meals, potable water, base camp services,

supply and equipment resupply, and use of all national contracts

and interagency agreements managed by DHS for response

operations.


Department of State

Coordinates international activities related to chemical,

biological, radiological, and nuclear incidents and events that

pose border threats as well as naturally occurring disease

outbreaks with international implications. Contributes to the

development of projections of the international consequences of

the event (e.g., disease spread, quarantine, isolation, travel

restrictions, pharmaceutical supply and distribution, and

displaced persons) through coordination with foreign states and

other international stakeholders, and assists in communicating

real-time actions taken by the United States and U.S. projections

of the international consequences of the event.

Department of Transportation (DOT)

In collaboration with DOD, GSA, and other transportation

agencies, provides technical assistance in identifying and

arranging for all types of transportation, such as air, rail, marine,

and motor vehicle and accessible transportation. Coordinates

with the Federal Aviation Administration for air traffic control

support for priority missions. At the request of ESF #8, provides

technical support to assist in arranging logistical movement

support (e.g., supplies, equipment, blood supply, etc.) from

DOT resources, subject to DOT statutory requirements.


APPENDIX 2: FAMILY ASSISTANCE CENTER STAFFING NEEDS

Staff Quantity Notes

FAC Group Supervisor 1

FAC Deputy Group Supervisor 1 per shift

Forensic Unit Leader 1 per shift

Family Interview Team Leader 1 per shift

Family Interviewers 1 per station per shift # of stations depends on FAC size

Family Interview Data Input Staff 1 per station per shift # of stations depends on FAC size

Antemortem Data Management Team

Leader

1 per shift

Antemortem Data Management Input Staff 1 per station per shift # of stations depends on FAC size

Antemortem Data Collection Team Leader 1 per shift

Antemortem Data Collection staff 1 per station per shift # of stations depends on FAC size

DNA Reference Collection Team Leader 1 per shift

DNA Collection Attendant 1 per station per shift # of stations depends on FAC size

Personal Effects Team Leader 1 per shift

Personal Effects Staff 1 per station per shift # of stations depends on FAC size

Family Management Unit Leader 1 per shift

Call Center Team Leader 1 per center per shift

Call Center Staff 1 per station per shift Depends on number of call

centers

Reception/Registration Team Leader 1 per shift

Reception/Registration Staff 1 per station per shift # of stations depends on FAC size

Notification/Disposition Team Leader 1 per shift

Notification/Disposition Staff Coordinate with LE

Health and Human Services Unit Leader 1 per shift

Case Assignment Team Leader 1 per shift

Case Assignment Staff 1 per station per shift # of stations depends on FAC size

Mental Health Services Team Leader 1 per shift

Mental Health Counselors 1 per station per shift # of stations depends on FAC size

Spiritual Services Team Leader 1 per shift

Spiritual Services Staff 1 per station per shift # of stations depends on FAC size

Childcare Team Leader 1 per shift

Childcare Staff 1 per station per shift # of stations depends on FAC size

Mass Care Team Leader 1 per shift

Mass Care Staff 1 per station per shift # of stations depends on FAC size

First Aid Team Leader 1 per shift

First Aid Staff 1 per station per shift # of stations depends on FAC size


APPENDIX 3: JUSTICE OF THE PEACE PRECINCTS

Bell County Hon. Ted Duffield, Pct. 1 Hon. G.W. Ivey, Pct. 3 Pl. 2 PO Box 88 205 E. Central Ave Belton, TX 76513 Temple, TX 76501 E-mail: [email protected] E-mail: [email protected] (254) 933-5183 (254) 770-6831 Hon. Donald Engleking, Pct. 2 Pl. 1 Hon. Garland K. Potvin, Pct. 4 Pl. 1 PO Box 415 301 Priest Drive Salado, TX 76571 Killeen, TX 76541 E-mail: [email protected] E-mail: [email protected] (254) 933-5398 (254) 634-5882 Hon. David Barfield, Pct. 3 Pl. 1 Hon. William Cooke, Pct. 4 Pl. 2 205 East Central Ave PO Box 517 Temple, TX 76501 Killeen, TX 76540 E-mail: [email protected] E-mail: [email protected] (254) 770-6822 (254) 634-7612

mailto:[email protected]







