HEART OF TEXAS REGIONAL MASS FATALITY MANAGEMENT PLAN

Transcription

1 HEART OF TEXAS REGIONAL MASS FATALITY MANAGEMENT PLAN November 2016 Prepared By Centurion Solutions LLC

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3 TABLE OF CONTENTS TABLE OF CONTENTS... 3 PREFACE... 5 RECORD OF CHANGES... 7 PLAN MAINTENANCE AND DISTRIBUTION... 9 INTRODUCTION...11 PURPOSE, MISSION, AND SCOPE...13 ASSUMPTIONS...23 CONCEPT OF OPERATIONS...25 COMMUNICATIONS...33 LOGISTICS...37 OPERATIONAL COMPONENT: SAFETY & SECURITY...39 OPERATIONAL COMPONENT: SITE MANAGEMENT...45 OPERATIONAL COMPONENT: HUMAN REMAINS/PERSONAL EFFECTS RECOVERY & TRANSPORTATION...51 OPERATIONAL COMPONENT: CALL CENTER...59 OPERATIONAL COMPONENT: FAMILY ASSISTANCE CENTER...63 OPERATIONAL COMPONENT: VICTIM IDENTIFICATION CENTER & MORGUE OPERATIONS...73 APPENDICES...83 APPENDIX A: DEFINITIONS...85 APPENDIX B: ACRONYMS...87 APPENDIX C: AGENCY COORDINATION...91 APPENDIX D: RELIGIOUS PRACTICES REGARDING FINAL DISPOSITION...99 APPENDIX E: FAMILY ASSISTANCE CENTER STAFFING REQUIREMENTS APPENDIX F: JUSTICE OF THE PEACE PRECINCTS APPENDIX G: DSHS DISASTER BEHAVIORAL HEALTH SERVICES APPENDIX H: LOCAL RESOURCES APPENDIX I: FUNERAL HOME CAPABILITES & CONTACT INFORMATION APPENDIX J: MEDICAL EXAMINER/FORENSIC SERVICES PROVIDER CONTACT INFORMATION APPENDIX K: TEXAS STATE DISASTER MORTALITY STRIKE TEAM

4 APPENDIX L: FORMS APPENDIX M: REFERENCES

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7 RECORD OF CHANGES Change # Date of Change Change Entered by Section # 7

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9 PLAN MAINTENANCE AND DISTRIBUTION This Heart of Texas Regional Mass Fatality Management Plan, as well as supporting appendices, shall be maintained by the Heart of Texas Emergency Preparedness Advisory Committee (EPAC), a group created by the Executive Committee of the HOTCOG to assist and advise elected officials in their decision-making responsibilities on matters related to Homeland Security. The EPAC maintains responsibility for contents of the document, but may delegate updates and revisions to local planning entities working in the HOTCOG region. The Heart of Texas Regional Mass Fatality Management Plan will be reviewed and updated every five years and as needed to reflect changes in regional capabilities and procedures, as well as lessons learned through exercises and incident responses. 9

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11 INTRODUCTION Mass fatality incidents (MFI) arise from natural (severe weather, disease outbreaks, etc.) and manmade disasters (accidental and intentional). It is defined as an event producing a number of deaths that exceed the capacity or capability of local authorities, thereby requiring assistance from outside the local jurisdiction. These incidents may cross jurisdictional boundaries, overwhelming the resources of a single jurisdiction and creating confusion in command and control, resource availability and allocation, and proper response protocols. In order to manage a mass fatality incident appropriately and reduce confusion and duplication of effort, a coordinated regional response is needed. The Heart of Texas Regional Mass Fatality Management Plan (hereafter called the MFM Plan) was developed for this purpose. Each mass fatality incident begins and ends with the affected local jurisdiction(s). Consequently, this Plan outlines an integration strategy that describes a scalable and flexible response, beginning with the use of local mutual aid, followed by state resources and then federal resources. It will also address the three components of MFI response site management, morgue operations, and family assistance and the roles and responsibilities of the responding agencies. This document stresses the importance of mutual collaboration and engagement between and among the federal, state, county, and municipal governments, in addition to the private sector and nongovernmental organizations (NGOs) within the region in response to an MFI. 11

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13 PURPOSE, MISSION, AND SCOPE The MFM Plan exists to provide the creation of a uniform, comprehensive strategy for regional MFI response by the HOTCOG, a six-county region in central Texas. It does not supersede existing local jurisdictional mass fatality management plans, but rather integrates these plans into a coordinated regional response. Written for the stakeholders in the HOTCOG, including government, private sector, and NGOs, this Plan offers operational guidance to agencies involved in the response to a catastrophic MFI. The Plan focuses on three broad areas: incident site, morgue operations, and family assistance; these areas are then divided into operational components of response. It is not intended to provide the detail one would expect to find in a standard operating procedure. The following six counties, which comprise HOTCOG constitute the geographic and implementation area of this Plan: Bosque County Falls County Freestone County Limestone County Hill County McLennan County Responsibilities Local Emergency Management Assign disaster responsibilities to all local agencies and officials. Ensure that all jurisdictional planning partners are represented in planning meetings, to include medico-legal authorities (Justices of the Peace), health authorities, death care providers, trauma service area regional advisory councils, law enforcement, and other agencies and organizations necessary to manage a mass fatality incident. At a minimum, maintain as a subset of Annex H, a local Mass Fatality Management plan addressing: o Family Assistance Center Operations o Tracking System Activation o Remains Recovery o Transporting Human Remains and Holding Morgue Pre-processing o Morgue Operations o Post-processing Storage of Human Remains o Remains Release for Final Disposition. Local Medico-Legal Authority (Justice of the Peace) Assume that initially all mass human fatalities will require an inquest (death investigation by medico-legal authority). Retain custody over body or body parts of decedents. Satisfy legal requirements of Chapter 49 of the Code of Criminal Procedure regarding inquests upon dead bodies. 13

14 Provide expertise and assist in developing local solutions for remains recovery, holding morgue operations, pre-processing transportation and storage, morgue operations, postprocessing transportation and storage and remains release for final disposition. Participate in local planning and contribute to the development of a local mass fatality management plan. Identify the surge capacity of the various agencies and local death care providers to strengthen and sustain local medico-legal authority response. In a mass fatality incident, assume responsibility for resolving victim identification and determining cause and manner of death. Local Health Departments (LHD and Health Service Regions (HSRs) fulfilling the LHD Role: Take a leadership role in the development and exercise of local mass fatality plans. Conduct local health authority roles to protect the health and safety of the public after a mass fatality incident has occurred. HSR Directors will fulfill this role only if no local health authority has been previously appointed. Assist Department of State Health Services (DSHS) with fulfilling responsibility for infectious disease investigations resulting in a mass fatality incident. Assist in determining the need for requesting state fatality surge resources. Work with authorities to pre-identify multiple sites for interim storage of human remains. Utilize the Public Health Information Network (PHIN) and redundant communication systems to rapidly disseminate and receive health alerts. Assist in implementing disaster-related mortality surveillance. Coordinate with DSHS and TDEM when State response and support has been requested at the local level. Trauma Service Area Regional Advisory Council (RAC) Role: Coordinate hospital preparedness and response activities within trauma service area boundaries. Provide templates for hospital level fatality surge plans. Assure hospitals have developed facility plans that provide temporary refrigerated human remains storage capacity for at least five percent (5%) of the facility s licensed bed for up to seventy-two (72) hours (see table below for details). Designate a position at regional Disaster Medical Coordination Centers (DMCCs) or other such organization to serve as a liaison to the Emergency Operations Center. Hospital # of Licensed Beds 5% of Licensed Beds County Baylor S&W Hillcrest Medical McLennan Center East Texas Medical Center Freestone Fairfield Falls Community Hospital 36 2 Falls Goodall- Witcher Hospital 25 1 Bosque Authority Hill Regional Hospital Hill Limestone Medical Center 20 1 Limestone Parkview Regional Hospital 58 3 Limestone Providence Health Center McLennan 14

15 Population Density The six-county HOTCOG region covers approximately 5,648 square miles and is home to 349,273 people. According to the 2010 Census, the number of people residing in the HOTCOG region is approximately 1.32% of the state s total population. The most densely populated county in the region is McLennan County, which includes the City of Waco, has a population of 234,906 people, with land area of 1,060 square miles (221 persons per square mile). The least densely populated county in the region is Falls County with approximately 17,866 people, with land area of 774 square miles (23 persons per square mile). The corresponding map illustrates the relative population density of the HOTCOG counties (see Figure 1 below). Figure 1 - HOTCOG Population Density 15

16 Religious Diversity In Texas, approximately 55% of the population is affiliated with one of 102 identified faith groups, according to research completed by the Texas Department of Health and Human Services (DSHS) in While the majority of religious groups represent Protestant and Catholic Christianity, six other faith groups exist: Baha i, Buddhism, Eastern Orthodox Christianity, Hinduism, Judaism, and Islam. These groups hold varying religious practices regarding death related to autopsy, burial, cremation, etc. An understanding of these practices and a relationship with faith leaders from each of these groups is critical to a successful MFI response especially in instances where specific religious burial preferences must be abandoned for public health concerns. Appendix D identifies the religious practices regarding final disposition. Ethnic Diversity According to an analysis of 2010 Census data, the Heart of Texas region is racially and ethnically diverse. The region s diversity is comparable overall with the State of Texas. Using categories that combine race/ethnic background in ways consistent with tables presented by the U.S. Census, the balance between major racial/ethnic groups is illustrated by the corresponding chart (Fig. 2). 2% Ethnic Diversity 1% 1% 10% 14% 5% 67% White, non-hispanic Hispanic Black/African-American American Indian/Alaskan Asian Other race More than one race Figure 2: Heart of Texas Ethnic Diversity 16

17 Hazards The HOTCOG region, with its vast geographic area and population, as well as its economic, governmental, medical, and transportation assets, is particularly susceptible to various forms of natural and manmade disasters. The susceptibility of the local jurisdictions to these hazards is identified in each county s Hazard Mitigation Plan. Natural Disasters The HOTCOG region is vulnerable to a myriad of natural disasters, some of which may result in MFIs. Table 1 on the following page lists the type of disaster and a brief description of the hazard. This information was retrieved from county-wide hazard mitigation plans completed in Type Drought Wildfire Excessive heat Flood Description Natural climatic condition caused by an extended period of limited rainfall beyond that which occurs naturally in a broad geographic area Any fire occurring in a wildland areas except for fire under prescription Extended waves of high heat and high humidity Riverine: Excessive precipitation levels and water runoff volumes within the watershed Coastal: Result of storm surge, wind-driven waves, and heavy rainfalls Urban: Development has obstructed the natural flow of water and decreased the ability of natural groundcover to absorb and retain surface water runoff Hail Winter storms Severe thunderstorm Tornado Flash: Result of heavy rainfall, dam or levee failure, or from sudden release of water Ice crystals that are an outgrowth of severe thunderstorms Snow, sleet, freezing rain, or a mix of wintery precipitation Winds > 58 mph, 1.0 inch hail, and may be accompanied by funnel clouds, straight-line winds, and tornadoes Violent windstorm characterized by a twisting, funnel-shaped cloud extending to the ground Table 1 Heart of Texas Natural Disaster Hazards Manmade Disasters In addition to natural disasters, the HOTCOG region is vulnerable to both accidental and intentional manmade disasters, possibly resulting in mass fatalities. Information related to specific county 17

18 hazards can be retrieved from county hazard mitigation plans. Table 2 lists the types of manmade disasters considered likely and a brief description for each incident. Type Active Shooter Utility interruption Improvised explosive device Pipeline failure Terrorism Toxic release/hazmat Transportation accident Description An Active Shooter is an individual actively engaged in killing or attempting to kill people in a confined and populated area; in most cases, active shooters use firearms(s) and there is no pattern or method to their selection of victims. The interruption or failure of one or more systems and networks that serve as essential services; failure of infrastructure may cause dire consequences to a single jurisdiction or the surrounding region A device placed or fabricated in an improvised manner incorporating destructive, lethal, noxious, pyrotechnic, or incendiary chemicals and designed to destroy, incapacitate, harass, or distract. It may incorporate military grade materials, but is normally devised from nonmilitary components. Disruptions originating from natural events such as geomagnetic storms and earthquakes, or from accidents, equipment failures, or deliberate interference The calculated use of unlawful violence or threat of unlawful violence to inculcate fear; intended to coerce or to intimidate governments or societies in the pursuit of goals that are generally political, religious, or ideological Solid, liquid, and/or gaseous contaminants that are released from fixed or mobile containers, due to an accident or intentional terrorist attack Airplanes (commuter and commercial) vehicles, public transit (buses and trains), boats, and trains (passenger and shipping) accidents that are associated with a deadly, injurious, or damaging unintentional incident Table 2 Heart of Texas Manmade Disaster Hazards Capabilities Assessment There are unique resource requirements associated with mass fatality incident response. Within the HOTCOG region there are limited mass fatality resource capabilities. See Appendix I for a listing of county specific mass fatality resources. Some of the region s limited resources include: Personnel Body bags 18

19 Call center Vehicles for transporting human remains While some hospitals do possess limited human remains storage areas, hospitals are not equipped to process the number of bodies resulting from an MFI. Their responsibilities must remain focused on caring for the living. This Plan does not supersede existing plans or policies at the local level, but should be used in concert with local county MFI plans for incident response. All six HOTCOG counties lack local forensic pathology capabilities and have Justices of the Peace as medico legal authorities. I. Justices of the Peace Justices of the Peace (JPs) are elected county officials whose duties include serving as the medicolegal authority in counties that do not maintain an Office of the Medical Examiner. There are 24 Justices of the Peace in the HOTCOG region. These JPs possess varying levels of expertise and education on mass fatality management, which will greatly impact the escalation of the response. For further detail on HOTCOG regional JP precincts, refer to Appendix F. II. Forensic and Pathology Service Providers Local JPs may need to utilize the capabilities of forensic and pathology service providers. A list of these providers and their staffing levels are identified below in Table 3. Additional contact information can be found in Appendix J. 19

20 Total Staff Forensic Pathologists Pathology Fellows Forensic Investigators Transport Personnel Autopsy Assistants Histology Technicians Drug Analysis Forensic Photographers Forensic Toxicology Trace Evidence Forensic Genetics Tarrant County ME Office YES YES YES YES % Southwestern IFS Travis County ME Office YES YES YES NO Bexar County ME Office YES YES NO NO Collin County ME Office NO NO NO NO 16 2 Harris County IFS YES YES YES YES Central Texas Autopsy FMMS of Texas (Beaumont) NO NO NO NO 45 3 FMMS of Texas (Tyler) YES YES YES YES PERSONNEL LAB SERVICES MORGUE Capacity Avg Daily Occupation Table 3: Pathology and Service Provider Capabilities 20

21 III. Heart of Texas Call Center The Heart of Texas 211 call center is legislatively mandated to provide comprehensive information and referrals representing all health and human services in the region. Operating from a statewide database of over 40,000 resources, the call center is capable of answering calls 24 hours a day, 7 days a week. The Heart of Texas 211 call center is staffed Monday through Friday from 8 AM to 5 PM with answering services rolling over to other providers during non-staffed hours. The 211 call specialists handle calls from people in need of assistance and disseminate information regarding changes in a disaster area. During an emergency, the urgency of calls may intensify, but continue to be calls from individuals needing assistance with food, shelter, information, and/or medical care. The Heart of Texas 211 call center can activate an additional Emergency Call Center as needed. The Emergency Call Center is staffed by HHSC Enterprise employees who are reassigned to the call center and have some call center experience. The Heart of Texas 211 Call Center provides caller data to Emergency Management officials for awareness and planning and are capable of providing information provided by Emergency Management officials to callers. IV. Hospitals There are eight hospitals in the HOTCOG region. Table 4 below lists the facilities, their location and cold storage capacity. Area hospitals do not have sufficient morgue space to house victims of an MFI. Hospitals normally are not considered for temporary storage of fatalities, as doing so compromises patient care. As such, communications to the general public and other transporters (Emergency Medical Service [EMS], contractors, funeral homes, pathology services, etc.) must be clear about where to take bodies of those who have died as a result of an MFI. Upon death, the presiding Justice of the Peace is responsible for the direction of fatality services. In addition, there must be provision for quickly removing deceased patients out of hospitals in order to allow healthcare facilities to care for their patients. Facility Location Cold Storage Capacity Baylor-Scott&White-I-35 Campus (Waco) Waco, TX 4 Baylor-Scott&White Herring Campus (Waco) Waco, TX 5 ETMC-Fairfield Fairfield, TX 0 Falls Community Hospital Marlin, TX 0 Goodall-Witcher Healthcare Foundation Clifton, TX 0 Hill Regional Hospital Hillsboro, TX 0 Limestone Medical Center Groesbeck, TX 4 Parkview Regional Hospital Mexia, TX 0 Providence Health Center Waco, TX 2 TOTAL COLD STORAGE CAPACITY 15 Table 4- Heart of Texas Area Hospitals 21

