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Emergency Support Function (ESF) # 20 Fatality Management Primary Agency Butte-Silver Bow County Coroner Preface Disasters have the capacity to produce large numbers of fatalities. The profound effects of mass fatalities on both loved ones and the entire community, and the ability to coordinate and obtain the needed fatality management resources are critical emergency response functions of the City-County. The purpose of this annex is to provide a guide for the management of fatalities caused by disasters. ---PAGE BREAK--- Butte–Silver Bow, Montana Emergency Operations Center ESF # 20 – Fatality Management Butte–Silver Bow Homeland Security and Emergency Management Agency Purpose: 1. This function addresses general policies and procedures for the collection, identification, and disposition of deceased persons for fatality management purposes and includes mass fatality incidents. Note The role of this ESF depends heavily on the cause of the fatalities. The Coroner’s Office is an integral part of the City-County’s fatality management process. They are responsible for the collection, identification, and disposition of the deceased in clearly delineated situations. Fatalities occurring by natural, non-terrorist means, however, involve the office only initially if at all, and their role then changes to one of support as needed. In these instances, fatality management comes directly under the City-County and the Fatality Management ESF. Primary: • County Coroner Support: • Law Enforcement Department • Butte-Silver Bow Fire Departments • Funeral Directors/Association • St. James Healthcare • Public Works Department • American Red Cross • Homeland Security and Emergency Management Agency • A-1 Ambulance • Public Health Department • Community Based Organizations: private, non-profit, and faith based Likely Tasks: General: • Maintain inventories of resources and equipment. • Maintain mutual aid agreements. Emergency Operations Center (EOC): • Obtain, coordinate fatality management resources as requested by field incident commanders. • Determine present and future need for medical examiner/fatality management resources. – Determine if the situation may require temporary morgue facilities. Likely Tasks Continued: – Identify potential sites and/or storage facilities for the dead, refrigeration units, trucks, trailers, etc.) as well as processing sites. • Establish and maintain a comprehensive record keeping system for continuous updating and recording of fatality numbers. • Coordinate implementation of the Mass Fatality Plan. Medical Examiner function includes: – Document location of bodies, body parts, property, and related evidence. – Collect and transport remains and associated personal effects and evidence. – Arrange for temporary storage when necessary. – Maintain custody of bodies, property, and personal effects (a shared function with law enforcement if additional facility security is required). – Initiate and maintain communication with families and next–of–kin. – Gather personal information from families, physicians, and other sources relevant to the identification of remains. – Conduct examinations relevant to cause and manner of death, identification of remains, and identification of human factors responsible for incident. – Coordinate release of remains and property following examination and identification. State of Montana Primary • Disaster and Emergency Services Support • Health and Human Services Actions • Develop guidelines and state plan for the management of mass fatalities resulting from all hazards. • Cooperate with state and local agencies to provide notification of deaths, fact sheet sharing for possible agents, field investigation information, interviews, autopsy findings, lab test results, and PIO releases. Actions Continued: • Assist with the collection, recovery, transportation, storage, examination and release of fatalities with other agencies. • Recover forensic, medical and physical evidence from the remains for the determination of crimes and for future admissibility in the criminal and civil courts. • Advise when normal procedures for remains disposition may pose a public health threat. Federal Government Primary • Department of Health & Human Services, U. S. Public Health Service Support • Department of Defense • Department of Veterans Affairs • Federal Emergency Management Agency Actions • Supplemental health and medical services, to include: – Needs assessment. – Victim identification. – Mortuary services. ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 20 FATALITY MANAGEMENT CEMP July 2011 20 - 3 Comprehensive Emergency Management Plan Emergency Support Function # 20 Fatality Management Primary Agency: Butte-Silver Bow Coroner’s Office Primary Coordinator: Butte-Silver Bow Coroner Support Organizations: Law Enforcement Department Butte-Silver Bow Fire Departments Funeral Directors/Association St. James Healthcare Public Works Department American Red Cross Homeland Security and Emergency Management Agency Public Health Department Community Based Organizations: private, non- profit, and faith based A-1 Ambulance I. INTRODUCTION. A. PURPOSE. This function addresses general policies and procedures for the mitigation, preparedness, response to and recovery from incidents with fatalities. It also provides an initial coordination framework of mass fatality response activities. B. SCOPE. This function may be utilized singularly, or in conjunction with the Crisis Action Team, or the Emergency Operations Center activation. C. SITUATION. 