Coryell County

Hon. John B. Guinn, Pct. 1 Hon. Beverly Jones, Pct. 3 Pl. 1 201 S. 2nd Street 508 Leon Street Copperas Cove, TX 76522 Gatesville, TX 76528 E-mail: [email protected] E-mail: NEED EMAIL (254) 547-5993 (254) 865-2912 Hon. Frank (Bill) W. Price, Pct. 2 Hon. Coy Latham, Pct. 4 Pl. 1 201 S. 2nd Street 508 Leon Street Copperas Cove, TX 76522 Gatesville, TX 76528 E-mail: [email protected] E-mail: NEED EMAIL (254) 547-6517 (254) 865-5913




Hamilton County

Hon. W. Mark Tynes, Pct. 1 Pl. 1 102 No. Rice Hamilton, TX 76531 E-mail: [email protected] (254) 386-1290



Lampasas County Hon. Andrew Garcia, Jr., Pct. 1 Pl. 1 Hon. Greg Chapman, Pct. 4 Pl. 1 PO Box 412/501 E 4th St PO Box 66/315 S. Pecan Lampasas, TX 76550 Kempner, TX 76539 E-mail: [email protected] E-mail: [email protected] (512) 564-1845 (512) 932-2182 Hon. Camron D. Brister, Pct. 2 Pl. 1 PO Box 96/200 N. 4th St Lometa, TX 76853 E-mail: [email protected] (512) 752-3497




Milam County

Hon. Rick Gommert, Pct. 1 Hon. Andy Isaacs, Pct. 3 512 N. Jefferson, Ste C 313 N. Main St. Suite G Cameron, TX 76520 Rockdale, TX 76567 E-mail: [email protected] E-mail: [email protected] (254) 697-7004 (512) 446-5214

Hon. Sam Berry, Pct. 2 Hon. Gary A Northcott, Pct. 4 512 N. Jefferson, Ste D PO Box 337/103 W. Hwy 79 Cameron, TX 76520 Thorndale, TX 76577 E-mail: [email protected] E-mail:[email protected] (254) 697-7008 (512) 898-5252






Mills County

Hon. Leland Knight, Pct. 1 PO Box 65 Goldthwaite, TX 76844 E-mail: [email protected] (325) 648-2278



San Saba County

Hon. Sharon Blossman, Pct. 1 500 E. Wallace St. San Saba, TX 76877 E-mail: [email protected] (325) 372-5746



APPENDIX 4: BEHAVIORAL HEALTH

The mental health of local, Regional, State, Federal government and nongovernment first

responders, disaster workers, survivors, and victims is paramount. Local jurisdictions

currently have Critical Incident Stress Management team members to assist responders

but the potential number of persons involved will possibly require additional behavior

health support.

Department of State Health Services can provide Disaster Behavioral Health Services to

affected jurisdictions during an incident. Disaster Behavioral Health Services is

responsible for the coordination of all-hazards services including Critical Incident Stress

Management to first responders, disaster workers, survivors, and victims. Disaster

Behavioral Health Services are provided through a network of mental health and

substance abuse service providers, Volunteer Organizations Active in Disasters (VOAD),

the Texas Critical Incident Stress Management Network, and other stakeholders.

Disaster Behavioral Health Services provides a Behavioral Health Assistance Team that

will:

Deliver disaster behavioral health support services to survivors, first responders,

disaster workers and communities impacted by a mass fatality incident in accordance

with established procedures.

Coordinate Family Assistance Center behavioral health operations to include

providing psychological, emotional, spiritual support, referral services, etc.

Coordinate with the local health authority to ensure disaster behavioral health

services are written into incident and/or phase specific response plans.

