Saving Johnny Butler
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A synopsis of Alabama's FAC system
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Saving Johnny Butler
- 1. FAC Saving Johnny Butler: The Role of the SMORT and Family Assistance Center (and Others) In Mass Casualty Disasters (And How You Can Help!) John R. Wible General Counsel Alabama Department of Public Health (Retired) Northwest Alabama VOAD - August, 2013
- 2. This is the State – The Great State of Alabama And this is the County – Cotton County xxxxxxxxxxxxxxxxxxxx John R. Wible, 2013 2
- 3. This is the Coroner • This is the Coroner of Cotton County, Quincy Sebem, III. He is the owner and operator of the Loving Care Brown Service Funeral Home. He has a budget of $7,000 per year and a staff of two, counting himself and his Wife, Sammie. • He’s about to be overwhelmed. John R. Wible, 2013 3
- 4. I work here . . . I’m the FAC Director John R. Wible, 2013 4
- 5. This is Johnny Butler John R. Wible, 2013 5
- 6. This is the University of Rural Alabama John R. Wible, 2013 6
- 7. And this is the DISASTER! John R. Wible, 2013 7
- 8. And the Fire! John R. Wible, 2013 8
- 9. Response Agency: A,B,C,D, E,F,G,H,I,J,K,L,M,N,O,P,Q,R,S,T,U,V,W,X,Y,Z John R. Wible, 2013 9
- 10. Rescue John R. Wible, 2013 10
- 11. Casualties Sixty-Seven Dead . . . One hundred Eighty-Five Injured John R. Wible, 2013 11
- 12. SMORT John R. Wible, 2013 12
- 13. SMORT Administration John R. Wible, 2013 13
- 14. On the Way John R. Wible, 2013 14
- 15. Victim Information Center John R. Wible, 2013 15
- 16. Family Assistance Center (FAC) • Activated quickly following a mass fatality incident • Provides critical and secondary services to family of victims • Coordinates with partner groups • Maintains a high degree of sensitivity and respect • And provides security and protection from media John R. Wible, 2013 16
- 17. FAC Services • Assist SMORT in identifying victims – Antemortem interviews • Provide comfort and assistance to families • Refer family members for: – Spiritual or psychological counseling – Medical assistance – Material needs John R. Wible, 2013 17
- 18. FAC Staff • County Coroner/Medical Examiner is Incident Commander • SMORT Commander is FAC Superior Officer • FAC Executive Director (FACED) and Deputy – Chief of Professional Personnel (ChoPPs) • Family Assistance Representatives (FARs) – Chief of Operations (Ops) • Antemortem Interviewers (AMIs) • Antemortem Data Entry Personnel (ADEP) • Administrative Staff (Admin) – Chief of Logistics (CoLog) John R. Wible, 2013 18
- 19. Faces of FAC John R. Wible, 2013 19
- 20. FAC Layout John R. Wible, 2013 20
- 21. Just Who is a “Family?” John R. Wible, 2013 21
- 22. Caring for Families, the FAR John R. Wible, 2013 22
- 23. FAC Partners in Service Baptists and Clergy Emergency Management Agency FAC Salvation Army Mental Health John R. Wible, 2013 23
- 24. Mental, Health or Spiritual Interventions • Psychological First Aid- comfort care • Crisis intervention- provide opportunities for family members to make decisions to regain control of their lives • Psychological education on stress symptoms and coping • Casualty support- connect with support systems decision making on disposition of remains • Spiritual Care Interventions by Disaster Chaplains John R. Wible, 2013 24
- 25. Identification of Remains John R. Wible, 2013 25
- 26. The Antemortem Interview John R. Wible, 2013 26
- 27. Data Entry and Reporting Coroner Quincy FAC Private Family Briefing Data Compilation (ADFS) Data Entry (FAC) Press Conference John R. Wible, 2013 27
- 28. Beginning to Wrap Up John R. Wible, 2013 28
- 29. Saying “Good-Bye” John R. Wible, 2013 29
- 30. Rituals John R. Wible, 2013 30
- 31. Saving Johnny Butler John R. Wible, 2013 31
- 32. Insights Gained Family Support and Services: FAC • Families must be identified quickly and given access to information and services that are victim sensitive and easily accessible. • There is a strong need for continuous flow of information. – Regularly scheduled family briefings and a – pro active approach to family issues and requests. • Consistent and equitable support to all victim family groups is a challenge, but is important. • “One stop” support center approach was efficient, provided a safe haven for families and helped facilitate ID process John R. Wible, 2013 32
- 33. FAC Wants You! John R. Wible, 2013 33
- 34. Volunteer Registration • https://alresponds.adph.alabama.gov/agreem ent.php?mode=unit • “Unit type” dropdown, click “SMORT” • “Choose Unit” dropdown, click – FAC Care Assistant, or – FAC Data entry-Admin, or – FAC Interviewer John R. Wible, 2013 34
- 35. John R. Wible, 2013 35