1. Mass fatalities may occur as a result of the impacts of emergencies to which the City-County is subject. ---PAGE BREAK--- FATALITY MANAGEMENT City & County of Butte–Silver Bow, Montana 20 - 4 CEMP July 2011 2. Primary concerns of a fatality situation are recovery of the human remains, identification of the human remains, determination of the cause and manner of death, and providing aid to distressed family members. D. POLICIES. 1. Butte – Silver Bow will follow policies regarding the removal of human remains authorized by the Coroner or his/her designee and protocols established in this annex and the Mass Fatality Plan for large-scale fatality events. 2. All human remains will be treated with the utmost respect and dignity during the collection and removal process. 3. Personnel involved in the collection, removal and transportation of human remains must use the appropriate levels of protective equipment to prevent any injury or exposure to pathogens. II. CONCEPT OF OPERATIONS. A. GENERAL. 1. Emergencies can potentially lead to mass fatality situations. A mass fatality is any situation where the number of fatalities exceeds the capabilities of the local response system and jurisdiction. 2. Emergency operations for the Coroner and mortuary service will be an extension of their normal duties. However, during widespread, multiple-site emergencies, Coroner and mortuary service personnel, resources and facilities may be in short supply. There can be instances of naturally occurring mass-fatalities, however, for which the Coroner has only an initial and then supporting role. 3. Existing mutual aid agreements may be able to augment and satisfy a temporary increase in local needs. If local capabilities are exceeded, support may be available from state and federal public health service groups. 4. Coordination between Coroner and mortuary service agencies is necessary to ensure emergency operational readiness. Each department having responsibility for Coroner and mortuary services must develop operating instructions and resource listings to support this plan. 5. A listing of available emergency Coroner, Medical Examiner and mortuary service resources will be developed and maintained by the Primary Agency and provided to the EOC. B. TASKS AND RESPONSIBILITIES. 1. Pre–Emergency Tasks. ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 20 FATALITY MANAGEMENT CEMP July 2011 20 - 5 a. Primary and support departments will coordinate with the Homeland Security and Emergency Management Agency to: • Maintain this Emergency Support Function (ESF). • Develop and maintain the Butte – Silver Bow Mass Fatality Incident Plan. • Pre-identify temporary morgue facilities. • Maintain inventories of resources and equipment and provide to HSEMA. • Pre-identify means of transporting the deceased if normal channels are unavailable. • Participate in drills, exercises and other scheduled training events. • Establish and maintain a comprehensive record keeping system for continuous updating and recording of fatality numbers. • Complete Incident Command System training for adequate implementation during emergencies. 2. General Emergency Tasks. a. Priorities for Response Fatality response will proceed according to the following priorities: Determine the number of fatalities and identify the location of the deceased; Recover human remains and personal effects; Process all human remains and personal effects; Provide family assistance services; Facilitate final disposition of human remains. b. Mass Fatality operations include the following recommended nine phases: 1. Notification: Disaster notification to the Coroner will typically be routed through routine 911 Communication Center or Emergency Operations Center established protocols. 2. Scene Evaluation and Organization: The Coroner determines the most effective and efficient approach for managing human remains by conducting an initial situation assessment. The mass fatality response organization is greatly influenced by the assessment. 3. Recovery of Remains: The Coroner oversees the human remains recovery with the goals of establishing a confirmed identification for each decedent, associating each dismembered remains with a particular decedent, documenting any injury pattern, and completing required investigations. 4. Fatality Collection Point: Fatality collection points provide short-term shelter, privacy, and security of human remains and associated evidence until transportation to the incident morgue is arranged. ---PAGE BREAK--- FATALITY MANAGEMENT City & County of Butte–Silver Bow, Montana 20 - 6 CEMP July 2011 5. Phase 1 Transportation and Temporary Storage: Phase 1 transportation and temporary storage refers to the movement of the human remains from the fatality collection point to the incident morgue. 6. Morgue Operations: Morgue operations will be conducted at sites established at the time of the incident. The goal of each morgue operation is to: Document the cause, manner, and mechanism of death; Confirm identity of the deceased; Provide a physical accounting for all deceased affected by the incident; Provide death notification, generate a death certificate, and release the deceased and associated personal effects to the next of kin for final disposition. 7. Phase 2 Transportation and Temporary Storage: Phase 2 transportation and temporary storage refers to the temporary storage and transport of human remains between the morgue facilities and the locations of final disposition. 8. Final Disposition: Final disposition options include individual burial, State-sponsored individual burial, entombment, temporary interment, voluntary cremation, and involuntary cremation. The Coroner must facilitate the release and final disposition of all human remains. 