mass fatality planning daniel jordan, phd
DESCRIPTION
Disaster planning in the US seems to have a a core weakness. Most disaster plans address multi-fatality events,not true mass fatality events such as the 1918 pandemic. Planners must address the fact that such events will someday occur and preparations are possible.TRANSCRIPT
Daniel Jordan, PhD, ABPP
Objectives: Develop and Organize
Establish MFC Response Policy &
Procedures
Understand Handling Deceased
Assist Families and Loved Ones
Familiarity with Death Certification Process
Establish Role of Mass Fatality Response
Coordinator in an Operations Center
Daniel Jordan, PhD, ABPP
Mass Fatality Planning Objectives: (FEMA)
Don’t become overwhelmed
Overcome denial and “disbelief”
Daniel Jordan, PhD, ABPP
FEMA Definition:Catastrophes vs Disasters
Mass vs Multi casualty and fatality
Community activity breaks down
Infrastructure (buildings, roads, water, power)
Daily life: Work, leisure, education
Social order
Local governance into recovery and beyond
Help from outside is not available FEMA and Enrico Quarantelli. “Emergencies, Disasters and Catastrophes
are Different Phenomena.”
Daniel Jordan, PhD, ABPP
Catastrophes: High Probability, Low Frequency
Health (Worst case, large scale, infrequent)
Pandemic: 5,000 to 80,000+ Ventura County
deaths, nation/world-wide, no/little mutual aid
Natural (Likely, not as large scale)
7.9 or larger earthquakes, dam failure, tsunamis,
likely some mutual aid from outside CA
Human-made (Less likely, smaller scale)
Biological or dirty bomb attack, larger than 9/11
Daniel Jordan, PhD, ABPP
Mass Fatality Incident Guidance
Planning tool,
not a plan
Start with worst case
scenario
Daniel Jordan, PhD, ABPP
Reality Check
It "may not be ethical, it may
not be nice, it may not even
be legal, but it might be the
only thing you can do.” Michael Leavitt, Secretary of
Health and Human Services
Daniel Jordan, PhD, ABPP
Reality Check: It Could Get Bad --Really, Really Bad
“The corpses had backed up at the undertakers’,
filling every available area of these establishments
and pressing into living quarters; in hospital
morgues overflowing into corridors; in the
[Philadelphia] city morgue overflowing into the
street. And they backed up in homes. They lay on
porches, in closets, in corners of the floor, on
beds.”
Barry, JM. (2004). The Great Influenza: The Epic Story of
the Deadliest Plague in History.
Daniel Jordan, PhD, ABPP
Reality Check: AHRQ* Plan (See Any Problems with This?)
Establish a Regional Home Death Management Process Set up regional hubs for body retrieval and processing
with a review by the Medical Examiner, a registration process, and a temporary holding place awaiting definite management.
Deploy refrigerated trucks from the hospital for body management, exchanged daily to regional processing sites.
Arrange for Web-based death certificate processing and secure tracking to the Department of Health.” *Agency for Healthcare Research and Quality
http://www.ahrq.gov/research/mce/mce8b.htm
Daniel Jordan, PhD, ABPP
Reality Check: A State Pan Flu Plan (See Any Problems with This?)
Handling of Deceased Bodies by the General Public, Such as At-Home-Death: If . . . the death of a family member occurs in your home . . . isolate the body in an area where it will not be touched or disturbed. If the body must be moved or otherwise touched . . . wear gloves and avoid contacting oral and respiratory secretions (from mouth, eyes, nose). Wash hands thoroughly after touching the body or surfaces contaminated by secretions. Thoroughly disinfect surfaces and launder clothing that may have been contaminated by secretions. Call appropriate authorities to report the death. State of ------------, Dep’t. of Health. Public Health Pandemic
Influenza Response Plan, Ver. 5. (emphasis added)
Daniel Jordan, PhD, ABPP
Reality Check: Mass Fatality Plan Weaknesses
Consider:
15-20% of the population has died
35-40% of the population is very sick
Nationwide pandemic, mutual aid is not
coming
Daniel Jordan, PhD, ABPP
Reality Check: Yes, It Could Get Bad -- Really, Really Bad
Epidemiological Modeling: Ventura County
could have between 5,000 and 125,000
deaths in a 6 to 8 week period (with a
second, smaller wave following the first)
Our society is not prepared
No society can be truly prepared
But we must do our best
Daniel Jordan, PhD, ABPP
Nationwide Pandemic: What’s Different from 1918?
Travel: Speed
Numbers
Frequency
of trips Plane landing at Maho Bay, St Maarten
Daniel Jordan, PhD, ABPP
Nationwide Pandemic: 1918 and Now
More people have impaired immune systems
due to medical advances allowing them to
live longer . . . overall our population has
lower immunity levels*
Elderly, transplant recipients, cancer survivors
getting chemotherapy or radiation, and viral
infections including HIV
We’re actually in worse shape than in 1918*http://www.evans.amedd.army.mil/PandemicFlu/1918.htm
Daniel Jordan, PhD, ABPP
Why Establish an MFC Plan?
