Heart of Texas REGIONAL MASS FATALITY MANAGEMENT PLAN

Heart of Texas REGIONAL MASS FATALITY MANAGEMENT PLAN Heart of Texas Council of Governments SERVING BOSQUE, FALLS, FREESTONE, LIMESTONE, HILL & McLENNAN COUNTIES Heart of Texas Regional Mass Fatality Management Plan Page 1

RECORD OF CHANGES Change # Date of Change Entered By Date Entered Heart of Texas Regional Mass Fatality Management Plan Page 2

WARNING: This document is FOR OFFICIAL USE ONLY (FOUO). It contains information that may be exempt from public release under the Freedom of Information Act (5 U.S.C. 552). It is to be controlled, stored, handled, transmitted, distributed, and disposed of in accordance with U.S. Department of Homeland Security (DHS) policy relating to FOUO information and is not to be released to the public or other personnel who do not have a valid need-to-know without prior approval of an authorized official. Development of this document and costs for its printing and distribution were supported by Grant Number XXX-XX-XX-XX to the Heart of Texas Council of Governments through the State Homeland Security Program, as awarded by the Federal Emergency Management Agency, DHS. Heart of Texas Regional Mass Fatality Management Plan Page 3

Heart of Texas Regional Mass Fatality Management Plan Table of Contents I. Purpose... 5 II. Explanation of Terms.... 5-6 III. Hazard and Vulnerabilities Assessment 6-8 IV. Situations and Assumptions.. 8-9 V. Mass Fatality Response... 9 VI. Evaluation & Assessment... 9-10 VII. Concept of Operations.. 10-11 VIII. Incident Management Structure...12 IX. Organization and Assignment of Responsibilities.... 13-17 X. Family Assistance Center 17 XI. Resource Management... 17-18 XII. Plan Review.... 18 XIII. Reference.. 19 APPENDIX A: JP CONTACT LIST AND MAPS APPENDIX B: FUNERAL HOME CAPABILITIES & CONTACT INFORMATION APPENDIX C: MEDICAL EXAMINERS CONTACT INFORMATION APPENDIX D: DMORT CONTACT INFORMATION APPENDIX E: HOSPITAL MORGUE CAPACITY INFORMATION APPENDIX F: TEMPORARY INTERNMENT LOCATIONS APPENDIX G: DECEASED BODY HANDLING PROCEDURES APPENDIX H: REGIONAL FATALITY MANAGEMENT INVENTORY ITEMS APPENDIX I: MOBILE MORGUE REQUEST PROCESS APPENDIX J: FAMILY ASSISTANCE CENTER APPENDIX K: INITIAL INCIDENT ASSESSMENT & SCENE RECOVERY CHECKLIST APPENDIX L: RELIGIOUS PRACTICES REGARDING FINAL DISPOSITION Heart of Texas Regional Mass Fatality Management Plan Page 4

Regional Mass Fatality Management Plan I. Purpose The purpose of this plan is to identify actions to be taken during the regional response of a mass fatality incident. This plan defines a concept of operations for the fulfillment of NIMS compliant organizational roles and responsibilities for a coordinated regional response effort. Primary objectives in mass fatality management include handling human remains in a dignified, respectful, timely, methodical, and safe manner; accomplishing the identification of victims and the certification of cause and manner of death; and advancing to the final disposition of remains according to the wishes of the next of kin, whenever possible. Management of the overall disaster is accomplished using the Incident Command System as codified by the NIMS. The primary functions of command, operations, planning, logistics, and administration/finance are the foundation of a scalable platform that can expand or contract as the scope of the disaster dictates. The Justice of Peace role in an incident is to function in concert with the Incident Commander. Each mass fatality incident begins and ends with the local affected 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 federal resources. This document stresses the importance of mutual collaboration and engagement between the federal, state, county, and municipal governments, in addition to the private sector and non-governmental organizations (NGO)s within the region in response to a Mass Fatality Incident (MFI). II. Explanation of Terms A. ACRONYMS DC: District Coordinator DMORT: Disaster Mortuary Operational Response Team DSHS: Department of State Health Services EOC: Emergency Operations Center FAC: Family Assistance Centers IC: Incident Command JIC: Joint Information Center JIS: Joint Information System Heart of Texas Regional Mass Fatality Management Plan Page 5

JP: Justice of the Peace MACC: Multi-Agency Coordination Center MFI: Mass Fatality Incident MOU: Memorandum of Understanding NIMS: National Incident Management System PPE: Personal Protective Equipment RAC: Regional Advisory Council RMOC: Regional Medical Operations Center TDEM: Texas Division of Emergency Management TER: Texas Electronic Registry TMORT: Texas Disaster Mortuary Response Team TSA M: Trauma Service Area M B. DEFINITION Mass fatality incidents arise from natural and manmade disasters (accidental and intentional) and disease outbreaks. Defined as an incident with more fatalities than the local jurisdiction can effectively manage, mass fatality incidents historically require outside assistance and support. 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. III. HAZARD AND VULNERABILITIES ASSESSMENT The HOTCOG Region, with its vast geographic area and population, as well as its economic, governmental, medical, and transportation assets, makes it particularly susceptible to various forms of natural and manmade disasters. According to the HOTCOG Regional Homeland Security Strategic Implementation Plan, completed in 2013, the region is vulnerable to the following hazards: Very Likely: o Flooding o Tornadoes o Wind Storm o Hazardous Material Incident o Transportation / Roadway Infrastructure Incidents o Critical infrastructure failure Likely: o Wildfire o Organized Crime Occasional: o Winter storms Heart of Texas Regional Mass Fatality Management Plan Page 6