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23 ASSUMPTIONS This MFM Plan is based on the following assumptions: Incidents will occur within the HOTCOG region that will result in fatalities. These incidents may be the result of natural or manmade hazards, or a combination of both. During the incident, the medicolegal authorities (JPs) responsible for managing fatalities will continue to experience their normal caseload and will need to manage both the incident and standard services. Medicolegal authorities (JPs) in the region have limited resources including personnel, supplies, and capacity to respond to and manage fatalities. Incidents will occur that will surpass these limited resources, likely requiring the aid of neighboring jurisdictions and state and federal agencies. Response to the incident may be hindered by compounding incidents or the failure of critical infrastructure. Mass fatality incident response will require coordination with local agencies and organizations for support. The local JP retains control and authority over fatality management, even when the response is supported by regional, state, or federal assets. Temporary interment, although a last resort, will likely be implemented in the event of catastrophic incidents with vast numbers of fatalities or when the surrounding infrastructure is severely compromised. Incidents resulting from an act of terrorism will involve the Federal Bureau of Investigation (FBI) as the lead investigative agency and will require close cooperation and coordination with local authorities. Mass fatality incidents will draw attention from media and curious bystanders. Family members and friends will make numerous calls and inquiries to authorities regarding their loved ones approximately 100 times the number of victims during the course of the incident. Family Assistance Center (FAC) operations for disasters involving aviation (but not military- or intelligence agency-related), selected rail, highway, marine, pipeline, or hazardous materials (Hazmat) accidents will be the responsibility of the National Transportation Safety Board (NTSB) to coordinate. Local responders will still be needed for staffing and operating the FAC. Family members and close friends of victims will require a secure location to give and receive accurate, timely, and credible information; an FAC must be established to provide for these needs. Victim identification is a lengthy scientific process that requires great accuracy and attention to detail to ensure that each victim is correctly identified through the necessary methods. Catastrophic incidents with staggering numbers of fatalities may result in the implementation of crisis standards of death care in victim identification and disposition. This concept is similar to the implementation of crisis standards of care for injured patients during disasters with a catastrophic number of casualties. Mass fatality incident responses will present challenging ethical and legal issues. Successful resolution of these challenges may require a consensus of elected officials, primary stakeholders, and subject matter experts. Examples of these issues include but are not limited to 23

24 temporary interment, disposition of contaminated, fragmented, unidentified, or unclaimed human remains, and public health concerns. Families will press for the quick identification and release of their family members; identification expectations must be managed early in the response. A data management system will be an essential component in mass fatality management. The system should have the capacity to track the movement and storage of victims, and manage data needed to accomplish identification and disposition. Title 10 Department of Defense (DoD) Mortuary Affairs (MA) assets (i.e. active military forces) are limited, only possessing basic MA capabilities to process victims. Officially, DoD MA assets do not have a mission to recover victims, but other DoD assets may be able to support this type of mission assignment upon request. Title 32 National Guard MA assets possess the capability to recover victims from noncontaminated areas and from limited chemical, biological, radiological, nuclear, and high- yield explosive (CBRNE) contaminated areas. Public evaluation of government s ability to manage the disaster effectively is often based on a few key factors, including the appropriate management of victims and their families. The Federal Disaster Mortuary Team (DMORT) will not be immediately available locally; expected arrival time will be 3-5 days depending upon the approval of disaster declarations. 24

25 CONCEPT OF OPERATIONS Response Objectives The response objectives of mass fatality management include the following: To recover and identify victims in a safe, timely, and dignified manner while respecting their religious and cultural traditions To assist family members and friends in coping with the tragedy To deploy regional assets in a timely manner and reduce duplication of efforts To maximize regional resources to avoid dependence on state or federal resources Local, State, and Federal Agency Coordination Coordination among local, state, and federal agencies is essential for a structured and effective response to an MFI. Figure 3 below illustrates the integration of and request for assistance from differing levels of government (mutual aid, state assistance, Emergency Management Assistance Compact [EMAC], and federal support) for all types of disaster response, including mass fatality management. Figure 3 - National Response Framework Sequential Response 25

26 Resource Requests Process Heart of Texas Regional Mass Fatality Management Plan Response to an MFI follows established emergency management procedures, in which control of the incident remains local, with assistance requested through the proper channels. Local mutual aid (neighbor-to-neighbor) will be utilized prior to requests for regional assistance from other Heart of Texas counties. When a regional response is needed, the affected jurisdiction can request assistance from Heart of Texas jurisdictions as resources from the State of Texas might take hours to mobilize. If the region is unable to fulfill the request, the request for State assistance is sent from the affected local jurisdiction to TX Department of Public Safety (DPS) Region 6A Disaster District Committee (DDC) 11. If the DDC is unable to fulfill the request, the request for assistance is sent up to the State Operations Center (SOC) located at DPS Headquarters and/or the State Medical Operations Center (SMOC) located at the Department of State Health Services (DSHS) Headquarters. If the state is unable to fulfill the request, the state may request assistance through the Emergency Management Assistance Compact (EMAC) and through the Federal Emergency Management Agency (FEMA). This complete resource request process is illustrated in Figure 4. Again, any resources that arrive from the aforementioned agencies fall under the operational control of Incident Command. A coordinated MFI response must be based in effective integration with local, regional, state, and federal responding entities. Plan Integration Proper integration of local, regional, state, and federal plans will aid in increasing response efficiency. Responding agencies should understand the roles of the local, regional, state, and federal entities involved in mass fatality management. The following list is not all-inclusive and accounts for plans and concepts of operations related to MFI response. I. Local Figure 4: Resource Request Process County Emergency Management Plan, Appendix 4 to Annex H, Mass Fatality Management Plan: Identifies actions to be taken local jurisdictions in a mass fatality incident and addresses NIMS compliant organizational roles and responsibilities for local response agencies. 26

27 II. Regional Regional Interoperable Communications Plan (RICP): Facilitates immediate interoperable communications between public safety entities operating in the Heart of Texas region. III. State State of Texas Emergency Management Plan, Appendix 4 to Annex H, Mass Fatality Management Plan: Identifies action to be taken during the state response supporting local jurisdictions in a mass fatality event and addresses NIMS compliant organizational roles and responsibilities for state agencies; recommends the same for local and regional responders State of Texas Mass Fatality Management Response Operating Guidelines: Addresses operational guidelines for state entities responsible for responding to MFIs Tactical Interoperable Communications Plan (TICP): Facilitates immediate interoperable communications between public safety entities operating in the state of Texas Texas Code of Criminal Procedure Title 1. Code of Criminal Procedure Chapter 49. Inquests Upon Dead Bodies Subchapter A. Duties performed by Justices of Peace regarding powers, duties, limits, and discretion related to fatalities. IV. Federal Department of Health and Human Services (HHS) Fatality Management Plan: Outlines the approach for managing mass fatalities across the full local, state, and federal response spectrum and for deploying federal assets to support local and state governments to mitigate the effects of a disaster Operational Considerations I. Enactment Phase Any incident consistent with one or more of the following criteria may precipitate the enactment of resource coordination procedures within this Plan: A situation in which a known catastrophic event (i.e. pandemic influenza or tornado) is likely to occur, resulting in large numbers of fatalities An incident involving protracted or complex decedent recovery operations A situation in which there are remains contaminated by CBRNE agents or materials An MFI that affects multiple JP jurisdictions or presents regional implications requiring the involvement of multiple JPs An incident that significantly compromises the jurisdictional or the affected JP s infrastructure, leaving it unable to function at its primary or backup locations An incident or other special circumstance requiring a multi-agency or regional response to support MFM operations 27

28 A situation in which the affected JP requests assistance from one or more regional JP partners, even in the absence of a state or federally declared disaster The EMC or designated official(s) determine additional resource requirements and may activate the local emergency operations center in support of an MFI as necessary. The following information impacts the need for additional resources: Potential or actual number of fatalities Condition of human remains Size and accessibility of the incident site Level of difficulty in recovery Possible CBRNE hazards Type and number of personnel and equipment needed for search and rescue, human remains location, recovery, and transportation Location of morgue (if a temporary facility is needed) and Victim Identification Center Type and number of personnel and equipment needed to process and identify human remains Site for Family Assistance Center and estimate of personnel needs Recommendation of Crisis Standards of Care to appropriate authorities o o o o o o o Regarding deviations from Crisis Standards of Care, while it is recognized that there are a variety of cultural differences in death care practices, catastrophic mass fatality incidents may necessitate deviation from these standards to varying degrees. Specific deviations may include but are not limited to the following: Ceremonial recovery (e.g. responders, military, elected officials, etc.) Temporary interment Autopsy procedures Release of remains Timing and location of burial Memorial services 28

29 II. Operations Phase Upon enactment of the resource management considerations of this regional MFM Plan, numerous agencies and responders will be responsible for the recovery and identification of victims and the care of their family members and loved ones. These responsibilities have been separated into nine operational components, each of which includes the appropriate coordinating functional area, emergency support function (ESF) and annex, coordinating agencies, concept of operations, and agency responsibilities. These operational components are identified within their respective sections of this document. III. Demobilization Phase As the Incident or Unified Command supports ongoing operations, it will develop and oversee the implementation of the demobilization plan. The development of this plan, which is the responsibility of the Planning Section in coordination with the Incident Commander/Unified Command, will occur as soon as possible in the response, and may be implemented over time as the response continues. These plans will include demobilization of the onsite incident management group, the public safety and security response, and responder safety and health operations. As expected, there may be some overlap of critical tasks between the operations and demobilization phases. While the focus of this phase is demobilization, all ongoing operations will continue to receive support from the Incident Commander, Unified Command, Area Command, and other coordination organizations. These operations will include resources from external sources, which still must be logistically identified, requested, staged, used, and supported. In addition, the FAC may still be operational, and will require ongoing support. Organizational Structure I. National Incident Management System/Incident Command System Any mass fatality occurring in a Heart of Texas jurisdiction will follow the Incident Command System (ICS) management guidelines which contain five functional areas: Command, Operations, Planning, Logistics, and Finance/Administration. The National Incident Management System is designed to be flexible and scalable to meet the needs of the incident. Incident Command determines the degree of organization expansion to combat and resolve the incident best; Unified Command may be necessary to meet the response demands. The Unified Command may request local or county capabilities or resources as needed; requests must flow through appropriate channels to their respective county or city Emergency Operations Center (EOC). II. Organizational Chart The Charts below illustrates how an MFI response may operate according to ICS guidelines (Figs. 5 & 6). In addition to Operations, fatality management personnel may have representation in Planning, Logistics, and Finance/Administration. This illustration is meant to display every operational component of MFI response, some of which may not be activated depending on the nature of the incident. 29

30 Figure 5: Sample Mass Fatality Management Organization Chart 30

31 Mass Fatality Operations Figure 6- Example Mass Fatality Management Organizational Chart 31

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33 COMMUNICATIONS Interoperable Communications Following any disaster, including an MFI, responding agencies will follow their normal communications protocols. Given the complexity and number of agencies involved in a mass fatality response, there are likely to be agencies that cannot communicate directly with each other. The Communications Unit Leader will assist in resolving any communications issues and relay information between agencies if necessary. The EOC activation is particularly critical if the MFI response is ongoing and requires coordination of recovery of remains with other efforts, such as in the aftermath of a tornado. If this coordination is not possible, the responsible agency will utilize alternate communication methods (i.e. fax, , WebEOC, amateur [ham] radio) to provide updates to the EOC. More information regarding communications interoperability can be found in jurisdiction Emergency Management Plans, Annex B - Communications. The Heart of Texas Regional Interoperable Communications Plan (RICP) addresses interoperable communications equipment and planning. This communication is critically important to a regional MFI response. Communication Hardware and Technology The Logistics Section is tasked with providing the necessary communications hardware and technology needed to manage an MFI effectively. Due to the activities associated with an MFI, additional locations (Call Center, Family Assistance Center, and Temporary Morgue) may require communication resources. These resources may include, but are not limited to: Telephonic and computer connectivity to support MFM operations Technical component operators of MFI-related call centers Computer servers support at MFI locations IT infrastructure to support antemortem and postmortem data collection systems Interoperability between MFI branches and law enforcement agencies, fire departments, search and rescue teams, etc. More information regarding specific radio and communication technology in participating agencies can be found in jurisdiction Emergency Management Plans, Annex B - Communications. Public Information and Messaging In an MFI, it is imperative that public information and messaging be timely, accurate, and regularly updated. Providing such public information will aid response and recovery efforts and bring a sense of security and understanding to the public. Failure to provide timely, accurate, and updated information can result in mixed and inaccurate messages, unreasonable expectations, and an angry constituency. More detailed information regarding incident communications is found in the affected jurisdiction s Emergency Management Plan, Annex I - Public Information. 33

34 I. Public Messaging Information will be reported through the local Public Information Officer (PIO) or a Joint Information Center (JIC) to the general public that will not only give verified details as to what has taken place at an incident, but will also manage expectations about how long the search and recovery effort will take and why. These messages should not undermine the response efforts of the region. Telephone numbers and website addresses will be disseminated for: A call center to report missing persons Family members and friends outside the area who wish to obtain information on the recovery and identification effort, incident investigation, and other concerns Volunteer opportunities Donations management II. Family Briefings Private briefings for families and friends will be held on a regularly-scheduled basis to report on the progress of recovery efforts, identification of victims, the investigation, site visits and memorial services (if appropriate), return of personal effects, and a description of services available at the FAC. These briefings should commence within 24 hours of FAC operations activation. Briefings should be held at least daily, even if there is no new information to report. Greater detail regarding family briefing procedures is found in the FAC Operational Component. III. Messaging Sequence It is imperative that critical information (i.e. details of the investigation, progress of recovery efforts, identification of victims, etc.) is shared in this order: Fatality management responders Victim family members and friends (referred to as FAC patrons ) at briefings General public and media Families must receive information from responders prior to the media and public. Release of victimspecific incident information may be delayed to allow for family notification and briefings. This is essential to the success of the response. IV. Emergency Public Information Responsibilities Public information may cause challenges during incident response. It is essential for cohesive and efficient mass fatality management to control public information inflow and outflow appropriately. The local Public Information Officer (PIO) represents the affected jurisdictions and serves as the single point of contact for the incident, and conducts press briefings. PIO messages directed to the media will include written statements summarizing details. More detailed information regarding the PIO is found in the each jurisdiction s Annex I. A Joint Information System (JIS) may need to be implemented to establish parameters of how the public information function will operate at an incident. If a JIC is established, it may be necessary for a local Public Information Officer to report to the JIC for incident information coordination and 34

