During mass fatality events, search and recovery activities usually involve locating and removing bodies, body parts, and personal effects. Personal effects are those items carried by, or being transported with, an individual. Every mass fatality site should be regarded as a crime scene unless otherwise indicated by the MEC. Only authorized individuals should be allowed within the secure perimeter. Relatives of victims should be referred to the FAC.

The appropriate authorities must readily identify safety issues, such as the stability of a building in a structural collapse. The MEC should work with the incident command center and other agencies (i.e., hazmat) to determine the existence of any hazards and what actions should be taken to mitigate them, including the level of personal protective equipment required by rescue/recovery personnel. The MEC must have a sufficient number of people capable of functioning in a contaminated area. Universal precautions should be maintained at all times. Search and recovery of the remains should not take place until it is determined that the site is safe.

Every body, body part, or personal belonging is identified and tagged with a unique number. During all operations, bodies and body parts should be treated in a respectful and dignified manner. If possible, human remains should be covered or shielded from public view. If the bodies are scattered over an extensive area, a grid system is utilized in an effort to document the location, assist in recreation of the scene, and further the investigative process (7). Recovery and removal of the remains occurs after the search and tagging of a grid sector has been completed. Unless the remains are in danger of destruction, disintegration, or decomposition, bodies should not be moved from the scene until after the arrival of the MEC. If any of these dangers exist, bodies should be moved immediately to a safe fatality collection point (6). The fatality collection point is a location where the bodies can be temporarily placed until a temporary morgue can be established. The temporary morgue is used as a holding area until the morgue examination center (for morgue operations) is established (8). Some sources refer to the temporary morgue as the site for morgue operations (6). Sometimes the MEC’s existing facilities may be the optimal site for morgue operations (7). For example, during the terrorist attack on the World Trade Center, additional morgue facilities were not needed as most human remains were crushed, fragmented, or commingled. Instead, innovative methods for DNA analysis were implemented using new computer software to assist with the identification process of every bit of human remains recovered (10).

Morgue operations are divided into several different stations to record and provide information about the deceased for eventual comparison to antemortem records. This information is used to confirm identification and establish the facts surrounding the death. Each body is escorted through each of the stations to ensure that (a) the remains are not mixed up with other remains, (b) documentation is complete, and (c) proper respect is paid to the deceased at all times (7). Any form of identification (i.e., driver’s license) found in the vicinity of a body may provide information useful in
uncovering the identity of the victim. Such findings, however, do not confirm the victim’s identification (9). Traumatic injury resulting from the disaster event may cause significant distortion of body habitus and facial features, thereby complicating the timely and accurate identification of the victim. The MEC may request assistance from experts in pathology, anthropology, dentistry, mortuary affairs, search and recovery, and others as needed to assist with the identification process.

In the mass fatality morgue, identification procedures are initiated as follows (1):

After identification of the remains is completed, relatives should be contacted in an expedient fashion by the MEC or a designee. Psychosocial and religious support services should be readily available. If cremation is necessary to avoid secondary contamination or spread of disease, it should not undertaken in the mass fatality morgue (6). In most circumstances, as soon as the identification is confirmed, the remains should be released and moved to a place designated by the family. Personal effects should be returned to the family as soon as possible. Unidentifiable bodies can be embalmed and stored pending further investigation (6).

The site for the family assistance center should be established quickly utilizing locations such as in a hotel, conference center, school, or church. While the FAC should not be too close to the disaster scene, it should be easily accessible to families and provide adequate accommodations for those relatives coming from distant locations. Access to the FAC should be secure and limited to family members of victims only while providing adequate privacy and protection from media representatives. Individual meetings are conducted with families of the victims to collect antemortem data, which may be utilized in the identification process. Briefings by the MEC or staff should be performed at least twice daily to keep the families informed about the progress of the investigation and identification process. Grief counselors or religious support personnel should be present when the MEC notifies the family that victim’s identification has been confirmed. The American Red Cross (ARC) or other appropriate
agency may assist with family support, transportation, housing, supplies, and volunteer coordination. Medical and mental health professionals as well as religious clergy should be readily available. In addition, phone banks, computer/Internet access, and meal service may be provided to families at the FAC. Table 43-2 provides an overview of preparedness essentials for mass fatality incidents.