The 6-county HOTCOG Region covers 5,611 square miles and is home to over 349,000 residents. The HOTCOG region combined would be the 8 th largest city in Texas and with its diverse geography presents challenges for responders and planners. The most populated area in the Heart of Texas region is the City of Waco with over 124,000 residents. A. NATURAL DISASTERS The HOTCOG Region is vulnerable to a variety of natural disasters, some of which may result in Mass Fatality Incidents. The table below lists the type of disaster, a brief description and the occurrence frequency for the region. The information below was retrieved from the HOTCOG Regional Homeland Security Strategic Implementation Plan Type Description Potential Flooding Riverline: Excessive precipitation levels and water runoff Very Likely 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 Flash: Result of dam or levee failure after minutes or hours of heavy amounts of rainfall, or from sudden release of water held by an ice jam Tornadoes Violent windstorm characterized by a twisting, funnelshaped Very Likely cloud extending to the ground Windstorm Winds > 57.5 mph Very Likely Wildfire Any fire occurring in a wildland areas except for fire under Likely prescription Winter Storm Snow, sleet, freezing rain, or a mix of wintery precipitation Occasional B. MANMADE DISASTERS In addition to natural disasters, the HOTCOG Region is vulnerable to both accidental and intentional manmade disasters, possibly resulting in mass fatalities. The region is home to numerous transportation corridors, multiple manufacturing plants, multiple universities and colleges. The following table briefly lists the manmade accidental and intentional incidents that threaten the HOTCOG Region. Heart of Texas Regional Mass Fatality Management Plan Page 7

Type Description Potential Organized Crime Four or more murders occurring during a particular event Likely with no cooling-off period between the murders, typically at a single location in which the victims are killed by an individual or more Toxic Release/ CBRNE Solid, liquid, and/or gaseous contaminants that are released from fixed or mobile containers, due to an accident or Very Likely Transportation / Roadway Infrastructure Incidents 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 Very Likely Critical infrastructure failure The failure of one or more systems and networks that make up the infrastructure of society in which the failure of that infrastructure causes dire consequences to the surrounding region Very Likely IV. SITUATIONS AND ASSUMPTIONS A. Situation The region is vulnerable to natural disasters, hazardous materials incidents, transportation accidents, and acts of terrorism. An occurrence could result in multiple deaths that would require a response that could overwhelm local capabilities. Support from neighboring jurisdictions, counties, state agencies, and federal agencies may be required. In Texas, approximately 55% of the population is affiliated with one of 102 identified faith groups, many of which are represented in the HOTCOG region. While the majority of religious groups represent Protestant and Catholic Christianity, six other most represented faith groups exist: Baha i, Buddhism, Eastern Orthodox Christianity, Hinduism, Judaism, and Islam. B. Assumption Mass fatality disasters have the potential to quickly overwhelm a single jurisdiction s resources depending on the capacity of the facility and the number of fatalities. Offices that are overwhelmed may seek assistance at region, state and federal levels. Jurisdictions within the Heart of Texas Region (Bosque, Falls, Freestone, Limestone, McLennan, Hill) will provide assistance in the necessary acts of recovery, evacuation, Heart of Texas Regional Mass Fatality Management Plan Page 8

sanitation, temporary storage of remains, notification of next of kin, counseling, and release of remains. Segments of the population represent 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. Specific information regarding religious preferences can be found in Appendix L. V. MASS FATALITY RESPONSE A. Purpose The purpose of the Mass Fatality Response Plan is to define roles and procedures in preparedness, response, and recovery from mass fatality incidents. The plan will provide proper coordination of incident response activities and establishes methods for sensitive and respectful care in handling human remains. The goal of these guidelines is to enhance the ability of the Heart of Texas Region to respond to and manage a surge in the number of decedents as a result of any disaster. While the importance of religious and cultural considerations is recognized, it is not addressed here. These guidelines focus on decedent processing for medical and legal purposes. VI. EVALUATION & ASSESSMENT An initial site visit will be conducted by Emergency Responders/Emergency Support Agencies to determine the following: The number of fatalities. Condition of the human remains, i.e. burned, dismembered, etc. Difficulties anticipated in the recovery of human remains and the types of personnel and equipment needed, i.e. search & rescue, heavy equipment, dog teams, etc. Locations of the incident as far as the accessibility and difficulties that may be encountered in transporting human remain from the scene. Formulation of a plan for documentation, body recovery, and transportation. Ascertain the types and numbers of personnel needed to staff the recovery site and morgue operations. Try to anticipate what type of facility would be the most useful for the families of the victims as a Family Support Center. Determine the extent of possible chemical, biological, radiological, or other hazards associated with recovery operations. Heart of Texas Regional Mass Fatality Management Plan Page 9

