Resource Factors in Mass Fatality Management

Tsunami Health ConferenceWorld Health Organization

May 5, 2005

Thomas J. BrondoloDeputy Commissioner

Office of Chief Medical ExaminerCity of New York

Purpose of Talk

• To identify and discuss four factors of Mass Fatality Incidents (MFI’s) that impact resource requirements.

Presentation Outline• Identification:

– The primary medicolegal task in an MFI• Four factors

– Number of fatalities– Rate of recovery– Manifest– Condition of remains

• Three Case Studies:– WTC Terrorist Attack– Crash of Flight 587– Thailand tsunami disaster

Identification

• Four Factors– Number of fatalities– Rate of recovery– Manifest– Condition of remains

SEPTEMBER 11, 2001

WORLD TRADE

CENTER

NEW YORK CITY

WTC – Four Events

• 8:46am Flight 11 hits North Tower• 9:03am Flight 175 hits South Tower• 9:58am South Tower collapses• 10:28am North Tower collapses

Within 10 seconds 1,350ft tower reduced to 70 foot pile of compressed rubble

Manifest

Manifest

Partial Manifest

Partial Manifest

Fragmented Remains

FragmentationSlow Recovery

Triage Station

Memorial Park

Distribution of Fatalities• North tower, above impact 1356• South tower, above impact 618• Both towers, below impact 146

– Approx 15,000 escaped • Unknown location in towers 26• Bystanders/nearby bldgs 18• No information 17• First responders 421

– NYFD 343– PAPD 37– NYPD 23– Other 18

• Airplanes 147• Total 2749

Importance of a ManifestNumber of Fatalities

Totals09/11/01 20,00010/01/01 7,00012/01/01 3,05001/01/04 2,749

Initially 20,000 (88 foreign countries)Now 2,749 (67 foreign countries)

Rate of Recovery 9//11/01 - 9/11/04Condition of Remains

0

100

200

300

400

500

600

9/11

/200

1

11/1

1/20

01

1/11

/200

2

3/11

/200

2

5/11

/200

2

7/11

/200

2

9/11

/200

2

11/1

1/20

02

1/11

/200

3

3/11

/200

3

5/11

/200

3

7/11

/200

3

9/11

/200

3

11/1

1/20

03

1/11

/200

4

3/11

/200

4

5/11

/200

4

7/11

/200

4

9/11

/200

4

Date

Rem

ains Received

R-IDV-ID

WTC Summary

-High volume-Fragmented-No Manifest-Slow recovery

American Airlines Flight 587 November 12, 2001

• Airbus 300 – 600• JFK to Santo Domingo• 251 passengers and 9 crew• Belle Harbor, Queens, 81 sec. after takeoff• 5 fatalities on ground

American Airlines #587

• 265 total fatalities, all identified in 1month• Remains recovered: 2,058• Remains identified: 1,750 85%• Remains not identified: 308 15%

Final Disposition

• Family groups have not decided on resting place for unidentified and unclaimed remains.

• Hundreds of unidentified and unclaimed remains are stored in a trailer at our office.

Flight 587 Summary

-Med volume-Fragmented-Manifest-Fast recovery

Thailand Tsunami• High number of fatalities (5,395)

– Over large geographic area (across six provinces)• No manifest

– Multiple nationalities– Limited antemortem data

• Fast recovery– Many collection points

• Intact bodies– High heat, fast decay

Thai Tsunami Summary

-High volume-Intact bodies-No Manifest-Fast recovery

Resource Issues

– Number of fatalities• Higher the number

– More labor intensive– Need for quick command and control– Body storage, primary goal

– Manifest• No manifest

– Dedicated resources to antemortem collection

Resources Issues

– Rate of Recovery• Fast recovery

– Will overwhelm initial resources– Need for quick command and control– Body storage, primary goal

– Condition of Remains• Fragmented or decomposed remains

– No manifest, the identification process will take months, even years

Case Study SummaryRemainsExam

DNA Death Certificate

Cost IT/Records ResourceFactors

WTC 6/2002 Continues Continues $100 million

< $530,000

<$ ???

High volumeFragmentedNo ManifestSlow recovery

Flight 587 5 days 20 days 30 days

Continues

60 daysMed volumeFragmentedManifestFast recovery

ThaiTsunami

> 4 months

Continues ContinuesContinues

High volumeIntact bodiesNo ManifestFast recovery