Complete encounter data forms and report to Disaster Behavioral Health Services

daily.

Disseminate situational reports to local mental health authorities, the Critical Incident

Stress Management network and the Disaster Behavioral Health Consortium.

Take a leadership role in writing federal grant applications for longer term behavioral

health services.


APPENDIX 5: LOCAL RESOURCES

Logistical requirements supporting incident site operations for an MFI may include the

resources listed in the following table. Identifying these logistical requirements needed at

the site is the responsibility of the Assessment Team and the Incident Commander.

THE FOLLOWING INFORMATION REQUIRES INPUT FROM COUNTY

EMCs/REPRESENTATIVES County -

Resources

Bell

County

Coryell

County

Hamilton

County

Lampasas

County

Milam

County

Mills

County

San Saba

County

Assessment

Team (CSI)

Bio Seal

System

Body Bags

Cadaver

Dogs

Call Center

Building

Call Center

Personnel

Call Center

Equipment

FAC

Building

FAC

Personnel

HazMat

Decon

Morgue

Location

FAC

Building

Mortuary

TFDA

On-Site

Refrigeration

Storage

PPE

SAR Team

Temporary

Morgue

Building

10K SqFt

Floor Space

VIC

Building

VIC

Personnel


APPENDIX 6: FUNERAL HOME CAPABILITES & CONTACT INFORMATION

Bell County

Funeral Home Contact Information Capabilities

Harper-Talasek Funeral Home

Contact Person: Cheri O’Braden

503 N. Main St.

Belton, TX 76513

Phone:(254)699-8200

E-Mail: [email protected]

Refrigerated Storage (Morgue): Yes

Refrigerated Trucks: None

Hewett-Arney Funeral Home*

Contact Person: Amanda Arney

14 W. Barton Ave

Temple, TX 76501

Phone: (254)778-3200

Fax: (254) 778-3206


Refrigerated Storage (Morgue): None


Heritage Funeral Home

Contact Person: Rachel Dwyer

425 E. Central Texas Expressway

Harker Heights, TX 76548

Phone: (254) 690-9119


Refrigerated Storage (Morgue):

Unknown

Refrigerated Trucks: Unknown

*not associated w San Saba location

Harper-Talasek Funeral Home

Contact Person: Thomas Roberts

506 N. 38th St.

Killeen, TX 76543

Phone: (254) 699-8200



Unknown







Killeen Memorial Funeral Home

Contact Person: Rachel Dwyer

3516 Lake Rd.

Killeen, TX 76543

Phone: (254) 690-7185



Unknown


*associated w Harker Heights location

Broecker Funeral Home

Contact Person: Dave Broecker

949 West Village Rd.

Salado, TX 76571

Phone: (254) 947-0066



Unknown


Hornsby-Murcherson Funeral Home

Contact Person: Don Summers

201 S. Martin Luther King Dr.

Temple, TX 76501

Phone: (254) 773-3320



Unknown


Branford/Dawson Funeral Home

Contact Person: Wayne Dawson

718 S. 7th St.

Temple, TX 76504

Phone: (254) 773-2053


Refrigerated Storage (Morgue): No


Chisolm’s Family Funeral Home and Florist

Contact Person: Leon Chisolm

3100 S Old FM 440

Killeen, TX 76549

Phone: (254) 245-9365



Unknown








Coryell County


Scott’s Funeral Home

Contact Person: Bill Cole

1614 South F.M. 116

Copperas Cove, TX 76522

Phone: (254) 542-7337

E-Mail:


Unknown


Crawford-Bowers Funeral Home

211 W Ave B

City?

(254) 547-1275

E-Mail:

Refrigerated Storage (Morgue): No

Refrigerated Trucks: No

Scott’s Funeral Home of Gatesville

Contact Person: Bill Cole

PO Box 82/2425 E. Main St.

Gatesville, TX 76528

Phone: (254) 865-5411


Refrigerated Storage (Morgue): Will

have by end of year

Refrigerated Trucks: No

*Funeral homes that wish to participate; not an all-inclusive list.

