Emergency management and mass
fatalities: Who owns the dead?

Written by: Jim Crabtree

Received: 21st July, 2009
LA County EMS Agency, 10430 Slusher Ave, Santa Fe Springs, CA 90670, USA
Tel: +1 562 944 6734; E-mail: jcrabtree@dhs.lacounty.gov

Journal of Business Continuity & Emergency Planning Volume 4 Number 1

INTRODUCTION
Disaster-related events that involve mass fatalities are in some ways easier to manage because they tend not to be time-sensitive in terms of life and safety objectives; however, overall emergency management processes can be much more complex as mass fatality events exist at the intersection of competing jurisdictions and authorities.  This paper will explore the emergency management issues and potential conflicts that can occur at a mass fatality incident.

Basic death investigation

The basic management and investigation of any unexpected death follows a standard process that is guided by legal necessities.  The first step is to identify the decedent, then determine the cause and circumstances of the death. Investigatory details will guide the certification of the manner of death (natural, accident, homicide, suicide), which can have significant effects on insurance claims and settling estates. Next come notification of the next of kin and the return of any personal effects. Filing the necessary paperwork, such as the certificate of death, finalises the process and allows for closure to occur emotionally, financially, legally and historically.  The ramifications of a death investigation are so critical that laws have been crafted and refined over many centuries to direct the process. The final legal authority for almost any unexpected death rests with the coroner. Different designs of coroner systems exist that either place the coroner within law enforcement (sheriff ’s coroner system), as an elected official (the office of coroner) or an appointed medical organizational structure (medical examiner system). For the purposes of this paper, the word ‘coroner’ will be used to represent all system designs. While it varies by local law, it should be recognised that even civilian coroners are given significant legal authority and a status that approaches and in some situations can even exceed that of classical sworn law enforcement officers.  Conflict does not tend to arise between the various participants in most death investigations, as the many tasks are generally performed sequentially, with the findings handed off to the next involved authority. For example, emergency medical personnel are called to render aid to a person in distress. Upon arrival they determine that the person is dead and cannot benefit from medical interventions.  They then document their findings and turn control of the scene over to law enforcement for investigation and follow through.  Legally, law enforcement representatives have authority over the scene but not the dead body itself — the coroner has sole authority over the body.  Manipulation or transportation of the body cannot occur without the coroner’s consent. The coroner/medical examiner then transports the body and performs whatever medical examinations are deemed necessary for their investigation, including autopsy and collection of tissue samples. The coroner’s findings are then shared with law enforcement personnel who add these findings to their investigation and use the information to possibly make an arrest and present the case for prosecution. Overlapping tasks and interfering with another agency’s work is generally not a major problem because at each phase of the event, authority and control is handed off to the next organisation only when the prior organisation has finished.

MASS FATALITY SITUATIONS
This system works well for situations involving the death of just one or two persons, but what is the process when the event involves mass fatalities? The definition of a mass fatality event would be one in which a large number of deaths occur over a short amount of time. Common examples of a sudden mass die-off would be transportation accidents, terrorist attacks, and natural events such as earthquakes, hurricanes or flooding. In terms of fatality management, these types of events can usually be finalised within a few days or weeks. However, mass die-offs that occur over an extended time period can also happen, as in the case of a pandemic.  In this type of situation, mass fatality management may last a year or more. 1 Management of a mass fatality event
and the stress that it places on the local system is determined more than anything else by the availability of local resources. A large urban area may have sufficient resources to be able to handle a 400-victim air crash, while a rural community may need significant assistance with a 30-person bus crash. In both situations, however, the critical objective is the melding of the needs of different agencies into an integrated response.