- 36. For A Copy of Presentation and the Text • See “FAC Presentation,” a download on Slideshare 7 <slideshare.net> • See also my Facebook Page John R. Wible, 2012 36
Editor's Notes
- This is a story about a young man, Johnny Butler, and his journey from his home to the University of Rural Alabama (TURA) as in “Toora, Loora, Loora.” (John Sings)
- It is April 24, and this is the Great State of Alabama and the pre-civil war county of Cotton. Being an old county, Cotton County is located in the rural Black Belt of Alabama, the old cotton producing region. By nature, Cotton County is rural – very rural. There aren’t that many people here – except during the school year where the population is swelled by the enrollment of the University, a former State Teacher’s College, founded somewhere in the distant past by Miss Julia Tutwiler and funded by Governor Bibb Graves.
- This is the Coroner of Cotton County, Quincy Sebem, III. He is the owner and operator of Loving Care Brown Service Funeral Home. As Coroner, he has a budget of $7,000 per year and a staff of two, counting himself and his Wife, Sammie.He doesn’t know it, but he’s about to be overwhelmed.
- "What sort of day was it? A day like all days, filled with those events that alter and illuminate our times... all things are as they were then, and you are there.” That’s where I come in. I work here . . . I carry a badge … I’m the FAC Director. My life, too, is about to get interesting.
- Now, this is Johnny Butler, a bright kid from Crenshaw County, Alabama. He’s a whiz at math and science, the kind of kid that has a real future. He can go anywhere he wants to go, so his teachers tell him. He’s from the grand ole Butler family, a family that came to Alabama, via Charleston, S.C. in the 1700s from Ireland. In Ireland, the Lord Butler was the Chancellor to the King. Perhaps one day, Johnny will be the Chancellor of a great university . . . Perhaps not.Johnny’s been selected from all the other kids in Crenshaw County to compete in the State Science Fair at the University of Rural Alabama. He’s excited to go. On April 24, his parents proudly take him and drop him and his project display off at the gym. He’ll spend several days living in the dorm as the TURA students are on spring break and in showing his project in the great hall of the gym with all the other bright students from the rest of Alabama. This is the proudest day his family has seen – that will change.
- Now, this is the University of Rural Alabama, the home of the “Fighting Okra,” the defending NAIA basketball champions. Their gym is a showplace for a college of this size. They’ve put a lot of money into it so it will look special. Of course, with tight budgets, some cuts had to be made here and there – in this case, some of the cross-members in the ceiling and roof were substituted with lesser-grade materials. Nobody will see them and since there’s no snow in Rural Alabama, the roof doesn’t have to withstand all that much weight any way. As we later learn, some of the wall material turned out not to be quite as flame-retardant as advertised. Oh, and the water for the showers is heated by natural gas.These will turn out to be fateful decisions.April 25. Here, you see all the science projects proudly displayed in the gym – hundreds of them, presented by hundreds of kids – black and white, Asian and Latino. “Fat kids, skinny kids, kids who climb on rocks. Tough kids, sissy kids. Even kids with chicken pox.” All to be viewed and judged by a blue ribbon panel of scientists including one Nobel Laureate, Dr. David J. Wineland of the National Bureau of Standards in Boulder, Colorado. This trip will be an eventful one for Dr. Wineland.Here , we see a group shot of but a few of the students – all bright, all promising, all have miles and miles of future ahead of them – or do they?And, Johnny Butler is in the middle of it all, a handsome, winsome, articulate young man who’d make a great physicist some day. He’s particularly interested in showing his project, ironically, “The Physics of the Wind,” to the famous Dr. Wineland.It is now April 26, and some problems begin. A Cold front has begun moving in from Northwestern Arkansas and a Warm Front up from South Louisiana. There may be a bit of “weather.” There is some consideration concerning cancelling the rest of the conference, but the logistics of it all will not permit that, so, school authorities agree to go on with the Fair. The day is spent in final preparation for the judging on the next day.Johnny is honored to have dinner that night with Dr. Wineland and they do discuss physics and wind. Johnny is excited beyond belief and Dr. Wineland is more than impressed with the young man.However, in the night, problems really begin to ensue – there will be blood.
