Mass fatality planning Daniel Jordan, PhD


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Disaster planning in the US seems to have a a core weakness. Most disaster plans address multi-fatality events,not true mass fatality events such as the 1918 pandemic. Planners must address the fact that such events will someday occur and preparations are possible.

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Mass fatality planning Daniel Jordan, PhD

  1. 1. MassFatalityCatastropheResponseDaniel Jordan, PhD,
  2. 2. Objectives: Develop and Organize  Establish MFC Response Policy & Procedures  Understand Handling Deceased  Assist Families and Loved Ones  Familiarity with Death Certification Process  Establish Role of Mass Fatality Response Coordinator in an Operations CenterDaniel Jordan, PhD,
  3. 3. Mass Fatality Planning Objectives: (FEMA)  Don’t become overwhelmed  Overcome denial and “disbelief”Daniel Jordan, PhD,
  4. 4. Mass Fatality Planning Objectives: (Jordan)  vs.Daniel Jordan, PhD,
  5. 5. FEMA Definition: Catastrophes vs Disasters  Mass vs Multi casualty and fatality  Community activity breaks down  Infrastructure (buildings, roads, water, power)  Daily life: Work, leisure, education  Social order  Local governance into recovery and beyond  Help from outside is not available  FEMA and Enrico Quarantelli. “Emergencies, Disasters and Catastrophes are Different Phenomena.”Daniel Jordan, PhD,
  6. 6. Catastrophes: High Probability, Low Frequency  Health (Worst case, large scale, infrequent)  Pandemic: 5,000 to 80,000+ Ventura County deaths, nation/world-wide, no/little mutual aid  Natural (Likely, not as large scale)  7.9 or larger earthquakes, dam failure, tsunamis, likely some mutual aid from outside CA  Human-made (Less likely, smaller scale)  Biological or dirty bomb attack, larger than 9/11Daniel Jordan, PhD,
  7. 7. Mass Fatality Incident Guidance  Planning tool, not a plan  Start with worst case scenarioDaniel Jordan, PhD,
  8. 8. Reality Check It "may not be ethical, it may not be nice, it may not even be legal, but it might be the only thing you can do.”  Michael Leavitt, Secretary of Health and Human ServicesDaniel Jordan, PhD,
  9. 9. Reality Check: It Could Get Bad -- Really, Really Bad  “The corpses had backed up at the undertakers’, filling every available area of these establishments and pressing into living quarters; in hospital morgues overflowing into corridors; in the [Philadelphia] city morgue overflowing into the street. And they backed up in homes. They lay on porches, in closets, in corners of the floor, on beds.”  Barry, JM. (2004). The Great Influenza: The Epic Story of the Deadliest Plague in History.Daniel Jordan, PhD,
  10. 10. Reality Check: AHRQ* Plan (See Any Problems with This?)  Establish a Regional Home Death Management Process  Set up regional hubs for body retrieval and processing with a review by the Medical Examiner, a registration process, and a temporary holding place awaiting definite management.  Deploy refrigerated trucks from the hospital for body management, exchanged daily to regional processing sites.  Arrange for Web-based death certificate processing and secure tracking to the Department of Health.”  *Agency for Healthcare Research and Quality  Jordan, PhD,
  11. 11. Reality Check: A State Pan Flu Plan (See Any Problems with This?)  Handling of Deceased Bodies by the General Public, Such as At-Home-Death: If . . . the death of a family member occurs in your home . . . isolate the body in an area where it will not be touched or disturbed. If the body must be moved or otherwise touched . . . wear gloves and avoid contacting oral and respiratory secretions (from mouth, eyes, nose). Wash hands thoroughly after touching the body or surfaces contaminated by secretions. Thoroughly disinfect surfaces and launder clothing that may have been contaminated by secretions. Call appropriate authorities to report the death.  State of ------------, Dep’t. of Health. Public Health Pandemic Influenza Response Plan, Ver. 5. (emphasis added)Daniel Jordan, PhD,
  12. 12. Reality Check: Mass Fatality Plan Weaknesses  Consider:  15-20% of the population has died  35-40% of the population is very sick  Nationwide pandemic, mutual aid is not comingDaniel Jordan, PhD,
  13. 13. Reality Check: Yes, It Could Get Bad -- Really, Really Bad  Epidemiological Modeling: Ventura County could have between 5,000 and 125,000 deaths in a 6 to 8 week period (with a second, smaller wave following the first)  Our society is not prepared  No society can be truly prepared  But we must do our bestDaniel Jordan, PhD,
  14. 14. Nationwide Pandemic: What’s Different from 1918?  Travel: Speed  Numbers  Frequency of trips Plane landing at Maho Bay, St MaartenDaniel Jordan, PhD,
  15. 15. Nationwide Pandemic: 1918 and Now  More people have impaired immune systems due to medical advances allowing them to live longer . . . overall our population has lower immunity levels*  Elderly, transplant recipients, cancer survivors getting chemotherapy or radiation, and viral infections including HIV  We’re actually in worse shape than in 1918 * Jordan, PhD,
