AAMA : Blogs : Preparing for Disaster: The Growing Trend of Mass Fatality Management

By: Aislynn Turner, MPA and Michelle Constant, Constant and Associates, Inc. on behalf of the Los Angeles County Emergency Medical Services Agency

Abstract

Recent disasters have highlighted the need for mass fatality management at healthcare facilities. Delays in notification, mismanagement of personal effects, and bottlenecks in the transfer process can add to the grief and trauma experienced by families following disaster.  Distraught family members can cause stress on an already taxed healthcare system and lead to negative press, lawsuits, and a damaged reputation for the healthcare facility. When coordinated collectively, among healthcare professionals, medical examiners, and EMS, all involved stakeholders are able to more effectively ensure notification to families and expedite the decedent management process.

As a forward-leaning agency, Los Angeles County Emergency Medical Services (EMS) Agency has completed a groundbreaking resource for healthcare facilities – the Los Angeles County Mass Fatality Management Guide for Healthcare Entities. This Guide aids healthcare facilities in developing an organized, realistic plan to manage a surge of fatalities on a countywide level. Numerous facilities have now used the Guide to successfully develop and test their plans through coordinated exercise. This innovative project has significantly improved Los Angeles County’s ability to respond to mass fatality incidents. Healthcare entities throughout the nation are encouraged to use this Guide as a resource for developing mass fatality management plans tailored to their own environment.  The Guide can be accessed at http://ems.dhs.lacounty.gov/Disaster/MassFatality.htm.

Introduction

The sometimes misunderstood notion that healthcare facilities’ day-to-day operations would hardly change during disaster incidents can cause devastating effects. Healthcare entities will have a primary focus on surging to facilitate lifesaving operations. They will also confront a myriad of complex issues, which may include a significantly increased number of fatalities. Another common perception is that the risk of catastrophic disaster is too low to become overly concerned about the issue. However, recent disasters that left hospitals and clinics short-staffed and inadequately prepared to manage the surge of decedents remind us of the importance of actively planning for and training staff to respond to disaster. Table 1 lists examples of such incidents.

Table 1. Recent Catastrophic Incidents

As these incidents have demonstrated, the medical care system will be severely taxed during a disaster. If facilities are unable to process and identify decedents in a timely fashion, the facility’s ability to provide healthcare for its patients may be impeded, reunification of decedents with family members will be delayed, and cultural and religious preferences may be neglected, causing added grief and stress for families during a time when they are already highly distressed. This could result in negative press, lawsuits, and a damaged reputation for the healthcare facility.

The Los Angeles County Model

In partnership with a multi-agency, multi-discipline Project Oversight Group, the Los Angeles County EMS Agency completed a groundbreaking resource for all Los Angeles County healthcare facilities in 2008, and revised and expanded it in January 2013 – the Los Angeles County Mass Fatality Management Guide for Healthcare Entities. Local, state, and federal levels of government, as well as numerous healthcare facilities and organizations, contributed to this prolific achievement. The Guide provides a framework to aid healthcare facilities in developing a detailed, well-organized and realistic plan to manage a surge of fatalities on a countywide level and to effectively transition from normal to disaster operations.

The Mass Fatality Management Guide for Healthcare Entities is organized into two primary components, a base guide and appendices. The base guide provides step-by-step direction in the development of mass fatality plans. The base guide is organized into sub-chapters, to include Plan Development, Activation, Operations, and Demobilization. Appendices provide significant supplemental resources to aid in plan development. Such resources include facts and answers sheets, forms, and a community-wide response matrix showing the role of healthcare partners and all levels of government in mass fatality management. An online toolkit has also been made available on the EMS Agency website at http://ems.dhs.lacounty.gov/Disaster/MassFatality.htm that includes an electronic copy of this Guide, as well as multiple resources for planners.

Numerous facilities throughout Los Angeles County have now developed their own mass fatality management plans using the Guide. The Guide has also been vetted via a tabletop exercise and a countywide functional exercise where review and testing of the Guide was a primary objective. This project is regarded as an innovative achievement, the first to approach mass fatality management on a countywide level, and has significantly improved Los Angeles County’s ability to respond to mass fatality incidents.

Building Your Own Plan

Benefits for your healthcare entity that would result from creating a mass fatality management plan include timely notification to families, policy driven management of personal effects, expedited transfer to medical examiners or mortuaries, better understanding of cultural needs regarding death, and a more knowledgeable, confident staff. Additionally, many Hospital Preparedness Program (HPP) grants stipulate that mass fatality plans must be in place for a healthcare entity to be eligible for funding.  Healthcare entities throughout the nation are encouraged to use the Los Angeles County Mass Fatality Management Guide for Healthcare Entities as a resource for developing their own countywide mass fatality management plans tailored to their own environment.

To begin the planning process, a team of healthcare facility and government partners should be assembled to discuss how countywide coordination of mass fatality management could be achieved. Each county will have unique dynamics that need to be considered, such as the types of disasters the region is susceptible to, and the number, geographic location, and capabilities of area hospitals, clinics, and skilled nursing facilities. Planners should consider reaching out to prominent healthcare facilities, local health organizations, the local health department, and emergency management organizations to obtain diverse perspectives on area needs and capabilities. State and federal partners may also need to be consulted for additional expertise.

A number of resources exist to support plan development. In addition to the Los Angels County’s Guide, New York City has developed a plan[2], as well as Santa Clara County in California,[3] Seattle and King County in Washington[4], and California[5] state.  Lessons learned and best practices from past disasters involving mass fatalities are often publicly available for reference, either online or upon request. Furthermore, many emergency responders from across the nation and globe who have experience in mass fatality management are eager to share their experiences and can be consulted as needed.

At least three plan development meetings are recommended to write the plan. Once drafted, the plan should be shared with all area healthcare facilities so that they can develop their own plans based on one coordinated, countywide strategy. Plans should be tested through coordinated exercise annually, if possible.

Mass fatality management is a growing trend throughout the nation, especially on the countywide level, and it will likely continue to expand in the coming years. Establishing mass fatality management plans will not only enhance our nation’s capabilities, but also mitigate the effects of disaster.