- April 27 dawns with clouds overhead and high aloft – ominous clouds, foreboding clouds, the kind of clouds you know are up to no good. It’s a hot and sticky day for April, even in Rural Alabama. The humidity is very high and the air has a strangely electric feel to it.The kids are all gathered in the gym, hundreds of them with their projects set up on the floor. They are all spit and polished and ready to be judged. Everyone just knows that he or she is a winner. Dr. Wineland is the Chief Project Investigator. He begins to lead his team of judges as they methodically observe each project and question the students about the projects. The school caretaker, Harlan Regis, gets concerned even though the students are completely unaware that outside, the sky goes from blue to hazy, to gray, to charcoal, to black – to green.Like the proverbial freight-train an horrific EF-5 tornado bears down on the campus. It has the school in its cross-hairs. Before the kids can say OMG, the gym becomes a bulls-eye: windows blow out, doors suck in, seats come un-moored – and then that terrible crack as the roof-span gives way dropping every bit of its one ton for each 80 square feet of concrete on the once-prized parquet floor smashing beautiful science projects and sandwiching once-innocent children.
- The falling roof crashes through the floor and ruptures the gas main, the pilot light from the hot water heaters ignites the surging gas and the rubble, still blowing up billows of concrete and sheetrock dust, becomes one giant ignition chamber and the gym explodes sending some bricks all the way across the campus. The explosion is immediated by a flash fire that mushrooms as though it were a bomb.In 20 seconds, it’s all over. The “Mother of All Alabama Tornadoes” moves on to wreak more havoc on Cotton County and then lift back to the clouds which bore it on “buzzard’s wings.” However, the all-consuming fire continues to burn unabated until it self-consumes in minutes.What can survive this inferno?
- Miraculously, some do. One is Dr. Wineland, who is found wandering, covered with dust and ash, completely dazed. He has somehow survived and has, himself, dragged clear a number of now-nameless children, some still alive – some not. Asked to come back later to TUNA to receive an award for his meritorious service, he declines, never able to see such a sight again
- Later, much later, when the smoke clears and the dust settles, the scoreboard which once counted free-throws, dunks and bank-shots, now counts casualties -Sixty-Seven Dead . . . One hundred Eighty-Five Injured – men, women and children.
- One such agency carries the designation State Mortuary Operational Response Team,SMORT. Remember Coroner Quincy? There is no possible way that he, the local coroner, can begin to even locate and identify the decedents, let alone prepare them for release to their soon-to-be grieving families. Thus, a volunteer organization which started with funeral home directors and other mortuary personnel is alerted by EMA – SMORT formed by funeral directors and personnel just a time such as this. Quincy was acquainted with SMORT through his training with the Coroners’ Association. He remembers that SMORT is composed of funeral directors, funeral employees, coroners, other trained personnel, as well as administrative support staff, and security personnel; And it has a number of responsibilities under the direction of the Coroner whom they assist. These responsibilities include: provision of temporary morgue facilities victim identification decedentprocessing and preparation for disposition of remains to funeral home directors at the request of families.SMORT has available to it personnel that can provide additional services such as forensic dental pathology and forensic anthropology to aid in identification of remains. It works closely with the Alabama Funeral Home Director’s Association, Alabama Board of Funeral Service, the Alabama Department of Forensic Science and ADPH as well as with local coroners and medical examiners.SMORT is patterned after the federal Disaster Mortuary Operational Response Team (DMORT), which is administered since 2007 by HHS, National Disaster Medical System (NDMS.) Like DMORT, SMORT has a two-part process that utilizes a sophisticated computer program for matching physical characteristics. If necessary, the families of the decedents provide as much information about their loved one as possible: medical or dental records, X-rays, fingerprints, photos or descriptions of tattoos, clothing and jewelry; blood type information and objects that may contain the decedents’ DNA, such as hair or a toothbrush. SMORT provides or procures hot/cold running water, electricity, HVAC, adequate and secure drainage, parking, communications, and security. An ideal temporary morgue established within a building needs 5000-8000 ft2.The information gathered, called antemortem, or "before death" information, is entered into a computer program called VIP (Victim Identification Profile), which is capable of assimilating 800 different item categories, including graphics, photographs and x-rays. As forensic scientists (pathologists, anthropologists, odontologists) examine the recovered remains, they enter their findings - called postmortem data—into VIP (Victim Identification Profile). Coroner Quincy is aware that this mass casualty event could be determined to be of national importance or might exceed the capacity of even SMORT. That being the case, DMORT could be activated to assist, by HHS at the request of ADPH or through AEMA through EMAC, Interstate Mutual Aid overseen by FEMA.
