mass fatality morgue operations - hsdl.org

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Mass Fatality Mass Fatality Morgue Operations

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Page 1: Mass Fatality Morgue Operations - hsdl.org

Mass FatalityMass FatalityMorgue Operations

Page 2: Mass Fatality Morgue Operations - hsdl.org

Topics to ConsiderTopics to ConsiderTopics to ConsiderTopics to Consider• Logistics

Location s pplies/eq ipment personnel– Location, supplies/equipment, personnel

• Factors influencing victim ID and morgue ops• Operating proceduresOperating procedures

– Morgue operations – Evidence and data management

Q lit t l d– Quality control and assurance

• Tail-end issues– Group remains, end of ID processp , p

• Family member interactions• Ethical considerations

Page 3: Mass Fatality Morgue Operations - hsdl.org
Page 4: Mass Fatality Morgue Operations - hsdl.org

Mass Fatality M t Mass Fatality M t Management

LogisticsManagement

LogisticsLogisticsLogistics

Page 5: Mass Fatality Morgue Operations - hsdl.org

Morgue RequirementsMorgue RequirementsMorgue RequirementsMorgue Requirements

• Secure• Secure• 5000-8000 sq ft• Hot/cold running waterHot/cold running water• Electricity• HVAC• Drainage• Parking• Restrooms• Communications

Page 6: Mass Fatality Morgue Operations - hsdl.org

M L tiM L tiMorgue LocationMorgue LocationD N t U• Hangar

• Abandoned

• Do Not Use:– School

warehouse• National Guard

– Public facility– Hospital

armory• ME/Coroner office

Page 7: Mass Fatality Morgue Operations - hsdl.org

Coroner Office

Information Management

DNA Collection

Refrigerat

Unprocess

Supply Storage

StaEntD

oo Office Management Collection ted truck

sed remainsPersonal

Door

aff trance or

Pathology Anthropology

Admitting Triage

Protective Equipment

Rem

Pathology Anthropology

mains Entranc

Ref

Pro

e Door

frigerated tru

ocessed rema

RadiographyFingerprintDental Photography

uck

ains

Page 8: Mass Fatality Morgue Operations - hsdl.org

Incident MorgueE t i 990

Incident MorgueE t i 990Egyptair 990Egyptair 990

Quonset Naval Air QStation

November 1999

Page 9: Mass Fatality Morgue Operations - hsdl.org

Incident MorgueIncident MorguegEgyptair 990

gEgyptair 990

RI ME Office

Providence, RI

February 2000

Page 10: Mass Fatality Morgue Operations - hsdl.org

Incident MorgueIncident MorgueExecutive AirExecutive Air

Wilkes-Barre/

ScrantonScranton International

Airport

May, 2000

Page 11: Mass Fatality Morgue Operations - hsdl.org

Incident MorgueIncident MorgueCorporate Airlines

Kirksville, MOCorporate Airlines

Kirksville, MOArea inside 40,000 sq ft , qwarehouse

Page 12: Mass Fatality Morgue Operations - hsdl.org

Continental Express 3407Continental Express 3407Continental Express 3407Buffalo, NY

Continental Express 3407Buffalo, NY

Erie County Medical Examiner’s OfficeExaminer s Office

Page 13: Mass Fatality Morgue Operations - hsdl.org

Morgue PersonnelMorgue PersonnelggForensic– Pathologists

Logistics– Supply technician

Management– QA/QC manager

– Anthropologists– Odontologists– Medicolegal investigators

– Runners/trackers• Bar code system

– Data entry personnel

– ID manager– Evidence manager

• HR, PE g g– Fingerprint specialists– Technical support

• Radiology techs,

– Accountant/property manager

– Liaisons to other agencies

– Family member b i f dieners, dental

assistants, morgue techs

– DNA specialists

briefer– POCs for families

DNA specialists– AM interviewers and

DNA techs

Page 14: Mass Fatality Morgue Operations - hsdl.org

Disaster Mortuary OperationalResponseTeam

State/local MFI teams• Funeral directors• Medicolegal/forensic personnel

• Forensic personnel• Logistics personnel• AM interviewers

• Emergency managers• Logsiticians

Page 15: Mass Fatality Morgue Operations - hsdl.org

Factors i fl i ID d

Factors i fl i ID d influencing ID and morgue operationsinfluencing ID and morgue operationsmorgue operationsmorgue operations

