Mass Fatality Planning: Delineating Roles

Transcription

1 Mass Fatality Planning: Delineating Roles Mona Anand, MSPH Research Specialist Arizona Center for Public Health Preparedness Mel & Enid Zuckerman College of Public Health University of Arizona January 10, 2008 Objectives Describe key responsibilities that need to be fulfilled during a mass fatality incident. Describe the public health role during a mass fatality incident. Recognize the main differences between a natural or manmade disaster and a pandemic in respect to mass fatality management. Delineate the roles of local agencies and professionals during a mass fatality incident. 1

2 Mass Fatality..any number of fatalities resulting from any incident that is greater than the local Mortuary Affairs System can effectively handle without outside assistance from the county, state, or federal assets. Mass Fatality Management Critical incident response component concerned with Recovery Transport Identification Protection Human Remains 2

3 Goals of Mass Fatality Management Recover and Protect Identify Preserve Collect evidence Release remains How will this be done? Cochise County What is the concern? Mass Fatality Management requires: Staff Resources Collaboration In order to: Recover and Protect Identify Preserve Collect evidence Release remains Provide family support services Evaluate public health risk Ensure Mortuary Affairs System personnel safety 3

4 Consider: Who is trained? What will they do? How will they accomplish the task? Who will provide support? Why is it important to consider these factors? All-Hazards Planning Confined Incident: terrorist incident, man-made, or natural disaster Localized Immediate Impact and Response Federal assets available Key Concern: Identity and Volume 4

5 All-Hazards Planning Pandemic Worldwide Impact occurs in waves All response sectors operating at capacity Depletion of funds and resources Key Concern: Volume What is our capacity and capability? Local Agencies Office of the Chief Medical Examiner Emergency Manager Law Enforcement Public Health Department Fire Department HAZMAT Units Public Works Department Environmental Services Department Funeral Homes Funeral Homes Cemeteries Department of Transportation Transfer Companies Local Health Care facilities Lead Agency or Support Agency 5

6 Lead Agency / Support Agency Lead Agency Assumes overall authority to manage aspect of incident Designated by the National Response Plan, local and state regulations Support Agency Provides support services to the lead agency Assists lead agency in accomplishing goals Lead Agency Office of the Medical Examiner Essential component of Incident Command Assumes primary responsibility for ALL mass fatalities response activities that occur both at the scene and at other service points of delivery. Directs the overall mass fatalities response efforts. Who is the Incident Commander of a mass fatalities incident? 6

7 Command Responsibilities Incident Commander Overall Command Directs ALL response efforts Requests and coordinates all assets from local, state, and federal agencies Coordinates effective response Collaborates with the Medical Examiner/Coroner Medical Examiner Legally responsible for mass fatalities scene Directs the mass fatalities response efforts Coordinates local resources with respect to mortuary affairs. Works closely with Incident Commander Lead Agency: Medical Examiner Arizona Revised Statute Section to: Take charge of bodies Identify victims Perform autopsies Determine cause of death Maintain custody of unclaimed bodies Issue death certificates Recover and Protect Identify Preserve Collect evidence Release remains Provide family support services Evaluate public health risk Ensure Mortuary Affairs System personnel safety 7

8 Lead Agency: Emergency Management Support the local ME. Identify local assets Request and secure local assets. Help coordinate other agencies. Coordinate all planning activities: Memorandums of Agreement/Understanding Response plans Recover and Protect Identify Preserve Collect evidence Release remains Provide family support services Evaluate public health risk Ensure Mortuary Affairs System personnel safety Support Agency: Law Enforcement Protect and secure the disaster site, morgue site, FAC, etc. May assist in unloading & escorting remains Body Recovery? Recover and Protect Identify Preserve Collect evidence Release remains Provide family support services Evaluate public health risk Ensure Mortuary Affairs System personnel safety 8

9 Support Agency: Fire Department/ HazMat Advise ME on hazards at the incident site and decontamination procedures. MAY aid in recovery of remains and setting up decontamination stations. Assist in decontaminating bodies (if necessary) Recover and Protect Identify Preserve Collect evidence Release remains Provide family support services Evaluate public health risk Ensure MAS personnel safety Support Agency: Funeral Home Industry Provide support in morgue activities: transcribe case and file data collect ante-mortem data EXCELLENT asset for staffing Family Assistance Center Ensuring cultural appropriate practices are adhered to and provided Recover and Protect Identify Preserve Collect evidence Release remains Provide family support services Evaluate public health risk Ensure Mortuary Affairs System personnel safety 9