HISTORICAL MANAGEMENT TECHNIQUES
Understanding how mass fatality events were managed throughout most of the
20th century can help sort out necessary activities from mere traditions.  Transportation technology changed substantially during the 19th and 20th centuries such that for the first time, large numbers of people could be involved in accidents with many of them being killed.  Reports of how bus, train and aeroplane crashes were handled into the early 1960s describe the typical response.2–9  During the most of the 20th century, mass fatality transportation events in the USA happened in rural areas because so much of the country was rural during this time. The local responders or investigators at these events were commonly listed as being the local sheriff and the coroner (who would possibly also be the local funeral director).  Contemporary reports of a 1938 air crash in Los Angeles County described the recovery team as being the sheriff and a group of Civilian Conservation Corps youths who climbed the mountain to
bring down the victims on litters.10,11  After the 1942 plane crash that killed actress Carole Lombard, the sheriff, assisted by the military, removed the victims from the crash site on horseback.12,13  Lacking designated coroner’s facilities, the bodies would be brought back to the local funeral home. The funeral director, working either with or as the coroner, would make formal identifications based mostly on personal effects and visual recognition. The managing funeral director would then use his own staff, supplies and telephones to notify the next of kin.  His direct costs in this process would be recovered through the sale of merchandise or services such as caskets and embalming.  Contemporary reports of mass fatality incidents before the 1970s rarely list any involvement of a fire department in the body recovery process — their role was purely fire suppression. Most likely this is due to the restrictions on allowing fire personnel or equipment to leave their jurisdiction and the need to return to the station quickly to make themselves available for the next call. The exceptions would be fire disasters such as theatres or schools, where the fire department had an expected lengthy on-scene presence anyway.  Because most fire departments were not routinely performing extrication and rescue activities of any kind until the 1970s, the necessary disentanglement and extrication of the deceased after a traffic collision was typically described as having been performed by the tow-truck driver, who would carry pry-bars and cutting torches.

MODERN MANAGEMENT STANDARDS
The casualness of such procedures is not acceptable to meet 21st-century standards.  Whether by law or modern convention, fatality investigations are now codified.14  In any sudden death situation today, the first objective is to secure the scene and set boundaries. Advances in scientific capabilities mean that material considered as evidence can range between large artefacts or trace molecules, and their proper collection and protection are critical for drawing accurate conclusions. The site where the fatalities have occurred needs to be mapped out, with a grid system established to document the location of all physical elements, including both general debris and human remains. Each item then needs to be marked, documented for inventory and identification, and photographed before it is removed from the site. This tedious process is the responsibility of many different agencies, which are then expected to share their findings as part of the complete investigation.  The recovered human remains are brought to a central morgue for a complete examination and documentation, to include photographs, x-rays, fingerprinting, dental examination and DNA recovery.  The end result of this medical processing is to issue a proper death certificate that includes a positive identification and a documentation of injuries for inclusion in the final incident report.  Simultaneously, work is also being carried out with family members to make formal notifications and arrange for release of the properly identified remains and personal effects to the legal next of kin.  A pandemic situation would require different tactics. As a contagious disease spreads through a community it is expected that people would arrive at hospitals seeking treatment. Some people would die and their remains would be brought to the hospital morgue.  Identification and documentation of these deceased would be handled by the hospital, with the remains generally being released directly from the hospital.  Some of these hospital deaths may meet the standard of being a coroner’s case based upon legal definitions that would prevent the treating hospital MD from signing the death certificate. While the details vary by jurisdiction, laws allow a treating physician to certify the cause of death only for chronic medical conditions that they have been treating for an extended period of time (commonly from 20 to 90 days). Traditionally excluded from a private MD certification of death are unexpected deaths or those from a contagious disease. In an effort to reduce this bottleneck, some pandemic plans have measures that would allow a treating physician to certify a pandemic death if it meets certain case definitions or other criteria. 15  A major problem with body recovery during a pandemic would be situations where large numbers of people die in their homes. These victims may be discovered only through welfare checks or due to odours emanating from behind closed doors. In these cases, identification of the deceased and certification of the death would require more investigation than a hospital death. A greater pandemic planning problem, however, is deciding who should make the removal. The coroner’s office is responsible for removing unexpectedly dead bodies from private homes in normal times, but to cope with the increased caseload and the expected pandemic-related labour shortages, would necessitate the coroner’s office seeking outside assistance to accomplish the task.  Should this assistance come from funeral directors who would not automatically be government representatives while ostensibly performing a legal role, or from other government agencies such as law, fire or public works? The image of a bell-ringer with a cart asking people to ‘bring out your dead’ is inconceivable today, but may actually return sometime out of pure necessity. Whoever ultimately makes the initial removal would bring the remains to a central location for processing and the coroner would still issue the final certification.  What does the law say about the responsibilities of a death investigation and certification? Coroner laws vary by locality but they all carry a consistent theme. In California, for example, Government Code s. 2749 holds that it is the duty of the coroner to determine the circumstances, manner and cause of all violent, sudden or unusual deaths, including situations where the deceased has not been seen by a doctor 20 days before death.  Clearly then, the local coroner is always in charge of all death investigations. Even at large situations that automatically involve federal agencies, such as an air crash, the final paperwork is legally issued by the local coroner authority.

