New Mexico Mass Fatality Incident Plan 2012 Mass Fatality Plan Working Group New Mexico Office of the Medical Investigator Michelle Aurelius MD Ross Zumwalt MD Sarah Lathrop PhD Wendy McQuade PhD Chandra Gerrard, RT (R) (CT) Amy Boule, BA, MBA Sharon Pruitt, BS Peter Loomis DDS Amy Wyman MA David Dryden BS Yvonne Villalobos BA New Mexico Department of Health Tom Torok MD Mary Schumacher Carol Karps 1 Plan Finalized June 30, 2012 Executive Summary The New Mexico Office of the Medical Investigator (OMI) developed a mass fatality plan (MFP) to describe how OMI will respond to any event resulting in a number of fatalities that overwhelms OMI’s capacity. The MFP assigns roles and responsibilities to OMI staff members, describes how OMI will coordinate response activities with other agencies, and provides specific instructions and contact information for varied mass fatality incidents (MFIs), from aviation disasters to chemical releases to influenza pandemics. In the event of a MFI, OMI will be tasked with removing remains from the scene of the MFI, certifying cause and manner of death, identifying decedents, and returning remains to next-of-kin when possible. These tasks will be accomplished in a manner that ensures the health and safety of responding personnel and respects the dignity of the victims throughout the process. The goal of the MFP is to coordinate OMI’s response to MFIs and outline preparations for the contingencies arising from large numbers of bodies, while maintaining day-to-day operations. When responding to a MFI, OMI will use the Incident Command System (ICS) to deploy resources and personnel and interact with other agencies responding to the event. This is part of the National Incident Management System (NIMS), which is designed to provide a standardized management approach to emergencies for all responding local, state, tribal, and federal government agencies. The Chief Medical Investigator or designee (Chief) will be responsible for the activation and management of the MFP and will report to the Incident Commander (IC). The Chief will determine which of the three levels of response (local, regional, state or higher) is needed and request appropriate aid, including Disaster Mortuary Operational Response Teams (DMORT). The Chief will designate a Director of Field Operations (DFO) who is responsible for coordinating the recovery of remains. A designated Communications Director will oversee interactions with other responding agencies. OMI personnel, as well as volunteers qualified to assist with mortuary procedures and family aid, will report to the Chief or their designated supervisor and director. 2 Specifics of morgue operations will depend on the location and size of the MFI and are detailed in the plan. During the response to a MFI, OMI personnel may be called upon to assume additional roles and responsibilities beyond their routine job descriptions and work closely with first responders, hospital personnel, DMORT members, funeral directors, and non-governmental organizations providing victim assistance. OMI’s response is considered a component of New Mexico’s All- Hazard Emergency Plan, drawing on OMI’s expertise in the safe handling of remains. OMI’s MFP provides a framework for a strategic response to a chaotic event with elements that can be scaled for size and tailored for the type of event. 3 Table of Contents Executive Summary 2 Table of Contents 4 Abbreviations 6 Introduction 7 Notification and Activation of Plan 9 Mass Fatality Plan Organization Chart 12 Biosafety 13 Mass Fatality Incident Scene Evaluation, Organization, and Operation 18 Morgue Operations 25 Mass Fatality Administrative Support 36 Public Communications 37 Financial Support 39 Information Technology 40 Religious and Cultural Considerations 41 Family Assistance 45 Plan Maintenance and Implementation 53 Summary including Activation of Plan 55 Appendices (see following page) A-Z 4 Appendices Table of Contents Appendices Hospital Contact Information A Funeral Home Contact Information B Language Interpretation Contact Information C OMI Consultants Contact Information D Religious/Spiritual Contact Information E Cultural Resources Contact Information F Potential Locations for Family Assistance Center G Letter of Support for IT H Investigation of Remains – Autopsy Protocol I BSL 3 – Autopsy Protocol J Infectious Diseases K Autopsy Floor Plan L Exposure/Accident Report Form M Pandemic Influenza N Bioterrorism O Conventional Explosives P Nuclear Detonations/Radioactive Contaminations Q Chemical Releases R Hazardous Materials- EMO – Albuquerque S Natural Disasters T Fires U Aviation Disasters V NM OMI MFI Odontology Manual W Article on Biologic Terrorism X Radiology Manual Y Radiography Requirements – ASFR 2007 Z 5 Abbreviations