Determine the need for activation of state and/or federal resources. The request will be initiated by the Incident Commander in coordination with the County EOC/RMOC/MACC. VII. CONCEPT OF OPERATIONS A. General The City/County is responsible for developing and maintaining emergency mass fatality plans within the legal authority delegated to the City/County through the State of Texas. Local and regional resources should be used before requesting additional resources through the region prior to requesting resources from the State of Texas. The City/County prepares and coordinates procedures, personnel, equipment, supplies, and facilities necessary to conduct activities associated with the mass fatality incident, including: a. Provide and test communications equipment. b. Maintain permanent and temporary morgue capability for human remains (Develop MOU with agencies for refrigerated truck availability; pre-identify temporary internment locations, etc). c. Provide identification and appropriate level PPE for all City/County response personnel. d. Maintain current call lists for supplemental resources of equipment, personnel, or other resources. e. Maintains a temporary interment plan as a component of their emergency response plan. f. Coordinate with the RMOC as needed. B. Direction and Control a. All mass fatality management decisions regarding response are made at the local jurisdiction level. b. In accordance with a mission assignment and mutual aid agreements resource support organizations assisting will retain administrative control over their resources and personnel but will be under the operational control of the requesting jurisdiction s Incident Commander. c. Management of fatality related operations under the direction of the Justice of Peace is coordinated with the Incident Commander. d. Volunteer groups and individuals may also offer services to assist the Incident Commander or Justice of Peace. This may include forensic pathologists from other regions and members of various funeral associations and dental societies. Funeral service personnel can be a valuable asset to provide, at a minimum, additional staff to monitor custody and processing steps for each set of remains Heart of Texas Regional Mass Fatality Management Plan Page 10

through the morgue process. Likewise, dental personnel, even if they possess no forensic experience, can assist forensic dentists in a number of areas. For such volunteers who are not already pre-registered, the Incident Commander through the Emergency Operation Center Volunteer Coordinator should ensure that each volunteer acknowledges a liability waiver for work-related injury and registers in for each period of service. Regardless of the source of personnel (local, regional, state, federal, or volunteer), detailed time records must be maintained to document the nature and periods of duty for each and every person assisting during the operation. Heart of Texas Regional Mass Fatality Management Plan Page 11

VIII. INCIDENT MANAGEMENT STRUCTURE Example: Organization Chart for Decedent Operations in a Mass Fatality Heart of Texas Regional Mass Fatality Management Plan Page 12

IX. ORGANIZATION AND ASSIGNMENT OF RESPONSIBILITIES A. General The County Judge/City Mayor has the overall authority in a Mass Fatality incident. The County Judge/City Mayor will set the incident objectives, manage the incident operations, oversee the application of resources, and has responsibility over all personnel involved in the response. B. Role of the Justice of the Peace The Justice of the Peace performs death pronouncement, assumes custody of the deceased in order to determine identity, document findings, inventory belongings, tracking the deceased, initiate the death investigation, make notification to family and authorities, determine cause and manner of death, issue death certificates, and coordinate disposition of the remains. Resources normally available to the Justice of the Peace may be outweighed by the volume of deceased remains. The Justice of the Peace may request and obtain additional resources by identifying equipment and personnel assets needed to manage the deceased and channeling those requests through the Incident Command or local Emergency Operations Center. This may include specialized assets to assist with decontamination of deceased who were exposed to chemical, radiological, or biological agents. Heart of Texas Regional Mass Fatality Management Plan Page 13

If the Justice of the Peace requests the assistance of the Medical Examiner s Office they routinely use for their non-mass disaster autopsy needs, the Medical Examiner s Office will assist the Justice of the Peace under his/her authority. Bosque Falls Freestone Hill Limestone McLennan County ME used for Autopsy Services Dallas Co. Institute of Forensic Science Dallas Co. Institute of Forensic Science Dallas Co. Institute of Forensic Science Dallas Co. Institute of Forensic Science Dallas Co. Institute of Forensic Science Dallas Co. Institute of Forensic Science C. Task Assignments 1. County/City/Emergency Management: Endorse and support a Mass Fatality Response Plan consistent with the City/County Emergency Operations Plan. Cooperate and coordinate with local, MACC, RMOC, state, and federal mass fatality resources through all phases of the emergency. Identify sites for temporary internment and develop MOUs. Issue a Disaster Declaration 2. Local Jurisdiction Responsibilities Process for notifying the County Judge. The activation of the Regional Mass Fatality Response Plan in coordination with Incident Command. The process for carrying out field operations according to Texas statutes. Procedures for examinations, identification, and notification of next of kin. The use of Funeral Homes for mortuary services. The use of the NIMS structure for all emergency operations. Coordination of response and recovery teams. Identify temporary internment locations. 3. Justice of the Peace: Establish manner and cause of death. The Justice of the Peace may request assistance from the TER for death certificate processing, as needed. Heart of Texas Regional Mass Fatality Management Plan Page 14

