Capability Cliff Notes Series PHEP Capability 5—Fatality Management What Is It And How Will We Measure It?

Learning Objectives Become familiar with Capability Functions Become familiar with Tasks that complete the Functions Understand how these Functions and Tasks are measured or may be measured in the future (Performance Measures)

Fatality Management Fatality management is the ability to coordinate with other organizations (e.g., law enforcement, healthcare, emergency management, and medical examiner/coroner) to ensure the proper recovery, handling, identification, transportation, tracking, storage, and disposal of human remains and personal effects; to certify cause of death; and to provide access to mental/ behavioral health services to the family members, responders, and survivors of an incident. How can health departments ensure fatalities are addressed, and the families of those affected are given support?

Fatality Management Functions What Can Health Departments Do to Address Fatalities and Support Families? 1.Determine role for public health in fatality management 2.Activate public health fatality management operations 3.Assist in the collection and dissemination of ante-mortem data 4.Participate in survivor mental/behavioral health services 5.Participate in fatality processing and storage operations

Capabilities and Measures Resources The performance measure for this capability is 5.1 Identify Roles With Partners: Has public health identified its roles and responsibilities in support of fatality management in relation to those of key partners (e.g., emergency management, coroners and medical examiners, and funeral directors) with regards to the following elements?: Identify planning and/or response duties of public health and key partners related to fatality management Identify legal/regulatory authority governing fatality management in the jurisdiction (e.g., determining cause of death, identifying remains, family notification, burial permits) Identify critical pathways, trigger points, and circumstances leading to public health response actions Identify any legal waivers that would need to be in place in order to carry out public health’s fatality management activities Only if requested by jurisdiction’s fatality management lead (e.g., emergency management, law enforcement, state medical examiner, etc.): A formal written agreement for public health to support fatality management activities in the jurisdiction. Specific data elements can be found in the 2014 Performance Measures Specification Guidance on the OEPR website, pages at the following link: capabilities

Function 1: Determine role for public health in fatality management How can health departments identify ways to assist in managing fatalities? 1.Before an incident, identify the possibilities for fatalities and the impact of those fatalities, based on risk assessment. 2.Before an incident, coordinate with subject matter experts to determine public health’s role in addressing fatalities. 3.Before an incident, coordinate with jurisdictional, private and federal organizations that cover Emergency Support Function 6 (Mass Care) and other Emergency Support Function 8 functions, such as behavioral health, to determine their roles and requirements for the response.

Task Elements There are elements that health departments should keep in mind to address different aspects of the tasks: Letters of agreement with agencies to share resources, facilities, and other potential support Documentation that identifies how public health has participated in planning activities Coordination with SMEs to determine roles and responsibilities of public health All-hazards fatality management including addressing public health roles Training on mass fatality incident response, ESF-8, and fatality management Personal protective equipment to support designated public health roles

Function 2: Activate public health fatality management operations Tasks: What do health departments need to do to start fatality management operations? 1.Assess information from the incident to determine what resources are needed from public health. 2.Identify and coordinate ESF 8 resources and expertise to make recommendations regarding all phases of human remains disposition: recovery, processing (e.g., decontamination, infection control, and other mitigation measures), storing, and disposing. 3.Coordinate with appropriate partners to begin processes for human remains disposition. (Public health may have supporting role.) 4.Coordinate incident details among members of the public health and medical health systems by sharing information between programs and linking information databases, based on the scope of the incident.

Task Elements There are elements that health departments should keep in mind to address different aspects of the tasks: List of potential fatality management advisory roles that public health may need to fill Training on jurisdictional fatality management plan Material required to manage fatality operations System to record and track fatalities

Function 3: Assist in the collection and dissemination of ante-mortem data Tasks: How should health departments assist in gathering and sharing ante-mortem information? 1.Coordinate with partners to establish a mechanism (e.g., Family Assistance Center) to collect ante-mortem information. 2.Coordinate with partners to identify and assemble the resources required to collect and communicate ante-mortem data. 3.Coordinate with partners to assist, if needed, in sharing ante-mortem information with families of the deceased and law enforcement officials. 4.Coordinate with partners to support electronic recording and reporting of ante- mortem data through electronic systems or other information sharing platforms.

Task Elements There are elements that health departments should keep in mind to address different aspects of the tasks: Procedure for the collection of antemortem data Family notification procedures and protocols Training on family assistance Central repository/database for antemortem and postmortem data

Function 4: Participate in survivor mental/behavioral health services Tasks: How can health departments assist survivors in getting mental/behavioral health services? This can be a lead role, or a supporting role in finding and referring to services. 1.Coordinate with partners to assemble staff and resources for non- intrusive mental/behavioral health services to responders. 2.Coordinate with partners to provide culturally appropriate assistance (e.g., addressing language barriers and religious or cultural practices). 3.Coordinate with partners to provide mental/behavioral health services to family members of the deceased and incident survivors.

Task Elements There are elements that health departments should keep in mind to address different aspects of the tasks: Resources to provide mental/behavioral health support to responders, survivors, and families List of staff that could potentially fill fatality management roles Identification of services to provide to responders and family members of the deceased Training on death notification, providing relief to families, and spiritual care

Function 5: Participate in fatality processing and storage operations Tasks: How can health departments participate or assist in processing and storage of fatalities? 1.Make recommendations to lead agency on procedures for the safe recovery, receipt, identification, decontamination, transportation, storage, and disposal of human remains. Recommendations can also include an assessment of the need for temporary burial, procurement of public property for temporary burial, and security/privacy requirements of the processing facility. 2.Assist, if needed or requested, in multi-specialty forensic analysis to identify human remains and determine the cause and manner of death. 3.Coordinate with partners to support electronic reporting of deaths. 4.Coordinate with partners to facilitate the collection and reporting of mortality information (e.g., vital records).

Task Elements There are elements that health departments should keep in mind to address different aspects of the tasks: Support of the coordination of healthcare organization fatality management plans Identification of the required data elements for electronic death reporting Training on radiological terrorism and contaminated deceased body management Equipment required to process, store, and/or dispose of human remains

Questions? Please contact: Rachel Coles Program Evaluator--CDPHE