LEARNING THROUGH EXPERIENCE
An example of a situation where this process did not begin as smoothly as one
would have hoped was the crash of Alaska Air flight 261 into the ocean off the coast of California on 31st January, 2000 at 4:21 pm. There were 88 deaths resulting from the crash. The crash site was approximately 12–15 miles off the coast, in water that was over 200 metres deep, but it fell within the legal jurisdiction of Ventura County.  Because of its marine location, the US Coast Guard was initially in charge. By 5:00 pm, Ventura County became involved through its sheriff department and opening of the county Emergency Operations Centre (EOC) The military also had a significant presence in the area through its Point Mugu naval air station.  The legal jurisdictions were not initially clear for an event such as this. This crash occurred prior to wide dissemination and training on the National Incident Management System (NIMS) and the National Response Framework, understanding of which might have aided the
response. When it was finally established that the role of death certification clearly fell to the local Ventura County coroner, its office was overwhelmed. Without prior experience or training and not possessing the capability to recover remains from such a remote location, the first plan was simply to issue death certificates without attempting any body recovery.  Certification was originally to be based totally upon names from the passenger manifest.  What was forgotten in this situation was the National Transportation Safety Board (NTSB) Family Assistance Act 1996.16 Under the Act, the air carrier had to provide families of crash victims transportation to the crash site — including meals and lodging, daily briefings and psychological support, memorial service, and continued contact and updates on the investigation. Community standards also required that all human remains would be recovered and identified to the highest level of certainty before being returned to the next of kin for disposition.  Multiagency coordination began on the third day of the incident and daily incident action plans began to be issued. Assistance eventually came from six federal organisations, two state agencies, four county offices and five private organisations, and the necessary coordination was established.
 
RESPONSE ROLES AT A FATALITY EVENT
In any large mass fatality event, the many necessary tasks fall into general jurisdictional responsibilities:
• law enforcement: scene safety and accessibility including ending any violent threats and the collection and preservation of evidence;
• fire/rescue: scene safety and accessibility including fire suppression and hazardous material control, extrication of wounded victims and movement to a
casualty collection point;
• emergency medical services (EMS) and receiving hospitals: transport and treatment of living victims;
• coroner: identification of remains, documentation of injures, interface with
next of kin;
• federal law enforcement: investigation of terrorism;
• National Transportation Safety Board: investigation of the crash;
• Local Health Officer and Centers for Disease Control: pandemic control.
While all these different groups are performing mitigation activities related to the mass fatality incident, one major reality cannot be escaped — lifting and carrying human remains demands significant physical effort. However it is organised, the office of coroner is routinely one of the smallest government agencies with the least number of personnel to perform such laborious tasks. This imbalance becomes most acute in a mass fatality event when the labour necessary to remove and handle human remains is at its highest. Labour shortages should also be anticipated in pandemic situations when absenteeism will be the highest. Whenever there are large numbers of human remains to be moved, the coroner will always require assistance from another agency with better staffing. In most emergency situations today, the fire department is viewed as the most readily available source of labour.  Another aspect of body recovery that becomes necessary in a mass fatality incident is the need for specialised skills to accomplish the task. Common causes of mass fatality incidents such as transportation accidents mean that it is almost derigueur that the human remains will also be inaccessible and require specialized skills for recovery and extraction.  Extrication techniques such as heavy lifting, shoring, cutting and digging are to be anticipated when trying to access and
remove human remains. The presence of hazardous materials contamination could also necessitate the use of personal protective equipment and decontamination techniques. Such skill sets and the necessary equipment to accomplish them are not generally possessed by coroner personnel but are part of a typical fire department rescue unit.