35 dissemination. Roles will be assigned based on the JIC structure and communication will flow following approval by the affected jurisdiction(s). During activation, the local Public Information staff may maintain contact information as necessary and will coordinate with the JIC for specific operating instructions. The JIC may serve as a single point of dissemination for incident-related information. This single voice requirement in a regional response is essential and provides several important benefits to the participating jurisdictions, including: Ensuring that JIC has authority over public information corresponding to the responsibility included in that role Ensuring the accuracy of information with a clearly defined process of gathering facts, verification and approval Providing a single point of contact for media, the public, stakeholders and others with high interest in the incident Helping to eliminate multiple and conflicting reports and statements that can cause confusion, inappropriate decisions and lack of trust Helping to speed the process of information delivery by a clearly defined approval process Monitoring media reports and conversations on social media to gauge community understanding and reaction and to provide the earliest indication of rumors, misinformation or emerging issues While the JIC must maintain its role of being the single, authoritative and authorized source of information about the incident, therefore representing equally all the jurisdictions participating in the JIC, this does not preclude the individual jurisdictions from communicating. Jurisdictions can continue with the dissemination of public information about their jurisdiction and the impact of the incident to their jurisdiction. Liaisons from the Fire, Search and Rescue, Law Enforcement, and Fatality Management branches will provide timely, accurate, and verified information about their respective branches to the PIO for dissemination. It is critical during a MFI response that all victim information is communicated first to the families, and then to the general public. Consequently, until legal next-of-kin (NOK) is notified, JPs, as the medicolegal authority, will not release information about victim identification. It is inevitable, however, that rumors will spread, particularly for high-profile victims. It is the role of the JIC to dispel those rumors whenever possible. Some keys for addressing rumors and leaked information are found in local Annex I. 35

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37 LOGISTICS Any MFI response will require significant logistical resources. The requests for and acquisition, delivery, storage, and expenditure of any and all materials, equipment, and facilities used in support of an MFI response must be managed effectively. The responsibility for all aspects of logistical support falls on the Logistics Section within the ICS structure. The Planning Section, in concert with the Operations Section, determines logistical requirements and relays those requirements to the Logistics Section using appropriate request procedures. All resource requests are specified by category, kind, and type, including size, capacity, capability, skill, and other characteristics. Specific brands and/or manufacturers are not necessarily included in requests. Identified needs are relayed to the Logistics Section for validation and procurement. Resource funding is processed by the Finance and Administration Section. Failures to requisition, acquire, distribute, and account properly for logistical support in an MFI response could jeopardize jurisdictional efforts to seek and obtain reimbursement. Incident Site Logistical requirements supporting incident site operations for an MFI may include: Site assessment Site safety and security Specialized personnel and cadaver dogs Personal protective equipment Location, marking and scene documentation Recovery and storage of remains and personal effects Transportation of remains and personal effects Identification of incident site resource requirements is the responsibility of the Operations Section. Appendix H provides a list of some but not all available local resources. Family Assistance Center Logistical requirements supporting FAC operations for an MFI may include (but are not limited to): communications systems (telephone, radio, public address system, and internet access), computer hardware and software, furniture (desks, chairs, sofas, etc.), paper goods (cups, tissues, etc.), food (meals and snacks), copy machines and paper, signage, and badging. In some instances, temporary lodging may need to be arranged for some or all family members. A Family Assistance Center facility must be compliant with the Americans with Disabilities Act (ADA) of 1990 and meet Texas Accessibility Standards. Victim Identification Center Logistical requirements supporting Victim Identification Center operations may include (but are not limited to): IT equipment (computers, printers, scanners, fax capabilities, internet access, copy machines, telephones), office equipment (desks, chairs, etc.), and file storage systems (boxes or drawers) 37

38 Morgue Operations Logistical requirements supporting morgue operations for an MFI may include (but are not limited to): electricity, running water, heating, ventilation, and air conditioning (HVAC) systems, lighting, temporary storage, medical equipment, expendable medical supplies, PPE, computer hardware and software, and biohazard waste containers. The Logistics Section will likely need to store and manage morgue supplies at the morgue. Expendable medical supplies will be depleted at varying rates and therefore must be monitored closely. Depletion of any given supply item could abruptly halt morgue operations and cause significant delays in the identification process. Communication between morgue operations and the Logistics Section must be efficient and constant to ensure continuous functionality of the morgue. 38

39 OPERATIONAL COMPONENT: SAFETY & SECURITY Coordinating Emergency Support Function & Annex Lead ESF #13/Annex G: Law Enforcement Supporting ESF #10/Annex Q: Hazardous Materials Coordinating Agency / Authority Primary: Incident Commander (situational dependent) Secondary: Law Enforcement State Supporting Agencies Texas Commission on Environmental Quality Texas Department of Public Safety Texas Division of Emergency Management Texas Department of State Health Services Texas Department of Transportation Texas Task Force 1 Texas National Guard Concept of Operations Local and Regional Supporting Agencies / Services EMS, Environmental, Fire, Food/Water/Rehab, HazMat, Health, Law Enforcement, Medicolegal Authority (JP), Public Information, Road and Bridge/Public Works, Safety, Shelter, Call Center, Food/Water/Rehab Federal Supporting Agencies Federal Emergency Management Agency U.S. Environmental Protection Agency U.S. Department of Health and Human Services U.S. Department of Transportation Safety considerations must be a common theme throughout the entire MFI response process and is the responsibility of both leaders and responders alike. Safety precautions must be exercised in all aspects of human remains processing at the incident site, temporary storage facilities, and morgue settings. The first priority in a mass fatality response is establishing a secure perimeter encompassing the entire area impacted, creating controlled access points, and restricting entry to and exit from the site. When response operations include a temporary morgue operation and/or Family Assistance Center, similar security requirements exist for those facilities. Security requirements fall on the law enforcement agency or agencies with jurisdiction over the site where the incident occurs. I. Hazmat and CBRNE Considerations Mass fatality incidents sometimes involve sites that are contaminated by hazardous materials. These materials may range from mild irritants to highly toxic and lethal substances. Prior to any MFI site processing, the area must be examined by a fire department or other specifically trained and equipped Hazmat Team to determine if hazardous materials are present. If so, the team should act to prevent responder exposure or mitigate the threat with appropriate countermeasures. Concerns for evidence, personal effects, and human remains handled at the site or subsequently removed from the site must be addressed to prevent hazardous materials from escaping site containment. 39

40 When human remains and/or personal effects are contaminated with CBRNE agents, subject matter experts (SMEs) in CBRNE agents and materials are needed to identify how these agents/materials influence safe handling, recovery, transport, processing, storage, and release of the human remains. Management of contaminated human remains requires extensive planning and fatality management cannot commence before CBRNE hazards are addressed. In the event of an intentional or accidental man-made incident involving some type of explosion, there is a requirement for a bomb squad response and investigation. II. Risk of Infectious Disease from Human Remains The Pan American Health Organization reported that dead bodies from natural disasters do not pose significant risk to responders who exercise suitable precautions. Victims of natural disasters usually die from trauma and are unlikely to have acute or epidemic-causing infections. The risk that dead bodies pose for the public is extremely small. However, persons who are involved in close contact with the dead may be exposed to chronic infectious hazards, including hepatitis B virus, hepatitis C virus, HIV, enteric pathogens, and mycobacterium tuberculosis. Suitable precautions for these persons include training, use of body bags and disposable gloves, good hygienic practices, and vaccinations recommended by the local health authority. III. Personal Protective Equipment At the incident site, appropriate PPE requirements must be identified, and responders must be outfitted accordingly before accessing the MFI site. Anyone allowed access to the incident site should be provided a safety briefing first, and identified PPE requirements should be strictly enforced. Responders health should be monitored throughout the progression of site management. Personnel working in the morgue must comply with international safety precautions and wear appropriate PPE. Biohazard waste bags and sharps containers must be available for disposal of used scalpels, syringes, and all waste generated from human remains processing. Personnel assigned to work in morgue operations must have completed blood-borne pathogens training prior to assignment of duties in the morgue. IV. Responder Well-Being Participating in mass fatality response operations exposes responders to exceptional circumstances that may be traumatic, such as: dead bodies, fragmented remains, decomposing remains, and contact with grief-stricken family members. Behavioral health professionals should be assigned to monitor responder well-being and conduct debriefings of personnel upon completion of their participation of the incident response. Medical personnel should be assigned to support responders to an MFI. Extreme environments, long work hours, and exposure to health risks pose potential dangers to responders and medical support is required at the incident site, morgue facilities, Victim Identification Center, and Family Assistance Center. V. Site Security Control over any incident site must be managed in a fashion similar to standards established for that of conventional crime scene investigations. Media, curiosity seekers, and victim family members can 40

41 be expected. Access must be controlled to maintain the integrity of the site and to facilitate coordinated response efforts. VI. Morgue Security Morgue facilities involved in MFI victim identification and processing are also of interest to media, curiosity seekers, and victim family members. Strict security measures must be imposed to limit access of unauthorized personnel and prevent disruption of postmortem processing. It should be noted that while the Victim Information Center (VIC) is a separate element, it is most frequently colocated with the morgue and therefore has no additional security requirements. VII. Family Assistance Center Security The Family Assistance Center serves to aid the family and friends of MFI victims. It also serves to gather victim antemortem data useful in identification efforts. Specific zones of security must be established and access controlled by levels of authorization. VIII. Badging and Identification In the event that an incident response continues beyond one or two days, an access control system utilizing some form of identification or badging should be implemented for access to the site, morgue, and FAC. Identification at the FAC should distinguish between responders and FAC patrons. Patron identification distinctions should be subtle to avoid clearly identifying them to the press and general public. Local Agency Responsibilities I. County Road and Bridge Departments and Local Public Works/Utilities/Streets Departments Establishes traffic patterns and barrier plan to control site access in coordination with the Operations Section and local law enforcement II. Emergency Medical Services (EMS) Providers Provide medical support to responders III. Fire Department Determine hazmat threats and mitigation actions IV. Incident Commander/Unified Command Overall site authority Establish site priorities and incident objectives Manage site activities Request additional resources through the Emergency Operations Center V. Incident Safety Officer Provide MSDS (Material Safety Data Sheets) 41

42 Determine appropriate PPE for responders recovering human remains Monitor all processes for safety compliance Enforce safety compliance Report any safety violations to the Incident Commander/Unified Command VI. Law Enforcement Agency Defines site perimeters and establish barrier plan Controls ingress, egress, and access to incident facilities (incident site, EOC, morgue, FAC, and VIC) Control incident site as a potential crime scene (dependent upon situation) and conduct investigations as appropriate Provide personnel and resources for maintaining security at incident facilities Enforce security compliance and report any violations to the Incident Commander/Unified Command VII. Local Health Authority Recommend appropriate medical countermeasures and other precautionary measures for first responders Provide behavioral/mental health support to incident responders VIII. Medicolegal Authority (Justice of the Peace) Overall authority regarding disposition of human remains and personal effects Coordinate with law enforcement officials to determine cause(s) of death IX. Public Information Officer Provide authorized information to the public Regional Agency Responsibilities I. American Red Cross Provide site responders with food, water, and rehabilitation services II. Heart of Texas Regional Advisory Council Provide site responders with access to regional resources to support mass fatality operations State Agency Responsibilities State agencies may need to be utilized to support local incident operations. These resources should be requested through the appropriate methods and coordinated by the Emergency Operations Center and Incident Command/Unified Command. I. Texas Commission on Environmental Quality Provide environmental guidance 42

43 II. Texas Department of Public Safety Heart of Texas Regional Mass Fatality Management Plan Provide operational resources Provide support to local law enforcement agencies in order to ensure site and facility security III. Texas Division of Emergency Management Provide operational resources IV. Texas Department of State Health Services Provide Disaster Behavioral Health Services to first responders and site disaster workers Provide Texas Funeral Director Association Disaster Mortality Strike Team to assist local authorities in evaluating and characterizing a mass fatality incident, and assisting with initial stages of response Provide responders with personal protective equipment V. Texas Department of Transportation Provide support to local agencies to establish traffic patterns and barrier plans to control site access in coordination with the Operations Section VI. Texas Task Force 1 Provide support to local first responders for search and rescue activities Provide cadaver dogs to support search and recovery efforts VII. Texas National Guard Provide 6th Civil Support Team to monitor and map actual limits of contamination Provide decontamination technical support Provide personnel and other resources to support local agencies Federal Agency Responsibilities Federal agencies may need to be utilized to support local incident operations. These resources should be requested through the appropriate methods and coordinated by the Emergency Operations Center and Incident Command/Unified Command. I. Federal Emergency Management Agency Provide technical guidance to document response to and recover from a MFI Support local agencies through the provision of State-requested resources II. U.S. Environmental Protection Agency Provide environmental guidance 43

44 III. U.S. Department of Health and Human Services Provide Disaster Behavioral Health Services to first responders and site disaster workers Provide Disaster Mortuary Operational Response Team to safely recover remains and personal effects IV. U.S. Department of Transportation Activate National Transportation Safety Board for transportation-related (e.g. train, airplane) MFI National Transportation Safety Board provide technical guidance to safely recover remains and personal effects 44

45 OPERATIONAL COMPONENT: SITE MANAGEMENT Coordinating Emergency Support Function & Annex Lead ESF #13/Annex G: Law Enforcement Supporting ESF #4/Annex F: Firefighting Supporting ESF #8/Annex H: Health and Medical Supporting ESF #10/Annex Q: Hazardous Materials Supporting ESF #5/Annex: Emergency Management Coordinating Agency / Authority Primary: Incident Commander (situational dependent) Secondary: Medicolegal Authority (JP) State Supporting Agencies Texas Commission on Environmental Quality Texas Department of Public Safety Texas Department of State Health Services Texas Division of Emergency Management Texas Task Force 1 Texas National Guard Local and Regional Supporting Agencies / Services Emergency Management, EMS, Fire, Food/Water/Rehab, HazMat, Health, Law Enforcement, Medicolegal Authority (JP), Public Information, Search and Rescue, Shelter Federal Supporting Agencies Federal Emergency Management Agency U.S. Environmental Protection Agency U.S. Department of Defense U.S. Department of Health and Human Services U.S. Department of Justice U.S. Department of Transportation Concept of Operations Site operations for MFI response involve several agencies representing diverse interest and areas of responsibility. The type and nature of the incident will determine which agencies have response roles. Law enforcement may have overall responsibility but search and rescue teams, fire departments, EMS, the jurisdictional medicolegal authority (JP), and others will also have key response duties. The investigation of the incident will fall upon law enforcement but the human remains will be the responsibility of the medicolegal authorities (JP). Manmade incidents, whether accidental or intentional, may require a joint effort from several agencies. I. Site Assessment The MFI site must be assessed in order to determine the level of response required and identify resource requirements. The assessment, at a minimum, should address the logistical concerns related to the incident. The Operations Section is responsible for the identification of necessary resources at the incident site. 45

46 II. Search and Rescue Initial emergency management responses in an MFI focus on saving lives. However, as time passes focus shifts in the response efforts from rescuing the living to recovery efforts; managing the decedents. Search and Rescue (SAR) units from local fire departments and/or law enforcement agencies will be activated to conduct rescue operations to locate casualties and fatalities. Local EMS resources will be needed to address medical needs of survivors located by SAR Teams. These EMS assets must also tend to the medical needs of the responders at the site. All rescue assets must be mindful of crime scene preservation techniques and exercise caution to protect potential evidence as they conduct their operations. Investigation efforts take precedence over human remains recovery when those tasks are assigned to separate teams. III. Investigation The location of the incident will dictate which JP has authority for death certification of victims. In any MFI, the JP inquest resources are likely to be initially overwhelmed. Local law enforcement will likely assume responsibility for conducting a preliminary investigation into the circumstances surrounding the MFI when in question. Law enforcement investigators will process death scenes to document the site properly and record, collect, and safeguard evidence. The JP will assume responsibility for the victims and associated personal effects. IV. Human Remains Recovery Authority to move human remains from an MFI site rests with the JP having jurisdictional purview. The JP may delegate that authority to representative(s) participating in site processing. The recovery of human remains must be managed in an efficient yet meticulous and respectful manner. As the overall response effort and identification process continues in the MFI response, it may be necessary to review details of where human remains were first located and by whom. That initiative could be impeded without accurate accounts of the human remains recovery process. The JP will be responsible for assigning a human remains numbering system to track the location at the site where the human remains was found. The numbering technique may be tailored to comply with any agency s format but should remain as uncomplicated as possible in order to reduce errors or confusion. Care must be taken when deciding on the numbering format as these unique human remains numbers will need to provide a competent means for tracking by relating each human remains to its site location, through the identification process, during storage, and until final disposition. V. Personal Effects Items of personal effects not considered investigative evidence will remain at the site for collection by a team(s) designated by the medicolegal authority (JP). Clothing found on victims and personal effects in the clothing will be kept with the victim and transported to the morgue with the body. Disassociated personal effects from the site will be transported to the designated morgue or another secured location determined by the medicolegal authority (JP). The victims personal effects collection efforts must be documented and accounted for in a manner similar to human remains recovery. 46