4. Law Enforcement: Provide security and investigation of the scene, and/or security of transportation as needed. Establish security for short-term morgue operations, and other mass fatality operations. 5. Funeral Home/Mortuary Services: Provide morgue capacity, including equipment, supplies, personnel, and PPE. Participate with local jurisdictions to maintain sufficient supply of body bags. Facilitate transportation of human remains. Provide family with funeral services. 6. Public Information Officer Prepare statements to the media in coordination with the JIC, utilizing the JIS. 7. DSHS Health Service Region 7 / Local Public Health District:: Assist the jurisdictional medico-legal authority and law enforcement agencies in the tracking and documenting of human remains and associated personal effects. Reduce the hazard presented by chemically, biologically, or radiologically contaminated human remains (when indicted and possible). Assist in the establishment of temporary morgue facilities. Assist in disaster related mortality surveillance. Assist in the collection of antemortem data in a compassionate and culturally competent fashion from authorized individuals. Assist in assessing the threat of vector-borne diseases. Ensure provision of psychosocial support to the families of the deceased. Coordination of a Family Assistance Center. Heart of Texas Regional Mass Fatality Management Plan Page 15

8. Mental Health 9. Hospital: 10. EMS: 11. Fire/Hazmat: 12. RMOC: Provide immediate crisis intervention. Assess the scope of disaster and provide support for first responders and their families. Provide short and long term support for emotional needs. Ensure provision of psychosocial support to the families of the deceased, in conjunction with public health. Assist in the coordination of FAC. Participate with local jurisdictions to maintain sufficient supply of mortuary supplies. Assist in recovery and transport to care for injured victims. Assist with evaluation of the incident site/scene safety. Provide life saving operations. Protect property from fire and hazards. Assist with decontamination of remains. Provide guidance regarding hazards at the incident scene and consultation on decontamination. Assist with coordinating the regional health and medical response activities. Locate additional regional health and medical resources (if needed). Assist with requesting additional health and medical resources, or other resources pertinent to incident needs. Heart of Texas Regional Mass Fatality Management Plan Page 16

X. FAMILY ASSISTANCE CENTER In the aftermath of a catastrophic mass fatality, a fundamental and essential component of the care and management of the dead is the expeditious establishment of a Family Assistance Center (FAC). The establishment of a FAC is necessary to facilitate the exchange of information and to address the families needs. The traditional FAC is a secure facility established as a centralized location to provide information about missing persons who may be victims of the disaster; a gathering point where information is exchanged in order to facilitate the body identification process and the reunification of next of kin; a location for the collection of DNA; and where spiritual and emotional support is provided for those awaiting information about their loved ones. Also, given the circumstances, additional supportive services such as housing information/referral, insurance, and legal assistance may be provided. A more on setup and operations of a Family Assistance Center can be found in Appendix J. X. RESOURCE MANAGEMENT A. Resource Management is the responsibility of the City/County EOC. The RMOC/MACC are available to assist with health and medical resources (including fatality management) if needed; once the County resources are anticipated to be, or have been depleted. B. Response to a MFI should follow 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, which may be requested through the: Texas Division of Emergency Management, Region 11, Disaster District Committee (DDC) Region Medical Operations Center (RMOC), which is acute care-focused Heart of Texas Regional Mass Fatality Management Plan Page 17

Multi-Agency Coordinating Center (MACC) Note: When a regional response is needed, it is recommended that the RMOC and/or MACC be activated to ensure consistency and collaboration among the HOTCOG region. Once the MACC and RMOC are operational, all requests will come to these entities before being considered by the DDC. XII. PLAN REVIEW B. The Regional Mass Fatality Workgroup is responsible for maintaining and updating this plan on an annual basis or as needed. XIII. References Used Council of Governments; Heart of Texas Region, Texas. Texas Homeland Security Response Plan. Dane County, Wisconsin. (2004). Emergency Operations Plan Annex H. Mass Fatality Response Mortuary Care. Department of State Health Services, Texas. (2010). DSHS Mass Fatality Planning Toolkit. Horry County, South Carolina. (2006). Emergency Management Plan; Section 7. Mass Casualty Response Plan. Washington County, Texas. (2009). Appendix 7 to Annex H. Washington County Mass Fatality & Mortuary Annex. Harris County, Texas. (2012). Regional Mass Fatality Management. Concept of Operations Council of Governments; Heart of Texas Region, Texas. (2013). Regional Homeland Security Strategic Implementation Plan National Association of Medical Examiners, Mass Fatality Plan Heart of Texas Regional Mass Fatality Management Plan Page 18