ASSISTANCE TO THE CORONER
The specific type of assistance that might be required and the length of time that the assistance can be expected between the coroner and a fire department are not spelled out. Research performed for this paper failed to find evidence of written agreements describing cooperation that would be routinely offered or expected between the local fire/rescue personnel and coroner responders. Are there any requirements that fire/rescue resources must aid the coroner in their work?  Services rendered by a fire department beyond fire prevention and fire suppression seem to occur under the concepts of either ‘public assistance’ or ‘agency assistance’.  Cats commonly climb high into trees and frequently it seems as if they cannot get back down by themselves. Who is responsible for rescuing a feline in distress?  At one time fire departments accepted this as part of their duties and routinely sent personnel and equipment to extricate the cat. This service was seemingly provided as a public assistance, that is, they were assisting the owner of the cat. Once it was recognised that cats are able to eventually rescue themselves — as demonstrated by the lack of cat skeletons found in trees — fire departments have routinely stopped providing feline rescue services.17–19 How fire departments were originally tasked with providing this pet rescue service and how they finally demonstrated that it was no longer their responsibility could clarify the expectations that are placed on fire resources at a mass fatality scene.  The expectations for a fire department to provide assistance to the coroner after a single fatality situation can be seen following a motor vehicle crash in an urban area.  At 3:00 am, a vehicle crash occurs on a roadway. Several persons are seriously injured and at least one person is killed. As the dead body is trapped in the heavily damaged vehicle, extrication skills will be needed for removal before transport. Fire and rescue units initially respond, perform any necessary fire suppression, extricate the living victims, then provide medical care and commonly EMS transport of the injured to local hospitals. By law, the deceased victim may not be moved or manipulated without permission from the coroner. The coroner has been notified and is expected to arrive in around four hours (not unusual in a busy system — body removals are not emergencies). The fire/rescue unit cannot be out of service for this length of time so they leave the scene, making themselves available for other calls. Law enforcement personnel remain on scene, completing their investigation and maintaining a secure scene for the coroner. The fire department shift changes at 6:00 am and another crew begins its work day.  At 7:00 am the coroner arrives at the accident scene, begins their investigation and requests assistance from the fire department to extricate the body from the damaged vehicle as they do not possess the tools or skills to do this work themselves. A new shift of fire-fighters is then dispatched to the scene to extricate the body. Their work is performed either as an agency-assist task to the coroner or as a public-assist task to the deceased victim. Should the fire department resources have stayed on scene until the coroner’s arrival? How long should the fire/rescue personnel stay on scene to provide coroner assistance?  After the September 11th World Trade Center collapse, fire-fighters from the New York fire department (FDNY) stayed on scene for eight months, assisting in what was purely a body recovery event.  One of the stated reasons for their continued involvement was their need to be involved in recovering the remains of their own members who died in the incident — this under the tradition that the FDNY stays on scene until all its members ‘come home’. It should be noted however that the FDNY representatives working at ground zero were on full duty and receiving a full salary during that entire time.  This begs the question as to how long firefighters would have stayed or been allowed to stay had only civilians died in this event.  Should the decision for having fire department personnel stay at a disaster scene be based on actual need, a dedication to serve, or an available budget?  This last question is the main point that
needs to be considered as budgets shrink.  What is the best use of reduced available resources? Current emergency department (ED) crowding has EMS personnel sometimes waiting hours in an ED to be able to move a patient off their ambulance gurney and onto the hospital bed. Is this delay in making a fire/EMS unit available for additional runs a hospital problem because they do not have enough beds or should the fire/EMS system be able to absorb the increased standby time by having more available ambulance units on each shift?  Applying this concept to a mass fatality event, is it appropriate to routinely assume that the fire service will automatically be able to assist with a job that statutorily belongs to the coroner?

NIMS AND ICS AT A MASS FATALITY EVENT
The immediate response to a major incident assumes that the greatest initial need will be for the rescue and treatment of living victims. Rescue personnel and extrication equipment will be routinely sent to the scene from the first dispatch.
Later, as a complete size-up is made and it is learned that survivors are few or nonexistent, the transition is made from search and rescue to search and recovery. During the initial response, many different agencies are on scene, all pursuing their own operational objectives. Inevitably, an overlap between the rescue and recovery tasks will occur. During this period, having to choose between performing rapid rescues or quality evidence preservation will happen. Protecting life and safety always come first, but are not necessarily the most important task, as the recovery of critical evidence could potentially stop a criminal plot or discover an unknown mechanical defect and actually wind up saving many more lives.  The best method to sort out these overlapping and conflicting priorities is to institute unified command. Unified command is an aspect of NIMS that brings together the representatives of all the
agencies who are working on the incident.  Under unified command, they establish ‘one set of objectives, strategies and goals’ where ‘no agency’s legalities will be compromised or neglected’. NIMS directs ‘Diverse leaders to set priorities, concerns and limitations’ and ‘agree on an organizational structure’.20 The NIMS directive is to ‘designate an operations section chief ’ from the ‘agency that has the greatest involvement in the incident’. Unfortunately, identifying this agency at a mass fatality event is not always easy. More than one agency may actually have statutory supremacy. For example, the National Transportation Safety Board performs the crash investigation but the coroner performs the death investigation.  Both authorities depend on the findings of the other to arrive at accurate conclusions.  Their authority is legally equivalent, but at different levels of government.  Because of their frequent use of ICS principles, especially in wildland fire situations, fire agency command staff would probably be the most experienced at implementing formalised NIMS/ICS procedures at an emergency scene. The many diverse organisations are supposed to cooperate through unified command principles, but who should fill the very important command role to prioritise what are possibly conflicting objectives?  The State of California has a well developed field response integration system called Firescope (Firefighting RESources of California Organised for Potential Emergencies). Firescope publishes a field operations guide which gives clarification in developing a unified command
structure. According to Firescope material (emphasis added): Those organizations that participate in Unified Command should have statutory responsibility for some portion of the incident or event. Assisting and cooperating agencies with no statutory responsibility that nonetheless contribute resources to the incident should not function at the Unified Command level. These agencies should instead, assign an Agency Representative to effectively represent their agencies and resources through the Liaison Officer. Within a Unified Command, one person is selected as spokesperson for the groups. Typically, the person representing the agency with the highest resource commitment or most visible activity on the incident is selected. In some cases, this task may simply be assigned to the person with the most experience.21  Firescope’s field operations guide also proposes model ICS structures using allhazard type scenarios for implementation at specific incidents. Published Firescope scenarios do not however specifically address a mass fatality situation. There is a mass casualty scenario and under that ICS structure the position of morgue manager is assigned simply to ‘assist [the] Coroner or Medical Examiner’ In preparing a system to manage a mass
fatality event it must be accepted that there is a strong need for establishing prior agreements and understanding. A fire department is not statutorily responsible at a mass fatality event — the coroner is.  However, the fire department will most likely have the highest commitment of resources. Fire command personnel may be assigned command positions simply because of their experience in applying ICS mechanisms, but it is also of benefit for any coroner agency to ensure that thelocal fire department leadership has a good understanding of the specialised needs that exist at a mass fatality event that are different from typical fire-related events.

