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Amanda Sozer, Ph.D. Arbie Goings November 2, 2013 Be Prepared for the Worst Emergencies: Mass Fatality Family Assistance Center Operations for the Public.

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Presentation on theme: "Amanda Sozer, Ph.D. Arbie Goings November 2, 2013 Be Prepared for the Worst Emergencies: Mass Fatality Family Assistance Center Operations for the Public."— Presentation transcript:

1 Amanda Sozer, Ph.D. Arbie Goings November 2, 2013 Be Prepared for the Worst Emergencies: Mass Fatality Family Assistance Center Operations for the Public Health Community

2 Overview Introductions Lecture: –Mass Fatality (MF) Response Overview –Mass Fatality Family Assistance Center (MF FAC) Overview –Purpose of MF FAC –Determining the Reported Missing –Size and Location of the MF FAC –MF FAC Operations and Staffing –Stages of MF FAC Operations Discussion Exercise

3 SNA Teams MF Response Experience Includes: Joplin, Missouri Haiti Earthquake Continental #3407 Comair #5191 Hurricane Katrina American Airlines #587 9/11 World Trade Center 9/11 Pentagon 9/11 Pennsylvania Egypt Air #990 plane crash Alaska Air #261 plane crash West Texas Fertilizer Plant Explosion Georgia Tri-State Crematorium Columbia Shuttle Crash Hurricane Rita (cemetery disruption) Corporate Air #5966 plane crash Colgan Air #3407 Hurricane Ike Hurricane Floyd US Air Express #5481 International Mass Fatalities (Humanitarian) o Cyprus o Lebanon o Iraq o Colombia o Guatemala o Afghanistan

4 Disaster (Destruction) Casualty (Injured) Fatality (Death) Mass Fatality

5 5 A situation with deaths that exceed local available resources. Will differ with each locality depending on the available resources. Main goal: Returning the bodies of the deceased to their families.

6 MF Operational Components 1.Field Operations - recovery of human remains 2.Family Assistance Center - collection of antemortem data 3.Morgue - collection of postmortem data 4.Identifications - comparison of antemortem and postmortem information for identification

7 Response Components Identification and Reunification RecoveryFACMorgue

8 The OCME is Responsible for: Situational assessment & requesting support Establishing operations: –Search and recovery –Morgue –Temporary storage of remains –Family assistance center Identifying the deceased, issuing death certificates & notifying next of kin

9 MA MF Management Plan The purpose of the Commonwealth of Massachusetts Fatality Management Plan is to provide a general guidance in managing the recovery, identification and repatriation of human remains in an efficient and effective manner while maintaining the dignity and respect of the deceased.

10 Objectives of the MF Management Plan Identifying the relevant administrative rules and regulations Defining the situational assumptions Specifying the incident command system and activation process Documenting management agency roles and responsibilities Providing a mass fatality operational response overview Identifying resource support Outlining incident scene considerations and evaluation criteria Describing the general operations of and resource requirements. o body recovery o mortuary operations o storage and tracking o family assistance Providing general guidance on transiting from the response back to normal operations. o identification o issuance of death certificates o repatriation to family

11 Objectives of a Typical MF Response Investigate and recover human remains Determine cause and manner of death Provide families with accurate and timely information Perform accurate and timely identification of victims Rapidly return the victims to their legal next of kin

12 Operations Flow – Sudden MF

13 Operations Flow – Pandemic Death Surge

14 Making the Identification Information collected from the human remains in the morgue (post-mortem) Dental Fingerprints Medical Devices Surgeries Body art Physical characteristics DNA Information collected from the victims families or other agencies (ante-mortem) Dental Fingerprints Medical Devices Surgeries Body art Physical characteristics DNA Forensic Pathologist: Death Certificate and Release of Body IT

15 Mass Fatality Family Assistance Center (MF FAC) Operations MF FAC is is an integral part of the identification process

16 MF FAC Operations Purpose is often confused/misunderstood Especially when pre planning ESF 8 Leads to communities being ill prepared Complicates MF response The MF FAC is the interface with families and public FAC vs VIC Purpose may vary depending on cause of incident Traditional mass fatality (hurricane, terrorist attack) Natural Causes (pandemic flu)