  16. 16. Why Establish an MFC Plan?  Notify and assist families  Protect families, property, estates -- the future  Identify the deceased, repatriate as possible  Maintain evidence trail  Determine and certify causes of death  Track patterns for prevention and mitigation  Properly dispose of remainsDaniel Jordan, PhD,
  17. 17. Need a Multi-Agency Plan  Health Department  Hospitals  Community health entities  Mortuaries  County/City planning agencies, parks departments  and moreDaniel Jordan, PhD,
  18. 18. Community-Wide Scene(s) Plans
  19. 19. The Scene: Contained Event to Nationwide Disease Outbreak  Single Contained Incident  County-wide event  Regional to nation-wide catastropheDaniel Jordan, PhD,
  20. 20. Transport Plans
  21. 21. Transport of Deceased  Assume: System is overwhelmed  From scenes to funeral homes and/or morgues  Funeral homes and morgues to burial sites  Access to appropriate vehicles, ambulances, hearses, trucks,  Body bags, boards, coffins, equipmentDaniel Jordan, PhD,
  22. 22. Disaster Morgue Plans
  23. 23. Morgue Standards  Out of sight from bystanders and victims.  Access control: Only authorized staff.  Attempt to identify all human remains.  Photographs and descriptive information for each body.  Collect and store, find refrigerated containers or temporary burial to allow for subsequent investigation and/or identification.Daniel Jordan, PhD,
  24. 24. Family Assistance Center Plans Psychological First Aid Community Intervention
  25. 25. Family and Community Assistance Centers  Removed from the press, the morgue  Mental Health staff trained in psychological first aid  Emotional support and practical information  Gathering place for families to get information and provide support to each other  Establish community response plansDaniel Jordan, PhD,
  26. 26. Be able to address whether dead bodies cause epidemics  Dead bodies from natural disasters do not have epidemic causing diseases (e.g., cholera, typhoid, malaria, or plague).  Victims of disease need some precautions  Follow precautions, use Personal Protective Equipment (PPE) use Partially Derived from: Morgan, O., Tidball- Binz, M. & Van Alphen, D. Eds. (2006). Management of dead bodies after disasters: a field manual for first responders. Washington, D.C: PAHO.Daniel Jordan, PhD,  Avian Flu Virus
  27. 27. How Urgent is Collection of Dead Bodies?  Body collection is not the most urgent task after a natural disaster.  The living are our priority.  No significant public health risk is related to simple presence of dead bodies.  Collect bodies as soon as possible and maintain identification.Daniel Jordan, PhD,
  28. 28. Health Risks to the Public and Workers Handling Dead Bodies  Rescue workers, morgue workers, etc. have small risk from tuberculosis, hepatitis B and C, HIV, and diarrheal diseases.  Infectious agents causing these diseases last no more than two days in a dead body (HIV may survive up to six days).  Reduce risk with rubber boots and gloves.  Little risk to general publicDaniel Jordan, PhD,
  29. 29. Handling the Deceased: Examples of Advice  Follow DOC/EOC  Cover the body or instructions head before moving  Universal precautions  Use backboards  Volunteers only (even  Double glove and tape staff should be wrists volunteers)!  Use shovels not hands  Masks help emotionallyDaniel Jordan, PhD,
  30. 30. Human & Social Welfare Plans
  31. 31. Survivors: Special Considerations  Orphans (especially if 1918 pattern held)  Elderly  People with special needs  Language barriersDaniel Jordan, PhD,
  32. 32. Mental Health Issues  The primary desire of relatives (from all religions and cultures) is to identify their loved ones.  Help with decision-making.  Grieving and traditional burial are important for the personal and community recovery and healing. [See Cultural Competencies in MFCs plan.]Daniel Jordan, PhD,
  33. 33. Examples of Dealing with Victims, Loved Ones, Bystanders  Act with respect and dignity for all involved.  Reduce pain witnesses may feel (they will watch handling of the deceased).  Handle deceased as if they were still alive.  Avoid “M.A.S.H. humor.”  Watch for signs of stress among responders and help them get time.Daniel Jordan, PhD,
  34. 34. Communications and Media Plans
  35. 35. PIOs, Journalists  Challenge comments or statements regarding the need for mass burial or incineration of bodies to avoid epidemics.  Consult PAHO/WHO, ICRC, the IFRC or local Red Cross sources.  Don’t join alarmists by spreading bad information.Daniel Jordan, PhD,
  36. 36. Disposition andCollective Burial PlansIt Can [Will] Happen Again
  37. 37. Coffins on loading dock 1918Daniel Jordan, PhD,
  38. 38. Mass coffins 1918Daniel Jordan, PhD, 1918 pandemic viewing area
  39. 39. Mass grave digging 1918Daniel Jordan, PhD,
  40. 40. Modern Collective Burial imageDaniel Jordan, PhD,