Notify and assist families
Protect families, property, estates --the future
Identify the deceased, repatriate as possible
Maintain evidence trail
Determine and certify causes of death
Track patterns for prevention and mitigation
Properly dispose of remains
Daniel Jordan, PhD, ABPP
Need a Multi-Agency Plan
Health Department
Hospitals
Community health entities
Mortuaries
County/City planning agencies, parks
departments
and more
Community-Wide Scene(s)
Plans
Daniel Jordan, PhD, ABPP
The Scene: Contained Event to Nationwide Disease Outbreak
Single Contained Incident
County-wide event
Regional to nation-wide
catastrophe
TransportPlans
Daniel Jordan, PhD, ABPP
Transport of Deceased
Assume: System is overwhelmed
From scenes to funeral homes and/or
morgues
Funeral homes and morgues to burial sites
Access to appropriate vehicles, ambulances,
hearses, trucks,
Body bags, boards, coffins, equipment
Disaster MorguePlans
Daniel Jordan, PhD, ABPP
Morgue Standards
Out of sight from bystanders and victims.
Access control: Only authorized staff.
Attempt to identify all human remains.
Photographs and descriptive information for each
body.
Collect and store, find refrigerated containers or
temporary burial to allow for subsequent
investigation and/or identification.
Family Assistance CenterPlans
Psychological
First Aid
Community
Intervention
Daniel Jordan, PhD, ABPP
Family and Community Assistance Centers
Removed from the press, the morgue
Mental Health staff trained in psychological first aid
Emotional support and practical information
Gathering place for families to get information and provide support to each other
Establish community response plans
Daniel Jordan, PhD, ABPP
Be able to address whether dead bodies cause epidemics
Dead bodies from natural disasters do not have epidemic causing diseases (e.g., cholera, typhoid, malaria, or plague).
Victims of disease need some precautions
Follow precautions, use Personal Protective Equipment (PPE) use
Partially Derived from: Morgan, O., Tidball-Binz, M. & Van Alphen, D. Eds. (2006).
Management of dead bodies after disasters: a field manual for first
responders. Washington, D.C: PAHO.
Avian Flu Virus
Daniel Jordan, PhD, ABPP
How Urgent is Collection of Dead Bodies?
Body collection is not the most urgent task
after a natural disaster.
The living are our priority.
No significant public health risk is related to
simple presence of dead bodies.
Collect bodies as soon as possible and
maintain identification.
Daniel Jordan, PhD, ABPP
Health Risks to the Public and Workers Handling Dead Bodies
Rescue workers, morgue workers, etc. have small risk from tuberculosis, hepatitis B and C, HIV, and diarrheal diseases.
Infectious agents causing these diseases last no more than two days in a dead body (HIV may survive up to six days).
Reduce risk with rubber boots and gloves.
Little risk to general public
Daniel Jordan, PhD, ABPP
Handling the Deceased:Examples of Advice
Follow DOC/EOC
instructions
Universal precautions
Volunteers only (even
staff should be
volunteers)!
Use shovels not hands
Masks help emotionally
Cover the body or
head before moving
Use backboards
Double glove and tape
wrists
Human & Social Welfare
Plans
Daniel Jordan, PhD, ABPP
Survivors: Special Considerations
Orphans (especially if 1918 pattern held)
Elderly
People with special needs
Language barriers
Daniel Jordan, PhD, ABPP
Mental Health Issues
The primary desire of relatives (from all religions and cultures) is to identify their loved ones.
Help with decision-making.
Grieving and traditional burial are important for the personal and community recovery and healing. [See Cultural Competencies in MFCs plan.]
Daniel Jordan, PhD, ABPP
Examples of Dealing with Victims, Loved Ones, Bystanders
Act with respect and dignity for all involved.
Reduce pain witnesses may feel (they will
watch handling of the deceased).
Handle deceased as if they were still alive.
Avoid “M.A.S.H. humor.”
Watch for signs of stress among responders
and help them get time.
Communications and Media
Plans
Daniel Jordan, PhD, ABPP
PIOs, Journalists
Challenge comments or statements
regarding the need for mass burial or
incineration of bodies to avoid epidemics.
Consult PAHO/WHO, ICRC, the IFRC or
local Red Cross sources.
Don’t join alarmists by spreading bad
information.
Disposition and Collective Burial
Plans
It Can [Will] Happen Again
Daniel Jordan, PhD, ABPP
Cremation vs Burial (PAHO* Guidelines)
Cremation is not universally accepted destroys evidence.
Large amounts of fuel are needed.
Achieving complete incineration is difficult, often resulting in partially incinerated remains that have to be buried.
