mass fatality morgue operations - hsdl.org
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Mass FatalityMass FatalityMorgue Operations
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
Mass Fatality M t Mass Fatality M t Management
LogisticsManagement
LogisticsLogisticsLogistics
Morgue RequirementsMorgue RequirementsMorgue RequirementsMorgue Requirements
• Secure• Secure• 5000-8000 sq ft• Hot/cold running waterHot/cold running water• Electricity• HVAC• Drainage• Parking• Restrooms• Communications
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
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
Incident MorgueE t i 990
Incident MorgueE t i 990Egyptair 990Egyptair 990
Quonset Naval Air QStation
November 1999
Incident MorgueIncident MorguegEgyptair 990
gEgyptair 990
RI ME Office
Providence, RI
February 2000
Incident MorgueIncident MorgueExecutive AirExecutive Air
Wilkes-Barre/
ScrantonScranton International
Airport
May, 2000
Incident MorgueIncident MorgueCorporate Airlines
Kirksville, MOCorporate Airlines
Kirksville, MOArea inside 40,000 sq ft , qwarehouse
Continental Express 3407Continental Express 3407Continental Express 3407Buffalo, NY
Continental Express 3407Buffalo, NY
Erie County Medical Examiner’s OfficeExaminer s Office
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
Disaster Mortuary OperationalResponseTeam
State/local MFI teams• Funeral directors• Medicolegal/forensic personnel
• Forensic personnel• Logistics personnel• AM interviewers
• Emergency managers• Logsiticians
Factors i fl i ID d
Factors i fl i ID d influencing ID and morgue operationsinfluencing ID and morgue operationsmorgue operationsmorgue operations
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
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
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
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
Smarter Forms/DatabasesSmarter Forms/DatabasesINTERPOL DVI-AM
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
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)
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
Operating Operating p gProcedures
p gProcedures
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
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)
T il d IT il d ITail-end IssuesTail-end Issues
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
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.
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?
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
Q ti ?Q ti ?Questions?Questions?
paul sledzik@ntsb [email protected]
202-314-6134
www.ntsb.gov/family