47 Local Agency Responsibilities I. Emergency Management Heart of Texas Regional Mass Fatality Management Plan Assist medicolegal authority (JP) Work with Chief Elected Official to develop Disaster Declaration Request resources to meet MFI response requirements II. Emergency Medical Services (EMS) Providers Provide medical support to responders III. Fire Department Assist medicolegal authority (JP) Conduct search and rescue for incident survivors Perform hazmat identification, containment, and mitigation Support EMS with medical response for incident casualties and responders IV. Incident Commander/Unified Command Overall site authority Establish site priorities and incident objectives Manage site activities Request additional resources through the Emergency Operations Center V. Law Enforcement Agency Assist medicolegal authority (JP) with site assessment Control site security and access Perform incident investigation Document the scene VI. Local Health Authority Assist medicolegal authority (JP) Recommend appropriate medical countermeasures and other precautionary measures for first responders VII. Medicolegal Authority (Justice of the Peace) Overall authority regarding disposition of human remains and personal effects Process and recover dead bodies and human remains fragments Work with law enforcement to perform cause of death and incident investigation Assign unique tracking number(s) for human remains Manage recovery of personal effects 47

48 VIII. Public Information Officer Provide information to the public as authorized by the Incident Commander/Unified Command and medicolegal authority (JP) IX. Search and Rescue Team Assist fire departments in locating incident survivors Mark locations of encountered dead bodies and human remains fragments Mark locations of encountered dead pets Regional Agency Responsibilities I. American Red Cross Provide food, water, and rehabilitation services to incident responders State Agency Responsibilities I. Texas Commission on Environmental Quality Provide environmental guidance to address issues associated with the incident and human remains II. Texas Department of Public Safety Assist local enforcement in conducting the incident investigation III. Texas Department of State Health Services Provide Texas Funeral Director Association Disaster Mortality Strike Team to assist local authorities in evaluating and characterizing a mass fatality incident, and assisting with initial stages of response Provide Disaster Behavioral Health Services to first responders and site disaster workers IV. Texas Division of Emergency Management Provide resources as requested V. Texas Task Force 1 Provide search and rescue Provide cadaver dogs to support search and recovery efforts VI. Texas National Guard Provide 6th Civil Support Team to monitor and map actual limits of contamination Provide decontamination technical support 48

49 Federal Agency Responsibilities I. Federal Emergency Management Agency Heart of Texas Regional Mass Fatality Management Plan Provide resources as requested Provide technical guidance to document response to and recover from a MFI II. U.S. Environmental Protection Agency Provide environmental guidance III. U.S. Department of Defense Provide an Explosive Ordinance Disposal Team from Fort Hood IV. U.S. Department of Health and Human Services Provide Disaster Behavioral Health Services to first responders and site disaster workers Provide Disaster Mortuary Operational Response Team to safely recover remains and personal effects V. U.S. Department of Justice Provide the Federal Bureau of Investigation to work with the National Transportation Safety Board to investigate transportation (e.g. train, airplane) related MFIs Provide the Federal Bureau of Investigation and the Alcohol, Tobacco Firearms to investigate explosive materials or explosions VI. U.S. Department of Transportation National Transportation Safety Board activated for a transportation (e.g. train, airplane) related MFI National Transportation Safety Board provide technical guidance to safely recover remains and personal effects 49

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51 OPERATIONAL COMPONENT: HUMAN REMAINS/PERSONAL EFFECTS RECOVERY & TRANSPORTATION Coordinating Emergency Support Function & Annex Lead ESF #8/Annex H: Health and Medical Supporting ESF #13/Annex G: Law Enforcement Supporting ESF #10/Annex Q: Hazardous Materials Coordinating Agency / Authority Primary: Medicolegal Authority (JP) Secondary: Incident Commander (situational dependent) State Supporting Agencies/Services Texas Department of Public Safety Texas Department of State Health Services Texas Division of Emergency Management Texas Task Force 1 Texas National Guard Local and Regional Supporting Agencies / Services Emergency Management, Fire, Food/Water/Rehab, Law Enforcement, Medicolegal Authority (JP), Public Information, Search and Rescue, Shelter Federal Supporting Agencies Federal Emergency Management Agency U.S. Department of Health and Human Services U.S. Department of Justice U.S. Department of Transportation Concept of Operations Mass fatality incident sites require a comprehensive approach to documentation and recovery of all human remains from the site. All MFI sites must be controlled as crime scenes until the investigation has concluded or a determination is reached that no crime has occurred. Investigation of the incident takes precedence over recovery of human remains and personal effects. Recovering human remains and associated personal effects requires multiple participants from a variety of disaster response agencies. Control over the human remains at the sites rest with the medicolegal authority (JP). Investigative authority resides with the local law enforcement agency within jurisdiction of the incident. Requirements for personnel and vehicles to perform this task may quickly exceed local capabilities and require use of contracted services or other resources. The Texas Funeral Directors Association (TFDA) has a disaster team with trained personnel and body transportation equipment, which must be requested through the local EOC. Body recovery and subsequent transportation of bodies from the incident site(s) to a designated morgue facility or temporary storage facility requires dedicated resources. Law enforcement, SAR, and EMS personnel and their equipment should not be diverted from other disaster response duties. A transportation log should be established to document the removal time, vehicle identification and operator information, and identity of the funeral home/service accepting responsibility for body transport. A body manifest should also be established to maintain accountability of human remains numbered bags being removed from the site. 51

52 I. Search for Victims Mass fatality incidents frequently have both casualties (injured victims) and fatalities. The search and rescue effort to locate and tend to incident survivors is a separate task from that of locating fatalities and should not be impeded. When fatalities are located by SAR teams, the team should mark and record the location of the fatality to aid later efforts by body recovery teams. II. Documentation of Remains and Personal Effects A detailed diagram must be sketched to indicate the location at the site where human remains are found. The diagram may aid in the identification of the victims and provide a better understanding of the cause of the incident. This diagram may be in addition to any crime scene sketch produced by law enforcement in the conduct of their scene investigation. A separate diagram should be sketched to document the location of personal effects at the site. Due to this region s hot weather conditions it may be necessary to move the human remains along with their personal effects to onsite refrigerated storage to preserve the decedents until it is time to transport to a morgue. The illustration below (Figure 7) depicts the onsite holding storage of human remains in a refrigerated truck. III. Decontamination of Remains and Personal Effects Human remains and personal effects of the victims at the site may be tainted with harmful or even dangerous CBRNE contaminants. Before human remains and personal effects can be processed at the site, they must be determined to be safe to contact. If determined unsafe, a Hazmat team must establish a decontamination strategy and perform decontamination tasks. Nothing should be removed from the site until it has been rendered safe. IV. Numbering Strategy for Human Remains and Personal Effects The medicolegal authority (JP) is responsible for the orderly, systematic removal of human remains from the site. A unique numbering system for dead bodies and disassociated human remains fragments must be established. The numbering Figure 7- Holding Refrigerated Truck technique may be tailored to comply with any agency s format but should remain as uncomplicated as possible in order to reduce errors or confusion. Care must be taken when deciding on the numbering format as these unique human remains numbers will need to provide a competent means for tracking by relating each human remains to its site location, through the identification process, during storage, and until final disposition. A separate but similar numbering system should be established to account for any items of personal effects not directly associated to a victim. Human Remains Numbering Strategy: 52

53 The numbering system starts in the field or disaster site. All individual remains must be given their own number. A simple consecutive and non-repeating number system is preferred (e.g., Bag 01, Bag 02, Bag 03, etc.). Prefixes MAY be used to clarify where they were found (e.g. F-01 for floating remains in the water, S-01 for submerged remains, Grid B-03, etc.). This is particularly important when remains are recovered from multiple sites. Remains not connected by clothing or tissue, must get different bags and numbers. Personal Effects Numbering Strategy: The numbering system associated with personal effects starts in the field or disaster site. All personal effects must be given their own number, labeled similarly to human remains. A simple consecutive and non-repeating number system is preferred for personal effects (PE) (e.g., PE 01, PE 02, PE 03, etc.). The numbering system must correspond to the recovered human remains if the PE is connected by clothing or tissue (e.g., Bag 01 and PE 01, F-02 and PE 02, S-03 and PE 03, etc.). Personal effects not connected by clothing or tissue, must get different bags and numbers. V. Personal Effects All reasonable efforts must be made to return personal effects to the legal next-of-kin of the victims. Personal effects deemed evidence in the incident investigation may be exempt from release. Items of disassociated personal effects must be re-associated with the victims. Personal effects must be cleaned (but not refurbished) prior to release to prevent further trauma to the families. VI. Release of Human Remains and Personal Effects from the Site The release of human remains from MFIs rests with the medicolegal authority (JP) with jurisdiction over the incident response. A transportation log should be established to document the vehicle information, driver s identity, time of release from the site, and destination. VII. Transportation of Human Remains Day-to-day human remains transport processes could easily become overwhelmed in a MFI response. The contracted resource may not have sufficient capability to expand to the level of response necessary for an MFI. The response may require requesting regional and other private sector resources. Mutual aid agreements should be exercised when local resources for body transportation are inadequate. Under certain circumstances, unconventional vehicles (such as enclosed trailers with metal flooring) may be used to assist in the transport of human remains. When unconventional vehicles are used, there will be a requirement to decontaminate the piece of equipment before return to its organization of origin. If regional resources cannot be located to support body transportation requirements, help from the TFDA should be requested through the local EOC. 53

54 VIII. Body Collection Points Heart of Texas Regional Mass Fatality Management Plan Human remains from a wide-spread MFI may surface from several sources including hospitals, nursing homes, private homes, and the general public. One or more body collection points may be necessary to facilitate body recovery. In these instances, there may also be a requirement for some type of field triage station to separate incident cases from non-incident cases and those with known identities from the unidentified. The illustration below (Fig. 8) depicts the flow process for this triage concept. Figure 8- Body Collection Points Local Agency Responsibilities I. Emergency Management Request resources to meet MFI response requirements 54

55 Request and obtain onsite holding, refrigerated cold storage for human remains, and personal effects Request appropriate vehicles to transport human remains II. Fire Department Hazmat materials mitigation Decontamination of remains prior to onsite storage III. Incident Commander/Unified Command Work with medicolegal authority (JP) to establish site priorities and determine transportation requirements for human remains, and personal effects Request additional resources through the Emergency Operations Center IV. Law Enforcement Agency Perform incident investigation Document the scene Provide security at incident sites, incident facilities, and during transport V. Medicolegal Authority (JP) Overall site authority during this operational phase Oversee recovery, removal, and transport of human remains, human remains fragments, and personal effects Devises a numbering strategy for human remains and personal effects Establish human remains, personal effects holding; onsite refrigerated cold storage Work with law enforcement to perform cause of death and incident investigation Establish transportation guidelines Determine transport needs Establish body collection points as necessary VI. Public Information Officer Provide information to the public as authorized by the Incident Commander/Unified Command and medicolegal authority (JP) VII. Search and Rescue Team Search and recovery of human remains and personal effects Regional Agency Responsibilities I. American Red Cross Provide food, water, and rehabilitation services for incident responders 55

56 II. Heart of Texas Regional Advisory Council Provide resources to support MFI operations State Agency Responsibilities I. Texas Department of Public Safety Assist local enforcement in conducting the incident investigation Assist local law enforcement in providing security at incident site, incident facilities, and for the transportation of human remains, and personal effects II. Texas Department of State Health Services Provide Texas Funeral Director Association Disaster Mortality Strike Team to assist local authorities in evaluating and characterizing a mass fatality incident, and assisting with initial stages of response Coordinate with the Texas Funeral Services Commission (TFSC) and other agencies to identify suitable locations for temporary body storage in the event that local sites are unavailable Provide Disaster Behavioral Health Services to first responders and site disaster workers III. Texas Division of Emergency Management Provide resources as requested IV. Texas Task Force 1 Provide personnel and cadaver dogs to support recovery efforts V. Texas National Guard Provide 6th Civil Support Team to provide decontamination technical support Federal Agency Responsibilities I. Federal Emergency Management Agency Provide resources as requested II. U.S. Department of Health and Human Services Provide Disaster Behavioral Health Services to first responders and site disaster workers Provide Disaster Mortuary Operational Response Team to safely recover remains and personal effects III. U.S. Department of Justice Provide the Federal Bureau of Investigation to work with the National Transportation Safety Board to investigate transportation (e.g. train, airplane) related MFIs 56

57 Provide the Federal Bureau of Investigation and the Alcohol, Tobacco Firearms to investigate explosive materials or explosions IV. U.S. Department of Transportation National Transportation Safety Board provide technical guidance to safely recover remains and personal effects 57

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59 OPERATIONAL COMPONENT: CALL CENTER Coordinating Emergency Support Function & Annex Lead ESF #2/Annex B: Communication Support ESF #6/Annex O: Human Services Coordinating Agency / Authority Public Information Officer State Supporting Agencies Texas Department of State Health Services Texas Division of Emergency Management Local and Regional Supporting Agencies / Services Emergency Management, Incident Commander, Medicolegal Authority (JP), Federal Supporting Agencies Federal Emergency Management Agency U.S. Department of Health and Human Services Concept of Operations The Call Center will receive over-the-phone initial missing person intake information, as well as information calls for volunteers and donations. Due to the limited availability of personnel and supportive technologies to implement a comprehensive Call Center capability that is able to prioritize missing persons call, it is likely that local jurisdictions will need to seek state or federal assistance in establishing the capability. In an MFI, the public will be advised via the media (television, radio, social media, etc.) to contact the Call Center to report missing persons. The Call Center will take the initial information, determine the nature of the call, and forward the information to law enforcement for processing. Based upon previous incidents, the Call Center should anticipate as many as 100 phone calls for each mass fatality victim. In the event a call center cannot been established or is slow to be established, the Heart of Texas 211 may serve as a simple initial call center to direct callers to the most appropriate resource. Emergency management will provide a list of incident facilities, including donation management centers, FACs, and JICs, to the Heart of Texas 211. The Heart of Texas 211 will utilize a process, such as the one demonstrated in Figure 9, to screen calls and direct the caller to the most appropriate resource(s). 59

60 Figure 9: 211 Call Center Process Local Agency Responsibilities I. Emergency Management Provide Call Center approved messages Provide Heart of Texas 211 with a list of designated incident facilities (i.e. JIC, FAC, etc.) and the contact information for each to aid in referrals Coordinate software, hardware, and personnel resources Provide facility for additional Call Center operations, as needed II. Incident Commander Ensure detailed MFI information is provided to the Public Information Officer Approve all messages and press releases Liaise with Call Center 60

61 III. Medicolegal Authority (JP) Heart of Texas Regional Mass Fatality Management Plan Work with the Public Information Officer to develop guidelines for releasing next of kin information IV. Public Information Officer Ensure that only approved information is released to the public Regional Agency Responsibilities Upon request, provide Public Information Officers and equipment to support a regional Joint Information System I. Heart of Texas 211 Provide Call Center facility and personnel State Agency Responsibilities I. Texas Department of State Health Services Provide Disaster Behavioral Health Services to call center personnel Debrief Helpline Specialists at the conclusion of each shift II. Texas Division of Emergency Management Provide resources as requested Federal Agency Responsibilities I. Federal Emergency Management Agency Provide resources as requested II. U.S. Department of Health and Human Services Provide Disaster Behavioral Health Services to call center personnel Provide VIP software to local jurisdictions Assist with setup, operation, and maintenance of VIP network. 61