9. Demobilization: At a time when the majority of remains have been recovered, documented, and released, the mortuary team will begin to demobilize operations. c. There is an important distinction between fatalities that are under the jurisdiction of the Coroner and those which are not. With Coroner jurisdiction, the Coroner forms a response team and the Coroner becomes a part of the Operations Section of the incident, and Fatality Management ESF # 20 supports and facilitates those on-scene activities. If the Coroner does not have primary jurisdiction, then ESF # 20 staff assume the coordinating role and the Coroner provides support as needed. d. Primary and support agencies will: • When notified of an emergency situation, may send a representative to the Butte – Silver Bow EOC, if appropriate. • Determine if there have been fatalities, the numbers involved, the causes of death, and jurisdiction. • Notify Coroner’s Office of emergency situation. • Plan for collection sites and personnel to bring fatalities in from the field (litter bearers). • Establish normal protocols and procedures for proper management of deceased. • Protect the property and personal effects of the deceased. • Establishment of temporary morgues. • Provide scene security and evidence identification. ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 20 FATALITY MANAGEMENT CEMP July 2011 20 - 7 • Provide security for temporary morgues. • Assess the need for family assistance center. • Arrange necessary transportation. 3. Specific Emergency Concepts and Responsibilities. a. Butte-Silver Bow Coroner’s Office is the primary department for ESF # 20 Fatality Management and will: • Facilitate and coordinate implementation of this Fatality Management ESF # 20 by assuming the position of Mass Fatality Group Supervisor within the EOC Operations Section. • Implement and coordinate the Butte – Silver Bow Mass Fatality Incident Plan. • Establish effective fatality management incident management structure within the on-scene Operations Section. • Procure equipment and supplies necessary for: — Tag and flag operations. — Establishment of a temporary morgue, if needed. — Body transportation. — Temporary cold storage (portable units refrigeration trucks, or portable refrigeration containers). • Make appropriate notifications and report to incident scene to provide advice and assistance to the IC while survivors are rescued. • Analyze resource needs and request assistance, as required. • Establish and supervise Tag & Flag Teams. • Identify, set up, and coordinate activities at the Incident Morgue to include: — Victim tracking. — Fingerprinting. — Physical examinations. — Withdrawal of blood and body fluids. — Forensic examinations. — Victim identification. — Preparation for final disposition and release of remains. • Determine identity and cause of death, complete reports, and work with the State Medical Examiner for issuance of death certificates. • Arrange for release or disposition of personal effects. • Advise on the use of Personal Protective Equipment as appropriate. • Assure epidemiological monitoring and surveillance is occurring. • Establish and maintain a comprehensive recordkeeping system for continuous updating and recording fatality numbers. • Establish Public Information capabilities within the on-scene structure or within the Joint Public Information System at the EOC to ensure accurate and expedient dissemination of information. • Maintain records of cost and expenditures to accomplish this ESF and forward them to the EOC Finance/ Administration Section Chief. ---PAGE BREAK--- FATALITY MANAGEMENT City & County of Butte–Silver Bow, Montana 20 - 8 CEMP July 2011 b. Law Enforcement Department: • Coordinate perimeter control and scene security at incident site(s), at designated mortuaries and/or temporary morgue sites, and Family Assistance Centers. • Escort refrigerated vehicles from incident scene to morgue sites. • Support search and recovery activities. • Assist in activities to document, reconstruct, and investigate incident Support search and recovery activities. • Provide assistance to support management of human remains. • Assist Coroner with notification of next of kin or representative. • Record costs and expenditures and forward them to this ESF’s Group Supervisor. c. American Red Cross: • Notify HSEMA when activated. • Provide a representative to the EOC to coordinate ARC operation. • Assist with the identification and establishment of support facilities for responder care and feeding. • Establish facilities and facilitate the exchange of information for victim and family support services. • Provide additional services such as family escorts, public inquiry and locator program, childcare services, and assistance with planning of memorial services. • In application to aircraft incidents: • Establish Family Assistance Centers for family members. • Registration and identification of family members; • Mental health support; • Physical health support; • Childcare as needed; • Spiritual care support; • Assist Coroner with notification of next of kin or representative. • Record costs and expenditures and forward them to this ESF’s Group Supervisor. d. Homeland Security and Emergency Management Agency: • Coordinate public information through the EOC/Joint Information Center if activated. • Coordinate State and Federal resource support activities including specialized DMORT teams through the EOC if activated. e. Fire Departments-Career and Volunteer: • Assist with emergency services at disaster scene, fatality collection points, and incident morgue. • Provide hazardous materials consultation. • Support search and recovery efforts. • Conduct gross decontamination. ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 20 FATALITY MANAGEMENT CEMP July 2011 20 - 9 • Provide assistance to the Coroner for the removal/recovery of remains. • Record costs and expenditures and forward them to this ESF’s Group Supervisor. f. Funeral Directors/Association: • Assist in recovery, transportation, mortuary operations, identification and notification. • Coordinate embalming, transportation and final disposition of bodies. g. Community/Faith Based Organizations: • Advise on issues of cultural/religious sensitivity • Provide grief counseling. • Recruit and coordinate clergy. • Provide assistance with mental health support for emergency workers and families as appropriate. • Assist in providing language services for family assistance centers as requested. h. St. James Healthcare/Hospital System: • Provide reports to the Coroner emergency related deaths at hospital facility. i. Public Works Department: • Provide equipment, personnel, and other resources for heavy and specialized equipment. • Identify contractors who can provide heavy and specialized equipment to support fatality management activities. • Record costs and expenditures and forward them to this ESF’s Group Supervisor. j. Public Health Department: • Assure epidemiological monitoring and disease control surveillance are occurring as well as other requested public health related activities. • Maintain records of cost and expenditures to accomplish this ESF and forward them to the EOC Finance/ Administration Section Chief. k. A-1 Ambulance: • Assist with transportation of human remains as requested. • Maintain records of cost and expenditures to accomplish this ESF and forward them to the EOC Finance/ Administration Section Chief. ---PAGE BREAK--- FATALITY MANAGEMENT City & County of Butte–Silver Bow, Montana 20 - 10 CEMP July 2011 C. ROLE OF BUTTE–SILVER BOW EOC. 1. When the EOC is activated, the EOC Manager may implement this Fatality Management ESF # 20 by designating the position of Fatality Management Group Supervisor within the EOC Operations Section to coordinate fatality management and mortuary services activities. The Fatality Management Group Supervisor is responsible for directing and coordinating emergency programs relating to Coroner and mortuary services. The Fatality Management Group Supervisor in the EOC will make any request to the state EOC through the EOC Manager for additional resources when all local Coroner and mortuary service resources have been exhausted. 2. The Fatality Management personnel will be alerted according to prescribed departmental/agency/ organization policy. All personnel will report to their pre– designated locations unless otherwise directed by their supervisor at the time they are notified of the emergency. Pre–designation of duties and responsibilities will facilitate a reduction in response time. 3. The Fatality Management Group Supervisor will establish and maintain lines of communication in the EOC during major response operations to facilitate coordination of activities and resources. 4. Fatality Management Group Supervisor duties may include: • Implements and coordinates the Fatality Management Plan. • Determine if the situation may require temporary morgue facilities. • Identify potential sites and/or storage facilities for the dead, (e.g. refrigeration units, trucks, trailers, etc.) as well as processing sites. D. LIFE SAFETY ASSESSMENT. An initial EOC priority is to gather as much intelligence about the extent of damage as soon as possible. As soon as possible, Coroner personnel will submit situation reports to the EOC. E. EVACUATION. 1. The Corner should implement evacuation orders due to unsafe buildings, fire danger, hazardous materials, or any other reason identified by competent authority. All agencies will take lawful actions necessary to save lives and property. 2. Large-Scale evacuation orders will be coordinated with the EOC to ensure the evacuees are moved to an appropriate shelter, and the requirements of access and functional needs populations and individuals are provided for. (see Evacuation Strategy-published separately) ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 20 FATALITY MANAGEMENT CEMP July 2011 20 - 11 F. FIELD OPERATIONS. 1. Coroner emergency actions include: • Determining the probable cause of any fatalities and the numbers involved. • Planning for collection site, if necessary, and personnel to bring fatalities in from the field, as well as security for site where fatalities occurred. • Establish effective fatality management incident management structure within the on-scene Operations Section. • Making sure that all fatality management procedures are followed. 2. Hazardous Materials Response. • Coroner or mortuary services units responding to a hazardous material incident will ensure that they have a full understanding of the Incident Commander’s assessment of the situation and that they take full and proper precautions to protect themselves. • Only personnel having proper training should be deployed to a hazardous material incident. G. MUTUAL AID AND AUGMENTATION FORCES. 1. Mutual aid can be requested from or provided to neighboring local governments. 