- Coroner Quincy knows that SMORT is administered by the Cullman County EMA where Phyllis Little is the Director and Kelly Allen is her Deputy. Doug Williams, a funeral director in Cullman is the statewide SMORT Commander. It utilizes only volunteers, but receives certain funding through ADPH from ASPR. Tim Hatch oversees the grant.SMORT has 50 personnel divided into 5 regional teams of ten persons. It has five large inflatable tents, three mobile units and three refrigerated trailers. All will be needed at this scene.“Funeral home.” That has an ominous ring to it doesn’t it. Yet, funeral homes in the State of Alabama are about to be busy. Sixty-seven Alabama children and adults are lost is less than one minute.
- One such student is Johnny Butler, lost in the melee’. Like hundreds of other families, the worried Butler family hear the news and drive quickly to the scene, clogging the highway. And like all loved ones, they want to find out whether their son is alive . . . or not. Only time and work, a lot of work, will tell.
- When the Butlers arrive at the scene, they find a policeman and tell him who they are and ask if there is any information on Johnny Butler. The Red Cross, called by EMA and in coordination with a branch of SMORT called the Family Assistance Center or FAC, has established a temporary place for families and friends to go. This is the Victim Information Center (VIC.) At the VIC, which has been hastily located at the municipal auditorium, the family finds many other worried and concerned families, some food, some organization and what little information there is.The municipal auditorium is close to the scene, perhaps too close. Bearing that in mind, EMA, in coordination with the FAC, establish a Center, the Family Assistance Center, at New Bethlehem, a local United Methodist church which is on the other side of town and unharmed by the monster-storm.
- FAC staff are trained to quickly activate the Center following the event as they have here. Over the next few days, they will provide critical and secondary services to the 5 to 7 expected family members of victims. The FAC will partner with a number of sister agencies, will at all times maintain a high degree of sensitivity and respect for both the family and the lost loved one. Perhaps most importantly, the FAC will provide a place of security and serenity away from the prying eyes of the media and the gawkers. None such will be allowed in FAC at any time.In the end, the FAC will be the families’ life-line to information as it becomes available, to sanity, and will begin to build the bridge to coping with what is to come.
- FAC will assist SMORT in identifying victims through conducting antemortem interviews, will provide comfort and assistance to families, and will refer family members forspiritual or psychological counseling, medical assistance, and material needs.
- The SMORT staff consists of the County Coroner/Medical Examiner who is theIncident Commander, the SMORT Commander, the FAC Executive Director (FACED) and Deputy Director, theChief of Professional Personnel (ChoPPs,) Family Assistance Representatives (FARs), the Chief of Operations (Ops,) Antemortem Interviewers (AMIs,) Antemortem Data Entry Personnel (ADEP,) Administrative Staff (Admin,) and the Chief of Logistics (CoLog).
- At the FAC, families will see these faces: Doug Williams, the SMORT Commander; Debbie Gaddy, R.N., the Deputy; Dr. Bill Morgan, the Autauga County Baptist Director of Associational Missions and Chief of Professional Personnel; and your FAC Director. Dr. Morgan supervises the Family Assistance Representatives, the to-be-determined Chief of Ops supervises the Antemortem Data Interviewers and the Chief of Logistics who will be FAC’s answer to MSgt. Bilko, the scrounger who can procure it . . . Just don’t ask him how or where he got it.We are currently actively recruiting both a ChoPPs and a CoLog as well as FARs, AMIs and Admins. Our goal in recruitment is to fill out the table of organization and equipment (TO&E) with a racially and culturally diverse team that includes people of different faiths, genders and disciplines who are best suited for their particular assignment.
