1. Handling the Dead in a Mass Fatality Incident Kathy Taylor, Ph.D. Forensic Anthropologist King County Medical Examiner’s Office

2. Medico-legal Investigation System Medical Examiner: Appointed position held by a board certified forensic pathologist. Medical Examiner: Appointed position held by a board certified forensic pathologist. Coroner: Elected position held by the election winner (no forensic background required) Coroner: Elected position held by the election winner (no forensic background required) Coroner/Prosecutor: Usually an elected position in which the county prosecutor also serves as coroner. Coroner/Prosecutor: Usually an elected position in which the county prosecutor also serves as coroner.

3. RCW 68.050 ME has jurisdiction over deaths: ME has jurisdiction over deaths: Of individuals in apparent good health without medical attendance for 36 hours preceding death. Of individuals in apparent good health without medical attendance for 36 hours preceding death. Caused by unlawful or unnatural means. Caused by unlawful or unnatural means. Involving suspicious circumstances. Involving suspicious circumstances. Caused by any violence whatsoever. Caused by any violence whatsoever. Caused by contagious disease. Caused by contagious disease. Resulting in unclaimed bodies Resulting in unclaimed bodies

4. Cause & Manner of Death Cause the injury or disease process responsible for a death the injury or disease process responsible for a deathManner N atural N atural A ccidental A ccidental S uicide S uicide H omicide H omicide U ndetermined U ndetermined

5. Duties in MFI Document, tag, map, and recover bodies from scene. Document, tag, map, and recover bodies from scene. Perform postmortem examinations, certify cause and manner of death. Perform postmortem examinations, certify cause and manner of death. Establish positive identification on all remains (whole or fragmentary). Establish positive identification on all remains (whole or fragmentary). Identifying and communicating with NOK Identifying and communicating with NOK Release bodies to funeral homes for disposition. Release bodies to funeral homes for disposition.

6. Special Concerns in MFI Processing large number of fatalities (postmortems, data entry, tracking of bodies, identification of whole or fragmentary remains, generating death certificates) Processing large number of fatalities (postmortems, data entry, tracking of bodies, identification of whole or fragmentary remains, generating death certificates) Obtaining antemortem data necessary to establish positive identification Obtaining antemortem data necessary to establish positive identification Communication Communication Continuing normal service to county Continuing normal service to county

7. Body Recovery Must consider if scene is a CRIME SCENE Must consider if scene is a CRIME SCENE Bodies may be fragmentary or decomposed Bodies may be fragmentary or decomposed Body recovery may not be immediate in a large scale MFI Body recovery may not be immediate in a large scale MFI Handle the public’s concern over “bodies sitting around” Handle the public’s concern over “bodies sitting around” Coordinate efficient method of body recovery so that bodies are not “lost in the system” Coordinate efficient method of body recovery so that bodies are not “lost in the system” Maintain the public’s trust in the system Maintain the public’s trust in the system

8. Identifying the Dead Coordinating with law enforcement or other agencies an effective system of reporting missing (unaccounted for) persons. Coordinating with law enforcement or other agencies an effective system of reporting missing (unaccounted for) persons. Collecting antemortem records on the missing. Collecting antemortem records on the missing. Collecting DNA samples if necessary. Collecting DNA samples if necessary. Matching body parts and positively identifying each individual. Matching body parts and positively identifying each individual. Decision whether to identify each body part. Decision whether to identify each body part.

9. Methods of Positive Identification Scientific Identification Scientific Identification Fingerprints Fingerprints Comparative Dental/medical radiography Comparative Dental/medical radiography DNA DNA Visual (unlikely in MFI) Visual (unlikely in MFI) Photo ID comparison (MFI dependent) Photo ID comparison (MFI dependent)

10. Communication with NOK Who are the dead? Who are the dead? Who are the NOK and LNOK? Who are the NOK and LNOK? Communication is long term – from the recovery through the examination process and beyond the disposition Communication is long term – from the recovery through the examination process and beyond the disposition MUST ESTABLISH AND MAINTAIN A TRUST IN THE SYSTEM!!! MUST ESTABLISH AND MAINTAIN A TRUST IN THE SYSTEM!!!