17 Purpose of MF FAC Operations Primary purpose is the collection of antemortem data for comparison to postmortem data collected at the morgue ID

18 Collection of Ante Mortem Data But First……… Who is TRULY missing?

19 Determine Who is Deceased Important to determine the truly missing: To not invest time gathering antemortem data on living persons Reduce costs Expedite the identification of those who are deceased

20 Katrina Statistics 910 Human Remains 13,947 Reported Missing

21 Antemortem Data Collection Reported Missing RM Number Family Contact Information General information Physical characteristics Medical information and records Dental Photographs DNA sample collection


23 MF FAC Operations If the primary purpose of the MF FAC is the collection of antemortem data for identification purposes, what about the other services?

24 MF FAC Support Services Psychosocial/Spiritual support Nutritional support Child care Basic medical support Housing (transportation incidents) Other incident specific support

25 MF FAC Operations FAMILY ASSISTANCE CENTER OPERATIONS ANTEMORTEM DATA COLLECTION Psychosocial/Spiritual Incident Specific Housing Nutritional Child Care Medical

26 MF FAC Operations Implementation Considerations

27 MF FAC Location Secure Controlled exits 24 hour security NOT near incident site or morgue to avoid Sights Sounds Odors Consider length of stay

28 Size Considerations Individuals present Family members and other visitors Average 10 family members per decedent Ex-100 decedents X10=1000 family members Staff Functional areas General meeting area Interview rooms Other components Data management Administration Storage Dental/pathology/DNA Visitor dining area Staff dining / respite area Counseling /meditation/notification area Childrens play area

29 Infrastructure Considerations Utilities Restrooms Parking Family Staff

30 MF FAC Possible Locations Hotel School/college Civic center Church Empty commercial space Governmental building

31 MF FAC Operations and Staffing Staffing considerations: No single agency typically can staff the FAC Will require coordination and support from multiple agencies Must follow incident command structure Staffing needs may change over time as needs change

32 MF FAC Operations and Staffing Reception Greets family members/visitors Credentialing (works with security) First contact with the FAC visitors Skill sets required: Pleasant demeanor Ability to interact with family members Understand ass Fatality Operations

33 MF FAC Operations and Staffing Security Controls entrances/exits Patrols parking lots/building exterior Credentialing (works with Reception) Provides a sense of safety Skill sets required: Law enforcement/security experience Ability to interact with grieving families

34 MF FAC Operations and Staffing Call Center Provides info to families/public Should be pre scripted for consistency Scheduling Data intake Relaying phone calls/takes messages Skill sets required: Proper telephone etiquette Attention to detail

35 MF FAC Operations and Staffing Data Intake Collects Ante Mortem data from families Follows up on cases with missing information Provides families with response information Interacts with forensic personnel Skill sets required: Comfort /experience dealing with grieving families Attention to detail

36 MF FAC Operations and Staffing Data Management Enters antemortem data into database Manages electronic and hard copy files Monitors changes to files Monitors completeness of data Skill sets required: Strong data entry skills and attention to detail Records management experience

37 MF FAC Operations and Staffing Information Technology/Information Resources Establishes and maintains network Establishes and maintains database Back-up Interacts with morgue operations Provides statistics/reports Skill sets required: Computer network experience Database management experience

38 MF FAC Operations and Staffing Family Affairs/Release Section Positive identification notifications (as requested) Coordinates remains release Local funeral providers Disaster mortuary companies Skill sets required: Experience dealing with families concerning their deceased loved ones Detail oriented

39 Forensic Sciences (Dental, Pathology, Fingerprints, DNA) Request antemortem records Collects DNA reference samples Provides information to family members Skill sets required: Forensic Dental/Pathology experience DNA collection and possible data interpretation MF FAC Operations and Staffing

40 Support Services Psychosocial/Spiritual support Nutritional support Medical support Child care Other incident specific support Skill sets required: As needed to supply necessary support

41 MF FAC Stages of Operations 1. Start up/surge 2. Steady state 3. Transition back to routine operations Return to pre-fatality operations Transition Outside resources diminish Steady State Fluid operations Start up / Surge Set-up, set policy and resource surge