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63 OPERATIONAL COMPONENT: FAMILY ASSISTANCE CENTER Coordinating Emergency Support Function & Annex Lead ESF #6/Annex O: Human Services Coordinating Agency / Authority Primary: Office of Emergency Management Secondary: American Red Cross State Supporting Agencies Texas Department of State Health Services Texas Division of Emergency Management Local and Regional Supporting Agencies / Services ARC, Emergency Management, Law Enforcement, Medicolegal Authority (JP), Ministerial Alliance, Public Information Officer, Salvation Army, Texas Funeral Directors Association, United Way Federal Supporting Agencies Federal Emergency Management Agency U.S. Department of Justice U.S. Department of Health and Human Services U.S. Department of Transportation Concept of Operations The Family Assistance Center (FAC) is the designated location/facility established to render support services for patrons (victim family members of mass fatalities and friends) who contact or travel to the incident location seeking help. Generally the FAC is one location serving an MFI, although in some cases a virtual FAC or a FAC with multiple sites will be used. In an MFI, the Operations Section and Incident/Unified Command, will evaluate the site(s) and will determine operational requirements for the FAC. If the MFI is a localized incident needing regional resources, the FAC Group Supervisor is appointed by the local jurisdiction. If the FAC is up in response to a multi-jurisdictional incident, the FAC Group Supervisor is appointed by Incident or Unified Command. The site used for an FAC will vary depending on the incident size and facility structure. The FAC should be ADA-compliant, meet Texas Accessibility Standards, and not be located close to the incident site or the morgue. Ease of access and availability for internet, information technology (IT) services, etc. are also determining factors. The FAC is scalable and based on incident-specific needs. The figure below offers a sample FAC layout (Fig. 10). 63

64 Figure 10 - Family Assistance Center Sample Layout I. Family Assistance Center Components The FAC is under the leadership of the FAC Group Supervisor and staffed by volunteers working together from multiple human services organizations throughout the region. While scalable to the size and scope of the incident and flexible to meet the needs of the situation and community, the FAC is structured to include three units: Forensic, Family Management, and Health and Human Services. Forensic: Performs family Interviews Receives detailed information from patrons to aid in identification process Establishes next-of-kin status Discusses family s initial preference for death notification: o Obtains immediate family contact information o Do not notify (families are content not knowing specific details of the identification) o Notify one time (i.e. when the first remains are identified) o Notify each time remains are identified o To notify until all known remains are identified o Through a third party (clergy, funeral director, etc.) Performs antemortem data management Provides clerical support for all aspects of the FAC Ensures that information from the family interview is entered into the database Manages all hard-copy files Scans victim photographs and other pertinent documents into the database 64

65 Performs antemortem records collection Requests medical records from physicians, dentists, etc. to aid in identification process Shares that information with the Postmortem Records Collection Team working at the VIC Maintains the DNA reference collection Obtains buccal swab DNA samples from biologically-related family members Manages personal effects Receives personal effects from the Quality Assurance Team at the VIC Inventories, cleans (but not restores), and catalogs personal effects Returns personal effects to family members Family Management Component: Missing Persons (Law Enforcement) o Receives calls forwarded from Call Center o Prioritizes missing persons calls o Processes missing persons reports Reception and Registration o Greets and registers patrons, including: Those whose loved ones are known missing, or possible missing Those who have already been interviewed by law enforcement o Issues access badges o Guides family and friends of victims whose missing status is not known to the American Red Cross Safe and Well website o Directs patrons who have not met with law enforcement to the appropriate personnel o Educates patrons about the FAC process Notification and Disposition o Notifies family members of an identification match in accordance with wishes stated during the family interview, such as: Do not notify (families are content not knowing specific details of the identification) Notify one time (i.e. when the first remains are identified) Notify each time remains are identified Wait to notify until all known remains are identified Notify through a third party (clergy, funeral director, etc.) Health and Human Services: Case Assessment o Provides support to patrons as needed (i.e., interpreters, translators, referrals to support agencies or resources) o Maintains help desk to answer questions and secure services available to patrons o Works with representatives from Child Protective Services to arrange for care of minors who are either separated from family member or have become situational orphans as a result of the MFI Behavioral Health Services 65

66 o Provides Psychological First Aid and/or behavioral health services to patrons and staff o Ensures that team members are present at family briefings and site visits Spiritual Services o Provides requested pastoral counseling and spiritual care to patrons of all faiths o Assists Call Center by talking with callers in distress o Arranges and conducts interfaith memorial services when appropriate o Ensures that team members are present at family briefings and site visits Childcare o Provides temporary respite care for children while parents or guardians are at the FAC for interviews, briefings, and/or meetings Mass Care o Provides meals each day and ensures snacks and drinks are available during all hours of operation for both patrons and staff o Arranges limited lodging for out-of-town family members o Gives hotel and restaurant meal vouchers if the FAC is located in a hotel with dining services o Makes Spiritual Care and Behavioral Health Services team members available for patrons and staff during meal times First Aid o Provides basic first aid or medical care for patrons and staff at the FAC o Serves as a liaison with medical service providers in the event of a medical emergency The Family Assistance Center Flowchart on the following page graphically depicts how these functions work together (Fig. 11). 66

67 Figure 11- Family Assistance Center Flowchart II. Family Assistance Center Personnel Needs Personnel needs are determined by the size and scope of the MFI (see appendix E). Each FAC will be operated by an FAC Supervisor, Unit Leaders, Team Leaders and support personnel. The FAC Group Supervisor is in charge of all FAC operations The FAC Supervisor will appoint Unit and Team Leaders who will give oversight to various aspects of FAC operations Non-Governmental Organizations from throughout the region will be requested to support FAC services and operations. These organizations will include NGOs such as the American Red Cross, Salvation Army, United Way, Citizen Corps, faith-based organizations, etc. Each NGO is responsible for credentialing its volunteers/employees Spontaneous unaffiliated volunteers will be directed to the Volunteer Reception Center before being permitted to work at the FAC 67

68 The information below (Table 5) delineates the requirements for scalable FACs, based upon an 8:1 ratio of patron to victim. Scale of Incident Small Medium Large Catastrophic Recommended FAC Stand Alone FAC Stand Alone FAC Stand Alone Remote or multiple facilities T Potential Fatalities < 50 fatalities fatalities >1,000 fatalities Daily Capacity for 8 stations/12 hr. 25 stations/12 hr. 50 stations/12 hr stations/12 per day = 96 per day = 300 per day = 600 hr. per day = 600 Critical Service interviews per day interviews per day interviews per day interviews per day Patrons < ,400 2,400 8,000 >6,000 Table 5 - Scaled FAC Operations Needs III. Family Briefings It is critically important that patrons receive a continuous flow of information and understand the identification process. It is also imperative that information be provided to the families before it is released to the media. Family briefings help to meet these needs. Family briefings are generally held at, or in close proximity to, the FAC. The FAC Family Management Unit Leader coordinates briefing operations with the JIC and the JP s office and makes sure family members are aware of the briefings. The JP or designated representative leads family briefings and has available spokespersons from other pertinent agencies/operations (e.g. Law Enforcement, Public Health, etc.) to bring patrons up to date on the latest developments in the MFI recovery and identification process, site visits, memorial services (if appropriate), return of personal effects, and a description of services available at the FAC. A conference call bridge is set up in the briefing room to connect to family members who are not on site. The Family Management Unit Leader also works with the logistics Section to ensure that facility needs in the briefing room are met and functional. The first family briefing should be held within 24 hours of FAC operations activation. Family briefings must be conducted at least once daily, ideally at a uniform time and should be held even if there is no significant news to report. Briefing location and times are posted throughout the FAC. Family briefings are not open to the media or general public. IV. Family Assistance Center Types The type of MFI determines the FAC model to be activated. Most MFIs require a standard FAC model: a single center where patrons come to receive services and provide information. In the event of a disease outbreak, however, where face-to-face contact is prohibited, a virtual FAC will be established. Likewise, if simultaneous MFIs occur, multiple FAC sites with a central processing hub might be most appropriate. MFI planning should include the three FAC scenarios. 68

69 The information below further clarifies each type of Family Assistance Center. (See Table 6) Standard FAC Virtual FAC Multiple FAC Sites Single incident Social distancing incident Several simultaneous incidents Patrons gather to receive services and provide antemortem information Patrons use internet/social media to receive information about services and provide antemortem information Satellite FACs for patron services, antemortem data collection, in addition to a central hub for call taking and data processing Standard Family Assistance Center Table 6 - Family Assistance Center Types Secure facility established at centralized location Patrons come to the facility to provide antemortem information and receive FAC services FAC staff works out of the facility Virtual Family Assistance Center Virtual FACs concentrate on communications with patrons that are conducted by telephone, internet, social media, or other non-face-to-face means. Due to the communicable nature of some disease outbreaks (i.e. pandemic influenza), the standard FAC model is not feasible; social distancing, with the distinct possibility of quarantine areas, prohibits a central facility for patrons to visit physically. In addition, a communicable disease outbreak would significantly alter the services provided by the FAC in the following ways: Communicable disease outbreaks are ongoing (chronic) rather than static (acute) incidents Deaths occur over a period of several weeks and may involve multiple family members at different times Most bodies have complete integrity and can be identified more readily Most information needs to be distributed to the public rather than bringing people in to obtain information The functions and personnel needs of a virtual FAC are identical to that of a standard FAC, only the information is provided through telephone, , and print media rather than by face-to-face communications. Multi-Site Family Assistance Center If multiple incidents occur simultaneously at varying points in the region (e.g. concurrent bomb blasts), multiple Family Assistance Centers may be activated. A designated lead FAC will be established along with various satellite locations in each area to process information intake from and provide care for patrons. To conserve manpower and other resources, a central processing hub will be established to handle communication and information distribution as well as victim antemortem processing from each of the MFIs. The process of standing up the lead and satellite units will be the same as the traditional FAC model: an Operations Section Chief or Incident/Unified Command approves the location, logistics provides furnishings and equipment, and personnel are assigned. Personnel demands are similar between the 69

70 different FAC locations. The designated lead FAC is managed by a FAC Supervisor, whereas satellites FACs are managed by a Deputy FAC Supervisor who reports to the lead FAC Supervisor. The Processing Hub is overseen by the Forensic Unit Leader and consists of a public information representative and runners that shuttle information between the lead and satellite FACs, the Processing Hub, and the morgue. Figure2 illustrates the relationship between the satellites, processing hub, and morgue operations. Local Agency Responsibilities Figure 12- Multi-Site FAC Operations The key to a successful FAC operation is the involvement of various NGOs working cooperatively under the FAC Group Supervisor s leadership to carry out the FAC s mission. I. Emergency Management Coordinates resources Responds to requests for additional resources Collaborates with NGOs to ensure all FAC positions are functional II. Law Enforcement Conducts comparative analysis of interview findings and victim records to assist in forensic identification of victims 70

71 III. Behavioral Health Conducts forensic interviews for investigation and identification purposes IV. Medicolegal Authority (JP) Works with the Public Information Officer to ensure appropriate release of next of kin information V. Ministerial Alliance Provides spiritual care for victims families at the FAC Provides information regarding faith-based dietary and funeral practice requirements VI. NGOs and Faith-Based Organizations Provide personnel and other resources, upon request, to support FAC operations VII. Public Information Officer Ensure that only approved information is released to the public Regional Agency Responsibilities Upon request provide Public Information Officers and equipment to support a regional Joint Information System I. American Red Cross and Heart of Texas TFDA Members Maintains the Help Desk and Case Management Areas Provides compassionate care II. Heart of Texas Regional Advisory Council Serves as liaison to hospitals Works with hospitals and local blood banks to operate the First Aid station in the FAC Coordinates the acquisition of buccal swab DNA samples from family members III. Salvation Army Provides meals to be served at the FAC Coordinates lodging as needed IV. Heart of Texas 211 Operates the 211 Call Center Refers appropriate individuals to the FAC 71

72 State Agency Responsibilities I. Texas Department of State Health Services Heart of Texas Regional Mass Fatality Management Plan Provides behavioral health services at the FAC for patrons and staff Coordinates psychological first aid (PFA) training Provides Disaster Behavioral Health Services to first responders and site disaster workers Debriefs Helpline Specialists at the conclusion of each shift II. Texas Division of Emergency Management Provides resources as requested Federal Agency Responsibilities I. Federal Emergency Management Agency Provides resources as requested II. U.S. Department of Health and Human Services Provides Disaster Behavioral Health Services to first responders and site disaster workers III. U.S. Department of Justice Provides Federal Bureau to oversee FAC functions following federal criminal incidents and other incidents as defined in HSPD-8 IV. U.S. Department of Transportation Provides National Transportation Board to oversee recovery and identification of fatally injured passengers involved in all civil aviation accidents and significant highway, rail, marine, pipeline, and hazardous material transportation accidents within the United States 72

73 OPERATIONAL COMPONENT: VICTIM IDENTIFICATION CENTER & MORGUE OPERATIONS Coordinating Emergency Support Function & Annex Lead ESF #8/Annex H: Health and Medical Coordinating Agency / Authority Primary: Medicolegal Authority (JP) Secondary: Local Health Department State Supporting Agencies Texas Department of State Health Services Texas Division of Emergency Management Local and Regional Supporting Agencies / Services Emergency Management, Law Enforcement, Medicolegal Authority (JP), Public Information Officer, Subject Matter Experts Federal Supporting Agencies Federal Emergency Management Agency U.S. Department of Health and Human Services Concept of Operations Morgue operations supporting victim identification processes in a MFI response are the responsibility of the medicolegal authority for the incident. All morgue resources support the medicolegal authority, who is responsible for victim death certification. Morgue operations are structured into two distinct units: Admitting/Processing and Forensics. The Victim Identification Center(VIC) conducts analysis by scientific evaluation of post- and antemortem data in order to reach conclusive evidence of positive identification. This group of SMEs (pathologists, odonatologists, anthropologists, and others) prepare identification reports to present to the medicolegal authority (JP) for death certification. The VIC is structured to include four units: Postmortem Data Management, Postmortem Records Collection, Data Analysis, and Quality Assurance. The process of how these units work together and with the morgue is detailed in Figure 13. The VIC is usually co-located with the morgue operation as it shares SME resources that are critical to both operational components during MFI response. Note: Health Information Portability and Accountability Act (HIPAA) regulations do not apply to an MFI. See HIPAA Privacy Rule 45- CFR (g) - Standard: Uses and Disclosures About Decedents. Due to the extensive resource and personnel requirements for both Morgue and Victim Identification Center operations, local jurisdictions will likely need to request additional resources from state and federal entities. Early identification and requests for additional resources is essential in order to ensure the success of Morgue and Victim Identification Operations. I. Morgue Operations Components Admitting/Processing Unit: Temporary Storage Team o Account for human remains received for examination 73

74 o Maintain storage environment o Re-associate remains based upon identification results o Comply with release instructions for remains Decontamination Team o Perform decontamination of human remains as necessary o Dispose of decontamination products Triage/Evidence Team o Gross examination of human remains present to verify anatomical articulation o Detect potential comingling o Segregate body parts o Locate and collect potential (non-human) evidence Admitting Team o Assign unique tracking number(s) o Establish medical records file o Assign trackers (human remains escort) Tracking Team o Guide human remains from station to station o Collect medical documentation generated by each station o Return human remains to temporary storage after all station examinations are complete Personal Effects o Separate personal effects from human remains after all station examinations are complete o Inventory and maintain custody of personal effects Forensics Unit: Photography Team o Photographs all human remains entering morgue o Maintains a photograph log o Supports individual morgue stations when additional photographs are needed Radiology Team o Radiographs all human remains entering morgue o Maintains a radiograph log o Supports pathology and anthropology stations when additional X-rays are needed Pathology Team o Examines all human remains processed through the morgue o Documents (chart) examination findings o Notes unique identifying features, injuries, and trauma o Conducts autopsies as necessary, recover evidence, collect necessary toxicology specimens Fingerprint Team o Obtains fingerprint impressions of all suitable human remains o Submits postmortem fingerprints to appropriate agency for records comparison o Reports findings to Victim Identification Center o Odontology Team o Examines, classifies and documents (charts) dental features represented in each human remains bag 74