11. Family Assistance Center (FAC) A reception center for family and friends of disaster victims A reception center for family and friends of disaster victims It provides a safe and protected (from media) environment for family. It provides a safe and protected (from media) environment for family. It assures family access to information (provided to family before its provided to the media) It assures family access to information (provided to family before its provided to the media) Provides KCMEO access to family members to obtain information necessary for identification. Provides KCMEO access to family members to obtain information necessary for identification.

12. Location of FAC Hotel, church, convention center, school Hotel, church, convention center, school The location must be accessible, away from the disaster, and have adequate resources (space, private rooms, telephone lines, restrooms, FAX and copy machine, televisions and radios, medical personnel) The location must be accessible, away from the disaster, and have adequate resources (space, private rooms, telephone lines, restrooms, FAX and copy machine, televisions and radios, medical personnel) The location must be secured so that media and others cannot infiltrate The location must be secured so that media and others cannot infiltrate

13. Staffing of FAC Medical Examiner or DMORT personnel to obtain identification information on decedents Medical Examiner or DMORT personnel to obtain identification information on decedents Translators Translators Counselors Counselors Chaplains Chaplains Medical personnel Medical personnel Security personnel Security personnel Others (depends on “disaster specific needs) Others (depends on “disaster specific needs)

14. Determining Cause and Manner Forensic Autopsies: Forensic Autopsies: Facility Facility Staff Staff Storage of bodies??? Storage of bodies??? Death certificates Death certificates Filing and processing Filing and processing

15. DMORT Disaster Mortuary Operational Response Team Disaster Mortuary Operational Response Team Requires a Presidential Disaster Declaration Requires a Presidential Disaster Declaration Resources and personnel to establish mobile morgue and handle processing of large numbers of fatalities. Resources and personnel to establish mobile morgue and handle processing of large numbers of fatalities. WMD team for decontaminating victims. WMD team for decontaminating victims. NOTE: DMORT operates under the umbrella of the local jurisdiction. NOTE: DMORT operates under the umbrella of the local jurisdiction.

16. Disposition Releasing bodies to funeral homes at request of NOK Releasing bodies to funeral homes at request of NOK Finding NOK Finding NOK Unclaimed bodies Unclaimed bodies Indigent status Indigent status How do you handle a large number of bodies that may be unclaimed??? How do you handle a large number of bodies that may be unclaimed???

17. Frustrations The ME will NOT have confirmed numbers available until after positive identification. The ME will NOT have confirmed numbers available until after positive identification. The ME will NOT call someone deceased until positive identification is established. The ME will NOT call someone deceased until positive identification is established. The NOK will be frustrated that answers are not immediate. The FAC is designed to help them through the process. The NOK will be frustrated that answers are not immediate. The FAC is designed to help them through the process.

18. ME frustrations cont. Families being incorrectly informed of MEO procedures and time frames. Families being incorrectly informed of MEO procedures and time frames. Other agencies or media insisting on answers we cannot provide immediately (i.e. who is dead and how many are dead). Other agencies or media insisting on answers we cannot provide immediately (i.e. who is dead and how many are dead).

19. ME Frustrations Movement of bodies prior to ME notification or without ME consent (IN VIOLATION OF RCW!!!) Movement of bodies prior to ME notification or without ME consent (IN VIOLATION OF RCW!!!) Loss of information because of mishandling of bodies (i.e. location) Loss of information because of mishandling of bodies (i.e. location) Removal of property or other identifiers Removal of property or other identifiers Other agencies reporting fatality numbers or names of deceased individuals. Other agencies reporting fatality numbers or names of deceased individuals.

20. TAKE HOME MESSAGES The public must have trust in the system The public must have trust in the system A community must care for and respect the dead A community must care for and respect the dead No agency acts independently in a disaster. No agency acts independently in a disaster. Even if the coroner/ME is not part of public health, the public health system will face challenges related to the dead in an MFI Even if the coroner/ME is not part of public health, the public health system will face challenges related to the dead in an MFI