Emergency management and mass fatalities: Who owns the dead?

Jim Crabtree, Senior Nursing Instructor, Los Angeles County EMS Agency

Abstract
Mass fatality incidents are always unexpected and put a sudden stress on local response agencies to cooperate and share resources to accomplish tasks that are outside their normal activities. Lines of legal authority are often conflicting when two or more agencies are statutorily in charge. Within the USA, the local coroner system is almost universally delegated as responsible for all involved tasks including body recovery, yet the coroner is almost always the smallest responding agency, with the smallest labour pool from which to draw and the least experience of formal Incident Command System (ICS) procedures at large incidents. This paper explores the many tasks required following a mass fatality incident and the necessity for pre-event written agreements to be negotiated between local, state and federal agencies to ensure that material and personnel can be readily shared and reimbursed without bureaucratic misunderstanding in order to accomplish known objectives. Also explored are potential National Incident Management System conflicts in applying unified command to situations where legal authority and level of commitment are not synonymous.

Keywords
mass fatalities, disaster management, incident command, death investigation

Jim Crabtree, RN, BSN, MICN began his career in the Emergency department at Martin Luther King hospital in Watts, California. He teaches at Los Angeles County's Paramedic Training Institute developing new curricula. As a member of Disaster Medical Assistance Team, he has provided medical aid in disaster areas. Since 1996, through his position at the Los Angeles County EMS Agency, he has been involved in researching and teaching about all types of disaster and terrorism events. He developed a practical curriculum for teaching Hospital Incident Command System (HICS) to medical professionals. He has taught at emergency care and disaster conferences throughout the United States as well as Tallinn, Estonia and Mumbai, India. Jim has published articles in the medical literature on topics as diverse as terrorism, disasters, geriatrics and the history of emergency medicine.

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