75 o Obtains radiographs of dentition Anthropology Team o Examines and classifies decomposed, mummified, skeletonized, and disarticulated/ fragmented remains o Documents findings o Notes unique identifying features, injuries, and trauma DNA Team o Collects appropriate DNA specimens from human remains o Establishes evidence chain-of-custody of collected specimens o Relinquishes collected specimens to appropriate laboratory or agency II. Morgue Operations Flowchart A Morgue Operations Flowchart on the following page depicts how these units and teams work together (Figure 3). 75

76 Figure 13- Morgue Operations Flowchart III. Temporary Morgue There may be a need for a temporary morgue facility to handle body surge from a MFI if existing resources are overwhelmed, compromised, or non-existent. A temporary facility may be an existing building or a temporary structure. Either option must have running water, electricity, and heating/air conditioning. The structure footprint must be a single floor configuration with a minimum of 10,000 square feet and arranged in such a manner to facilitate efficient morgue flow processing. It should also be located relatively close to the incident site yet sufficiently distanced to be clear of danger from the site and associated aftermath of the incident. The facility must also be conducive to security and controlled access. Avoiding highly-trafficked areas is preferable when possible. Potential facilities include but are not limited to commercial warehouses and National Guard Bureau (NGB) armories. 76

77 The unique numbering system for dead bodies, disassociated human remains fragments and personal effects that was established at the disaster site should be used by morgue personnel in order to reduce processing errors or confusion. A morgue case numbering system with suffixes applied may be similar to the following: Bag 01 Human Remains DM01 Digital Media DP01 Digital Photos PE01 Personal Effects BX01 Body X-rays FP01 Finger Prints DX01 Dental X-rays DN01 DNA Specimens (postmortem) DB01 DNA Family Samples (buccal swabs) DR01 DNA Reference Specimens (known victim DNA) IV. Death Certification The location of the incident dictates which medicolegal authority (JP) has responsibility for death certification. V. Victim Identification Center Components Postmortem Data Management o Maintains accountability of all records associated to each set of human remains o Restricts records access to authorized personnel o Documents information and records releases Postmortem Records Collection o Searches for and obtains patient records associated with victims o Logs, files and maintains security of records received Data Analysis o Conducts comparative analysis of antemortem and postmortem data for identification o Prepares identification reports for medicolegal authorities (JP) Quality Assurance o Conducts final review of human remains records and identifications o Verifies accuracy, correctness, and completeness of all morgue documentation 77

78 VI. Identification Findings Figure 14 - Victim Identification Process Findings that produce identification must be reported in a formal document for presentation to the medicolegal authority (JP) for approval. VII. Victim Identification Accuracy & Quality Assurance Potentially large numbers of fatalities resulting from an MFI do not reduce the standards for victim identification. The task of identifying MFI victims ranges from relatively simple to highly complex processes depending on the incident. Caution must be exercises to ensure identification procedures are based on sound evidence and reliable information. Results should be based on scientific findings rather than circumstantial evidence. It is most likely that legal issues of identification associated with victims of MFIs will come under scrutiny (by next-of-kin, media and others) and findings may be contested. Forensic findings leading to identification must be verified by a second SME. This peer review is conducted prior to findings being presented to the medicolegal authority (JP). The quality assurance (QA) check is also conducted on the morgue records to ensure that the documentation is in order. 78

79 The exception to victim identification processing standards exists for incidents producing catastrophic numbers of victims (i.e. from a pandemic outbreak), which could require a crisis standard of death care for the manner in which bodies are stored. In such circumstances, there may be a need for temporary interment of remains, if the victims cannot be identified expeditiously because of sheer numbers, contamination, or complete loss of infrastructure across the region. Specific guidelines for mass interment are detailed in the Department of Defense Joint Publication 4-06, Appendix B: Mass Interment, June 2006 (see Fig. 15 for greater detail). Location for a temporary interment site should be addressed in concert with the affected jurisdiction s legislators. VIII. Records Management All postmortem documentation generated from human remains processing and antemortem documents obtained from sources used for comparison purposes become the property of the medicolegal authority (JP) for the incident response. IX. Notification and Disposition Figure 15 - Mass Interment Official notification of next-of-kin (NOK) following victim identification and subsequent disposition of human remains is the responsibility of the medicolegal authority (JP) and is discussed further in the Family Assistance Center Operational Component, Family Management, Notification and Disposition. X. Personal Effects All reasonable efforts must be made to return personal effects to the legal next-of-kin of the victims. Personal effects deemed as evidence in the incident investigation may be exempt from release. Items of disassociated personal effects must be re-associated to the victims. Personal effects must be cleaned (but not refurbished) prior to release to prevent further trauma to the families. XI. Unidentified Human Remains Not all human remains recovered from a MFI may be identified. Human remains fragments that are unidentifiable are deemed common tissue. Unidentified bodies and common tissue not identified are held at the discretion of the medicolegal authority (JP). Final disposition of unidentified remains may be honored in a memorial service and buried in a common grave, usually on the one-year anniversary of the incident. 79

80 Local Agency Responsibilities I. Emergency Management Requests resources to meet MFI response requirements Assists in identifying and gaining access to building with private rooms to conduct interviews and collect antemortem records (Victim Identification Center) Assists in identifying and gaining access to building(s) with ample floor space (temporary morgue) Coordinates the access to and utilization of refrigerated cold storage for human remains, personal effects, and dead pets II. Law Enforcement Agency Provides security III. Medicolegal Authority (JP) Determines facility and personnel support requirements for processing human remains Approves morgue flow and station requirements for processing human remains Approves credentials of SMEs supporting identification efforts Approves protocols and procedures for morgue operations Communicates identification procedures to family members Works with JIC to communicate identification procedures to media and public Determines cause and manner of death for victims Certifies deaths Establishes death notification for next-of-kin Establishes release procedures for human remains Establishes release procedures for personal effects IV. Public Information Officer Works with the Joint Information Center, develops news releases regarding victim identification progress Ensures only approved messages are released Regional Agency Responsibilities I. Subject Matter Experts* Conducts discipline-specific examinations to aid in victim identification Analyzes data to suggest victim identifications Prepares formal identification reports for the medicolegal authority (JP) 80

81 * SMEs may be assembled from a variety of organizations, institutions, and the private sector to support the medicolegal authority (JP). State Agency Responsibilities I. Texas Department of State Health Services Provides Disaster Behavioral Health Services to responders and site disaster workers II. Texas Division of Emergency Management Provides resources as requested Federal Agency Responsibilities I. Federal Emergency Management Agency Provides resources as requested II. U.S. Department of Health and Human Services Provides Disaster Behavioral Health Services to first responders and site disaster workers Provides Disaster Mortuary Operational Response Team to conduct morgue operations regarding human remains and personal effects Assists the jurisdictional authorities/agencies in the recovery, tracking and documenting of human remains and associated personal effects Mitigates the hazard presented by chemically, biologically or radiologically contaminated human remains (when indicated and possible) Establishes temporary morgue facilities to assist in determining the cause and manner of death; performs postmortem data collection, examination and documentation Collects antemortem data in a compassionate and culturally competent fashion from appropriate individuals and returns human remains and personal effects to the authorized person(s) when possible Assists in identifying human remains 81

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83 APPENDICES A Definitions B Acronyms C Agency Coordination D Religious Practices E Family Assistance Center Staffing Needs F Justice of Peace Precincts G Behavioral Health H Local Resources I Funeral Home Capabilities J- Medical Examiner Contact Information K- Texas State Disaster Mortality Strike Team L- Regional Fatality Management Inventory M- VA Mobile Morgue Request Process N- Assessment and Scene Recovery Checklist O- References 83

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85 APPENDIX A: DEFINITIONS Antemortem: Prior to death. Casualty: A person who is injured in a mass fatality incident but does not die. Cause of Death: A formal, certified opinion by an attending physician or medicolegal authority of the internal medical condition and/or external incident or chain of incidents that resulted in death. Direct Reference: A DNA sample obtained from the deceased or their personal effects used for comparison with other DNA samples in laboratory identification procedures. Emergency/Disaster Declarations: Official emergency declarations made by specified elected officials at the local, state or federal level authorizing the use of equipment, supplies, personnel, and resources as may be necessary to cope with a disaster or emergency. Formal declarations are made when the incident requires more assets and resources than exist within the jurisdiction. Family Assistance Center: The designated location/facility established to exchange accurate, timely information and render support services for family members and friends of victims of mass fatalities who travel to the incident location. Family Reference: A DNA sample taken from a biological relative (only one generation removed) or a spouse of the deceased used for comparison with other DNA samples in laboratory identification procedures. Also referred to as indirect references. Fatality: A person who dies as a direct or indirect result of a mass fatality incident (interchangeable with victim, decedent). Fatality Management: The process of locating, recovering, processing, identifying and releasing victims of a mass fatality incident for final disposition. Human Remains: A deceased body or fragmented parts from a deceased body. Final Disposition of Human Remains: The concluding arrangement for the remains of the decedent, a decision of the next-of-kin. Options include burial, entombment, cremation or donation. Incident Command System: A prescribed method of command, control and coordination within the National Incident Management System to provide a common organizational structure designed to aid in the management of facilities, equipment, personnel, supplies and information. Justice of the Peace: An elected county official whose duties include serving as the medicolegal authority in counties that do not maintain an Office of the Medical Examiner. Just-in-Time Training: Instruction provided to capable individuals with general skills enabling them to perform task-specific functions immediately following the instruction. 85

86 Manner of Death: A classification of the fashion or circumstances that resulted in death (either: homicide, suicide, accidental, natural or undetermined). Mass Fatality Incident: An event producing a number of deaths that exceed the capacity or capability of local authorities, thereby requiring assistance from outside the local jurisdiction. Medicolegal: Of or pertaining to law as affected by medical facts. Missing Persons: Those persons whose whereabouts are unknown to family or friends following an incident. Morgue: The facility location where decedents undergo external and internal physical examinations. Mortuary Affairs: A term synonymous with fatality management, generally referring to the provision of necessary care and disposition of missing and decedent persons, including their personal effects. National Incident Management System: The part of the National Response Framework that outlines how the government and private entities at all levels can work together to manage domestic incidents, regardless of their cause, size, location or complexity. Next-of-Kin: Immediate family members including: parents, spouses, siblings and children. Non-Governmental Organization: Independent organizations free from government control. Patrons: Family members and close friends that visit and have access to the Family Assistance Center. Personal Effects: Belongings of an individual including clothing, clothing accessories, jewelry and other property on their person or otherwise in their possession. Postmortem: After death. Temporary Interment: A location where decedents are buried underground in individually marked spaces that may or may not become the final disposition location for some decedents. Temporary Morgue: An ad hoc morgue operation established specifically to process and identify human remains resulting from a mass fatality incident. Victim: A person who dies as a result of a mass fatality incident (interchangeable with fatality, decedent). Victim Identification Program: A disaster management computer software program designed to collect personal information of known and unknown individuals and then conduct comparative analysis to suggest best probable matches or exclusions of ante- and postmortem information to aid in identification processes of unidentified individuals 86

87 APPENDIX B: ACRONYMS ADA Americans with Disabilities Act of 1990 CBRNE DC DDC DMORT DoD DPS DNA DSHS EMAC EMS EOC EPAC ESF FAC FBI FEMA FOUO GPS Hazmat HHS HIV HOTCOG HOTRAC HVAC IC Chemical, Biological, Radiological, Nuclear and High-Yield Explosive District Coordinator Disaster District Committee Disaster Mortuary Operational Response Team Department of Defense Department of Public Safety Deoxyribonucleic Acid Department of State Health Services Emergency Management Assistance Compact Emergency Medical Service Emergency Operations Center Emergency Preparedness Advisory Committee Emergency Support Function Family Assistance Center Federal Bureau of Investigation Federal Emergency Management Agency For Official Use Only Global Positioning System Hazardous Materials Health and Human Services Human Immunodeficiency Virus Heart of Texas Council of Governments Heart of Texas Regional Advisory Council Heating, Ventilation and Air Conditioning Incident Command or Incident Commander 87

88 ICS IED IT JIC JIS JP MA MACC MOU MCFSD MFI MFM MSDS NIMS NGO NOK NTSB OEM PPE PFA PIO PPE QA RAC RICP ROC SAR SME Incident Command System Improvised explosive device Information Technology Joint Information Center Joint Information System Justice of the Peace Mortuary Affairs Multi-Agency Coordination Center Memorandum of Understanding Montgomery County Forensic Services Department Mass Fatality Incident Mass Fatality Management Material Safety Data Sheet National Incident Management System Non-Governmental Organization Next-of-Kin National Transportation Safety Board Office of Emergency Management Personal Protective Equipment Psychological First Aid Public Information Officer Personal Protection Equipment Quality Assurance Regional Advisory Council Regional Interoperable Communications Plan Regional Operations Center Search and Rescue Subject Matter Expert 88

89 SMOC SOC SOP TCEQ TDEM TFDA TSA VIC VIP State Medical Operations Center State Operations Center Standard Operating Procedure Texas Commission on Environmental Quality Texas Division of Emergency Management Texas Funeral Directors Association Trauma Service Area Victim Identification Center Victim Identification Program 89

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91 APPENDIX C: AGENCY COORDINATION Regional Response Agencies Heart of Texas American Red Cross Heart of Texas Regional Advisory Council Ministerial Alliance Serving a 6-county area (including all six HOTCOG counties), the Heart of Texas Red Cross Disaster Services provides emergency food and clothing, temporary shelter, emotional support to families, home damage assessments, public information and emergency communication in the event of a disaster. Disaster Action Teams, comprised of staff and trained volunteers, are primarily responsible for providing these services. The Heart of Texas Chapter of the American Red Cross is located in Waco, TX. The Heart of Texas Regional Advisory Council (HOTRAC [or RAC-M]) coordinates trauma providers to ensure the most efficient, consistent, and expeditious care of each individual who experiences an acute injury. HOTRAC represents Trauma Service Area M, which includes: Bosque, Falls, Hill, Limestone & McLennan counties. HOTRAC also provides support for Freestone County. Heart of Texas counties have organized Ministerial Alliances, which provide networks of communication between houses of worship to coordinate faith-based relief and recovery efforts and provide compassionate care. Ministerial Alliances also encourage and provide preparedness and training for faithbased organizations in emergency planning and response. 91

92 State Response Agencies Department of State Health Services (DSHS) Texas Department of State Health Services (DSHS) manages emergency disasters and all health aspects of emergency response. The HOTCOG region is located in DSHS Region 7. Notably, DSHS, in coordination with several other state agencies, has developed a Mass Fatality Management Plan and Response Operating Guide for Texas. Texas Commission on Environmental Quality (TCEQ) Texas Commission on Environmental Quality (TCEQ) responds to natural disasters, spills, and other environmental emergencies or situations. For incidents with contaminated sites, TCEQ provides technical and regulatory assistance in the management of wastes and other residual materials, such as run-off from decontamination processes. Texas Division of Emergency Management (TDEM) Texas Division of Emergency Management within the Department of Public Safety is responsible for emergency management programs including training, mitigation, preparedness, response, and recovery. The State Operations Center manages disaster response on a statewide level and aids in the appropriation of federal and state resources during disasters. The HOTCOG region is contained within District 6, Sub 6A. Texas Funeral Directors Association (TFDA) The State of Texas has equipment resources designed to support MFI processing. These resources include two portable morgue units and three temporary cold storage trailers. The TFDA Disaster Response Team maintains the equipment and trained personnel for deployment. The resources may be requested through the State Medical Operations Center in coordination with local emergency management and public health partners. Texas Military Forces (TMF) Texas Military Forces is comprised of three branches; Texas National Guard, Texas Air National Guard, and Texas State Guard. The TMF provides mission-ready military forces to assist State and local authorities in times of state emergencies. Missions are directed by the Commander-in-Chief of the Texas Military Forces (Governor of Texas) and commanded by the Texas Adjutant General. The 6th WMD Civil Support Team, located in Austin is immediately deployable to respond to incidents involving Weapons of Mass Destruction (WMD), as well as other disasters and catastrophic events, both natural and man-made. 92