DESIGNATED SUPPORT AGENCIES
California has traditionally led the way in creating documented pathways to respond and manage available resources in a disaster.  The California State Office of Emergency Services has published a statewide coroner mutual aid plan with a supplementary mass fatality management guide.22,23 This supplement identifies both the primary and support agencies that should accomplish specific tasks at a mass fatality incident. The document echoes the regulations by stating that the primary organisation to manage the death investigation and handling of human remains is the local coroner. More interesting to note, however, are the agencies that have been delegated to provide the secondary support for specific tasks.  This paper will only look at the tasks that require the greatest commitment of labour and equipment: decontamination, recovery of remains and transportation of the deceased. The mass fatality supplement separates the supporting agencies by jurisdiction, being either state or federal resources.

DECONTAMINATION
The state-level agencies delegated to assist the coroner with body decontamination are the California Department of Forestry and Fire Protection (Cal Fire) and California Department of Public Health (CDPH). Cal Fire is the state agency primarily responsible for wildland fire suppression in state-owned forest lands. A diverse organisation, it functions as the local fire department in many rural areas and could be a source of labour to perform decontamination. The mass fatality supplement, however, states that the CDPH is only responsible for ensuring observance of health regulations and policies.  CDPH provides guidance on performing decontamination but does not possess personnel or equipment to actually decontaminate human remains.  Federal assistance for decontamination is expected from the Centers for Disease Control (CDC), Environmental Protection Agency (EPA) and the Department of Defense (DoD). Much like the similar state agencies, the CDC and EPA have only an advisory role; only the DoD could possibly provide personnel and equipment to perform decontamination of human remains.

RECOVERY OF REMAINS
State assistance to the local coroner for recovery of remains has been assigned to the California Highway Patrol (CHP) and the Department of Justice (DOJ). The exact role of the CHP is not specifically spelled out in the mass fatality plan. As a law enforcement agency, it would certainly have an investigatory role and could secure the perimeter of the scene; however, it is unlikely that it would have enough surplus resources to provide physical assistance with body recovery. The mass fatality plan supplement calls for the DOJ to assist with identification though its databases of missing and unidentified persons, but this task does not generate additional labour pool resources to aid in actual body recovery.  Federal assistance for recovery of remains is to be provided by the NTSB, EPA, Federal Emergency Management Agency (FEMA) urban search and rescue teams and disaster mortuary operational response teams (DMORT). As described in the mass fatality supplement, the NTSB and EPA are expected to provide supportive and technical information, but nodirect role in the actual physical recovery of human remains is stated.  FEMA urban search and rescue teams are personnel drawn from existing fire departments and are prepared to respond to distant locations with skills and equipment to extricate living victims. Their defined role is not recovery of the deceased. The mass fatality supplement clearly states only that they might be able to support recovery of human remains.  DMORTs are groups of skilled individuals drawn mainly from the death care industry.  They are fully trained and equipped to process large numbers of fatalities through morgue operations and work in the family assistance centres. DMORTs have sufficient portable equipment that can readily turn a warehouse or even tent structures into a fully functional coroner’s type morgue facility for processing, tracking and identifying large numbers of human remains. DMORTs do not however possess training or equipment to perform heavy extrication.