Heart of Texas Regional Mass Fatality Management Plan Page 19

APPENDICES APPENDIX A: JP CONTACT LIST AND MAPS APPENDIX B: FUNERAL HOME CAPABILITIES & CONTACT INFORMATION APPENDIX C: MEDICAL EXAMINERS CONTACT INFORMATION APPENDIX D: DMORT CONTACT INFORMATION APPENDIX E: HOSPITAL MORGUE CAPACITY INFORMATION APPENDIX F: TEMPORARY INTERNMENT LOCATIONS APPENDIX G: DECEASED BODY HANDLING PROCEDURES APPENDIX H: REGIONAL FATALITY MANAGEMENT INVENTORY ITEMS APPENDIX I: MOBILE MORGUE REQUEST PROCESS APPENDIX J: FAMILY ASSISTANCE CENTER APPENDIX K: INITIAL INCIDENT ASSESSMENT & SCENE RECOVERY CHECKLIST APPENDIX L: RELIGIOUS PRACTICES REGARDING FINAL DISPOSITION APPENDIX

APPENDIX A: JUSTICE OF THE PEACE CONTACT INFORMATION & MAPS Bosque County Hon. Ray Ballmann, Pct. 1 440 E. Main, Suite 1 Meridian, Tx 76665 254-435-2921 Hon. Jamie Zander, Pct. 2 800 Main St Clifton, TX 76634 (254) 675-8939 APPENDIX A

Falls County Hon. Karen Meyers, Pct. 1 440 E. Main, Suite 1 Marlin, Tx 76661 (254) 883-1427 Hon. Preble Polk, Pct. 1 PO Box 748 Rosebud, Tx 76570 (254) 883-1427 Hon. Debra Trotter, Pct. 2 800 Main St Marlin, TX 76661 (254) 675-8939 Hon. Sharon Maxey Po Box 52 Chilton, Tx 76632 (254) 546-3700 APPENDIX A

Freestone County Hon. Theresa Farris, Pct. 1 440 E. Main, Suite 1 Fairfield, Tx 75840 (903) 389-8783 Hon. Beth Ireland, Pct. 3 440 E. Main, Suite 3 Fairfield, Tx 75840 (903) 389-3137 Hon. Debra Hamilton, Pct. 2 800 Main St Teague, TX 75860 (254) 739-2518 Hon. Theresa Farris, Pct. 4 112 E. Main, Rm 204 Fairfield, Tx 75840 (903) 389-0420 APPENDIX A

Hill County Hon. Martis Ward, Pct. 1 P.O.Box 1853 Whitney, Tx 76692 (254) 694-3140 Hon. Brad Henley, Pct. 3 101 East Live Oak Malone, Tx 76660 (254) 530-1034 Hon. John Milburn, Pct. 2 P.O. Box 316 Hillsboro, Tx 76645 (254) 582-4025 Hon. Charles Jones, Pct. 4 P.O. Box 206 Itasca, Tx 76055 (254) 687-2424 APPENDIX A

Limestone County Hon. Marcus Hanna, Pct. 1 310 S. Dallas St Groesbeck, Tx 76642 (254) 729-2933 Hon. Sherri LeNoir, Pct. 3 200 W. State St. Groesbeck, Tx 76642 (254) 729-3630 Hon. Freda Gremminger, Pct. 2 P.O. Box 194 Coolidge, Tx 76635 (254) 786-4938 Hon. Ray Jones, Pct. 4 205 S. McKinney St. Mexia, Tx 76667 (254) 562-7113 APPENDIX A

McLennan County Hon. Kristi DeCluitt, Pct. 1 205 S. McKinney St. Mexia, Tx 76667 (254) 562-7113 Hon. Belinda Summers, Pct. 2 205 S. McKinney St. Mexia, Tx 76667 (254) 562-7113 Hon. Walter Peterson, Pct. 1 Pl 2, Pct 7 205 S. McKinney St. Mexia, Tx 76667 (254) 562-7113 Hon. David Pareya, Pct. 3 205 S. McKinney St. Mexia, Tx 76667 (254) 562-7113 Hon. Barbara Lloyd, Pct. 4 205 S. McKinney St. Mexia, Tx 76667 (254) 562-7113 Hon. Pat Richardson, Pct. 5 205 S. McKinney St. Mexia, Tx 76667 (254) 562-7113 APPENDIX A