93 Texas Voluntary Organizations Active in Disaster (VOAD) The Texas Voluntary Organizations Active in Disaster is a state organization that assists in providing volunteers and support services in emergency response. Federal Response Agencies American Red Cross (ARC) Bureau of Alcohol, Tobacco and Firearms (ATF) Supports reunification efforts through its Safe and Well website and in coordination with government entities as appropriate. Provides supportive counseling for family members of the dead, for the injured and for others affected by the incident. Provides available personnel to assist in temporary infirmaries, immunization clinics, morgues, hospitals and nursing homes. Assistance consists of administrative support, logistical support or health services support within clearly defined boundaries. Acquaints families with available health resources and services and makes appropriate referrals. The ATF participates in conducting investigations involving acts of arson and bombings, illegal use of firearms and explosives and acts of terrorism. The Centers for Disease Control and Prevention (CDC) The Centers for Disease Control and Prevention (CDC) plays a key role in natural, biological, chemical, radiological and nuclear incidents. When a disaster occurs, the CDC is prepared to respond and support national, state and local partners to save lives and reduce suffering. The CDC also helps these partners recover and restore public health functions after the initial response. The Office of Public Health Preparedness and Response (OPHPR) provides strategic direction, support and coordination for CDC s preparedness and emergency response activities. Other CDC organizations and programs are also improving our ability to prepare for and respond to public health emergencies, including pandemic influenza. 93

94 Department of Defense (DoD[Title 10 Forces]) Department of Health and Human Services (HHS) Department of Homeland Security (DHS) DoD provides assistance, as available, in managing human remains, including victim identification and mortuary affairs and temporary internment of the dead. Title 10 Forces refers to Active Component soldiers, sailors, airmen and marines. Under routine circumstances these resources cannot be used for civil support. However, Title 10 Forces may be called upon as part of a DoD activation of its Joint Task Force-Civil Support in response to a CBRNE incident due to weapons of mass destruction. DoD Directive , Mortuary Affairs Policy, requires a Title 10 mortuary affairs force structure capable of providing support for search, recovery identification, evacuation and, when required, temporary interment, disinterment, decontamination, and re-interment of (among others) U.S. noncombatants. Department of Health and Human Services, responsible for Emergency and Human Services Support Function (ESF # 8), when requested by State, tribal or local officials, in coordination with its partner organizations, will assist the jurisdictional medicolegal authority and law enforcement agencies in the tracking and documenting of human remains and associated personal effects; reducing the hazard presented by chemically, biologically or radiologically contaminated human remains (when indicated and possible); establishing temporary morgue facilities; determining the cause and manner of death; collecting antemortem data in a compassionate and culturally competent fashion from authorized individuals; performing postmortem data collection and documentation; identifying human remains using scientific means (e.g., dental, pathology, anthropology, fingerprints and, as indicated, DNA samples); and preparing, processing, and returning human remains and personal effects to the authorized person(s) when possible; and providing technical assistance and consultation on fatality management and mortuary affairs. In the event that caskets are displaced, ESF #8 assists in identifying the human remains, re-casketing, and reburial in public cemeteries. ESF 8 may task HHS components and request assistance from other ESF #8 partner organizations, as appropriate, to provide support to families of victims during the victim identification mortuary process. Provides logistical support for deploying ESF #8 medical elements transportation of resources, use of disaster fuel contracts, emergency meals, potable water, base camp services, supply and equipment resupply and use of all national contracts and interagency agreements managed by DHS for response operations. 94

95 Department of State Department of Transportation (DOT) Disaster Mortuary Operational Response Team (DMORT) Department of Veterans Affairs (VA) Coordinates international activities related to chemical, biological, radiological and nuclear incidents and events that pose border threats as well as naturally occurring disease outbreaks with international implications. Contributes to the development of projections of the international consequences of the event (e.g., disease spread, quarantine, isolation, travel restrictions, pharmaceutical supply and distribution and displaced persons) through coordination with foreign states and other international stakeholders and assists in communicating real-time actions taken by the United States and U.S. projections of the international consequences of the event. In collaboration with DOD, GSA and other transportation agencies, provides technical assistance in identifying and arranging for all types of transportation, such as air, rail, marine and motor vehicle and accessible transportation. Coordinates with the Federal Aviation Administration for air traffic control support for priority missions. At the request of ESF #8, provides technical support to assist in arranging logistical movement support (e.g., supplies, equipment, blood supply, etc.) from DOT resources, subject to DOT statutory requirements. Federal resources for MFI response are within the control of the U.S. Department of Health and Human Services (HHS). Their equipment and staffing resources are contained by the Disaster Mortuary Operational Response Team (DMORT). Equipment resources include three portable morgues, one of which is located near Dallas, TX. DMORT teams are located throughout the U.S. and each team has an SME for every discipline of morgue operations. Members are fully credentialed and accredited by HHS and are recognized as having appropriate training and experience in MFI responses. DMORT is divided into teams and only the necessary teams are deployed to the incident. Texas, along with Louisiana, Arkansas, Oklahoma and New Mexico, are located in DMORT Region VI. DMORT also has national teams for FAC and WMD specific needs. Buries and memorializes eligible veterans and advises on methods for interment of the dead during national or homeland security emergencies. Environmental Protection Agency (EPA) Provides environmental technical assistance (e.g., air monitoring) and information in the event temporary interment is necessary and/or human remains are contaminated. 95

96 Federal Bureau of Investigation (FBI) Federal Emergency Management Agency (FEMA) National Disaster Medical System (NDMS) National Guard Bureau (Title 32 Forces) National Transportation Safety Board (NTSB) The FBI is the lead federal investigative agency for any mass fatality incident resulting from or suspected of resulting from domestic terrorism or other criminal acts. More detailed information regarding the management of terrorism incidents is found in each County s Emergency Management Plan, Annex V. Establishes an adult missing persons call center and assists in the disposition of cases. Shares missing persons data with ESF #8 and ESF #13 Public Safety and Security in support of identification of the dead and seriously wounded. Supports local death scene investigations and evidence recovery. Assists in victim identification. Provides logistical support for deploying required ESF #8 medical elements and coordinates the use of mobilization centers/staging areas, transportation of resources, use of disaster fuel contracts, emergency meals, potable water, base camp services, supply and equipment resupply and use of all national contracts and interagency agreements managed by DHS for response operations. The National Disaster Medical System (NDMS) is a federally coordinated system that augments the nation's medical response capability. The overall purpose of the NDMS is to supplement an integrated national medical response capability for assisting state and local authorities in dealing with the medical impacts of major peacetime disasters and to provide support to the military and the Department of Veterans Affairs medical systems in caring for casualties evacuated back to the U.S. from overseas armed conventional conflicts. The National Guard Bureau s Air National Guard maintains a Fatality Search and Recovery Team (FSRT) capable of recovering decedents from contaminated field settings under the authority, direction and supervision of local JP/MEs. This capability is part of the NGB CBRNE Enhanced Response Force Package and can be activated as either a state (Title 32) or federal (Title 10) asset and can be used to support civilian MFI response. One FSRT is located in Texas, the 149th FSRT, Lackland Air Force Base (San Antonio). The National Transportation Safety Board has authority for investigating all public transportation fatalities including civil aviation, railroad, highway, marine and pipeline accidents in the United States. In the absence of suspected criminal activity, NTSB is the lead investigative agency for transportation incidents. The Aviation Disaster Family Assistance Act of 1996 mandates transportation carriers meet the needs of aviation disaster victims and their families. These needs include victim identification, providing a Family Assistance Center and crisis counseling. 96

97 U.S. Army Corps of Engineers (USACE) Through ESF #3 Public Works and Engineering, provides technical assistance, equipment, and supplies as required in support of HHS to accomplish temporary restoration of damaged public utilities affecting public health and medical facilities. In the event of a catastrophic mass fatality incident, assists with the temporary interment of the dead. U.S. Immigration and Customs Enforcement (ICE) ICE is the principal investigative arm of the U.S. Department of Homeland Security and as such may have an investigative role in MFIs related to border control or immigration. 97

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99 APPENDIX D: RELIGIOUS PRACTICES REGARDING FINAL DISPOSITION Religious Group (Estimated Prevalence in Texas) Baha i Buddhism Protestant & Catholic Christianity (majority of the state) Eastern Orthodox Christianity Hinduism Judaism Islam Autopsy Burial Cremation Other Issues Allowed, as long as the body is treated with respect Not favored but allowed in necessary situations Must be buried within one hour s travel of the place of death Forbidden Body is not to be embalmed unless required by state law Allowed Allowed Embalming permitted Allowed Favored Allowed Funeral usually held within 2 days of death Forbidden unless there are compelling reasons Not permitted unless required by law Not permitted unless required by law, all blood stained clothing must be buried with the deceased (Orthodox) Not permitted unless required Favored along with entombment Forbidden Rare, though Preferred practiced to some extent Only form of Forbidden disposition used Although there are no specific restrictions on organ donation, donation of the entire body for experimentation or research is not consistent with Church tradition; embalming is permitted Embalming is not favored No removals are to be made from sundown Friday to sundown Saturday, unless death occurs in a public place (Orthodox) and, embalming is forbidden unless required by state law (Orthodox) Favored Forbidden Embalming allowed Information retrieved through research by Amy Burdette, Community Preparedness Section, Texas Department of State Health Services,

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101 APPENDIX E: FAMILY ASSISTANCE CENTER STAFFING REQUIREMENTS Staff Quantity Notes FAC Group Supervisor 1 FAC Deputy Group Supervisor 1 per shift Forensic Unit Leader 1 per shift Family Interview Team Leader 1 per shift Family Interviewers 1 per station per shift # stations depends on FAC size Family Interview Data Input Staff 1 per station per shift # stations depends on FAC size Antemortem Data Management Team Leader 1 per shift Antemortem Data Management Input Staff 1 per station per shift # stations depends on FAC size Antemortem Data Collection Team Leader 1 per shift Antemortem Data Collection staff 1 per station per shift # stations depends on FAC size DNA Reference Collection Team Leader 1 per shift DNA Collection Attendant 1 per station per shift # stations depends on FAC size Personal Effects Team Leader 1 per shift Personal Effects Staff 1 per station per shift # stations depends on FAC size Family Management Unit Leader 1 per shift Call Center Team Leader 1 per center per shift Call Center Staff 1 per station per shift Depends on # of call centers Reception/Registration Team Leader 1 per shift Reception/Registration Staff 1 per station per shift # stations depends on FAC size Notification/Disposition Team Leader 1 per shift Notification/Disposition Staff Coordinate with LE Health and Human Services Unit Leader 1 per shift Case Assignment Team Leader 1 per shift Case Assignment Staff 1 per station per shift # stations depends on FAC size Mental Health Services Team Leader 1 per shift Mental Health Counselors 1 per station per shift # stations depends on FAC size Spiritual Services Team Leader 1 per shift Spiritual Services Staff 1 per station per shift # stations depends on FAC size Childcare Team Leader 1 per shift Childcare Staff 1 per station per shift # stations depends on FAC size Mass Care Team Leader 1 per shift Mass Care Staff 1 per station per shift # stations depends on FAC size First Aid Team Leader 1 per shift First Aid Staff 1 per station per shift # stations depends on FAC size 101

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103 APPENDIX F: JUSTICE OF THE PEACE PRECINCTS Precinct 1 JP PO Box 172 Meridian, TX (254) Bosque County Precinct 2 JP PO Box 204 Clifton, TX (254)

104 Precinct 1 JP 440 E. Main, Suite 1 Marlin, TX (254) Precinct 3 JP PO Box 748 Rosebud, TX (254) Falls County Precinct 2 JP 334 Commerce St. Marlin, TX (254) Precinct 4 JP PO Box 52 Chilton, TX (254)

105 Precinct 1 JP 440 E. Main, Suite 1 Fairfield, TX (903) Precinct 3 JP 440 E. Main, Suite 3 Fairfield, TX (903) Freestone County Precinct 2 JP 800 Main St Teague, TX (254) Precinct 4 JP 112 E. Main, Rm 204 Fairfield, TX (903)

106 Precinct 1 JP 215 Colorado Whitney, TX (254) Precinct 3 JP 101 East Live Oak Malone, TX (254) Hill County Precinct 2 JP P.O. Box 316 Hillsboro, TX (254) Precinct 4 JP 103 East Adams Itasca, TX (254)

107 Precinct 1 JP 310 S. Dallas St. Groesbeck, TX (254) Precinct 3 JP 200 W. State St. Groesbeck, TX (254) Limestone County Precinct 2 JP P.O. Box 194 Coolidge, TX (254) Precinct 4 JP 205 S. McKinney St. Mexia, TX (254)

108 Precinct 1, Place 1 JP 501 Washington Ave, Suite 104 D Waco, TX (254) Precinct 2 JP 929 Elm 410 Texas Ave. Waco, TX (254) Precinct 4 JP 307 S. Madison McGregor, TX (254) McLennan County Precinct 1, Place 2 JP 501 Washington Ave, Suite 108 Waco, TX (254) Precinct 3 JP 201 North Reagan West, TX (254) Precinct 5 JP 1800 Richter Waco, TX (254)

109 APPENDIX G: DSHS DISASTER BEHAVIORAL HEALTH SERVICES The mental health of Local, Regional, State, Federal government and nongovernment first responders, disaster workers, survivors, and victims is paramount. Local jurisdictions currently have Critical Incident Stress Management team members to assist responders but the potential number of persons involved will possibly require additional behavioral health support. Department of State Health Services can provide Disaster Behavioral Health Services to affected jurisdictions during an incident. Disaster Behavioral Health Services is responsible for the coordination of all-hazards services including Critical Incident Stress Management to first responders, disaster workers, survivors, and victims. Disaster Behavioral Health Services are provided through a network of mental health and substance abuse service providers, Voluntary Organizations Active in Disasters (VOAD), the Texas Critical Incident Stress Management Network, and other stakeholders. Disaster Behavioral Health Services provides a Behavioral Health Assistance Team that will: Deliver disaster behavioral health support services to survivors, first responders, disaster workers and communities impacted by a mass fatality incident in accordance with established procedures. Coordinate Family Assistance Center behavioral health operations to include providing psychological, emotional, spiritual support, referral services, etc. Coordinate with the local health authority to ensure disaster behavioral health services are written into incident and/or phase specific response plans. Complete encounter data forms and report to Disaster Behavioral Health Services daily. Disseminate situational reports to local mental health authorities, the Critical Incident Stress Management network and the Disaster Behavioral Health Consortium. Take a leadership role in writing federal grant applications for longer term behavioral health services. 109

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111 APPENDIX H: LOCAL RESOURCES Logistical requirements supporting incident site operations for an MFI may include the resources listed in the following table. Identifying these logistical requirements needed at the site is the responsibility of the Operations Section and the Incident Commander/Unified Command. County Resources Bio Seal System (located at hospitals) Bosque County Falls County Freestone County Limestone County Hill County McLennan County 1 roll 1 roll 1 roll 1 roll 1 roll 2 rolls Body Bags Yes No Yes No No Yes Cadaver Dogs Call Center Building Call Center Personnel Call Center Equipment Comm Equip. No No No Yes No Yes Yes No No Yes No Yes Yes No No No No Yes Yes No No No No Yes Yes Yes Yes Yes Yes Yes Morgue Yes No No No Yes Yes FAC Building FAC Personnel FAC Equipment Yes No No Yes No Yes No No No No No Yes No No No No No Yes Flagging No No No Yes Yes Yes Forensic Path. HazMat Decon Mortuary TFDA No No No No No No Yes No Yes Yes Yes Yes No No No Yes No Yes GPS Yes Yes Yes Yes Yes Yes On-Site Refrig. Storage No No No No No No 111

112 PPE Yes Yes No No No Yes Remains Transport No No No No No Yes SAR Yes No No No No Yes Temporary Morgue Building Floor Space Tyvek Coveralls VIC Building VIC Personnel VIC Equipment Evidence Response Team Body Recovery Team Yes No Yes No No Yes Yes No No No No Yes No No No No No Yes No No No No No Yes No No No No No Yes Yes No No No No Yes Yes No Yes No No Yes 112