42 Start-up/Surge MF FAC establishment VERY hectic and at times confusing Convergence of numerous entities to form one operation Fine tune/change as necessary

43 Steady State Daily operations once MF FAC is established Only slight operational changes as needed In preparation for transition stage May be some fluidity of operations during this stage: Needs of various components will change as FAC operations continue Will affect both staffing and hard assets Examples from the Louisiana FAC following hurricane Katrina/Rita

44 Family Affairs September 2005May 2006

45 DNA September 2005May 2006

46 MF FAC Transition From larger MF FAC operations with outside support to local operations Relinquishing staffing, equipment, and facility Transferring records to local authorities Must convey to public FAC transition MF FAC operations never end

47 FAC Plans are Critical to a Successful Operation Focuses on the Interaction with Families

48 Mass Fatality Response SNA International SUDDEN DEATH © SNA International 2009

49 49 Situation: SUDDEN DEATH Soccer stadium downtown International soccer tournament Stadium capacity of 51,000 96 o F and high humidity 6:00pm game goes into Sudden Death overtime © SNA International 2009

50 Explosion on West Side of Stadium 50 © SNA International 2009

51 July 22, 2008Sozer, Niezgoda, and Associates, LLC 51 © SNA International 2009

52 West Side of Stadium 13,000 seats Players, coaches and support staff of team on West side of field = 50 Employees of stadium in the area =approximately 30 52 © SNA International 2009 Total fatalities can be upwards of 13,080

53 53 Balance of Stadium Approx 38,000 spectators 50 personnel with team on East side 70 employees All fled stadium after explosion Total estimated affected= 51,200 people What will this mean in terms of total reported missing persons? © SNA International 2009

54 Demographics Local residents U.S. residents from around the country Non-U.S. residents from various countries 54 © SNA International 2009

55 Time Table - Day 1 6:00pm - Explosion....on-site medical personnel begin to render aid and begin triage to local hospitals 6:15pm - Fire Department arrives and begins extinguishing fires, securing scene for both security and safety purposes 6:17pm - Calls begin to come in concerning incident and information on those at the tournament 6:25pm – Explosion Reported by news stations 6:30pm - Family members begin arriving at scene wanting information on survivors/deceased 7:00pm - First responders still battling fires-survivors continue to be triaged, treated and evacuated 55 © SNA International 2009

56 Time Table – Day 2 6:00am - Fires out rescue operations still ongoing…Much confusion among surviving family members…USAR teams inspecting weakened ends of west side of stadium 56 © SNA International 2009

57 Time Table – Day 2 6:00am - Scene declared safe to begin recovery operations 9:00am - Local, state, federal, NGOs, volunteers, faith based organizations, and various others all in town to begin identification and reunification efforts. 57 © SNA International 2009

58 Status at Scene West side of stadium completely collapsed with unknown numbers of bodies underneath Both ends of collapsed section unstable-not safe for rescue/recovery Much fragmentation of remains 58 © SNA International 2009

59 59 Identification of Human Remains Bodies beginning to decompose Scene has been secured to keep media, family members and all others out. Weather-still hot and humid Now What???? © SNA International 2009

60 MF Operational Components 1.Field Operations - recovery of human remains 2.Family Assistance Center - collection of antemortem data 3.Morgue - collection of postmortem data 4.Identifications – comparison of antemortem and postmortem information for identification

61 61 Family Assistance Center (FAC) When will FAC operations begin & end? Where will the FAC be located? What services will be offered? Who will staff and manage the FAC? How will the Local Boards of Health Support the Response Efforts?

62 62 Conclusion This would be a large scale, multi-jurisdictional investigation and recovery process with many dynamics effecting the reunification process. Planning for ANY mass fatality is always the First Step in mitigating the identification/reunification process. © SNA International 2009

63 Thank You! Amanda C. Sozer, Ph.D. Arbie Goings SNA International 4707B Eisenhower Ave. Alexandria, VA 22304 P:+1-703-370-1930 F:+1-703-370-1931

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