- In this event, New Bethlehem was transformed into the FAC with a number of service areas, all designed to accomplish its two major goals, taking care of the families and assisting SMORT to identify decedents so that ultimately, there can take place the sad reunion as the families are assisted in taking their loved one to their own funeral home. The service areas include a reception/screening checkpoint; a waiting area; a large family briefing room; a place for victim identification services and data entry/computer operations; and general operations, child care, staff break, and family feeding areas.
- Just who is a “family?” The working definition of victim and family groups is broad in scope. The Red Cross, National Transportation Safety Board and the military all define “family” as anyone that the primary victim’s family considered to be a family member. If other words, if they say they are “family,” we won’t question that. Of course, in a disaster of this magnitude, there might have to be limits placed on the size of these “families.”Whoever self-define as “family,” as in this case, they will or may present desperately seeking information, physical and emotional comfort, hydration, meals, and protection from media. In fact, though great emotion is not always immediately present in families, the Butler family appeared dazed or numb. We know that each of them will gradually go through stages of denial, hope, and then grief and despair. Our job is simply to be there with them and for them.At the URA disaster, we, the FAC staff found some family members to have irrational beliefs regarding the survival of their loved ones in face of certain death, which is common and not abnormal in early stages of the event. We even had a few individuals, none of the Butler family, though, who experienced stress-induced physical or behavioral symptoms of such severity that we had to refer them to other providers for urgent and immediate care.We learned through this that acute stress symptoms such as confusion, the presence of intrusive memories, increased anxiety and a sense of disbelief was present even in some of those who directly experienced or witnessed the incident.
- At New Bethlehem, each family had assigned to them a Family Assistance Representative (FAR) who served as their guide on this perilous and sad journey. Like all FARs, the Butler Family FAR, Miss Henrietta Mears, ministered to their needs, helped them procure things they needed and generally served as their “next friend.” The FARs exuded a sense of safety, calm, efficiency, community, and connectedness to social support. Above all, they provided the Butlers and the hundreds others like with hope. Where there is no hope, there is only despair. No one should despair in the FAC.
- The Butler Family has material needs as well as emotional needs. Miss Mears and the FARs through FAC have many resources upon whom to call should the need arise. EMA is the gateway, but people services are provided by Red Cross, Salvation Army, denominational disaster ministries, especially for Alabama’s FAC, The Alabama Baptist Disaster Relief Ministry consisting of Chaplaincy, child care, and food service (food supplied either by Red Cross of Salvation Army.) The Baptists even provide temporary shower units and self-contained clothes washing trailers.Most faiths and denominations have on-call clergy who can give spiritual counseling. EMA can provide mental health/social worker counseling if need be. All these resources and more are available to the families through the FAC. And, it’s the FAR’s job to see that they are connected.
- If the FAR refers a family member for mental health counseling through EMA/Red Cross, they may need psychological first aid - comfort care over and above what our FARs have been trained to give. A family member could also need crisis intervention support to provide opportunities for family members to make decisions to regain control of their lives, psychological education on stress symptoms and coping as well as casualty support such as connecting with support systems, decision-making on disposition of remains or spiritual care interventions by Disaster Chaplains or local clergy of the appropriate faith.
- The second, perhaps toughest, task facing the Butler family will be assisting SMORT through FAC in identifying remains. In this event, we have already witnessed search and recovery of remains and an assessment by Coroner Quincy of the condition of the remains. Some will be easy to identify, some will not. You know, but the Butler Family does not know, that what has already begun is the identification process. In this process, forensic experts, if necessary, will assess the length of time it might take to make a positive ID and what methods (esp. DNA) will be needed. Certainly, involved in the process is antemortem data collection involving the making of decisions about the release of remains to the family and receiving information on identification of common/unidentified corporeal fragments. Likewise, the Coroner is already working with due deliberate speed to determine an exact cause or manner of death for each decedent that has been identified.