113 APPENDIX I: FUNERAL HOME CAPABILITES & CONTACT INFORMATION BOSQUE COUNTY Funeral Home Contact Information Clifton Funeral Home 303 S Avenue F Clifton, TX Contact: Freddie Odom Phone: (254) Fax: (254) Foss Funeral Home 600 C Ave Valley Mills, TX Contact: Jerry Foss Phone: (254) Lawson Funeral Home 803 N Main St Meridian, TX Contact: Larry Lawson Phone: (254) Fax: (254) Transportation: 15 Suburban: 2 Funeral Coach: 6 Van: 3 Call Car: 4 Storage: 24 Refrigerated: 5 Non-Refrigerated: 19 Counselors: 3 Body Bags: 20 *Capabilities are subject to change Capabilities Transportation: 3 Suburban: 2 Funeral Coach: 1 Storage (non-refrigerated): 4 Counselors: 1 Transportation: 3 Funeral Coach: 3 Storage (non-refrigerated): 5 Counselors: 1 Transportation: 9 Van: 3 Call Car 1: 2 Call Car 2: 2 Funeral Coach: 2 Storage: 15 Refrigerated: 5 Non-Refrigerated: 10 Counselors: 1 Body Bags: 20 Accumulative Bosque County Funeral Home Capabilities 113

114 FALLS COUNTY Funeral Home Contact Information Adams Funeral Home 129 Coleman St Marlin, TX Phone: (254) Cook Gerngross Green Patterson 111 S 2nd St Rosebud, TX Phone: (254) Fax: (254) Dorsey-Keatts Funeral Home 907 Live Oak St Marlin, TX Phone: (254) Paul Funeral Home 208 Charles St Marlin, TX Phone: (254) Robertson Funeral Home 338 Commerce Street Marlin, TX Phone: (254) Capabilities Embalming machine Mortuary cots Accordion truck Tyvek boot covers, coveralls, duct tape, nitrile gloves, hand sanitizer, face masks, flashlights and GPS unit Disaster body bags with ID kits Access to pastoral/mental health resources Access to temporary morgue site Embalming machine Mortuary cots Accordion truck Tyvek boot covers, coveralls, duct tape, nitrile gloves, hand sanitizer, face masks, flashlights and GPS unit Disaster body bags with ID kits Access to pastoral/mental health resources Access to temporary morgue site Embalming machine Mortuary cots Accordion truck Tyvek boot covers, coveralls, duct tape, nitrile gloves, hand sanitizer, face masks, flashlights and GPS unit Disaster body bags with ID kits Access to pastoral/mental health resources Access to temporary morgue site Embalming machine Mortuary cots Accordion truck Tyvek boot covers, coveralls, duct tape, nitrile gloves, hand sanitizer, face masks, flashlights and GPS unit Disaster body bags with ID kits Access to pastoral/mental health resources Access to temporary morgue site Freestanding tent with walls Embalming machine Mortuary cots Accordion truck 114

115 Tyvek boot covers, coveralls, duct tape, nitrile gloves, hand sanitizer, face masks, flashlights and GPS unit Disaster body bags with ID kits Access to pastoral/mental health resources Access to temporary morgue site 115

116 Freestone County Funeral Home Contact Information Bowers Funeral Home 900 U.S. Hwy 84 Teague, TX Phone: (254) Capps Memorial Chapel 113 E. College St. Fairfield, TX Phone: (903) Griffin-Roughton Funeral Home 450 East Main St Fairfield, TX Phone: (903) Fax: (903) Moore s Angelic Funeral Home 406 Monroe St. Teague, TX Phone: (254) Fax: (254) Porter Chapel 212 W. Main St Wortham, TX Phone: (254) Capabilities Refrigerated Storage (Morgue): Refrigerated Trucks: Refrigerated Storage (Morgue): Refrigerated Trucks: Refrigerated Storage (Morgue): Refrigerated Trucks: Refrigerated Storage (Morgue): Refrigerated Trucks: Refrigerated Storage (Morgue): Refrigerated Trucks: 116

117 HILL COUNTY Funeral Home Contact Information Cornerstone Funeral Home 301 West Elm St Hillsboro, Texas Phone: (254) Marshall & Marshall Funeral Directors 201 N Bosque St Whitney, Texas Phone: (254) Marshall & Marshall Funeral Directors 2495 Corsicana Hwy. Hillsboro, Texas Phone: (254) Wade Funeral Home, Inc. 201 NW 3rd St Hubbard, TX Phone: (254) Fax: (254) Capabilities Refrigerated Storage (Morgue): Refrigerated Trucks: Refrigerated Storage (Morgue): Refrigerated Trucks: Refrigerated Storage (Morgue): Refrigerated Trucks: Refrigerated Storage (Morgue): Refrigerated Trucks: 117

118 LIMESTONE COUNTY Funeral Home Contact Information Blair-Stubbs Funeral Home 605 S. Mckinney Mexia, TX Phone: (254) Fax: (254) Blair-Stubbs Funeral Home 108 West 11th Street Thornton, TX Phone: (254) Dorsey & Keatts Funeral Home 602 North Ross Avenue Mexia, TX Phone: (254) Groesbeck Funeral Home Inc 1215 East Yeagua Street Groesbeck, TX Phone: (254) Fax: (254) Pearly Gates Funeral Home 827 Texas 171 Mexia, TX Phone: (254) Porter Funeral Home 208 N Canton St Mexia, TX Phone: (254) Capabilities Embalming machine Access to pastoral/mental health resources Embalming machine Access to pastoral/mental health resources Embalming machine Access to pastoral/mental health resources Refrigerated Storage: 4 Embalming machine Access to pastoral/mental health resources Embalming machine Access to pastoral/mental health resources Embalming machine Access to pastoral/mental health resources 118

119 MCLENNAN COUNTY Funeral Home Contact Information Aderhold Funeral Home Contact Person: Robert Payne 808 S. Reagan St. West, TX Phone: (254) Fax: (254) Bellmead Funeral Home Contact Person: James F. Hurst Jr. 809 La Clede St. Waco, TX Phone: (254) Fax: (254) Brazos Funeral Home P.O. Box Waco, TX Contact: Vidal DeLeon Phone: (254) Fax: (254) Cole Funeral Home Contact Person: Bobby Drake 1113 W. 5 th St McGregor, TX Phone: (254) Fax: (254) Connally Compton Funeral Home Contact Person: Bobby Drake/Sherri Evans 4400 W. Waco Dr. Waco, TX Phone: (254) Fax: (254) Dorsey-Keatts Funeral Home Contact Person: Robert Dorsey 1305 Elm St. Waco, TX Phone: (254) Fax: (254) Capabilities Refrigerated Morgue Capacity: 0 Prep Room Capacity: 1 Surge Capacity: 2 Body Bags: 2 Responders Available: 3 Transportation: Yes Refrigerated Morgue Capacity: 0 Prep Room Capacity: 2 Surge Capacity: 0 Body Bags: 2-3 Responders Available: 4 Transportation: Yes Refrigerated Morgue Capacity: 0 Prep Room Capacity: 2 Surge Capacity: 0 Body Bags: 0 Responders Available: 0 Transportation: No Refrigerated Morgue Capacity: 0 Prep Room Capacity: 1 Surge Capacity: Body Bags: Responders Available: 7-8 Transportation: Yes Refrigerated Morgue Capacity: 0 Prep Room Capacity: 6 Surge Capacity: 0 Body Bags: 8 Responders Available: 0 Transportation: Yes Refrigerated Morgue Capacity: 0 Prep Room Capacity: 10 Surge Capacity: 0 Body Bags: 5 Responders Available: 8 Transportation: Yes 119

120 Lake Shore Funeral Home Contact Person: Brent Shehorn 5201 Steinbeck Bend Waco, TX Phone: (254) Fax: (254) Littlepage Funeral Home Contact Person: Paxton Littlepage 711 E. Texas Mart, TX Phone: (254) Fax: (254) McDowell Funeral Home Contact Person: Andrea McDowell 1104 Chestnut St. Waco, TX Phone: (254) Fax: (254) Oakcrest Funeral Home Contact Person: Jim Moshinskie 4520 Bosque Blvd. Waco, TX Phone: (254) Fax: (254) Pecan Grove Funeral Home Contact Person: Matt Bell 3124 Robinson Dr. Waco, TX Phone: (254) Fax: (254) W. H. Little & Sons Mortuary Contact Person: Myrtle Littles 601 Ashburn St. Waco, TX Phone: (254) Fax: (254) Wilkirson Hatch Bailey Funeral Home 6101 Bosque Blvd. Waco, TX Contact: Hatch Bailey Phone: (254) Fax: (254) Refrigerated Morgue Capacity: 3 Prep Room Capacity: 8 Surge Capacity: 12 Body Bags: 4 Responders Available: 2-4 Transportation: Yes Refrigerated Morgue Capacity: 0 Prep Room Capacity: 3 Surge Capacity: 0 Body Bags: 3 Responders Available: 2 Transportation: No Refrigerated Morgue Capacity: 0 Prep Room Capacity: 10 Surge Capacity: 4 Body Bags: 10 Responders Available: 4 Transportation: Yes Refrigerated Morgue Capacity: 0 Prep Room Capacity: 1 Surge Capacity: 1 Body Bags: 0 Responders Available: 2 Transportation: No Refrigerated Morgue Capacity: 0 Prep Room Capacity: 1 Surge Capacity: 4 Body Bags: 0 Responders Available: 0 Transportation: No Refrigerated Morgue Capacity: 3 Prep Room Capacity: 14 Surge Capacity: 0 Body Bags: 20 Responders Available: 5 Transportation: Yes Refrigerated Morgue Capacity: 20 Prep Room Capacity: 2 Surge Capacity: 40 Body Bags: 10 Responders Available: 5 Transportation: Yes 120

121 Accumulative McLennan County Funeral Home Capabilities Refrigerated Morgue Capacity: 26 Prep Room Capacity: 66 Surge Capacity: 76 Body Bags: 85 Responders Available: 56 Transportation: 11 *Capabilities are subject to change 121

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123 APPENDIX J: MEDICAL EXAMINER/FORENSIC SERVICES PROVIDER CONTACT INFORMATION Provider Location Telephone Number Southwestern Institute of Forensic Science Dallas (214) Travis County Medical Examiner s Office Austin (512) Tarrant County Medical Examiner s Office Fort Worth (817) Bexar County Medical Examiner s Office San Antonio (210) Collin County Medical Examiner s Office McKinney (972) Harris County Institute of Forensic Science Houston (713) Central Texas Autopsy Lockhart (512) Forensic Medical Management Services of Texas Beaumont (409) Forensic Medical Management Services of Texas Tyler (903)

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125 APPENDIX K: TEXAS STATE DISASTER MORTALITY STRIKE TEAM Purpose Assist local authorities in evaluating and characterizing a mass fatality incident, provide situational awareness to the Texas Department of State Health Services and assist local jurisdictions with initial stages of response. Objectives 1. Evaluate mass fatality incident characteristics to determine the appropriate response resources required. 2. Assist in determining what local response resources are available and size the gap of necessary resources. 3. If additional resources are needed, assist with submitting requests for state or federal assistance and advocating for necessary resources and multi-agency involvement. 4. Assist local jurisdictions with body recovery, transport and establishment of a holding morgue and the recovery and transport of disinterred caskets (when needed). Limitation This is intended to be an initial effort to support local jurisdictions. This strike team is not intended to replicate the scope and capacity of a federal disaster mortuary operations response team (DMORT). Timeframe On-scene within hours post-incident; phase-out when local jurisdiction is able to manage independently and/or federal DMORT resources have arrived and an orderly transition has occurred. Supplies and Equipment a. Supplies: Infection Control Supplies: 120 cases of surgical masks 100 cases of hand sanitizer (12-ounce bottle) 120 cases of hand sanitizer (800 ml refill) 120 cases of disposable or reusable full face shields latex free 425 total cases of gloves latex free (located in Waxahachie, TX) o X-Small: 60 cases o Small: 65 cases o Medium: 75 cases o Large: 75 cases 125

126 o X-large: 65 cases o XX-large: 65 cases 120 cases of N-95 masks Mortuary Services Supplies: 50 cases of sealing duct tape (2 x 6- yards) 2300 cases of embalming fluids 15,000 body bags: leak-proof heavy duty with handles (issued to Medproducts in Eagle Pass, TX) Mortuary Supplies issued to Monarch Resources, Arlington, TX PPE: 780 cases N95 Mask & Anti-Viral Mask: 168 cases Duct Tape: 25 cases b. Equipment Three (3) Refrigerated Morgue Storage Trailers (20-tray capacity each): Equipment for each of 3-32 Refrigerated Trailers 1 20X20 Free Standing Tent with 4 sidewalls 1 Ferno Folding Prep Table 1 Dodge Embalming Machine 2 Ferno Maxi Mortuary Cots 2 Ferno Folding Cot 1 Ferno Accordion Truck 2 Human Remain Smooth Movers 1 Commercial Mobile Diesel Electrical Generator 20 Stainless Steel Morgue Trays Inventory List for each of the 3-32' Refrigerated Trailers: 16 cases (8 pouches per case) Bio-view human remain pouches 1 case Tyvek boot covers large (75 per case) 1 case Tyvek boot covers XL (75 per case) 4 cases Tyvek Coveralls Large (25 per case) 1 case Tyvek Coveralls XL (25 per case) 1 case Beaufont Head Covers(500 per case) 1 case Duct Tape (12 rolls per case) 2 cases Medium Nitrile Gloves (500 pair per case) 3 cases Large Nitrile Gloves(500 per case) 3 cases X-Large Nitrile Gloves (500 per case) 2 cases Small Nitrile Gloves (500 per case) 1 case 4oz Hand Sanitizer (24 bottles per box) 1 case 12 oz Pump Hand Sanitizer (12 bottles per box) 1 case 1 gal Refill Hand Sanitizer (4 bottles per box) 1 case N-95 face mask (20 boxes of 20) 1 case N-95 V2 face mask(20 boxes of 20) 126

127 APPENDIX L: FORMS 1. Initial Mass Fatality Assessment 2. Family Assistance Center (FAC) Site Selection Criteria 3. Missing Persons Identification Form 4. Decedent Tracking Sheet 5. Recovery Site Report 6. Recovery Site Field Log 7. Decedent Identification Form 8. Post Processing Storage Log 9. Remains Released for Final Disposition Log 127

128 INITIAL MASS FATALITY ASSESSMENT Incident Name: Date: Description of Incident Location: Type of Incident: Estimated Number of Fatalities: Other Pertinent Information & Notes: Transportation Natural Criminal Work Site Other: >100 Scene Hazards: Positive ID Challenges: Chemical Biological Radiological Nuclear Explosive Burns Fragmentation Other: 128

129 FAMILY ASSISTANCE CENTER (FAC) SITE SELECTION CRITERIA A SUMMARY OF CRITERIA FOR THE SELECTION OF A FAMILY ASSISTANCE CENTER (FAC) SITE SELECTION FACTORS: Type of disaster event and number of fatalities Location in relation to the disaster site and the morgue Availability of neutral, non-religious site (e.g. hotels, schools, etc.) Needs of the many participating agencies AVAILABILITY OF THE FACILITY- IMMEDIATE AND LONG TERM INFRASTRUCTURE Electrical power Telephone service A sufficient number of toilets Controlled heat/air conditioning, water and sewage Adequate parking Security options, including securing the media room Disability accommodations SPACE AND FLOOR PLAN- ACCOMODATING THE PERFORMANCE OF MANY FUNCTIONS AND DELIVERY OF SERVICES. SPACE SHOULD BE PROVIDED FOR: Operations center and administrative offices Large general assembly room with a public address system A media area that is physically separated from the families to not allow media access to victim s families Reflection room Death notification room Private counseling rooms for the staff members or response workers and for victims family members to use Medical area Reception area Kids play area with items to keep children occupied 129

130 MISSING PERSONS IDENTIFICATION FORM 130

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