Logistically difficult to arrange cremation of a large number of dead bodies. Pan-American Health Organization
Daniel Jordan, PhD, ABPP
Collective Burial Not Mass Graves
2.5 acres can hold about 2,000 bodies.
Gridding system, each body identified or identifying characteristics recorded.
Special training for heavy equipment operators.
Dilemma: Repatriation vs. permanence.
Avoid trauma, even international consequences of mass graves
Daniel Jordan, PhD, ABPP
Collective Burial Site Criteria
Accessible yet able to be protected.
Not linked to water tables.
Relatively flat expanses of open ground.
Dirt, low proportions of rock to be cleared.
Convertible to permanent cemeteries.
Neighborhood burials, local parks
Daniel Jordan, PhD, ABPP
Example Collective Burial Site Location:This is not an actual planned site, but an example of thinking through the process
Parcel ARN 234005014
Daniel Jordan, PhD, ABPP
Scary dairy close up with 100 year floodplainParcel ARN
234005014
MemorializingPlans
Collective burial sites planned as
temporary have become permanent
Daniel Jordan, PhD, ABPP
Winfield Township’s 1918 Influenza Mass Grave SiteHistory Of the 1918 Mass Graves in Winfield Township, Butler County PA
Daniel Jordan, PhD, ABPP
1918_Program_Service_b_Ukranian_Catholic.jpgwww.saxonburglocalhistory.com/Winfield.html
Daniel Jordan, PhD, ABPP
Alaska Inuit mass grave marker
site of a mass grave in
Brevig Mission, Alaska,
where 72 people were
buried following their
deaths during the
Spanish flu breakout of
1918. Ned Rozell
photo.
Photo by Ned Rozell
Daniel Jordan, PhD, ABPP
Castlebar, Ireland Memorial to the Flu Victims of 1918
Castlebar, Ireland Memorial to the Flu Victims of 1918
Daniel Jordan, PhD, ABPP
Maori memorial
Carved wooden Maori
cenotaph erected at
Te Koura marae.
Cenotaph designed
and carved by Tene
Waitere of Ngati
Tarawhai.
Photograph 1920 by
Albert Percy Godber.
Daniel Jordan, PhD, ABPP
1928 Hurricane, Florida
September 16, 1928, a hurricane hit near the Jupiter Lighthouse (FL) heading west across Palm Beach County to Lake Okeechobee. It destroyed hundreds of buildings and damaged millions of dollars in property. Lake Okeechobee dike collapsed -- 1,800 to 3,000 fatalities. 1,600 buried in a mass grave in Port Mayaca in Martin County. In West Palm Beach, 69 white victims were placed in a mass grave in Woodlawn cemetery and approximately 674 black victims were buried in this mass grave in the City's pauper's burial field. Many others were never found. On Sep. 30, 1928, the City proclaimed an hour of mourning for the victims with rites conducted at each burial site. 2,000 persons attended at the pauper's cemetery, black educator and activist Mary McLeod Bethune (1876-1955) read the Mayor's proclamation. This burial site was not again recognized until 1991, when a Yoruba (Nigerian religious) ceremony was held here.National Register #02001012 (2002)
International Dimensions
Planning
Daniel Jordan, PhD, ABPP
Managing bodies of foreign nationals
Families or countries may demand identification and repatriation of bodies.
Problems could have serious economic and diplomatic implications.
Bodies must be kept for identification.
Department of Foreign Affairs or Governor’s Office, foreign consulates, embassies, INTERPOL, etc.
Debriefing & Demobilization Plans
Daniel Jordan, PhD, ABPP
Give Every Consideration to Participants
Operational Debrief
Psychological First Aid, referral and
follow-up interventions
Information capture, tactical changes,
organizational learning and practice
Staff welfare, staff recovery
Overall follow-up planning
Daniel Jordan, PhD, ABPP
Demobilization
Body Recovery Demobilization
Personal Effects Recovery Demobilization
Family Assistance Center Demobilization
Morgue Demobilization
Collective Interment Operations
Demobilization
Daniel Jordan, PhD, ABPP
Breakout Session: Suggested (Initial) Mass Fatality Annex Work Groups
Scene(s) Management (may be entire County) including Transportation
Hospital Mass Fatality Plans Funeral Home/Mortuary Roles Disaster Morgue Family Assistance, Identification &
Viewing (cultural & religious issues) Health and Safety (universal precautions) Social Welfare (e.g., orphans, displaced
people) Communications and Media Disposition, Collective Burial, Memorials Demobilization
For each domain we
need at least:
Objectives
Policies
Management &
Organization Plan
Procedures
Daniel Jordan, PhD, ABPP
Contact
Daniel Jordan, PhD, ABPP
Research Psychologist
2240 E. Gonzales Road, Suite 220-M
Oxnard, CA 93036
Phone: 805-981-5258
Email: [email protected] or