APPENDIX A

APPENDIX B: FUNERAL HOME CAPABILITES & CONTACT INFORMATION Falls County Funeral Home Contact Information Wade Funeral Home Contact Person: Don Sims 201 NW 3 rd St. Hubbard, TX 76648 Phone: (254) 576-2531 Capabilities Refrigerated Storage (Morgue): Yes Refrigerated Trucks: None Wade Funeral Home Contact Person: Don Sims 201 NW 3rd St. Hubbard, TX 76648 Phone: (254) 576-2531 Refrigerated Storage (Morgue): Yes Refrigerated Trucks: None Wade Funeral Home Contact Person: Don Sims 201 NW 3rd St. Hubbard, TX 76648 Phone: (254) 576-2531 Refrigerated Storage (Morgue): Yes Refrigerated Trucks: None Wade Funeral Home Contact Person: Don Sims 201 NW 3rd St. Hubbard, TX 76648 Phone: (254) 576-2531 Refrigerated Storage (Morgue): Yes Refrigerated Trucks: None Wade Funeral Home Contact Person: Don Sims 201 NW 3rd St. Hubbard, TX 76648 Phone: (254) 576-2531 Refrigerated Storage (Morgue): Yes Refrigerated Trucks: None *Funeral Homes that wish to participate. Not an all inclusive list APPENDIX B

APPENDIX C: MEDICAL EXAMINER S CONTACT INFORMATION 1. Dallas County Medical Examiner 5230 Southwestern Medical Avenue Dallas, TX 75235 (214) 920-5900 2. Travis County Medical Examiner s Office 1231 Sabine Street Austin, TX 78701 (512) 854-9599 3. Tarrant County Medical Examiner 200 Feliks Gwozdz Place Ft. Worth, TX 76104 (817) 920-5700 4. Bexar County Medical Examiner s Office 7337 Louis Pasteur Drive San Antonio, TX 78229 (210) 335-4000 APPENDIX C

APPENDIX D: TEXAS STATE DISASTER MORTALITY STRIKE TEAM 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 12-24 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. Mass Fatality Incident Characterization Mass fatality incident characterization assists local, state and federal entities to identify the appropriate resources, capabilities and processes needed to manage this (and potentially multiple) mass fatality incident(s). Site Criteria 1. Type of incident: natural versus criminal/terrorist versus accident. 2. Recovery complexity: shifting terrain? Fixed or distributive location? Building material present? Types of buildings in close proximity? Need for excavation? Water/tides present? Need for extensive gridding? Identify whether a sifting site is needed (will require anthropology consult). Burning/smoldering? APPENDIX D

3. Contamination or infectious/transmissible disease present? Need for public health community constraints or special PPE for responders? 4. Environmental conditions factors: heat; cold; humidity; rain. 5. Incident characteristics: single occurrence versus reoccurring: one location versus multiple locations. Decedent Criteria 1. Number of decedents approximate or accurate number. 2. Condition of remains: complete remains? Fragmented/commingled? Decomposed? Burned? 3. Victim manifest: closed population (known number/names) versus open population with no available list. 4. If open population, who is collecting/managing missing persons data collection? 5. Characteristics/demographics of decedent group: children, adults, members of church group/business/tour group, etc. Response Capabilities Criteria 1. Local response capability: fully or partially operational? Decimated? Morgue operation capacity: medical examiner versus justice of the peace; forensic capabilities: pathologists, anthropologists, odontologists, investigators, fingerprint and DNA specialists, dieners, antemortem interviewers; Level of integration with both public health and emergency management. 2. Decedent transport capability: vehicles and manpower. 3. Personal Protective Equipment/supplies. 4. Data collection and reporting capability: antemortem (from families and friends) and postmortem (from scene and morgue); death reporting and certification. 5. Family Assistance Operations: single or multiple locations? Face to face versus virtual service needed? Cultural considerations: language, beliefs. Size of Strike Team Minimum of 4 individuals: Team Lead and 3 Team Members; maximum of 10 Teams (depending on number of locations). APPENDIX D

Request Procedures In order to request the assistance of the Texas State Disaster Mortality Strike Team, contact the local Texas Division of Emergency Management District Coordinator (TDEM DC). The DC for the TSA-M region is located at the Texas Department of Public Safety Office in Waco Texas and can be contacted at (254) 759-7165 or by contacting the State Operations Center at (512) 424-2208. APPENDIX D

APPENDIX E: HOSPITAL MORGUE CAPACITY INFORMATION Hospital Cold Storage Capacity? # of bodies able to hold Refrigerated truck agreement? Refrigerated truck agency Hill Regional Hospital YES 2 No TOTAL 1 Hospitals 1 Hospitals 2 Bodies 0 0 The RMOC will assist with obtaining additional morgue capacity upon request and as available. APPENDIX E

APPENDIX F: TEMPORARY INTERNMENT LOCATION It is recognized by the HOTRAC region, herein, the jurisdictions governing body maintain the responsibility for indentifying temporary internment location(s) and procedures within their specified geographical areas. APPENDIX F

APPENDIX G: DECEASED BODY HANDLING PROCEDURES Management of Dead Bodies after Disasters: a Field Manual for First Responders is a publication of the Area on Emergency Preparedness and Disaster Relief of the Pan American Health Organization, the World Health Organization, and the International Committee of the Red Cross. The full version is available at: www.paho.org/disasters (click on Publications Catalog). Topics included in the manual: Introduction Coordination Infectious Disease Risks Body Recovery Storage of Dead Bodies Identification of Dead Bodies Information Management Long-Term Storage and Disposal of Dead Bodies Communications and the Media Support to Families and Relatives Frequently Asked Questions Annex 1: Dead Bodies Identification Form Annex 2: Missing Persons Form Annex 3: Sequential Numbers for Unique Referencing Annex 4: Body Inventory Sheet Annex 5: Supporting Publications Annex 6: International Organizations Involved in the Development of this Document Annex 7: Mass Fatality Plan Checklist for Ministries of Health and National Disaster Offices APPENDIX G