10 Support Agency: Public Health May establish FAC Arrange for disaster mental health services Determine if remains pose a public health emergency Advice the ME on PPE Ensure staff working with dead bodies receives all required prophylaxis and vaccinations. Coordinate planning and response activities management of dead bodies. Recover and Protect Identify Preserve Collect evidence Release remains Provide family support services Evaluate public health risk Ensure Mortuary Affairs System personnel safety and more Public Health Role 1. Guide- on public health issues and personal protective equipment (PPE) 2. Supporter- of additional staff and services 3. Partner with the Office of ME 4. Epidemiologist- surveillance and investigation 10

11 Guide Medical Examiner Funeral directors, crematoriums, and cemeteries Morgue personnel biosafety concerns for human remains handlers and forensic pathologists. biosafety and safety of performing normal final disposition process. collection and packaging of lab specimens Guide ME and search and recovery teams health hazards at the incident site and PPE Public Good health and hygiene practices Proper techniques for minimizing exposure to dead bodies 11

12 Supporter Ensure availability of relevant resources, equipment and staff Help establish a Family Assistance Center Ensure provision of healthcare and mental health services for both family members of the deceased and morgue operations personnel including funeral directors Provide Subject Matter Experts as needed Partner/Advocate Provide response personnel receive prophylaxis medications and vaccinations as they are available. In Arizona, all personnel handling human remains during a disaster are considered first responders: Medical Examiner Funeral service personnel cemetery and crematorium personnel forensic dentists, anthropologists crime lab technicians and more Official link to the State 12

13 Epidemiologist Initiate a health watch program to monitor illness among mortuary affairs personnel Monitor outbreaks of disease among the public Implement prevention and control programs to safeguard the public health Support Agency: State Obtains request for processing remains and coordinates State assets that may assist in fatalities management operations. Develops and advocates policies. Monitors the public health risk. Assists healthcare services with temporary storage guidance for patient remains until transfer companies can pick up the dead. 13

14 Support Agency: State State Department of Transportation: Obtains refrigerated transportation assets to facilitate the moving of large numbers of remains Governor: Supports the ME/C by authorizing for further staff Permits ME/C to credential or deputize additional assistance from licensed pathologists and other professionals. Request Federal Disaster Mortuary Operational Response Team support. Joint Information Center (JIC): Established to organize information released to the press. All PH and ME/C press releases must go through the JIC. Support Agency: Federal Department of Homeland Security Emergency Preparedness and Response Directorate (including FEMA, SNS, NDMS, etc.) Federal Bureau of Investigation Department of Health and Human Services (HHS) Centers for Disease Control and Prevention (CDC) Environmental Protection Agency (EPA) Department of Veterans Affairs (VA) Various Department of Defense (DOD) Assets National Disaster Medical System (NDMS) 14

15 Organizing Assets Multiple jurisdictions + Innumerable resources How can this be mitigated? Organizing Assets 15

16 Incident Command Structure Organization Internal Flexibility Span of Control Allows for better communication Efficient use of resources Avoids duplication of efforts In summary Mass Fatality Management is complex. No one agency, department, or institution is adequately equipped to manage a mass fatality incident. Efficient mass fatality management will require collaboration between local agencies and professionals. All disasters, including a Mass Fatalities Incident, are LOCAL. 16

17 Questions? Workgroup Assignment 17

18 Discussion Scenario Tornado sets down of Smallville School during a volleyball game 250 Building occupants Discussion Scenario 110 spectators are uninjured and flee to the parking lot 50 critically injured At least 33 slightly injured 45 people missing At least 7 people dead 18

19 Discussion Assignment Discuss within your group this scenario and answer the following questions: 1. What are the primary goals and responsibilities that will need to be considered in this situation? 2. What type of skills and training are necessary to accomplish these goals? 3. Who will be expected to fulfill the responsibilities mentioned in Question 1? What type of role (lead or supportive) will these entities play? Discussion Assignment Discuss within your group this scenario and answer the following questions: 4. How will the entities listed in Question 3 accomplish the designated tasks? 5. List at least three issues that may arise as a result of this situation and describe how these issues can be best addressed. 19

20 Thank You! 20