TRANSPORTATION OF THE DECEASED
The mass fatality supplement says that the primary state support for transportation of the deceased will come from the CHP and that primary federal support will come from the Department of Transportation (DOT). Neither of these agencies has any resources for transportation of the dead.  The mass fatality plan suggests that the DOT could possibly identify and help arrange for various types of transportation, whether air, rail, marine or motor vehicle.  The transportation assets themselves would however come from private industry and require specific contracts to cover their use and reimbursement of costs.  Mutual aid and disaster planning are supposed to prepare for disasters by exploring and pre-designating resourcesthat will be available to accomplish the necessary objectives. As shown above, the California plan identifies many technical advisers but is woefully inadequate in establishing a known labour pool that will be readily available to perform the necessary physical work.

ROLE OF PRIVATE INDUSTRY
So far only government organizations involved in mass fatality situations have
been discussed. Kenyon International is a private corporation that is prepared and response. Kenyon International began in England in 1906 when a group of local funeral directors responded together to a major train accident. The cooperation was so effective that they later worked other mass fatality events. Today, Kenyon International is a part of Service Corporation International and headquartered in Houston, Texas. Most of the firm’s work is performed at events outside of the USA and commonly for large multinational corporations. Kenyon International draws its response staff from the death care industry and can provide morgue services, identification and transportation of remains, handling of personal effects and even a family call centre to disseminate information. As a private contractor, however, the firm’s priorities at a death scene could be focused on the recovery and management of only certain types of victims
from a large incident, such as employees of the transportation company but not the passengers.

DIFFERENCES IN MANAGEMENT OBJECTIVES
Managing a mass fatality event is different from other disaster events.24,25 It is important not to confuse the fatality management objectives with situations where theproblems of the living are the greater concern.  When managing a mass fatality situation, one of the most difficult aspects for responders who are accustomed to working with the living is to recognise that mass fatality situations are not emergencies.  There is no need to rush any aspect of the process. Accuracy trumps speed in all situations. Dead bodies do not cause epidemics; there is no need to rush any burial. Finalising an accurate identification and accounting of the all deceased victims is the benchmark.  Improper handling and accounting of personal effects can result in numerous problems. All personal effects must remain with the body as they play a role in identification (although they are not used to make the final identification). This can complicate overall security measures to absolutely ensure that valuable items are never lost or stolen. Returning these artefacts to family members can bring great comfort to the survivors; however, release of the items must also be performed in line with the laws of inheritance. As part of the decedent’s estate, personal effects shall be given only to the rightful heirs.  Unfortunately, these heirs may not be known initially.  Which vehicles are best used to transport the dead must be considered.  Ambulances should not be used for the dead as they are for the living. Damage to an ambulance from either odours or reputation after hauling the dead could render it unserviceable for future emergency use.  Working at a mass fatality scene is not for everybody. Even seasoned emergency workers can have psychological trauma from witnessing bodily mutilations. After the Alaska Air incident, a severed hand was recovered that still had its fingers crossed; a sign of hope from a victim who no longer had anything to hope for. Cell phones ringing on dead bodies can also be disturbing.  It is no secret who is calling thedeceased victim and what the caller hopes to hear. Sometimes called ‘the noise that gives nightmares’, these calls can cut through the psychological defence mechanisms that people working the scene use to separate themselves from the tragedy.  Policies that allow those working at the scene to routinely turn off the phones found on bodies during the recovery process can be of benefit.