2. Support may also be requested from state and/or federal agencies through the State EOC. 3. The National Response Framework assigns the National Disaster Medical System (NDMS) Section under Emergency Support Function #8 (ESF to provide victim identification and mortuary services. These responsibilities include: temporary morgue facilities, identification, forensic odontology, forensic pathology, forensic anthropology methods, processing, preparation, and disposition of remains. In order to accomplish this mission, Disaster Mortuary Operational Response Teams (DMORTs) were developed. DMORTs are composed of members with a particular field of expertise, who are activated in the event of a disaster. DMORT members are required to maintain appropriate certifications and licensure within their discipline. When members are activated, licensure and certification is recognized by all states, and the team members are compensated for their duty by the federal government as intermittent federal employees. During an emergency response, DMORTs work under the guidance of local authorities by providing technical assistance and personnel to recover, identify, and process deceased victims. The DMORTs are directed by the National Disaster Medical System (NDMS). Teams are composed of funeral directors, medical examiners, coroners, pathologists, forensic anthropologists, medical records technicians and transcribers, finger print specialists, forensic odontologists, dental assistants, x-ray technicians, mental health specialists, computer professionals, administrative support staff, and security and investigative personnel. ---PAGE BREAK--- FATALITY MANAGEMENT City & County of Butte–Silver Bow, Montana 20 - 12 CEMP July 2011 DMORT is a program of the U.S. Department of Health and Human Services which responds ONLY when requested. DMORT may be requested by any state or local jurisdiction in need by going through the departmental procedures for requesting federal assistance. H. MASS FATALITY INCIDENT PLANNING. The Butte – Silver Bow Emergency Management Plan and The Butte – Silver Bow Public Health Department Operations Plan, contain annexes describing specific procedures to be followed when there are mass fatalities, including jurisdictional considerations for the Coroner’s Office. III. ATTACHMENTS AND REFERENCES. A. ATTACHMENTS. 1. Mass Fatality Management (ESF # 20) Checklist. B. REFERENCES. None. C. PROVISO. This support annex has been prepared in accordance with the standards of the National Incident Management System and other Federal and State requirements and standards for emergency response plans applicable as of the date of the plan’s preparation. The plan provides guidance only; it is intended for use in further development for response capabilities, implementation of training and exercises, and defining the general approach to incident response. The actual response an incident is dependent on: 1. The specific conditions of the incident, including incident type, geographic extent, severity, timing, and duration; 2. The availability of resources for response at the time of the incident; 3. Decisions of Incident Commanders and political leadership; and 4. Actions taken by neighboring jurisdictions, the State, and the Federal Government. These and other factors may result in unforeseen circumstances, prevent the implementation of plan components, or require actions that are significantly different from those described in the plan. ---PAGE BREAK--- Annex III Emergency Support Function (ESF) # 20 FATALITY MANAGEMENT CEMP July 2011 20 - 13 Attachment 1 FATALITY MANAGEMENT (ESF # 20) CHECKLIST Pre–Emergency Work with Disaster and Emergency Services to: Maintain this Emergency Support Function (ESF). Maintain inventories of resources and equipment. Participate in drills, exercises. Develop emergency action checklists. Maintain mutual aid agreements. Emergency Emergency actions include: Determine if there have been fatalities and the numbers involved. Notify Coroner’s Office of situation. Plan for collection sites and personnel to bring fatalities in from the field (litter bearers). Make sure that locations are noted where each body was found and that all information is appropriately tagged or attached (i.e. date, time, approximate age, location and identification if known). Protect the property and personal effects of the deceased. Notify relatives. Provide scene security and evidence identification. Provide security for temporary morgues. When notified, report to the Butte – Silver Bow EOC. Emergency Operations Center (EOC) Implement this Fatality Management ESF # 20 by assuming the position of Fatality Management Group Supervisor within the EOC Operations Section Determine whether the situation falls under the jurisdiction of Coroner, notifying Coroner of the situation and coordinating with them as appropriate. Coordinate and facilitate the fatality management if the event is not under the jurisdiction of Coroner. Determine present and future need for medical examiner/fatality management resources. – Determine if the situation may require temporary morgue facilities. – Identify potential sites and/or storage facilities for the dead, refrigeration units, trucks, trailers, etc.) as well as processing sites. Obtain, coordinate fatality management resources as requested by field incident commanders. Establish and maintain a comprehensive record keeping system for continuous updating and recording of fatality numbers. Establish, maintain contact with the State EOC through the EOC Manager: – Provide information on status and need for fatality ---PAGE BREAK--- FATALITY MANAGEMENT City & County of Butte–Silver Bow, Montana 20 - 14 CEMP July 2011 management resources. Liaison with Montana Funeral Directors Association to provide assistance in the mass facilities incidents by providing recovery, evacuation, mortuary operations, identification and notification. Recovery Actions Compilation of final reports. Participate in after-action/improvement planning incident evaluation process. Provide continued support to fatality management personnel. Revise plans to reflect changes in programs and procedures.