APPENDIX H: REGIONAL FATALITY MANAGEMENT INVENTORY ITEMS Date Purchased Description Manufacturer Name and Location 12/27/2012 1 roll of BioSeal System Material@36"X100' and 1 Heat Sealer 12/27/2012 1 roll of BioSeal System Material@36"X100' and 1 Heat Sealer 12/27/2012 1 roll of BioSeal System Material@36"X100' and 1 Heat Sealer Barrier Products Barrier Products Barrier Products Falls Community Hosptial, Marlin, TX Goodall-Witcher Healthcare Foundation, Clifton, TX Hill Regional Hospital, Hillsboro, TX 12/27/2012 1 roll of BioSeal System Material@36"X100' and 1 Heat Sealer 12/27/2012 1 roll of BioSeal System Material@36"X100' and 1 Heat Sealer 12/27/2012 1 roll of BioSeal System Material@36"X100' and 1 Heat Sealer 12/27/2012 1 roll of BioSeal System Material@36"X100' and 1 Heat Sealer Barrier Products Barrier Products Barrier Products Barrier Products Hillcrest Baptist Medical Center, Waco, TX Limestone Medical Center, Groesbeck, TX Parkview Regional Hospital, Mexia, TX Providence Health Center, Waco, TX APPENDIX H

APPENDIX I: MOBILE MORGUE REQUEST PROCESS Mobile Morgue Request Process Temple Veterans Administration POC: 254-743-2902 Office 254-534-0458 Cell Alternate POC: 254-598-9707 The Process for request of the mobile morgue is as follows: Local EMC must initiate the request for the Mobile Morgue through the County Judge County Judge must request through the Governor s office Governor to Health and Human Services Health and Human Services to Washington Veterans Administration Washington Veterans Administration approves or disapproves Temple Veterans Administration Hospital Provides services with the approved request for deployment. Note: This asset will be housed at the Waco Veterans Administration location. APPENDIX I

APPENDIX J: FAMILY ASSISTANCE CENTER 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 a MFI, although in some cases a virtual FAC or a FAC with multiple sites will be used. In a MFI, an Assessment Team appointed by Incident or 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 stood up in response to a multiple-jurisdictional incident, the FAC Group Supervisor is appointed by Incident or Unified Command. The site used for a FAC will vary depending on the incident size and facility structure. The FAC must 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 APPENDIX J

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: Family Interview o Receive detailed information using VIP interview form from patrons to aid in identification process o Establish next-of-kin status o Discuss family s initial preference for death notification 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.) Antemortem Data Management o Provide clerical support for all aspects of the FAC o Ensure that information from the family interview is entered into the database o Manage all hard-copy files o Scan victim photographs and other pertinent documents into the database Antemortem Records Collection o Request medical records from physicians, dentists, etc. to aid in identification process o Share that information with the Postmortem Records Collection Team working at the Victim Identification Center DNA Reference Collection o Obtain buccal swab DNA samples from biologically-related family members Personal Effects o Receive personal effects from the Quality Assurance Team at the VIC o Inventory, refurbish (but not restore), and catalogue PE o Return PE to family members APPENDIX J

Family Management: Call Center o Receive missing persons calls from the public o Determine nature of call o Forward to law enforcement for processing Reception and Registration o Greet and register patrons, including: Those whose loved ones are known missing, or possible missing Those who have already been interviewed by law enforcement o Issue access badges o Guide family and friends of victims whose missing status is not known to the American Red Cross Safe and Well website o Direct patrons who have not met with law enforcement to the appropriate personnel o Educate patrons about the FAC process Notification and Disposition o Notify 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 Provide support to patrons as needed (i.e., interpreters, translators, referrals to support agencies or resources) o Maintain help desk to answer questions and secure services available to patrons o Work 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 o Provide Psychological First Aid and/or behavioral health services are to patrons and staff o Ensure that team members are present at family briefings and site visits Spiritual Services o Provide requested pastoral counseling and spiritual care to patrons of all faiths o Assist Call Center by talking with callers in distress APPENDIX J

o Arrange and conduct interfaith memorial services when appropriate o Ensure that team members are present at family briefings and site visits Childcare o Provide temporary respite care for children while parents or guardians are at the FAC for interviews, briefings, and/or meetings Mass Care o Provide three meals each day and ensure snacks and drinks are available during all hours of operation for both patrons and staff o Arrange limited lodging for out-of-town family members o Give hotel restaurant meal vouchers if the FAC is located in a hotel with dining services o Make available Spiritual Care and Behavioral health Services team members for patrons and staff during meal times First Aid o Provide basic first aid or medical care for patrons and staff at the FAC o Serve as a liaison with medical service providers in the event of a medical emergency A Family Assistance Center Flowchart on the following page graphically depicts how these functions work together APPENDIX J

