• If embalming remains, perform final rinse after embalming procedures. MEDICAL EXAMINER/CORONER

5. Final Disposition. GUIDE FOR MASS ! Determine location for storage until final disposition. ATALITY ANAGEMENT ! Determine if a public health hazard exists. Final F M ! Return of remains to family:

Disposition OF CHEMICALLY • Traditional burial. Bleach Sodium

• Sealed casket burial. 25 Pounds 50 Pounds ONTAMINATED EMAINS Hypochlorite 2.5 Pounds C R .50 Pounds • Voluntary cremation. 12.5 Pounds ! Government sponsored disposition. • Government burial. Prepared by • Cremation.

Water Department of Justice, Office of Justice Programs, Office 1 Gallon 5 Gallons 25 Gallons 50 Gallons 100 Gallons of State & Local Domestic Preparedness

Storage Department of Defense, US Army Soldier and Biological Additional Coordination Transport/ Chemical Command, Improved Response Program 1. Participate in establishing the Family Assistance Center (FAC).

Bleach Solutions Notional

! Convey FAC requirements to the Emergency Manager: Bleach High Test 6 Pounds

12 Pounds 24 Pounds Mass Fatality Incident Command .24 Pounds Hypochlorite • Determine specific role of the ME/C at the FAC. 1.2 Pounds • Determine who will oversee FAC (e.g., Public Health, American Red Cross). Ops Incident

• Hotline/help-line for notification and identification process. Morgue Commander • Location should be in reasonable proximity to Temporary Water 1 Gallon 5 Gallons

Morgue. 25 Gallons 50 Gallons 100 Gallons • Coordinate information dissemination to family and Public Information Officer (PIO). Chief • Need for multiple religious leader support. Medical • Address if and when personal effects may be released. Examiner 2. Maintain managing the daily caseload. ! Add additional shifts to handle incident remains so that Storage

original staff can focus on daily caseload. Transport/ ! Keep incident and daily caseloads separate. Evaluation Operations Command Logistics Finance Processing Flow of Contaminated Remains Planning & Control 3. Establish security for all aspects of the Mass Fatality Incident. ! To include all aspects of the incident operation, the daily caseload and the FAC. Incident Daily Operations Caseload

4. Determine financial issues. Decon Holding Morgue/

! Determine if incident is considered a presidential declared water. and Soap disaster. Chief Medical Examiner/Coroner (CME) Role is to create an

! Track all activities and expenses. be must (Remains Solution Bleach 1-2% infrastructure that can process a large number of contaminated

○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ remains, as well as accommodate integrating supporting assets

Websites: Solutions Decontamination Agent Chemical into the response effort.

