Abstract
BackgroundIn the United States (US), Medical Examiners and Coroners (ME/Cs) have the legal authority for the management of mass fatality incidents (MFI). Yet, preparedness and operational capabilities in this sector remain largely unknown. The purpose of this study was twofold; first, to identify appropriate measures of preparedness, and second, to assess preparedness levels and factors significantly associated with preparedness.MethodsThree separate checklists were developed to measure different aspects of preparedness: MFI Plan Elements, Operational Capabilities, and Pre-existing Resource Networks. Using a cross-sectional study design, data on these and other variables of interest were collected in 2014 from a national convenience sample of ME/C using an internet-based, anonymous survey. Preparedness levels were determined and compared across Federal Regions and in relation to the number of Presidential Disaster Declarations, also by Federal Region. Bivariate logistic and multivariable models estimated the associations between organizational characteristics and relative preparedness.ResultsA large proportion (42%) of respondents reported that less than 25 additional fatalities over a 48-hour period would exceed their response capacities. The preparedness constructs measured three related, yet distinct, aspects of preparedness, with scores highly variable and generally suboptimal. Median scores for the three preparedness measures also varied across Federal Regions and as compared to the number of Presidential Declared Disasters, also by Federal Region. Capacity was especially limited for activating missing persons call centers, launching public communications, especially via social media, and identifying temporary interment sites. The provision of staff training was the only factor studied that was significantly (positively) associated (p < .05) with all three preparedness measures. Although ME/Cs ranked local partners, such as Offices of Emergency Management, first responders, and funeral homes, as the most important sources of assistance, a sizeable proportion (72%) expected federal assistance.ConclusionsThe three measures of MFI preparedness allowed for a broad and comprehensive assessment of preparedness. In the future, these measures can serve as useful benchmarks or criteria for assessing ME/Cs preparedness. The study findings suggest multiple opportunities for improvement, including the development and implementation of national strategies to ensure uniform standards for MFI management across all jurisdictions.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-1275) contains supplementary material, which is available to authorized users.
Highlights
In the United States (US), Medical Examiners and Coroners (ME/Cs) have the legal authority for the management of mass fatality incidents (MFI)
Exceptions included the MFI Plan measure and Operational Capabilities measure, which remained significantly correlated to each other (OR = 3.44, 95% confidence interval (95% CI) [1.27,9.32], p < .05); ME/ Cs reporting highly developed plans were more than three times more likely to report a high level of organizational capabilities
Another significant result at both the bivariate and multivariate levels was that Coroners were more likely to report a higher score on the Pre-Existing Resource Network measures
Summary
In the United States (US), Medical Examiners and Coroners (ME/Cs) have the legal authority for the management of mass fatality incidents (MFI). Examples include the 2001 World Trade Center attacks (~3,000 deaths), the 2003 Western Europe heat wave (~35,000 deaths), the 2004 South Asian tsunami (~220,000-230,000 deaths), the 2005 Kashmir earthquake (~75,000 deaths), 2008 Sichuan, China earthquake (~87,000), the 2009-10 H1N1 pandemic (~20,000 deaths), the 2010 Haiti earthquake (~200,000 deaths), the 2011 Japan mega-disaster (~22,000 deaths), and the recent 2014 West Africa Ebola virus disease epidemic (~6,400 deaths) [1,2,3] In some cases, these massive fatality incidents completely overwhelmed local and even national capacity to respond appropriately, resulting in both acute and longterm adverse impacts on survivors and communities [4,5,6]. Another term, referred to as “Complex Fatality Management” (CFM), is being used in recognition of the fact that local capacity can be overwhelmed by even a single fatality if the incident involves hazardous chemical, biological, radiological, nuclear or explosive (CBRNE) agents. (Personal communication, Cynthia Galvin, 2014)
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