- After the Butler Family became comfortable with their FAR, Henrietta Mears, also a member of the Alabama Baptist Disaster Response Mission, they met with an FAC Staffer, Mr. Richard Cavett, an Antemortem Data Interviewer (AMI) who led them through the delicate process of obtaining data that helped SMORT, Coroner Quincy and the ADFS Staff identify a young man who was finally and sadly determined to be Johnny Butler.Miss Mears walked with them throughout this process. While AMIs move from family to family gathering information on the VIP form, FARs stay with their family until relieved.
- Behind the scenes at the FAC and out of view of the grieving families, the antemortem data which has been collected by AMIs such as Mr. Cavett is entered into a data collection system set up and installed in the FAC by the IT staff of ADFS. This information is uploaded to the ADFS HQ in Montgomery where the antemortem data is matched with the post-mortem data. The goal is to create a positive match. While ADFS suggests the match, Coroner makes the final call since this is his County and his responsibility.The system allows the FAC Ops to query the system periodically for reports on putative matches so that Coroner Quincy can be constantly informed as to the status of remains since he must report to the public, the press and most importantly to the families on the status of identification of victims.Data released outside a family is general in nature. Only the data that pertains to a particular family is released to the family. General informational sessions are held in the FAC as needed when facts become available. What only one family knows, every family knows, except as it pertains to an identified decedent.
- It is now April 30. The victims are identified and Coroner Quincy makes his rounds notifying each individual family privately. Such is the case with the Butler Family as Coroner Quincy, assisted by the FAC Director and the Family FAR, Miss Mears, notifies them of the truth of what they already knew – Johnny was one of the fatalities.If one can find good news in this, it’s that Johnny is intact and ready to be delivered to his family for burial. There will be many wreaths on the doors of Alabama tonight.
- Henrietta Mears and the Staff of the FAC begin to bid good-bye to the families as they have completed the immediate portion of the mission, that being taking care of families and reuniting them with their loved one. They have assisted the Butlers with making arrangements with Turner Funeral Home in Luverne to take Johnny, to make final preparations and to lay him to rest. This scene, too, is repeated over and over again.However, their job is not over.
- A vital part of this tragedy, as with many such tragedies, is the concept of rituals. In this case, the FAC established a designated area for pictures, messages, mementos, and tributes, such a flowers and teddy bears. The FAC staff assisted families with memorializing those lost-ones through faith based services as requested by families.It may be that some families will want to revisit the scene at a later time, though others will want to blot it from memory. If the former is the case, the FAC will assist local authorities in establishing memorials at perhaps one month and annual commemorations until the need is gone. After the site is released, the FAC has a continuing mission to work with local authorities to make visits to site where loved ones died. Families will be escorted by FARs, mental health and disaster chaplains. If requested by a family, the FAC will assist the family in obtaining remnants from the site such as rubble that is free of human remains and toxic materials.With the help of the Red Cross and mental health professionals, the FAC will endeavor to give special considerations for children: drawings, letters, additional support if attending services and memorials.
- Johnny Butler was one of 67 victims of that end of days at the University of Rural Alabama, but he was one. To his family, while they regretted the loss of the other 66, they grieved and grieve, the loss of the one. It is said that “the loss of a loved one turns our life upside down. Our world as we knew it has changed and those changes require that we in turn adjust to a new ‘normal.’”Perhaps it is also true that one who lives in memory is never really “lost,” but is forever “saved.” That’s the Mission of SMORT/FAC; Though many are “lost,” all are saved. It was a great honor to have had a small part in saving Johnny Butler.
- What did we learn today? We learned that victims’ families must be identified quickly and given access to information and services that are victim sensitive and easily accessible. We learned that there is a strong need for continuous flow of information delivered through regularly scheduled family briefings and a pro active approach to family issues and requests. We learned that consistent and equitable support to all victim family groups is a challenge, but it is important.Finally, we learned that the FAC, the “One stop” support center approach, was efficient, provided a safe haven for families, and helped facilitate the victim identification process.Does this sound like a mission you feel called to accept, a challenge you’d like to take, a set of memories you’d like to create . . . and share, then . . .
- The FAC wants you! You can be a volunteer, I know you can do it. Heck, if I can run the thing then anybody ought to be able to just take a part in it. To quote the great philosopher, “Snoop Dog,” “here’s how you order. . .”
- Just follow the directions. One more thing . . .
- The end.
- See “FAC Presentation,” a download on Slideshare 7 <slideshare.net>See also on Facebook.