minimum of 5 minutes). 5 of minimum

in contact with sodium hypochlorite solution for a for solution hypochlorite sodium with contact in All agents: agents: All SBCCOM - www2.sbccom.army.mil/hld Substances: Oily DOJ - www.ojp.usdoj.gov/osldps of Emergency Manager (EM) Role is to provide coordination Office of Victims of Crime - www.ojp.usdoj.gov/ovc between the Medical Examiner/Coroner (ME/C) and county, Remains Recovery DMORT - www.dmort.org state, and federal assets to support the ME/C in processing National Transportation and Safety Board - www.ntsb.gov remains in a Mass Fatality Incident (MFI). 4. Assemble necessary resources. • Determine what order personnel will enter scene to Managing The Incident Site ! See Resource Management. perform tasks, between the ME/C and Law Enforcement. • Use waterproof durable tracking/triage tag for remains and 1. Obtain information from Incident Commander (IC). personal effects. ! Type of incident and possible hazards. Resource Management ! Triage remains – autopsy or external examination. ! Type of chemical agent. ! Take photographs of remains (i.e., where they were found) to facilitate identification and evidence collection. ! Estimated number of remains. 1. Personnel. ! Location of scene and accessibility to remains. ! Determine and assemble personnel who can operate in PPE ! Consider establishing temporary cold storage if the holding morgue is not able to process remains quickly. ! Location of incident command post. and assist in the response effort. ! Determine and assign responsible jurisdiction’s ME/C person- nel to supervisory positions. 2. Holding Morgue. 2. Form a team to evaluate the specific incident. ! Form teams with local ME/C and law enforcement for each ! Establish private area at the incident site to perform: ! Form an evaluation team with Medical Examiner (ME/C), function. • Evidence collection. Hazmat technicians, Law Enforcement and other relevant ! Determine if additional non-ME/C personnel are needed and • Initial external evaluation. agencies and prepare to enter the scene. assign task to each. • Initial ID check. ! Check required level of Personal Protective Equipment (PPE). ! Establish shifts/breaks with PPE limitations in mind. • Removal and tagging of personal effects - separate into ME/C should have two 2-person groups (primary/backup) that durable and non-durable items. can operate in Level A PPE. ! Coordinate water/hydration stations. ! Determine: ! During evaluation: ! Establish support for ME/C staff (e.g., Critical Incident Stress Management (CISM)). • If law enforcement is needed to help identify evidence. • Determine issues (e.g., fragmentation, difficult excavation). • If ME/C needs to perform additional procedures as part of • Take initial pictures of site. 2. Assemble other agencies according to established the external evaluation (e.g., chemical agent body swab, • Determine total number of remains and their location. plan. clothing samples). • Determine initial number of cases for autopsy. ! Local agencies: HazMat teams, funeral home directors, ! Obtain: surrounding ME/Cs, local forensic labs, public health • Refrigeration storage units/vehicles based on situation. department, etc. 3. Plan incident specific operations with appropriate • Bulk storage for personal effects (e.g., 55-gallon agencies (e.g., Law Enforcement, Disaster Mortuary ! State agencies: Dept of Environment, National Guard, public drums). health department. Operational Response Team (DMORT), Emergency • New/unused paint cans to store evidence. Manager, and Department of Public Health). ! Federal agencies: Disaster Mortuary Operational Response ! Establish area to perform decontamination. Team (DMORT), Federal Emergency Management Agency ! Coordinate security requirements for remains processing with • Water and bleach/detergents for decon. (FEMA). Incident Commander. • Can incorporate detailed decon and monitoring remains to ! Military agencies: Joint Task Force–Civil Support. ! Determine morgue requirements and location: Holding Morgue verify clean. ! Volunteer agencies: American Red Cross (ARC). and Temporary Morgue. • Mitigate contaminated water run-off. • Try to co-locate Mass Fatality Management functions in • Use double remains pouches - first sealed with duct tape. close proximity to one another. 3. Assemble equipment according to established plan: ! Appropriate level of PPE for personnel. ! Determine decontamination solvents and safe handling 3. Transportation and Storage. ! Waterproof durable tracking tool. procedures based on the specific agent. ! Obtain refrigerated vehicles (e.g., trucks or railroad cars). ! Decontamination line/equipment for Holding and Temporary ! Establish criteria for autopsy based on ME/C capability and • Do not stack remains (use shelving units). Morgues. Law Enforcement evidence requirements. • Do not place remains higher than waist level of handlers. ! Refrigerated trucks for temporary storage/transportation. ! Determine chemical monitoring method and procedures, ! Use of available storage facility in accordance with estab- ! Ventilation fans. monitoring location and who will perform the monitoring. lished plan. • To obtain accurate chemical vapor concentration reading, ! Storage containers for personal effects. monitor bodies at the same temperature that they will be ! Tents/structure to keep remains from public view. 4. Morgue Operations. processed. ! Embalming station to include final rinse station (based on ! Determine if all morgue operations can be centralized in one ! Create infrastructure to process remains (see processing flow incident specific decision). location or if it must be decentralized into several smaller of contaminated remains diagram on the back of this guide). ! Additional remains pouches and duct tape. locations. • Establish who, what, when, where, and how for each ! Additional evidence collection containers (e.g., new paint cans). ! Establish morgue flow. function of Remains Processing. • Perform detailed decontamination and monitoring if remains • Personnel must continue to wear PPE until remains are are not previously verified clean. verified clean by chemical agent monitoring. Remains Processing • Perform autopsy on designated remains. ! Evaluate requirements for embalming based on incident • Perform external examination on all remains. circumstances. 1. Recovery. • Perform identification procedures. ! Establish effective communications between Holding Morgue, ! Determine who will perform the recovery of remains. Temporary Morgue, Family Assistance Center (FAC), and the ! Determine and assign team leaders and members as per ME/C Headquarters. plan. ! Avoid 24-hour operations when possible. • Assign tasks to each agency assisting in the recovery.