  41. 41. Cremation vs Burial (PAHO* Guidelines)  Cremation is not universally accepted destroys evidence.  Large amounts of fuel are needed.  Achieving complete incineration is difficult, often resulting in partially incinerated remains that have to be buried.  Logistically difficult to arrange cremation of a large number of dead bodies.  Pan-American Health OrganizationDaniel Jordan, PhD,
  42. 42. Collective Burial Not Mass Graves  2.5 acres can hold about 2,000 bodies.  Gridding system, each body identified or identifying characteristics recorded.  Special training for heavy equipment operators.  Dilemma: Repatriation vs. permanence.  Avoid trauma, even international consequences of mass gravesDaniel Jordan, PhD,
  43. 43. Collective Burial Site Criteria  Accessible yet able to be protected.  Not linked to water tables.  Relatively flat expanses of open ground.  Dirt, low proportions of rock to be cleared.  Convertible to permanent cemeteries.  Neighborhood burials, local parksDaniel Jordan, PhD,
  44. 44. Example Collective Burial Site Location:This is not an actual planned site, but anexample of thinking through the process Parcel ARN 234005014Daniel Jordan, PhD,
  45. 45. One Hundred Year Flood Plain Parcel ARN 234005014Daniel Jordan, PhD,
  46. 46. Scary dairy close up with 100 yearParcel ARN floodplain234005014Daniel Jordan, PhD,
  47. 47. Memorializing Plans Collective burial sites planned astemporary have become permanent
  48. 48. Winfield Township’s 1918 Influenza Mass Grave Site History Of the 1918 Mass Graves in Winfield Township, Butler County PADaniel Jordan, PhD,
  49. 49. 1918_Program_Service_b_Ukranian_C atholic.jpg Jordan, PhD,
  50. 50. Alaska Inuit mass grave marker  site of a mass grave in Brevig Mission, Alaska, where 72 people were buried following their deaths during the Spanish flu breakout of 1918. Ned Rozell photo. Photo by Ned RozellDaniel Jordan, PhD,
  51. 51. Castlebar, Ireland Memorial to the Flu Victims of 1918Daniel Jordan, PhD, ABPP Castlebar, Ireland Memorial to the Flu Victims of
  52. 52. Maori memorial  Carved wooden Maori cenotaph erected at Te Koura marae. Cenotaph designed and carved by Tene Waitere of Ngati Tarawhai.  Photograph 1920 by Albert Percy Godber.Daniel Jordan, PhD,
  53. 53. September 16, 1928, a hurricane hit near the Jupiter Lighthouse (FL) heading west across Palm Beach County to Lake Okeechobee. It destroyed hundreds of buildings and damaged millions of dollars in property. Lake 1928 Hurricane, Florida Okeechobee dike collapsed -- 1,800 to 3,000 fatalities. 1,600 buried in a mass grave in Port Mayaca in Martin County. In West Palm Beach, 69 white victims were placed in a mass grave in Woodlawn cemetery and approximately 674 black victims were buried in this mass grave in the Citys paupers burial field. Many others were never found. On Sep. 30, 1928, the City proclaimed an hour of mourning for the victims with rites conducted at each burial site. 2,000 persons attended at the paupers cemetery, black educator and activist Mary McLeod Bethune (1876-1955) read the Mayors proclamation. This burial site was not again recognized until 1991, when a Yoruba (Nigerian religious) ceremony was held here. National Register #02001012 (2002)Daniel Jordan, PhD,
  54. 54. Hurricane memorial statueDaniel Jordan, PhD,
  55. 55. InternationalDimensions Planning
  56. 56. Managing bodies of foreign nationals  Families or countries may demand identification and repatriation of bodies.  Problems could have serious economic and diplomatic implications.  Bodies must be kept for identification.  Department of Foreign Affairs or Governor’s Office, foreign consulates, embassies, INTERPOL, etc.Daniel Jordan, PhD,
  57. 57. Debriefing &Demobilization Plans
  58. 58. Give Every Consideration to Participants  Operational Debrief  Psychological First Aid, referral and follow-up interventions  Information capture, tactical changes, organizational learning and practice  Staff welfare, staff recovery  Overall follow-up planningDaniel Jordan, PhD,
  59. 59. Demobilization  Body Recovery Demobilization  Personal Effects Recovery Demobilization  Family Assistance Center Demobilization  Morgue Demobilization  Collective Interment Operations DemobilizationDaniel Jordan, PhD,
  60. 60. Breakout Session: Suggested (Initial) Mass Fatality Annex Work Groups  Scene(s) Management (may be entire For each domain we County) including Transportation need at least:  Hospital Mass Fatality Plans  Objectives  Funeral Home/Mortuary Roles  Disaster Morgue  Policies  Family Assistance, Identification &  Management & Viewing (cultural & religious issues) Organization Plan  Health and Safety (universal precautions)  Procedures  Social Welfare (e.g., orphans, displaced people)  Communications and Media  Disposition, Collective Burial, Memorials  DemobilizationDaniel Jordan, PhD,
  61. 61. Contact  Daniel Jordan, PhD, ABPP Research Psychologist 2240 E. Gonzales Road, Suite 220-M Oxnard, CA 93036 Phone: 805-981-5258 Email: or dan.jordan@ventura.orgDaniel Jordan, PhD,