The evolution of fatality management

Over the past few decades, there has been a refinement of the processes and requirements included under the contemporary definition of responsible fatality management. Changes in science and shifting social imperatives now allow, even demand, more sophisticated approaches to the recovery, identification and disposition of the remains of those killed in disasters. This transition is best illustrated by comparing two famous incidents that resulted in large life loss in the United States, almost 90 years apart.

Firemen work at the scene of the Triangle Shirtwaist Company fire in the Asch Building in this March 25, 1911 photo. Ninety-two years after the fire killed 146 young girls and women. (AP Photo)

Just before 5 p.m. on Saturday, March 25, 1911, a fire struck the Triangle Shirtwaist Factory on Washington Place in lower Manhattan in New York City. The factory made women’s blouses, also called shirtwaists or waists. In the following half hour, the bodies of some of the 146 women and girls who jumped from the ninth-floor windows or died on the factory floor were lined up on Greene Street.

The morgue at Bellevue Hospital was overwhelmed, so a temporary morgue was set up on the nearby 26th Street Pier at the East River. At the morgue, bodies were laid out side by side in open wooden coffins to facilitate identification. Family members of the victims would visit the morgue and walk through the rows of coffins hoping to be able to recognize their loved ones. Victims identified this way were released to the claiming family. At the time, this was considered a valid process for managing human remains in a mass-fatality incident.

In comparison to modern fatalities-management practices, this process was fraught with problems. The female victims were mostly between the ages of 13 and 23, and a large number were Jewish. Visual identification of so many victims of the same sex and in such a narrow age range, most of them disfigured by the effects of fire or the 100-foot fall to the sidewalk, allows an unacceptably high probability of error. Compound this by the fact that many were similarly dressed and bore some cultural resemblances, and the risk of misidentification was multiplied. Added to this was the indignity of having curiosity-seekers and newspaper photographers also wandering through the morgue.

Fast-forward to 2001, again in lower Manhattan, but this time at the site of the terrorist attack on the World Trade Center. Each time human remains were found in the rubble, they were handled individually, transported to the New York City Office of the Chief Medical Examiner and examined scientifically to determine identity. Fingerprints were compared wherever they were available. X-rays and records were collected from dentists and hospitals and compared to the post-mortem findings. Exhaustive descriptions of potential victims were gathered from family members and friends of the deceased and used as tools to aid in identification. DNA matching was employed extensively, at substantial cost, to positively identify the victims.

This suite of scientific tools was also used at the Pentagon and at the morgue in Shanksville, Pa., for the rest of the Sept. 11 victims. The effort involved hundreds of specialists across the broad spectrum of forensic disciplines that comprise a modern identification process.

Destruction to the Staten Island Ferry boat which was involved in a fatal accident at the ferry terminal in Staten Island, N.Y., Oct. 15, 2003. (AP Photo/ NTSB, Mike Hvozda, Pool)

If we look back at 20th century mass-fatality incidents in the U.S., we find a maturing but fairly consistent process for managing human remains in incidents with a large loss of life. Sensitivities to the needs of family members were evolving, and a heightened sense of dignity and respect for the deceased was codified as part of the national convention for mass-fatality management. Established scientific processes became more sophisticated and some, such as newly devised DNA technologies, were added to the identification toolbox.

A better organization
Even as new science and a heightened respect for the deceased were gradually incorporated into mass-fatality response, however, there was no single national approach to such incidents. That change would begin in the final decade of the century.

On Jan. 25, 1990, Avianca Flight 52 from Bogota, Colombia, to Kennedy International Airport in New York ran out of fuel and crashed in Cove Neck on Long Island, killing 73 of the 158 people on board. The response to this incident brought a unique group of people to the attention of the federal government and marked the beginning of a new approach to mass-fatality management.

In the 1980s, the National Funeral Directors Association had developed a plan for funeral industry professionals to have a role in large–life-loss incidents and had subsequently refined their concept to include personnel from existing forensic specialties. This concept, today called a Disaster Mortuary Operational Response Team (DMORT), was recognized by the federal government as a valid resource following the Avianca crash and was formally established as a network of 10 regional teams in 1992. Today, as part of the Department of Health and Human Services’ National Disaster Medical System, the DMORTs continue to be a primary source of assistance to communities that have to mount a mass-fatality incident response and is available as a federal response asset.

Since the establishment of this first structured response model, there have been two notable shifts in thinking about the approach to mass-fatality management. The first was the recognition and acceptance of the federal teams, accelerated by numerous successful deployments in the first few years of their existence.

In keeping with the law of unintended consequences, however, this led to a planning philosophy within some emergency management agencies that essentially substituted federal assets as the local solution to fatality management. Throughout the 1990s, communities across the U.S. sought and received the benefits of federal assistance for mass-fatality incident response.

The second shift was a result of the 9/11 attacks, when federal teams were deployed successfully to New York and Pennsylvania, in some cases for extended periods of time. The unanticipated prospect of multi-site terrorist attacks led some communities to refocus on the need for local fatality-response plans, reasoning that there was a real potential for federal assets to be unavailable under some extraordinary circumstances. What had been inconceivable was now a possibility.

It didn’t take long for the perceived need for more robust local fatality-management plans to be reinforced. Emerging public health projections of the impact of a pandemic influenza outbreak carried the implication that affected communities could have to be virtually self-sufficient. Requests for assistance through local or regional mutual aid compacts and the traditional use of federal assets could be unfilled if the outbreak is broad enough. Communities with limited resources began to take another look at local solutions.

Florida developed its own solution, the Florida Emergency Mortuary Operations Response System, while its neighbor to the north created, equipped and trained the Georgia Body Recovery Team. Funeral directors organizations in Maryland, Ohio, Texas and other states became part of their local mass-fatalities asset pools. Iowa recognized the need to address fatality management on a jurisdictional level between the counties and the state, which resulted in a regional solution.

Today, more and more jurisdictions are addressing their potential response to a mass-fatality incident as a local problem with a scalable solution. Just as the last decade has seen huge changes in fatality management response thinking, the next one may well make those thoughts more of a reality.

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