Today in the United States, some in society are hesitant to acknowledge or plan for “failure options” – in other words, admit that the worst of the worst can happen. The military requires planning for just about every situation including when operations do not go as planned. However, those in emergency management and domestic preparedness operations need to consider tragedy and events unimaginable to most people.
One “unimaginable” event that preparedness professionals must anticipate is a mass fatality incident on a regional or national level. Preparing for this type of event requires understanding the complex problem, ensuring adequate logistic resources, and detailed planning for this kind of incident. All three of these areas require careful and well thought out consideration.
The Complex Problem
The United States continues to improve preparedness efforts for a number of possible manmade and natural disasters. These improvements have occurred most notably since the 9/11 terrorist attacks in 2001 and Hurricane Katrina in 2005. Planners at the local, state, tribal, and federal levels continue to improve their plans and details of their responses to a number of likely events.
Nevertheless, the United States has little experience with a mass fatality incident on a national scale. The attacks of 9/11 and Hurricane Katrina were tragic but were not on the scale or scope of the 1918-1919 Spanish Flu pandemic, when a quarter of the U.S. population fell ill and more than 675,000 Americans died. Outside the United States, the 2004 Tsunami in South-East Asia and the 2011 earthquake, tsunami, and subsequent Fukushima Daiichi nuclear reactor failure are in the large-scale mass fatality incidents category, with numbers of deaths estimated close to 300,000 and 20,000, respectively. The need to recognize and strengthen fatality management, planning, and response are critical to recovery efforts during a mass fatality incident.
Regardless of the size of the mass fatality incident, the medical examiner/coroner (ME/C) is the legal authority to conduct victim identification (or augment the lead investigative agencies to complete victim identification). The ME/C determines the cause and manner of death and manages death certification. The ME/C is also responsible for other medico-legal activities such as notification of next of kin. The number of deceased is a significant driver in the amount and type of resources needed to search, recover, and identify decedents. In general, the higher the number of fatalities, the more resources required for managing and processing the remains. Understanding this requirement involves planners recognizing the need for greater numbers of adequately trained people to effectively manage a mass fatality incident.
Culturally, death in the United States is often considered a taboo topic. However, in 2014, the Centers for Disease Control and Prevention (CDC) estimated 2.6 million deaths in the United States. Most of these deaths are anticipated and processed through normal funeral home channels. However, of these 2.6 million reported deaths, there were 135,928 accidental and 42,826 suicide deaths. The total number of U.S. deaths recorded each year by the CDC ranged from 2,148,463 in 1990 to 2,626,418 in 2014. Therefore, this information provides a predictable number for funeral homes and services to process and plan for on an annual basis.
In addition, the number of caskets and cremations required each year are highly dependent on just-in-time logistics. Caskets and coffins are not stockpiled in large warehouses. Using “lean Six Sigma” business practices, materials to produce caskets are ordered, built, and delivered for just-in-time requirements. Based on material requirements that have been steady for almost 25 years, the U.S. funeral industry provides goods and services to citizens established on historical demands. This keeps costs down and provides a multitude of options for consumers. However, these options are costly, whereas throughput is the primary consideration during a mass fatality incident.
Decedent Remains Planning & Educational Resources
In response to a mass fatality/incident, planning for decedent management – which includes resources and mortuary options – is required. Options available for human remains in a mass fatality incident require prior planning (see Table 1). Ranging from caskets and cremation to more innovative approaches like biodegradable alternatives, each option should be considered for use in a mass fatality incident. The following recommendations would help mitigate the logistical impact of mortuary disaster operations:
- Integrate planning for mass fatality incidents into planning exercise considerations and execute mortuary operations during exercises.
- Participate in national mass casualty exercises like the U.S. Northern Command (NORTHCOM) Chemical, Biological, Radiological, and Nuclear (CBRN) Response Command Post Exercise, “Vibrant Response.”
- Explore plans that various hospitals, states, and regions have developed in response to mass fatality incidents. Each local, state, and tribal area is different, but planning for mass fatality incidents requires significant time and details to meet the demands of such an event.
- Vet options beyond caskets to mitigate the psychological impacts of a mass fatality incident.
|Options||Logistics considerations||Cost||Ease of use in domestic preparations|
|Casket||Materials, order times, number available||Relatively high||Acceptable means|
|Cremation||Crematorium facilities||Relatively high||Acceptable means|
|Remains Pouches||Requires prior planning||Relatively inexpensive||Less than acceptable except in emergencies|
|Freeze Dried||Still new option with limited facilities||Relatively high||Probably not a feasible option|
|Biodegradable||Newer option with limited facilities||Relatively high||Not standard practice or accepted across population|
A mass fatality incident is a crisis that no emergency planner would want to endure, but the likelihood of such an event does exist. The complexity and related logistical concerns require more consideration as highlighted by incidents that have occurred in various parts of the world. Planning at the regional and national levels, during exercises, would provide leaders with a better understanding of this multifaceted problem.
In addition to the hyperlinked websites throughout this article, additional educational resources on the topic of mass fatality incidents include:
- “Mass Fatality and Casualty Incidents: A Field Guide,” by Robert A. Jensen (1999)
- “Mass Casualty and High Impact Incidents: An Operations Guide,” by Henry T. Christen (2002)
- “Mass Fatalities: Managing the Community Response,” by Peter R. Teahen (2011)
- “Mass Fatality Management Concise Field Guide,” by Mary H. Dudley (2013)
- “Army Techniques Publication (ATP) 4-46, Contingency Fatality Operations” (2014)
Disclaimer: The views and conclusions expressed in the context of this document do not reflect the official position of the U.S. Government, Department of Defense, United States Department of the Army, or the U.S. Army Command and General Staff College. The author has no conflict of interest, including direct or indirect financial interest that is included in the materials contained or related to the subject matter of this manuscript.