Page 16: Mass Fatality Morgue Operations - hsdl.org

Wh t i id tifi ti ?Wh t i id tifi ti ?

antemortem postmortem

What is an identification?What is an identification?

antemorteminformation

postmorteminformation

comparison(unique biological characteristics)

identification

Page 17: Mass Fatality Morgue Operations - hsdl.org

Victim Identification Victim Identification FactorsFactors

• Antemortem data: types, availability, accuracy

• Number of fatalities

• Search/recovery challenges

• Condition of remains

• Decedent population: open or closed

• Identification focus: victims or remains

R l f DNA ID d/ i ti• Role of DNA: ID and/or re-association

• Concerns/expectations of society and NOK

Page 18: Mass Fatality Morgue Operations - hsdl.org

Antemortem DataAntemortem DataFamily Interview

Records DNA SamplesInterview data--Medical records

radiographs, surgeries

--Dental records

--Family

--Direct

--Death certificate

--Record location

--FingerprintsOpen vs. Closed Population

Missing persons Call Center vs ManifestMissing persons Call Center vs. Manifest

Page 19: Mass Fatality Morgue Operations - hsdl.org

The Antemortem InterviewThe Antemortem Interview

P i t i ti• Pre-interview preparation– Inform families of data collected during interview

• Dentist’s Contact Informationh i i ’ C f i• Physician’s Contact Information

• Prior Employment Contacts (i.e. fingerprints)• Military Service• DNA reference samples (direct and family)• DNA reference samples (direct and family)

• Interview– DMORT VIP: 8 pages

2 3 h l– 2-3 hrs to complete– Experienced interviewers

Page 20: Mass Fatality Morgue Operations - hsdl.org

Smarter Forms/DatabasesSmarter Forms/DatabasesINTERPOL DVI-AM

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Page 22: Mass Fatality Morgue Operations - hsdl.org
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Condition of RemainsCondition of RemainsCondition of RemainsCondition of RemainsComplete– ID of victimsID of victims– Conventional IDs– Faster IDs

FragmentaryID ll i ID f ll i ti– ID all pieces vs. ID of all victims

– DNA IDs– Reassociation of remains– Common tissue

Page 24: Mass Fatality Morgue Operations - hsdl.org

Closed Population

Decedent PopulationDecedent PopulationClosed Population

– Known number/names of victims– ID of all victims (not all remains)

Open Population– Unknown number of victims– Sort reported missing from actual missing

• Missing persons call center and verification staff– ID all specimens (not all victims)

Also consider multiple nationalities/cultures and demographics (i.e. age, sex, ancestry)g p ( g , , y)

Page 25: Mass Fatality Morgue Operations - hsdl.org

Fragmentary remains Complete remainsO

• Reported missing vs. actual missing• Increased reliance on DNA ID• Lesser role for conventional ID• ID all pieces vs ID all victims

• Reported missing vs. actual missing • Conventional ID• Minimal DNA required/corroborative role• Re association not required

Open pop

• ID all pieces vs. ID all victims• Re-association required

World Trade Center

• Re-association not required

Earthquake, cemetery flood

pulation

• Decedent list known• More rapid acquisition of antemortem data

• Decedent list known• More rapid acquisition of antemortem data

CloseMore rapid acquisition of antemortem data

• Increased reliance on DNA IDs• Lesser role for conventional ID • Re-association required

More rapid acquisition of antemortem data• Conventional IDs• Minimal DNA required/corroborative role• Re-association not required

ed popula

United 93, Egyptair 990 Mass transit MVA (e.g. motorcoach)

ation

Page 26: Mass Fatality Morgue Operations - hsdl.org

Operating Operating p gProcedures

p gProcedures

Page 27: Mass Fatality Morgue Operations - hsdl.org
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DMORT/NTSB SOPDMORT/NTSB SOP