BSL: Biosafety Level CMO: Chief of Morgue Operations DFO: Director of Field Operations DMI: Deputy Medical Investigator DMORT: Disaster Mortuary Response Teams EMS: Emergency Medical Services FDMI: Field Deputy Medical Investigator FDS: Field Deputy Supervisor FTL: Finger Print Team Leader HAZMAT: Hazardous Materials IC: Incident Commander ICS: Incident Command System NMSEOC: New Mexico Emergency Operations System MECs: Medical Examiner/Coroners MFI: Mass Fatality Incident MFP: Mass Fatality Plan NIMS: National Incident Management System OMI: Office of the Medical Investigator PPE: Personal Protective Equipment SEC: Supervisor of Evidence Collection UNMH: University of New Mexico Hospital 6 Introduction Mass fatality planning is an often-overlooked component of emergency preparedness. Attention and resources tend to be focused on triage, surge capacity, evacuation, and medical management of survivors without much regard for the safe handling and removal of human remains. To be truly prepared for disasters of all causes and scope, local, state, and national agencies must create plans for appropriately responding to a MFI, which is defined as an event in which the number of human bodies to recover, examine, and identify overwhelms local resources. Overall, the US has been relatively lucky, suffering only seven disasters (excluding wars) that resulted in one thousand fatalities or more. Prior to the 20th century, disasters were primarily natural in cause, shifting to more technologically-based events in more recent history. An epidemic of influenza in 1918 killed 650,000 US residents, with over 20 million victims worldwide. In more recent history, the bombing of the Alfred P. Murrah Federal Building in Oklahoma City in 1995 claimed 168 lives, the 2001 terrorist attacks claimed 2,972 victims in one day, and Hurricane Katrina, the deadliest hurricane to strike the Gulf Coast since 1928, claimed over 1,300 lives. In contrast, the 2004 tsunami in South Asia claimed 165,708 lives in Indonesia alone. MFI planning must include detailed, up-to-date operational procedures for safe, swift, effective responses to diverse events, from pandemic influenza epidemics to terrorist attacks to nuclear detonations. Given the recognized role and unique expertise of medical examiners and coroners (ME/Cs) in responding to fatalities of all types, ME/Cs should be at the forefront of developing MFI response plans, working with multidisciplinary response teams to ensure that previously identified best practices are followed in the wake of catastrophe. In order for New Mexico to be as highly prepared for an MFI as possible, the OMI, the statewide, centralized medical examiner’s agency, has written the following MFP in conjunction with the New Mexico Department of Health (NMDOH). A multidisciplinary team developed the plan, with each member bringing unique experience and perspective. Drawing on the experience of other jurisdictions, published best practices, and knowledge of local challenges, OMI has assembled a 7 plan that is as far-reaching yet as detailed as possible. While ideally this plan will never be needed, it is better to “hope for the best, but prepare for the worst.” The plan is presented in a general, “all-hazards” approach first, giving information about the roles of staff members, needed facilities, biosafety procedures, and responses that will be common to OMI’s response to an MFI. More detailed information based on types of MFIs (aviation disasters, bioterrorism, pandemic influenza, natural disasters, nuclear releases, etc.) is included in the appendices. These appendices include contact information for relevant participating agencies, special equipment and personnel needs for specific MFIs, and concerns that may be unique to certain types of MFIs. Copies of OMI’s MFP will be available in both electronic and hard copy formats at OMI’s office, as well as being distributed to other responding agencies and stakeholders. Contact information will be updated annually, and, where possible, a general title or position will be given rather than the person currently occupying that position (Chief Medical Investigator, Director of Information Technology, Office Manager, etc.). Questions regarding the content of this plan can be directed to OMI at its toll-free number, 1-800-432-5239. 8 Notification and Activation of Plan The Office of the Medical Investigator (OMI) investigates any death occurring in the state of New Mexico that is sudden, violent, untimely, unexpected or when a person is found dead and the cause of death is unknown. This would include any mass fatality incident in our jurisdiction. The OMI will take responsibility for the removal, storage, examination, identification, and certification of death of the fatalities. The