Hamilton County


Riley Funeral Home, Inc.

Contact Person: Sam Stewardson

402 W. Main

Hamilton, TX 76531

Phone: (254) 386-3117



Unknown


Rutledge-Jones Funeral Home, Inc.

Contact Person: Darryl Sterne

118W. 2nd St.

Hico, TX 76547

Phone: (254) 796-4722



Unknown






Mills County


Stacy-Wilkins Funeral Home*

Contact Person: Brody Stacy

1415 Parker St.

Goldthwaite, TX 76844

Phone: 325-648-2255




Lampasas County


Sneed Funeral Chapel*

Contact Person: Mark Sneed

201 E. 3rd Street

Lampasas, TX 76550

Phone: (512)556-1183







Milam County


Marek-Burns Laywell*

Contact Person: Maurice Goza

2800 N. Travis

Cameron, TX 76520

Phone: 254-697-3661

E-mail: [email protected]


Refrigerated Trucks: Yes via County

MOU

Green-Patterson Funeral Home*

Contact Person: Larry Patterson

2701 N. Travis Ave.

Cameron, TX 76520

Phone: (254) 697-6611




MOU

Phillips & Luckey Funeral Home*

Contact Person: Wallace Jones

1041 W. Hwy 79

Rockdale, TX 76567

Phone: 512-446-5454




MOU

Dorsey-Keatts Funeral Home

Contact Person: Janet Mathews

701 N. Crockett St.

Cameron, TX 76520

Phone: (254) 697-3331



Unknown

Refrigerated Trucks: Yes, via County

MOU

San Saba County


Blaylock Funeral Home

Contact Person: Brandon K. Blaylock

143 Nixon Lane

San Saba, TX 76877

Phone: (325) 372-1111; (325) 203-4027

E-mail: www.blaylockfuneralhome.com



MOU

Heritage Funeral Homes

Contact Person: Randy Holloway

1901 W. Wallace St.

San Saba, TX 76877

Phone: (325) 372-3923

E-mail: www.Heritagefuneraltx.com



MOU

*not associated with Heights or Killeen

locations





http://www.blaylockfuneralhome.com/

http://www.heritagefuneraltx.com/


APPENDIX 7: MEDICAL EXAMINER CONTACT INFORMATION MEDICAL EXAMINER’S CONTACT INFORMATION

1. Dallas County Medical Examiner

5230 Southwestern Medical Avenue Dallas, TX 75235 (214) 920-5900 dallascounty.org

2. Travis County Medical Examiner’s Office

1231 Sabine Street Austin, TX 78701 (512) 854-9599

travis.tx.us

http://maps.google.com/local_url?q=http://www.dallascounty.org/&dq=Dallas+area+medical+examiner&ie=UTF-8&fb=1&gl=us&hq=area+medical+examiner&hnear=Dallas,+TX&cid=0,0,6383094732288228662&ei=1ATsTK-3OYGGzAWRiPDFCw&oi=miw&ved=0CCEQnwIwAQ&sa=X&ct=miw_link&cd=1&cad=homepage,cid:6383094732288228662&s=ANYYN7mXxkYytgQsAlmLGo9y2ZoRknqFUw

http://maps.google.com/local_url?q=http://www.co.travis.tx.us/&dq=Austin+area+medical+examiner&f=q&source=s_q&output=js&hl=en&geocode=&abauth=56f566da:MjV2QCG0QLHtWbEhkQzbmKLekaY&vps=1&jsv=297a&sll=32.810749,-96.840089&sspn=0.002173,0.004115&gl=us&oi=miw&sa=X&ct=miw_link&cd=1&cad=homepage,cid:11528910860558487860&ei=xQXsTJeoD5K-zgSJnLD8CA&s=ANYYN7mM6wZhUsUx8i0HPy9ScGG4bG25UQ


APPENDIX 8: TEXAS STATE DISASTER MORTALITY STRIKE TEAM Purpose Assist local authorities in evaluating and characterizing a mass fatality incident, provide situational awareness to the Texas Department of State Health Services, and assist local jurisdictions with initial stages of response. Objectives

1. Evaluate mass fatality incident characteristics to determine the appropriate response resources required.

2. Assist in determining what local response resources are available and size the gap of necessary resources.

3. If additional resources are needed, assist with submitting requests for state or federal assistance and advocating for necessary resources and multi-agency involvement.