• Handling of remains• Data Management• Remains Documentation• Victim ID Methods• Medicolegal interpretations includingMedicolegal interpretations, including

cause/manner of death• FAC operations and AM data

collectioncollection• Re-association, embalming and

release of remains• Production of ID reports• Production of ID reports • Deviation from SOPs

Page 29: Mass Fatality Morgue Operations - hsdl.org

QA/QC in Data and QA/QC in Data and Evidence ManagementEvidence Management

Data Management: Evidence Management:Data Management:• Incorrect information from

the informant (AM)I f t i d t d

Evidence Management:• Dedicated evidence manager(s)• Robust (automated) evidence

b i & t ki• Informant misunderstands question (AM)

• Lack of standardized / di

numbering & tracking process• Concurrent tracking of evidence &

personnelanswers/recording (AM/PM)

• Typos and transpositions (AM/PM)

• Automated chain of custody logs & audit reports

• QA/QC programs to fit needs of MF (AM/PM)

• Handwriting (AM/PM)• Data in the wrong field

event• Evidence accountability

• misplaced HR, misidentified HR(AM/PM)

Page 30: Mass Fatality Morgue Operations - hsdl.org

T il d IT il d ITail-end IssuesTail-end Issues

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Notification and ReleaseNotification and ReleaseNotification and ReleaseNotification and Release• Straight-forward with whole bodiesg

• Fragmentary remains pose a challenge:Inform NOK of the potential for group remains and theInform NOK of the potential for group remains and the re-association process

F il i h ME/C ibilit• Family wishes vs. ME/C responsibility When and how often to notify?

-InitiallyEach time a fragment is identified-Each time a fragment is identified

-End of process-Never

Page 32: Mass Fatality Morgue Operations - hsdl.org

Group RemainsGroup Remains• Definitions:Definitions:

– Unidentified remains– Remains not examined beyond the initial triage – Tissue lacking all potentially identifiable characteristicsTissue lacking all potentially identifiable characteristics– Tissue yielding no information useful to death investigation

and determination of incident causation

• Families must understand that group remains may exist even after DNA analysis.

• ME/C in conjunction with families decides about the final disposition of group remains.

Page 33: Mass Fatality Morgue Operations - hsdl.org

Ethical ConsiderationsEthical Considerations

At h t i t d th id tifi ti d?• At what point does the identification process end?• Should the limited resources available be used to identify

all fragmentary remains of all victims?all fragmentary remains of all victims?• Should every specimen subjected to DNA analysis? If

not, why not?• Should remains recovered years after a disaster be

processed for identification?

Page 34: Mass Fatality Morgue Operations - hsdl.org

Recent Accident Victim Identification DataRecent Accident Victim Identification DataVictims Remains

Convent IDs

DNA IDs ID Time Comments

USAir 427 (1994) 132 1771 132 0 2 monthUSAir 427 (1994) 132 1771 132 0 2 month

Valujet 592 (1996) 110 4282 69 1 2.5 months

TWA 800 (1996) 230 1000 214 16 1 year

Comair 3272 (1997) 29 NA 29 0 1 week

Korean Air 801 (1997) 228 300 bags 94 72 6 months

Swissair 111 (1998) 229 2500 140 218 --

Egyptair 990 (1999) 217 6000 19 144 6 months 54 families did not provide DNA reference samplesDNA reference samples

Alaska Air 261 (2000) 88 950 61 85 4 months 3 not recovered

Executive Air (2000) 19 25 19 0 5 days

American 77 and Pentagon (2001) 188 2000 108 183 3 months 5 not identified5 unique DNA profiles

(terrorists)

United 93 (2001) 44 1300 10 44 3 months 4 unique DNA profiles (terrorists)

American 587 (2001) 265 2077 219 234 1 month*American 587 (2001) 265 2077 219 234 1 month

USAirways 5481 (2003) 21 43 19 2 1 week

Corporate Airlines 5966 (2004) 13 30 9 4 2 weeks

Comair 5191 (2006) 49 49 49 0 4 days

Page 35: Mass Fatality Morgue Operations - hsdl.org

Q ti ?Q ti ?Questions?Questions?

paul sledzik@ntsb [email protected]

202-314-6134

www.ntsb.gov/family