APPENDIX J

II. FAMILY ASSISTANCE CENTER PERSONNEL NEEDS Personnel needs are determined by the size and scope of the MFI. Each FAC will be operated by a 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 selected to carry out FAC services and operations. NGOs such as American Red Cross, Salvation Army, United Way, Medical Reserve Corps, etc. Each NGO is responsible for credentialing its volunteers/employees No spontaneous unaffiliated volunteers are permitted to work at the FAC, instead they will be directed to the Volunteer Reception Center If the MFI is a localized incident, the local jurisdiction selects the NGOs to carry out FAC operations. If the FAC is stood up in response to a multiple-jurisdictional incident, the UACC selects NGOs from throughout the region to provide FAC services. Scale of Incident Small Medium Large Catastrophic Recommended Type FAC Stand Alone FAC Stand Alone FAC Stand Alone Remote or multiple facilities Potential Fatalities < 50 fatalities 50 300 fatalities 300 1000 fatalities >1,000 fatalities Daily Capacity for Critical Service Operations 8 stations/12 hr. per day = 96 interviews per day 25 stations/12 hr. per day = 300 interviews per day 50 stations/12 hr. per day = 600 interviews per day 50-75 stations/12 hr. per day = 600 interviews per day Patrons <400 400 2,400 2,400 8,000 >6,000 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 is provided to the families before being 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 ME s office and makes sure family members are aware of the briefings. The ME or designated representative leads family briefings and has available spokespersons from other pertinent agencies/operations (i.e. 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 PE, 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. APPENDIX J

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 the FAC operations activation. Family briefings must be conducted at least once daily, ideally at a uniform time and are 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 will determine the FAC model to be activated. Most MFIs will require a standard FAC model: a singular 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 (see Table 5). The information below will help to further define each Family Assistance Center type. 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 data Satellite FACs for patron services, antemortem data collection, in addition to a central hub for call taking and data processing Standard Family Assistance Center 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 physically visit. In addition, a communicable disease outbreak would significantly alter the services provided by the FAC in the following ways: A communicable disease will be ongoing (chronic) rather than a static (acute) incident APPENDIX J

Deaths will occur over a period of several weeks and may involve multiple family members at different times Most bodies will have complete integrity and will be identified more readily Most information will need to be distributed out to the public rather than bringing people in to obtain information. Virtual FAC Functions Gathered information: Missing persons o Patron calls 211 Call Center to report initial information o Call Center forwards the information to Law Enforcement o LE returns call to patron for missing persons report o If Level 1 - known missing or Level 2 - likely missing patron is given instructions as to how to contact the FAC o Family Interview is conducted virtually between FAC interviewer and family member Known dead o Patron calls 211 Call Center to report a home death o Call Center notifies the appropriate Medicolegal authority o ME (or designee) calls the patron to schedule pickup or to give instructions as to what to do with the deceased Dispensed information: General information o Public Health Concerns: safety issues, food, water, medications, etc. o Financial Assistance: resources and application/referral process o Social Security: access to death and disability benefits o Legal Assistance insurance benefits and death-related concerns o Other patron services Individualized information and support o Burial sites o Death certificate information o Information regarding keeping the dead in the home if the body cannot be immediately removed o Stress and grief coping mechanisms o Clergy and behavioral health support Multi-Site Family Assistance Center If multiple incidents simultaneously occur at varying points in the region (i.e. concurrent bomb blasts), multiple Family Assistance Centers may be activated. A designated lead FAC would 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 APPENDIX J

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 each the lead and satellite units will be the same as the traditional FAC model; an Assessment Team approves the location, logistics provides furnishings and equipment, and personnel are assigned. Designated Lead FAC Operations Operational Functions: Registration Family interviews DNA reference collection Case assessment Behavioral health services Spiritual services Childcare Mass care Notification and disposition Personnel: FAC Supervisor Family Interview Team leader Family Management Unit and Team leaders Health and Human Services Unit and Team leaders FAC Satellite Location Operations Operational Functions: Registration Family interviews DNA reference collection Case assessment Behavioral health services Spiritual services Childcare Mass care Notification and disposition APPENDIX J

Personnel: Deputy FAC Supervisor Family Interview Team members Family Management Team members Health and Human Services Team members Processing Hub Operations Operational Functions Call Center Data Management Antemortem Records Personal Effects Refurbishing Information Distribution/Communications Center Personnel Forensic Unit Leader, team leaders, and teams (less Family Interview teams which are located at each FAC site PIO representative Runners to shuttle information between the FAC satellites, processing hub, and morgue The diagram on the following page illustrates the relationship between the satellites, processing hub, and morgue operations. APPENDIX J

APPENDIX J