STORAGE DURING PROCESSING
Storage of human remains during processing can be a problem. Refrigeration does not stop decomposition but only delays it.  A temperature of 38–42°F (3–5°) can keep a body for up to three months.  Freezing tissues is not good — it destroys micro structures and can even crack skulls and cause other fractures. Freezing and thawing can accelerate decomposition and should be avoided at all costs. Refrigerated trailers are a common solution and are frequently brought to the scene. Sometimes rented, their use is also frequently donated to the operation by private industry. In either situation, any company names or identification on the morgue trailers should either be covered or painted over to avoid the public relations damage to the company that can come from intense media coverage and association with the tragedy.  Ice rinks are sometimes proposed for use as temporary morgues. They should never be used in this fashion. A body laid on ice can stick to the surface causing damage; furthermore, any body lying on ice would still be only partially frozen — after any movement or repositioning, a freezing/thawing process would then happen. Walking on ice is difficult and dangerous in any situation; to try to move 90kg of dead weight over an icy surface risks serious injury to anyone attempting to do so. When the event is concluded, therecreational business of the ice rink would be forever destroyed.  Attempting to pack bodies in ice is also not practical. Acquiring ice in a disaster creates an unnecessary logistical problem and dealing with a massive run-off of potentially contaminated water has biological hazard considerations.  Whatever the difficulties in finding storage, bodies should never be stacked.  This is disrespectful, can obscure any attached identification, and distorts features, making later identification difficult.  If storage becomes a significant issue then temporary internments can be used. Not referred to as mass graves, temporary internments are where bodies are wrapped or bagged with accompanying documentation and laid respectfully in rows 1.5m deep (trenches are OK). The ground temperature remains 50–55 °F (10–12 °C) and good documentation will allow for future disinterment and reburial if necessary.  A mass fatality event that causes significant trauma means that dismemberment and comingling of remains can be a problem.  Recovered body fragments should not be mixed together. Dismembered segments can be considered related only if they remain anatomically connected, but if physically separated they should be recovered, marked and stored separately for later identification.  The process of returning fragmented human remains to families requires a discussion to determine their wishes.  Survivors should be asked if they want notification and release of remains for burial when the first piece is identified or only after all remains are recovered and identified. If an incomplete body is released for burial then the family should also state what they want to happen to any additional pieces that are later discovered and identified. Do they wish them to be returned for additional burial or do they wish them to be respectfully cremated?

SHOULD ALL REMAINS BE TREATED EQUAL?
Equality in death during the recovery process is a public relations issue that should be considered. When the World Trade Center collapsed, the victims included both civilian office workers and professional rescuers such as fire-fighters and law enforcement officers. During the recovery process, human remains that were recognised as civilian were respectfully covered and removed from the site. When remains were recognised as those of a firefighter they were covered with an American flag and awarded a dramatic ceremony where the ground zero workers
would line up and salute during the removal process. The message that was seen on the world stage of the differences in personal worth, based totally on one’s chosen profession, was communicated very clearly during that time. Mass fatality events will always have social and political overtones, but they should not be reflected in the recovery work.

LEGAL CONSIDERATIONS
A forgotten aspect arising out of a mass die-off that is not seen in disaster planning is the inevitable overloads within the legal system resulting from increases in the need to settle estates and insurance claims. The need for an efficient process to expediently issue death certificates without a body became a challenge for the New York courts after September 11th.  Inefficiencies in probate law would become most apparent in pandemic situations.  Wills could actually be rendered obsolete when entire blood lines are wiped out and the only living heirs to be found are very low on the line of descent.  These sole surviving heirs may not be easily discovered and significant research and investigation to establish ownership claims, settle property titles and providefor care of children may result in an economic calamity unknown in the world since the Black Death in medieval Europe.  Ownership claims for inherited property arising out of Holocaust era deaths are still current cases in the 21st century.  Through the public administrator process, the government may become the custodian of large amounts of valuable personal property and even real estate for which there suddenly exists a fiduciary duty to protect.

CONCLUSION
Mass fatality events are fortunately not common. This means that few emergency managers have ever experienced working one and will likely make many mistakes should they have to do so. Mass fatality events are never resolved by just one agency; their very nature mandates involvement of different organizations with competing objectives. Resolving these conflicts through the use of NIMS/ICS processes can happen, but only when the management personnel fully understand how to use NIMS and ICS properly. Establishing formal written agreements between different agencies regarding their role expectations before the event happens can aid the response, especially in determining who is able to provide the necessary labour to assist the
coroner. Fallout from mismanagement after a mass die-off can significantly complicate the recovery process, and for many of the activities involved, there is only one chance to get it all correct.