4. Assist local jurisdictions with body recovery, transport and establishment of a holding morgue and the recovery and transport of disinterred caskets (when needed).

Limitation This is intended to be an initial effort to support local jurisdictions. This strike team is not intended to replicate the scope and capacity of a federal disaster mortuary operations response team (DMORT). Timeframe On-scene within 12-24 hours post-incident; phase-out when local jurisdiction is able to manage independently and/or federal DMORT resources have arrived and an orderly transition has occurred. Mass Fatality Incident Characterization Mass fatality incident characterization assists local, state and federal entities to identify the appropriate resources, capabilities and processes needed to manage this (and potentially multiple) mass fatality incident(s). Site Criteria

1. Type of incident: natural versus criminal/terrorist versus accident.

2. Recovery complexity: shifting terrain? Fixed or distributive location? Building material present? Types of buildings in close proximity? Need for excavation? Water/tides present? Need for extensive gridding? Identify whether a sifting site is needed (will require anthropology consult). Burning/smoldering?

3. Contamination or infectious/transmissible disease present? Need for public health community constraints or special PPE for responders?

4. Environmental conditions factors: heat; cold; humidity; rain.

5. Incident characteristics: single occurrence versus reoccurring: one location versus multiple locations.


Decedent Criteria 1. Number of decedents – approximate or accurate number.

2. Condition of remains: complete remains? Fragmented/commingled? Decomposed? Burned?

3. Victim manifest: closed population (known number/names) versus open population with no available list.

4. If open population, who is collecting/managing missing persons data collection?

5. Characteristics/demographics of decedent group: children, adults, members of church group/business/tour group, etc.

Response Capabilities Criteria 1. Local response capability: fully or partially operational? Decimated? Morgue operation

capacity: medical examiner versus justice of the peace; forensic capabilities: pathologists, anthropologists, odontologists, investigators, fingerprint and DNA specialists, dieners, antemortem interviewers; Level of integration with both public health and emergency management.

2. Decedent transport capability: vehicles and manpower.

3. Personal Protective Equipment/supplies.

4. Data collection and reporting capability: antemortem (from families and friends) and postmortem (from scene and morgue); death reporting and certification.

5. Family Assistance Operations: single or multiple locations? Face to face versus virtual service needed? Cultural considerations: language, beliefs.

Size of Strike Team Minimum of 4 individuals: Team Lead and 3 Team Members; maximum of 10 Teams (depending on number of locations). Request Procedures In order to request the assistance of the Texas State Disaster Mortality Strike Team, contact the local Texas Division of Emergency Management District Coordinator (TDEM DC). The DC for the TSA-L Region is located at the Texas Department of Public Safety Office in Waco Texas and can be contacted at (254) 759-7165 or by contacting the State Operations Center at (512) 424-2208.


APPENDIX 9: MOBILE MORGUE REQUEST PROCESS

Temple Veterans Administration POC: 254-743-2902 Office 254-534-0458 Cell Alternate POC: 254-598-9707 The Process for request of the mobile morgue is as follows:

Local EMC must initiate the request for the Mobile Morgue through the County Judge

County Judge must request through the DDC

DDC will go through the SOC and SOC will contact Governor’s Office

Governor to Health and Human Services

Health and Human Services to Washington Veterans Administration

Washington Veterans Administration approves or disapproves

Temple Veterans Administration Hospital Provides services with the approved request for deployment.

Note: This asset will be housed at the Waco Veterans Administration location.