REFERENCES
(1) Barry, J. (2004) ‘The Great Influenza:
The Epic Story of the Deadliest Plague
In History’, New York: Viking Penguin.
(2) Weir, C. B. (1930) ‘Ohio’s prison
holocaust’, Casket & Sunnyside, Vol. 60, No. 5, p. 30. (3) Lane, C. B. (1939) ‘Kentuckians
cooperate nobly on recent flood
disaster’, Casket & Sunnyside,Vol. 69,
No. 9, p. 12.
(4) Casket & Sunnyside, (1942) ‘Explosion
kills thirty one’ Vol. 72, No. 5, p. 18.
(5) Schuller, F. C. (1966) ‘Funeral home
ambulances play vital role in Austin
massacre’ Casket & Sunnyside, Vol. 96,
No. 10, p. 24.
(6) Mortuary Management, (1951) ‘The
mortician’s part in civil defense’, Vol. 38,
No. 3, pp. 16–17.
(7) Mortuary Management, (1959) ‘Chicago
funeral directors render distinguished
service in Chicago fire disaster’, Vol. 46,
No. 1, p. 31.
(8) Knauss C. M. (1965) ‘Handling of
multiple deaths from accident’, Mortuary
Management, Vol. 52, No. 2, p. 14.
(9) Hosick, J. (1966) ‘Handling the
Christmas Eve bus fatalities’, Mortuary
Management, Vol. 53, No. 1, p. 38.
(10) United Press (1938) ‘Nine feared dead in
big transport plane lost in Tehachapis’,
The Fresno Bee, May, p. A1, 17th May.
(11) United Press (1938) ‘Nine are found
dead in plane on LA peak’, The Fresno
Bee, p. A1, 18th May.
(12) Associated Press (1942) ‘Carole Lombard
killed with 21 others in plane crash near
Las Vegas’ The Fresno Bee, p. A1, 17th
January.
(13) United Press (1942) ‘Carole Lombard’s
body recovered; inquest held’, The Fresno
Bee, p. A1, 19th January.
(14) US Department of Justice (1999) ‘Death
Investigation a Guide for the Scene
Investigator’, Government Printing
Office, Washington, DC.
(15) Los Angeles County Coroner, EMS and
Public Health (2008) ‘Mass Fatality
Incident Management: Guidance for
Hospitals and Other Healthcare
Entities’, Los Angeles, CA, available at:
http://ems.dhs.lacounty.gov/ManualsPro
tocols/MFIM/MFIGuidanceForHospital
s808.pdf (accessed 21st June, 2009).
(16) National Transportation Safety Board
(2000) ‘Federal Family Assistance Plan
for Aviation Disasters’, GovernmentPrinting Office, Washington, DC.
(17) Windsor, Ontario Canada Fire
Department (n.d.) ‘Does the fire
department rescue cats from trees?’,
available at: http://www.windsor
fire.com/ecom.asp?pg=faq&article=40
(accessed 1 July 2009).
(18) City of Reading, Pennsylvania Fire
Department (n.d.) ‘Does the fire
department rescue cats from trees?’,
available at: http://www.readingpa.
gov/fire_rescue_faqs.asp#fire16 (accessed
1 July 2009).
(19) City of Redmond, Washington Fire
Department (n.d.) ‘Does the fire
department rescue cats from trees?’,
available at: http://www.redmond.gov
/insidecityhall/fire/faqs.asp (accessed 1
July 2009).
(20) US Department of Homeland Security
(2008) ‘National Incident Management
System’, Government Printing Office,
Washington, DC.
(21) Governor’s Office of Emergency
Services — Firescope (2007) ‘Field
Operations Guide ICS 420-1’,
California, available at:
http://www.firescope.org/ics-bigfog/
ICS420-1FOG8x11Cmplt.pdf
(accessed 21st June, 2009).
(22) California Office of Emergency Services
Law Enforcement Branch’ (2006) ‘State
of California Coroners Mutual AidPlan’, Sacramento, CA, available at:
http://www.oes.ca.gov/WebPage/oes
website.nsf/OESBranchContentPortal?
ReadForm&type=Coroner’s%20Mutual
%20Aid%20Plan&look=Law%20Enforce
ment%20Branch&Div=Law+Enforceme
nt+and+Victim+Services+(LEVS)&
Branch=Law%20Enforcement%20
BranchCoroner’s%20Mutual%20Aid%20
Plan (accessed 21st June, 2009).
(23) Governor’s Office of Emergency
Services (2007) ‘The California Mass
Fatality Management Guide: A
Supplement to the State of California
Coroners’ Mutual Aid Plan’, California,
available at: http://www.oes.ca.gov/
WebPage/oeswebsite.nsf/OESBranchCo
ntentPortal?ReadForm&type=Mass%20F
atality%20Management%20Guide%20&
look=Law%20Enforcement%20Branch&
Div=Law+Enforcement+and+Victim+
Services+(LEVS)&Branch=Law%20
Enforcement%20BranchMass%20Fatality
%20Management%20Guide (accessed
21st June, 2009).
(24) Los Angeles County Coroner, EMS and
Public Health, ref. 15 above.
(25) Pan American Health Organization
(2006) ‘Management of Dead Bodies
after Disasters: A Field Manual for First
Responders’, Government Printing
Office, Washington, DC.